Background For children who have uncontrolled asthma despite the use of low-dose inhaled corticosteroids (ICS), evidence to guide step-up therapy is lacking.

Methods We randomly assigned 182 children (6 to ...

Haiti -- A View from the Ship

(No abstract is available for this citation)

Haitian Amputees -- Lessons Learned from Sierra Leone

(No abstract is available for this citation)

Individual Genomes on the Horizon

(No abstract is available for this citation)

How to Think about Future Health Care Spending

(No abstract is available for this citation)

Whole-Genome Sequencing in a Patient with Charcot-Marie-Tooth Neuropathy

Background Whole-genome sequencing may revolutionize medical diagnostics through rapid identification of alleles that cause disease. However, even in cases with simple patterns of inheritance and unambiguous diagnoses, the relationship between ...

Can States Pick Up the Health Reform Torch?

It is impossible to recall another time when a single incident -- in this case, the off-cycle election of a U.S. senator -- so thoroughly implicated the long-term direction of ...

Be Not Afraid

Voters are angry and distrustful of Washington. Democrats have lost their nerve. Republicans, sensing weakness, are closing in for the kill. We have seen this health care reform horror movie ...

Rapid Medical Relief -- Project Medishare and the Haitian Earthquake

On the evening of January 12, 2010, a few hours after the Haitian earthquake, the leaders of Project Medishare in Miami began contacting Haitian associates, faculty and staff of the ...

Civil-Military Collaboration in the Initial Medical Response to the Earthquake in Haiti

Two days after Haiti's devastating earthquake, a medical relief team made up in part of four emergency physicians and four emergency nurses from Stanford University Hospital and three emergency physicians ...

The Missing Voice of Patients in Drug-Safety Reporting

A patient wants to know about symptoms she may have from a prescription drug she is taking. Consulting the label's "Adverse Reactions" section, she finds a wealth of data. Little ...

Can the States Nullify Health Care Reform?

On February 1, the Virginia Senate passed a bill stating that "No resident of this Commonwealth . . . shall be required to obtain or maintain a policy of individual insurance coverage." ...

Health Care Volunteers and Disaster Response -- First, Be Prepared

The human suffering that followed the devastating earthquake in Haiti, and the many survivors in urgent need of lifesaving care, brought an outpouring of support from the U.S. health care ...

Tumor-Associated Macrophages and Survival in Classic Hodgkin's Lymphoma

Clinically relevant biomarkers for predicting the outcome of treatment in patients with Hodgkin's disease have not been established. In this study, gene profiling and immunohistochemical analysis were used to find such a marker. A strong association was found between a poor outcome of treatment and an increased number of CD68+ cells in the microenvironment of Reed-Sternberg cells. CD68, a marker of macrophages, outperformed the conventional International Prognostic Score and is available for immunohistochemical staining of diagnostic samples of Hodgkin's lymphoma.

Low Diagnostic Yield of Elective Coronary Angiography

In this national registry of data on cardiac catheterization, only 38% of elective, diagnostic coronary angiograms showed obstructive lesions, and 39% of angiograms were interpreted as showing no disease. The findings indicate a relatively low diagnostic yield of elective coronary angiography, a procedure that exposes patients to substantial radiation.

Oral Ivermectin versus Malathion Lotion for Difficult-to-Treat Head Lice

There are limited treatments for head lice. In this multicenter, cluster-randomized trial of 812 patients in 376 households, oral ivermectin was found to be superior to topical malathion lotion in eradicating head-lice infestation.

Use of the Thyroid Hormone Analogue Eprotirome in Statin-Treated Dyslipidemia

This randomized, placebo-controlled, double-blind, multicenter trial assessed the safety and efficacy of the thyromimetic compound eprotirome in lowering the serum low-density lipoprotein cholesterol level in patients with hypercholesterolemia who were already receiving simvastatin or atorvastatin. Eprotirome was associated with decreased LDL levels in patients treated with statins.

