Interview: The collaboration between endodontists and GPs to preserve dentin

Thu, 17 May 2012 20:20:15 +0200

In an interview conducted at the recent American Association of Endodontists Annual Session in Boston, Tom Gallop, CEO of SS White, discussed the collaboration between endodontists and restorative dentists to preserve dentin and therefore improve outcomes for patients.

Athletes are reminded to wear mouthguards

Thu, 17 May 2012 14:08:19 +0200

TAMPA, FL, USA: This year, more than 3 million teeth will be knocked out during youth sporting events, and the cost of replacing a knocked-out tooth can mount to $20,000, according to the National Youth Sports Safety Foundation.
 Athletes are 60 percent more likely to suffer an injury to the mouth when not wearing a mouthguard.

Majority of Swedes brush their teeth the wrong way

Thu, 17 May 2012 06:54:44 +0200

GOTHENBURG, Sweden: Only one in ten Swedes brushes his teeth in a way that effectively promotes the prevention of tooth decay, researchers at the University of Gothenburg’s Sahlgrenska Academy have found. The elderly in particular need to improve their toothbrushing behaviour.

Conical internal connections will fuel growth in dental implant market

Thu, 17 May 2012 06:00:20 +0200

The dental implant and bone graft substitute market is the most rapidly advancing segment of dental technology, and leading competitors in this market must consistently develop new products supported by research from scientific and academic organizations to remain competitive. Recent cases have demonstrated that when companies lose a segment of support from the scientific community, their market shares tend to suffer significantly.

Straumann announces majority stake acquisition of Neodent to gain presence in South America

Wed, 16 May 2012 10:12:44 +0200

AMSTERDAM, the Netherlands/BASEL, Switzerland: Straumann has announced the significant expansion of its business in emerging markets with an acquisition that will secure the company a 49 per cent stake in Neodent, a South American leader in implant dentistry. The news broke today during the Swiss dental group’s Capital Markets Day event in Amsterdam that was held to map out future strategies for the dental implant and restorative markets.

The Evolving Primary Care Physician

Wed, 16 May 2012 21:00:11 +0200

New England Journal of Medicine, Volume 366, Issue 20, Page 1849-1853, May 2012.

Secondary Prevention after Ischemic Stroke or Transient Ischemic Attack

Wed, 16 May 2012 21:00:11 +0200

New England Journal of Medicine, Volume 366, Issue 20, Page 1914-1922, May 2012.

Case 15-2012

Wed, 16 May 2012 21:00:11 +0200

New England Journal of Medicine, Volume 366, Issue 20, Page 1924-1934, May 2012.

“Half-Half” Blisters

Wed, 16 May 2012 21:00:11 +0200

New England Journal of Medicine, Volume 366, Issue 20, May 2012.

Somatic STAT3 Mutations in Large Granular Lymphocytic Leukemia

Wed, 16 May 2012 21:00:11 +0200

New England Journal of Medicine, Volume 366, Issue 20, Page 1905-1913, May 2012.

Memory Enhancement and Deep-Brain Stimulation of the Entorhinal Area

Wed, 16 May 2012 21:00:10 +0200

New England Journal of Medicine, Volume 366, Issue 20, Page 1945-1946, May 2012.

Warfarin and Aspirin in Patients with Heart Failure and Sinus Rhythm

Wed, 16 May 2012 21:00:10 +0200

New England Journal of Medicine, Volume 366, Issue 20, Page 1859-1869, May 2012.

Mental Illness — Comprehensive Evaluation or Checklist?

Wed, 16 May 2012 21:00:10 +0200

New England Journal of Medicine, Volume 366, Issue 20, Page 1853-1855, May 2012.

Intramuscular versus Intravenous Benzodiazepines for Status Epilepticus

Wed, 16 May 2012 21:00:08 +0200

New England Journal of Medicine, Volume 366, Issue 20, Page 1943-1944, May 2012.

Warfarin in Heart Failure

Wed, 16 May 2012 21:00:08 +0200

New England Journal of Medicine, Volume 366, Issue 20, Page 1936-1938, May 2012.

Azithromycin and the Risk of Cardiovascular Death

Wed, 16 May 2012 21:00:06 +0200

New England Journal of Medicine, Volume 366, Issue 20, Page 1881-1890, May 2012.

Grief, Depression, and the DSM-5

Wed, 16 May 2012 21:00:06 +0200

New England Journal of Medicine, Volume 366, Issue 20, Page 1855-1857, May 2012.

Lost in Translation — ¿Cómo se dice, “Patient Protection and Affordable Care Act”?

Wed, 16 May 2012 21:00:06 +0200

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

Risk of Natalizumab-Associated Progressive Multifocal Leukoencephalopathy

Wed, 16 May 2012 21:00:06 +0200

New England Journal of Medicine, Volume 366, Issue 20, Page 1870-1880, May 2012.