Medical Progress: Commotio Cordis

Ventricular fibrillation and sudden death triggered by a blunt, nonpenetrating, and often innocent-appearing unintentional blow to the chest without damage to the ribs, sternum, or heart (in the absence of underlying cardiovascular disease) constitute an event known as commotio cordis. This review provides information on the clinical profile of this event, the physiological mechanisms underlying it, and steps that can be taken to prevent the event and to resuscitate the victim, should it occur.

Red Puffy Ears

A 63-year-old man with a history of recurrent aseptic meningitis presented with fever and headache. The physical examination showed scleral injection and mild nuchal rigidity. Analysis of the cerebrospinal fluid ...

Dermoscopy of Phthiriasis

A 50-year-old man presented with a 1-month history of mild, generalized pruritus. A total-body examination of the patient's skin revealed small, yellowish-brown flecks in the hair of the upper arm ...

Case 7-2010 -- A 49-Year-Old Man with Peripheral Neuropathy and Ascites

A 49-year-old man was admitted to this hospital because of ascites. During the past 4 years, paresthesias and weakness of the lower legs and hands had developed, followed by difficulty breathing, peripheral edema, and during the past year, blurred vision, optic-disk edema, and ascites. Imaging studies subsequently revealed retroperitoneal lymphadenopathy and lytic lesions in the tibia and sacrum. A diagnostic procedure was performed.

Toward a Personalized Treatment of Hodgkin's Disease

In this issue of the Journal, Steidl et al.1 provide a technically sound and important model for using molecular tools to better predict how various cancers will respond to currently ...

Medical Imaging in the 21st Century -- Getting the Best Bang for the Rad

In the United States, the average radiation dose to which we are exposed has doubled in the past 30 years.1,2 The average dose from natural background sources has not changed, ...

Considering Recertification

In this issue of the Journal, Clinical Decisions presents a fictitious vignette involving a 55-year-old physician who practices internal medicine with a subspecialty in endocrinology.1 On completion of his training, ...

American Board of Internal Medicine Maintenance of Certification Program

This interactive Journal feature presents the case of an internist with a time-unlimited certificate from the American Board of Internal Medicine (ABIM) who is deciding whether to enroll in the Board's Maintenance of Certification program. Two recommendations, either of which could be considered correct, are presented. Which recommendation do you choose? At NEJM.org you can vote for one and then, if you wish, submit a comment about your decision. Voting results and a broad selection of comments will be posted.

Ameliorating Amyotrophic Lateral Sclerosis

A newly implicated molecular pathway in skeletal muscle regulates the formation of the neuromuscular junction and is implicated in a mouse model of amyotrophic lateral sclerosis.

Stem-Cell Transplantation for Sickle Cell Disease

To the Editor: As described by Hsieh et al. (Dec. 10 issue),1 the use of nonmyeloablative hematopoietic stem-cell transplantation as ...

Biventricular Pacing

To the Editor: Yu et al. (Nov. 26 issue)1 found that among patients with bradycardia, the left ventricular ejection fraction ...

Insulin Regimens in Type 2 Diabetes

To the Editor: In the Treating to Target in Type 2 Diabetes (4-T) study, Holman et al. (Oct. 29 issue)1 ...

Case 36-2009: A Man with Cough, Hoarseness, and Abnormalities on Chest Imaging

To the Editor: In the Case Record (Nov. 19 issue),1 Choy and colleagues note the interest stemming from phase 1 ...

Imaging in Early-Stage Hodgkin's Lymphoma

To the Editor: Data on exposure to low-dose ionizing radiation from medical imaging procedures indicate that medical imaging can potentially ...

The GHESKIO Field Hospital and Clinics after the Earthquake in Haiti -- Dispatch 3 from Port-au-Prince

After the January 12 earthquake in Haiti, the Port-au-Prince clinic of the Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO) became a refugee camp and an ...

Returning Home to Haiti -- Providing Medical Care after the Earthquake

As I left an anesthesiology lecture on January 12, someone stopped me to ask whether I had checked on my family in Port-au-Prince. When he explained that there had been ...

CME: Low Diagnostic Yield of Elective Coronary Angiography

(No abstract is available for this citation)

CME: Oral Ivermectin versus Malathion Lotion for Difficult-to-Treat Head Lice

(No abstract is available for this citation)

CME: Commotio Cordis

(No abstract is available for this citation)

AIDS in America -- Forgotten but Not Gone

(No abstract is available for this citation)

Five Next Steps for a New National Program for Comparative-Effectiveness Research

(No abstract is available for this citation)

The FDA and Safe Use of Long-Acting Beta-Agonists in the Treatment of Asthma

(No abstract is available for this citation)

Contaminated Heparin Associated with Adverse Clinical Events and Activation of the Contact System and Outbreak of Adverse Reactions Associated with Contaminated Heparin

(No abstract is available for this citation)

Choosing Asthma Step-up Care

(No abstract is available for this citation)

The Israeli Field Hospital in Haiti -- Ethical Dilemmas in Early Disaster Response

(No abstract is available for this citation)

Health Care Reform -- Where Do We Go from Here?

(No abstract is available for this citation)

Ministry of Touch -- Reflections on Disaster Work after the Haitian Earthquake

(No abstract is available for this citation)

The Democrats' Last Ditch -- Reconciliation or Bust

(No abstract is available for this citation)

Step-up Therapy for Children with Uncontrolled Asthma Receiving Inhaled Corticosteroids

Background For children who have uncontrolled asthma despite the use of low-dose inhaled corticosteroids (ICS), evidence to guide step-up therapy is lacking.

Methods We randomly assigned 182 children (6 to ...

Haiti -- A View from the Ship

(No abstract is available for this citation)

Haitian Amputees -- Lessons Learned from Sierra Leone

(No abstract is available for this citation)

Individual Genomes on the Horizon

(No abstract is available for this citation)

How to Think about Future Health Care Spending

(No abstract is available for this citation)

Whole-Genome Sequencing in a Patient with Charcot-Marie-Tooth Neuropathy

Can States Pick Up the Health Reform Torch?

It is impossible to recall another time when a single incident -- in this case, the off-cycle election of a U.S. senator -- so thoroughly implicated the long-term direction of ...

Be Not Afraid

Voters are angry and distrustful of Washington. Democrats have lost their nerve. Republicans, sensing weakness, are closing in for the kill. We have seen this health care reform horror movie ...

Rapid Medical Relief -- Project Medishare and the Haitian Earthquake

On the evening of January 12, 2010, a few hours after the Haitian earthquake, the leaders of Project Medishare in Miami began contacting Haitian associates, faculty and staff of the ...

Civil-Military Collaboration in the Initial Medical Response to the Earthquake in Haiti

The Missing Voice of Patients in Drug-Safety Reporting

A patient wants to know about symptoms she may have from a prescription drug she is taking. Consulting the label's "Adverse Reactions" section, she finds a wealth of data. Little ...

Can the States Nullify Health Care Reform?

On February 1, the Virginia Senate passed a bill stating that "No resident of this Commonwealth . . . shall be required to obtain or maintain a policy of individual insurance coverage." ...

Health Care Volunteers and Disaster Response -- First, Be Prepared

The human suffering that followed the devastating earthquake in Haiti, and the many survivors in urgent need of lifesaving care, brought an outpouring of support from the U.S. health care ...

Tumor-Associated Macrophages and Survival in Classic Hodgkin's Lymphoma

Low Diagnostic Yield of Elective Coronary Angiography

Oral Ivermectin versus Malathion Lotion for Difficult-to-Treat Head Lice

Use of the Thyroid Hormone Analogue Eprotirome in Statin-Treated Dyslipidemia

Medical Progress: Commotio Cordis

Red Puffy Ears

Dermoscopy of Phthiriasis

Case 7-2010 -- A 49-Year-Old Man with Peripheral Neuropathy and Ascites

Toward a Personalized Treatment of Hodgkin's Disease

In this issue of the Journal, Steidl et al.1 provide a technically sound and important model for using molecular tools to better predict how various cancers will respond to currently ...