Stem Cells and Spinal Cord Repair

Wed, 16 May 2012 21:00:06 +0200

New England Journal of Medicine, Volume 366, Issue 20, Page 1940-1942, May 2012.

Association of Coffee Drinking with Total and Cause-Specific Mortality

Wed, 16 May 2012 21:00:05 +0200

New England Journal of Medicine, Volume 366, Issue 20, Page 1891-1904, May 2012.

Predicting Risk of Progressive Multifocal Leukoencephalopathy from Natalizumab

Wed, 16 May 2012 21:00:05 +0200

New England Journal of Medicine, Volume 366, Issue 20, Page 1938-1939, May 2012.

Regulatory Review of Novel Therapeutics — Comparison of Three Regulatory Agencies

Wed, 16 May 2012 21:00:04 +0200

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

Nevus Sebaceous

Wed, 16 May 2012 21:00:03 +0200

New England Journal of Medicine, Volume 366, Issue 20, Page 1923, May 2012.

Emergency Departments, Medicaid Costs, and Access to Primary Care — Understanding the Link

Wed, 16 May 2012 21:00:01 +0200

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

Continuing Bisphosphonate Treatment for Osteoporosis — For Whom and for How Long?

Wed, 09 May 2012 21:00:02 +0200

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

Bisphosphonates for Osteoporosis — Where Do We Go from Here?

Wed, 09 May 2012 21:00:01 +0200

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

Beyond the “R Word”? Medicine's New Frugality

Wed, 02 May 2012 21:00:10 +0200

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

Combination Chemotherapy in Advanced Adrenocortical Carcinoma

Wed, 02 May 2012 21:00:09 +0200

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

From an Ethics of Rationing to an Ethics of Waste Avoidance

Wed, 02 May 2012 21:00:07 +0200

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

A Randomized Trial of Urodynamic Testing before Stress-Incontinence Surgery

Wed, 02 May 2012 21:00:04 +0200

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

A Clinical Trial to Maintain Glycemic Control in Youth with Type 2 Diabetes

Sun, 29 Apr 2012 19:00:26 +0200

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

TODAY — A Stark Glimpse of Tomorrow

Sun, 29 Apr 2012 19:00:16 +0200

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

Erratum: A 62-Year-Old Man with Paresthesias, Weight Loss, Jaundice, and Anemia

Thu, 26 Apr 2012 23:04:39 +0200

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

Performance Improvement in Health Care — Seizing the Moment

Wed, 25 Apr 2012 21:00:01 +0200

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

The Evolving Primary Care Physician

Wed, 16 May 2012 21:00:11 +0200

New England Journal of Medicine, Volume 366, Issue 20, Page 1849-1853, May 2012.

Secondary Prevention after Ischemic Stroke or Transient Ischemic Attack

Wed, 16 May 2012 21:00:11 +0200

New England Journal of Medicine, Volume 366, Issue 20, Page 1914-1922, May 2012.

Case 15-2012

Wed, 16 May 2012 21:00:11 +0200

New England Journal of Medicine, Volume 366, Issue 20, Page 1924-1934, May 2012.

“Half-Half” Blisters

Wed, 16 May 2012 21:00:11 +0200

New England Journal of Medicine, Volume 366, Issue 20, May 2012.

Somatic STAT3 Mutations in Large Granular Lymphocytic Leukemia

Wed, 16 May 2012 21:00:11 +0200

New England Journal of Medicine, Volume 366, Issue 20, Page 1905-1913, May 2012.

Memory Enhancement and Deep-Brain Stimulation of the Entorhinal Area

Wed, 16 May 2012 21:00:10 +0200

New England Journal of Medicine, Volume 366, Issue 20, Page 1945-1946, May 2012.

Warfarin and Aspirin in Patients with Heart Failure and Sinus Rhythm

Wed, 16 May 2012 21:00:10 +0200

New England Journal of Medicine, Volume 366, Issue 20, Page 1859-1869, May 2012.

Mental Illness — Comprehensive Evaluation or Checklist?

Wed, 16 May 2012 21:00:10 +0200

New England Journal of Medicine, Volume 366, Issue 20, Page 1853-1855, May 2012.

Intramuscular versus Intravenous Benzodiazepines for Status Epilepticus

Wed, 16 May 2012 21:00:08 +0200

New England Journal of Medicine, Volume 366, Issue 20, Page 1943-1944, May 2012.

Warfarin in Heart Failure

Wed, 16 May 2012 21:00:08 +0200

New England Journal of Medicine, Volume 366, Issue 20, Page 1936-1938, May 2012.

Azithromycin and the Risk of Cardiovascular Death

Wed, 16 May 2012 21:00:06 +0200

New England Journal of Medicine, Volume 366, Issue 20, Page 1881-1890, May 2012.

Grief, Depression, and the DSM-5

Wed, 16 May 2012 21:00:06 +0200

New England Journal of Medicine, Volume 366, Issue 20, Page 1855-1857, May 2012.