Medical Imaging in the 21st Century -- Getting the Best Bang for the Rad

In the United States, the average radiation dose to which we are exposed has doubled in the past 30 years.1,2 The average dose from natural background sources has not changed, ...

Considering Recertification

American Board of Internal Medicine Maintenance of Certification Program

Ameliorating Amyotrophic Lateral Sclerosis

A newly implicated molecular pathway in skeletal muscle regulates the formation of the neuromuscular junction and is implicated in a mouse model of amyotrophic lateral sclerosis.

Stem-Cell Transplantation for Sickle Cell Disease

To the Editor: As described by Hsieh et al. (Dec. 10 issue),1 the use of nonmyeloablative hematopoietic stem-cell transplantation as ...

Biventricular Pacing

To the Editor: Yu et al. (Nov. 26 issue)1 found that among patients with bradycardia, the left ventricular ejection fraction ...

Insulin Regimens in Type 2 Diabetes

To the Editor: In the Treating to Target in Type 2 Diabetes (4-T) study, Holman et al. (Oct. 29 issue)1 ...

Case 36-2009: A Man with Cough, Hoarseness, and Abnormalities on Chest Imaging

To the Editor: In the Case Record (Nov. 19 issue),1 Choy and colleagues note the interest stemming from phase 1 ...

Imaging in Early-Stage Hodgkin's Lymphoma

To the Editor: Data on exposure to low-dose ionizing radiation from medical imaging procedures indicate that medical imaging can potentially ...

The GHESKIO Field Hospital and Clinics after the Earthquake in Haiti -- Dispatch 3 from Port-au-Prince

After the January 12 earthquake in Haiti, the Port-au-Prince clinic of the Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO) became a refugee camp and an ...

Returning Home to Haiti -- Providing Medical Care after the Earthquake

As I left an anesthesiology lecture on January 12, someone stopped me to ask whether I had checked on my family in Port-au-Prince. When he explained that there had been ...

CME: Low Diagnostic Yield of Elective Coronary Angiography

(No abstract is available for this citation)

CME: Oral Ivermectin versus Malathion Lotion for Difficult-to-Treat Head Lice

(No abstract is available for this citation)

CME: Commotio Cordis

(No abstract is available for this citation)

Top 5 - The Lancet

Top 5 - The Lancet Infectious Diseases

[Leading Edge] Gates Foundation's decade of vaccines

The GAVI Alliance celebrated the tenth anniversary of its foundation on Jan 29 this year. During its 10 years GAVI has overseen the delivery of vaccines to around 250 million children in the world's poorest countries, a programme that has probably averted around 5 million deaths.

[Reflection and Reaction] Quinine for the treatment of malaria in pregnancy

Adoke Yeka and colleagues rightly call for the discontinuation of quinine monotherapy in sub-Saharan Africa. However, combination therapies using quinine for the treatment of uncomplicated malaria in pregnancy were discounted. We agree that artemether with lumefantrine, azithromycin, artesunate with mefloquine, or dihydroartemisinin with piperaquine should be investigated for their potential use in the treatment of pregnant women with uncomplicated malaria. However, with the exception of azithromycin, all of these compounds are contraindicated in the first trimester. Priority should be given to investigating treatment regimens including azithromycin with quinine and azithromycin with chloroquine that are safe for use throughout pregnancy.

[Reflection and Reaction] Is it too soon to eliminate quinine?

Adoke Yeka and colleagues question the use of quinine monotherapy as a second-line treatment in Africa in the era of artemisinin-based combination therapy. We discuss the rationale for continuing to treat malaria in Africa with quinine.

[Reflection and Reaction] Inflammation as the cause of coronary heart disease

It was with great satisfaction that I saw, published in The Lancet Infectious Diseases, a Review by Charlotte Warren-Gash and colleagues on influenza as a trigger for acute myocardial infarction and cardiovascular diseases deaths.

[Reflection and Reaction] Acinetobacter baumannii infections in children

In their Review, Drosos E Karageorgopoulos and Matthew E Falagas discussed in depth the emerging role of Acinetobacter baumannii in multidrug-resistant infection and the many therapeutic problems it poses. Although they also emphasised the risk factors and characteristics of patients who are susceptible to colonisation and infection, there was no mention of A baumannii infection in children. Over the past few years, we have noted that A baumannii has been the cause of severe infections of the CNS in children with postsurgical meningitis or mechanical ventilation. The majority of children were unsuccessfully treated with broad-spectrum antibiotics. Our personal experience was recently confirmed by others.

[Reflection and Reaction] Vaccine safety: misinformed about the misinformed

Concern about the antivaccination movement is clearly warranted. It is also correct that most concerns about vaccine safety can, in theory, be allayed by logic and reason, and that the role of vaccines in improving public health should never be understated. The accumulation of more evidence and clearer communication about the differences between causation and correlation, would also help.

[Cross-talk] It doesn't apply to me

In September 1969, while in Exeter attending the annual meeting of the British Association for the Advancement of Science, the immunologist Sir Peter Medawar suffered a near-fatal stroke. Then aged 54, he was at the height of his powers. A professor at 32, a Fellow of the Royal Society at 34, and a Nobel laureate at 45, he was later the Director of the National Institute for Medical Research in London.

[Newsdesk] Giuseppe Cornaglia: a Renaissance man of microbiology

When Giuseppe Cornaglia, associate professor of microbiology at Verona University, Italy, was a young boy living in Sardinia, he would dream of travelling beyond the limits of the island. When he started to do so, he kept a travel journal. After spending almost a decade in “the top floors” of the European Society for Clinical Microbiology and Infectious Diseases (ESCMID), he reflects that his version of Gulliver's Travels would run to volumes if he had continued. His work with the society continues as ESCMID immediate past-president, and Cornaglia told TLID about this ideal combination of his passions for microbiology, travel, history, culture, and for people.

[Newsdesk] Polio eradication within 5 years now a real possibility

Last year was a significant one for polio eradication. Real progress was made simultaneously in northern Nigeria, on the Afghanistan–Pakistan border, and in the remaining pockets in Bihar and Uttar Pradesh in India, cutting the number of cases worldwide to 1597 (correct as of Feb 2, 2010). The new bivalent oral polio vaccine (bOPV), which targets type 1 and type 3 polioviruses, was licensed in late 2009 and has been in use since December. Starting in February, March, and April, 2010, multiple mass immunisations are planned in all four remaining countries where polio is endemic, at the start of a 3-year intensive effort to finally halt polio transmission worldwide.

[Newsdesk] HIV/AIDS on the rise in young people in Kenya

Although the general rate of new infections with HIV and deaths from AIDS has been falling in Africa because of improvements in awareness and use of antiretroviral medicines, reports that people age 15–24 years are at higher risk of contracting the virus are causing concern among HIV/AIDS campaigners and governments. African countries might be facing a new chapter in the HIV/AIDS crisis originating in unsafe sexual practices among younger age groups.

[Newsdesk] Gates Foundation $10 billion pledge for vaccine development

At the recent annual meeting of the World Economic Forum in Davos, Switzerland, Bill and Melinda Gates pledged US$10 billion to aid vaccine efforts in the world's poorest countries.

[Newsdesk] Infectious disease surveillance update: influenza

As of Jan 31, 2010, confirmed cases of pandemic H1N1 influenza have been reported in more than 209 countries and overseas territories worldwide, including at least 15 174 deaths.

[Newsdesk] FDA steps up efforts to improve food safety

Outbreaks of salmonella caused by tainted food products in the USA continue to shine a light on the need for improved food safety. In 2008–09 outbreak more than 700 people were infected after exposure to peanut products produced by Peanut Corporation of America (PCA), and in 2009–10 over 200 people have been infected after exposure to tainted salami products produced by Daniele International.

[Newsdesk] Research brief

Infection with hepatitis C virus (HCV) puts individuals at risk of cirrhosis and hepatocellular cancer. Standard interferon-based therapy for HCV infection is costly, time-consuming, and fails in about 50% of patients, but the lack of good assay systems has hampered the development of new HCV antivirals. Two recent studies may help to remedy this situation. In the first, researchers describe a cell-based fluorescent reporter system that allows real-time imaging of HCV infection. The system consists of human hepatoma cells (Huh-7.5) stably transduced with fluorescently labelled interferon-β promoter stimulator protein 1, a substrate of the HCV-encoded protease HCV NS3-4A. Productive infection of these cells with HCV causes fluorescence relocalisation, which can be used to study HCV biology and to develop antiviral drugs. In the second study, researchers develop a simple screen for HCV antivirals based on the ability of compounds to alleviate HCV-mediated killing of Huh-7.5 cells stably transduced with an HCV NS3-4A protease-cleavable derivative of the proapoptotic factor Bid. A screen of 1280 compounds identifies 47 compounds that substantially inhibit one or more aspect of the HCV life cycle.

[Media Watch] Books: International health links manual

The Tropical Health and Education Trust's International Health Links Manual is a well written and detailed guide on how to establish collaborative development partnerships between health-sector organisations in the UK and counterparts in developing countries. Although the focus is on partnerships with UK-based organisations, the general principles are valid for organisations in other parts of the world who wish to embark on similar partnerships.

[Media Watch] Books: The geographic spread of infectious diseases

The spread of disease throughout cities, countries, and the world relies on the spatial nature of transmission. Urban cities might face very different effects to rural communities, depending on the nature of the disease. Infections might cluster or they might move rapidly through modern transportation networks. At a smaller scale, an individual's social and travel networks might cause them to encounter infected individuals in a variety of ways.

[Media Watch] Books: Red book 2009

The Red Book of the American Academy of Pediatrics has grown in size and scope from the first edition in 1938 to the twenty-eighth edition in 2009. It is an impressive reference text, with 984 pages and a list of contributors comparable to a North American Who's Who in the specialty of paediatric infectious diseases. In addition to the presentation, diagnosis, treatment, and control of specific infections, the book also has sections on antimicrobial treatment, prophylaxis, vaccination, and recommendations for care of children under special circumstances. This last section is among the most useful and interesting, because it condenses a host of issues that infrequently arise in paediatric practice, ranging from discarded needle stick injuries in the community, through evaluating children adopted from abroad, to possible exposure to biological terrorism.

[Review] Virological follow-up of adult patients in antiretroviral treatment programmes in sub-Saharan Africa: a systematic review

Following large-scale roll-out of antiretroviral therapy in sub-Saharan Africa, the non-clinical efficacy of antiretroviral therapy has received little attention. We aimed to systematically review virological efficacy and drug-resistance outcomes of programmes of antiretroviral therapy in sub-Saharan Africa. 89 studies with heterogeneous design, definitions, and methods were identified. Overall, in on-treatment analysis, 10 351 (78%) of 13 288 patients showed virological suppression after 6 months of antiretroviral therapy, 7413 (76%) of 9794 after 12 months, and 3840 (67%) of 5690 after 24 months. Long-term virological data are scarce. Genotyping results were available for patients with virological failure (HIV-1 RNA greater than 1000 copies per mL). Most patients (839 of 849; 99%) were infected with a non-B HIV-1 subtype. However, drug-resistance patterns were largely similar to those in subtype B. Resistance profiles were associated with the antiretroviral drugs commonly used: the lamivudine-associated M184V mutation was most common, followed by K103N which is associated with non-nucleoside reverse transcriptase inhibitors. Thymidine-analogue mutations and the K65R mutation were less common. First-line antiretroviral therapy regimens used in sub-Saharan Africa are effective. Profiles of drug resistance suggest that a second-line treatment regimen based on protease inhibitors, with a backbone of nucleoside reverse transcriptase inhibitors, is a reasonable option for patients with HIV in sub-Saharan Africa who experience first-line treatment failure.

[Review] Antibiotic prescribing in hospitals: a social and behavioural scientific approach

Antibiotics have dramatically changed the prognoses of patients with severe infectious diseases over the past 50 years. However, the emergence and dissemination of resistant organisms has endangered the effectiveness of antibiotics. One possible approach to the resistance problem is the appropriate use of antibiotic drugs for preventing and treating infections. This Review describes how the volume and appropriateness of antibiotic use in hospitals vary between countries, hospitals, and physicians. At each specific level—cultural, contextual, and behavioural—we discuss the determinants that influence hospital antibiotic use and the possible improvement strategies to make it more appropriate. Changing hospital antibiotic use is a challenge of formidable complexity. On each level, many determinants play a part, so that the measures or strategies undertaken to improve antibiotic use need to be equally diverse. Although various strategies for improving antibiotic use are available, a programme with activities at all three levels is needed for hospitals. Evaluating these programme activities in a way that provides external validity of the conclusions is crucial.

[Review] Tuberculosis and air travel: a systematic review and analysis of policy

WHO international guidelines for the control of tuberculosis in relation to air travel require—after a risk assessment—tracing of passengers who sat for longer than 8 h in rows adjacent to people with pulmonary tuberculosis who are smear positive or smear negative. A further recommendation is that all commercial air travel should be prohibited until the person has two consecutive negative sputum smears for drug-susceptible tuberculosis or two consecutive cultures for multidrug-resistant tuberculosis. In this Review I examine the evidence put forward to support these recommendations and assess whether such an approach is justifiable. A systematic review identified 39 studies of which 13 were included. The majority of studies found no evidence of transmission. Only two studies reported reliable evidence of transmission. The analysis suggests that there is reason to doubt the value of actively screening air passengers for infection with Mycobacterium tuberculosis and that the resources used might be better spent addressing other priorities for the control of tuberculosis.

[Review] Combination therapy for visceral leishmaniasis

Combination therapy for the treatment of visceral leishmaniasis has increasingly been advocated as a way to increase treatment efficacy and tolerance, reduce treatment duration and cost, and limit the emergence of drug resistance. We reviewed the evidence and potential for combination therapy, and the criteria for the choice of drugs in such regimens. The first phase 2 results of combination regimens are promising, and have identified effective and safe regimens as short as 8 days. Several phase 3 trials are underway or planned in the Indian subcontinent and east Africa. The limited data available suggest that combination therapy is more cost-effective and reduces indirect costs for patients. Additional advantages are reduced treatment duration (8–17 days), with potentially better patient compliance and lesser burden on the health system. Only limited data are available on how best to prevent acquired resistance. Patients who are coinfected with visceral leishmaniasis and HIV could be a reservoir for development and spread of drug-resistant strains, calling for special precautions. The identification of a short, cheap, well-tolerated combination regimen that can be given in ambulatory care and needs minimal clinical monitoring will most likely have important public health implications. Effective monitoring systems and close regulations and policy will be needed to ensure effective implementation. Whether combination therapy could indeed help delay resistance, and how this is best achieved, will only be known in the long term.

[Personal View] Otitis media and its consequences: beyond the earache

An international group of multidisciplinary experts on middle-ear and paediatric infections met to explore where consensus exists on the management of acute otitis media. After informal discussions among several specialists of paediatric infectious disease, the group was expanded to include a larger spectrum of professionals with complementary expertise in middle-ear disease. Acute otitis media is a very common bacterial infection in children worldwide, leading to excessive antibiotic consumption in children in most countries and to a substantial burden of deafness and suppurative complications in developing countries. The group attempted to move beyond the existing controversies surrounding guidelines on acute otitis media, and to propose to clinicians and public health officials their views on the actions needed to be taken to reduce the disease burden caused by acute otitis media and the microbial antibiotic resistance from the resulting use of antibiotics. Definition of acute otitis media and diagnostic accuracy are crucial steps to identify children who will potentially benefit from treatment with antibiotics and to eliminate unnecessary prescribing. Although the group agreed that antibiotics are distributed indiscriminately, even to children who do not seem to have the disease, no consensus could be reached on whether antibiotics should be given to all appropriately diagnosed children, reflecting the wide range of practices and lack of convincing evidence from observational studies. The major unanimous concern was an urgent need to reduce unnecessary prescribing of antibiotics to prevent further increases in antibiotic resistance. Prevention of acute otitis media with existing and future viral and bacterial vaccines seems the most promising approach to affect disease burden and consequences, both in developed and developing countries.

[Personal View] Reducing empiricism in malaria vaccine design

Gains in the control of malaria and the promising progress of a malaria vaccine that is partly efficacious do not reduce the need for a high-efficacy vaccine in the longer term. Evidence supports the feasibility of developing a highly efficacious malaria vaccine. However, design of candidate malaria vaccines remains empirical and is necessarily based on many unproven assumptions because much of the knowledge needed to design vaccines and to predict efficacy is not available. Data to inform key questions of vaccine science might allow the design of vaccines to progress to a less empirical stage, for example through availability of assay results associated with vaccine efficacy. We discuss six strategic gaps in knowledge that contribute to empiricism in the design of vaccines. Comparative evaluation, assay and model standardisation, greater sharing of information, collaboration and coordination between groups, and rigorous evaluation of existing datasets are steps that can be taken to enable reductions in empiricism over time.

[Clinical Picture] The peaks and valleys of ocular histoplasmosis syndrome

Ophthalmological examination of a 55-year-old white woman with longstanding ocular histoplasmosis syndrome (OHS) and recently diagnosed multiple sclerosis revealed poor central vision, peripapillary atrophy, extensive subretinal pigment deposition (), old choroidal neovascularisation (CNV; ), and punched-out chorioretinal scars in the absence of any anterior segment and vitreous inflammation. Cirrus HD retinal optical coherence tomography (OCT) scan revealed markedly disrupted topography of the internal limiting membrane and retinal pigment epithelium layers resulting from extensive chorioretinal scarring (). The so-called peaks and valleys seen on retinal OCT in this patient are in stark contrast to the smooth contours of these layers in eyes of healthy individuals.

[Leading Edge] Gates Foundation's decade of vaccines

[Reflection and Reaction] Quinine for the treatment of malaria in pregnancy

[Reflection and Reaction] Is it too soon to eliminate quinine?

[Reflection and Reaction] Inflammation as the cause of coronary heart disease

[Reflection and Reaction] Acinetobacter baumannii infections in children

[Reflection and Reaction] Vaccine safety: misinformed about the misinformed

[Cross-talk] It doesn't apply to me

[Newsdesk] Giuseppe Cornaglia: a Renaissance man of microbiology

[Newsdesk] Polio eradication within 5 years now a real possibility

[Newsdesk] HIV/AIDS on the rise in young people in Kenya

[Newsdesk] Gates Foundation $10 billion pledge for vaccine development

At the recent annual meeting of the World Economic Forum in Davos, Switzerland, Bill and Melinda Gates pledged US$10 billion to aid vaccine efforts in the world's poorest countries.

[Newsdesk] Infectious disease surveillance update: influenza

As of Jan 31, 2010, confirmed cases of pandemic H1N1 influenza have been reported in more than 209 countries and overseas territories worldwide, including at least 15 174 deaths.

[Newsdesk] FDA steps up efforts to improve food safety

[Newsdesk] Research brief

[Media Watch] Books: International health links manual

[Media Watch] Books: The geographic spread of infectious diseases

[Media Watch] Books: Red book 2009

[Review] Virological follow-up of adult patients in antiretroviral treatment programmes in sub-Saharan Africa: a systematic review

[Review] Antibiotic prescribing in hospitals: a social and behavioural scientific approach

[Review] Tuberculosis and air travel: a systematic review and analysis of policy

[Review] Combination therapy for visceral leishmaniasis

[Personal View] Otitis media and its consequences: beyond the earache

[Personal View] Reducing empiricism in malaria vaccine design

[Clinical Picture] The peaks and valleys of ocular histoplasmosis syndrome