Lost in Translation — ¿Cómo se dice, “Patient Protection and Affordable Care Act”?

Wed, 16 May 2012 21:00:06 +0200

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

Risk of Natalizumab-Associated Progressive Multifocal Leukoencephalopathy

Wed, 16 May 2012 21:00:06 +0200

New England Journal of Medicine, Volume 366, Issue 20, Page 1870-1880, May 2012.

Stem Cells and Spinal Cord Repair

Wed, 16 May 2012 21:00:06 +0200

New England Journal of Medicine, Volume 366, Issue 20, Page 1940-1942, May 2012.

Association of Coffee Drinking with Total and Cause-Specific Mortality

Wed, 16 May 2012 21:00:05 +0200

New England Journal of Medicine, Volume 366, Issue 20, Page 1891-1904, May 2012.

Predicting Risk of Progressive Multifocal Leukoencephalopathy from Natalizumab

Wed, 16 May 2012 21:00:05 +0200

New England Journal of Medicine, Volume 366, Issue 20, Page 1938-1939, May 2012.

Regulatory Review of Novel Therapeutics — Comparison of Three Regulatory Agencies

Wed, 16 May 2012 21:00:04 +0200

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

Nevus Sebaceous

Wed, 16 May 2012 21:00:03 +0200

New England Journal of Medicine, Volume 366, Issue 20, Page 1923, May 2012.

Emergency Departments, Medicaid Costs, and Access to Primary Care — Understanding the Link

Wed, 16 May 2012 21:00:01 +0200

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

Continuing Bisphosphonate Treatment for Osteoporosis — For Whom and for How Long?

Wed, 09 May 2012 21:00:02 +0200

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

Bisphosphonates for Osteoporosis — Where Do We Go from Here?

Wed, 09 May 2012 21:00:01 +0200

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

Beyond the “R Word”? Medicine's New Frugality

Wed, 02 May 2012 21:00:10 +0200

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

Combination Chemotherapy in Advanced Adrenocortical Carcinoma

Wed, 02 May 2012 21:00:09 +0200

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

From an Ethics of Rationing to an Ethics of Waste Avoidance

Wed, 02 May 2012 21:00:07 +0200

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

A Randomized Trial of Urodynamic Testing before Stress-Incontinence Surgery

Wed, 02 May 2012 21:00:04 +0200

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

A Clinical Trial to Maintain Glycemic Control in Youth with Type 2 Diabetes

Sun, 29 Apr 2012 19:00:26 +0200

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

TODAY — A Stark Glimpse of Tomorrow

Sun, 29 Apr 2012 19:00:16 +0200

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

Erratum: A 62-Year-Old Man with Paresthesias, Weight Loss, Jaundice, and Anemia

Thu, 26 Apr 2012 23:04:39 +0200

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

Performance Improvement in Health Care — Seizing the Moment

Wed, 25 Apr 2012 21:00:01 +0200

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

[Editorial] Sinusitis and antibiotics

Few would now disagree that inappropriate use of antibiotics leads to emergence of antibiotic-resistant bacteria. Thus, new sinusitis clinical practice guidelines from the Infectious Diseases Society of America (IDSA) are to be welcomed, because one of their aims is “to reduce excessive or inappropriate use of antimicrobial agents in patients with acute viral rhinosinusitis or self-limited bacterial infection”.

[Comment] Rapid HIV tests: from meta-analysis to field application

In The Lancet Infectious Diseases, Nitika Pant Pai and colleagues concluded, in a systematic review and meta-analysis, that a rapid point-of-care HIV test, Oraquick, had a slightly lower sensitivity for oral specimens (98·03%) than blood specimens (99·68%), but specificities were similar (99·74% vs 99·91%). Although the positive predictive values (PPVs) were similar (98·65% vs 98·50%) in high-prevalence settings (HIV prevalence >1%), they identified a lower PPV for oral specimens (88·55%) than blood specimens (97·65%) in lower-prevalence settings.

[Comment] The end of postoperative antimicrobial prophylaxis?

In The Lancet Infectious Diseases, Hiroshi Imamura and colleagues report data from a randomised controlled trial of antimicrobial prophylaxis in patients having distal gastrectomy for cancer. Patients were randomly assigned to receive 1 g of cefazolin before the incision only or an additional dose once after closure and twice daily for 2 days after surgery. The rates of surgical-site infection were much the same between groups: 9% in the extended treatment group and 5% in the intraoperative alone group.

[Comment] Effects of malaria and its treatment in early pregnancy

Malaria can have devastating consequences for pregnant women and their developing fetuses. The lack of information on the effect of malaria in the first trimester has been previously identified as an important knowledge gap in estimating the burden of malaria in pregnancy. Similarly, few data are available on the safety in early pregnancy of the artemisinin class of compounds, alone or as combination therapies, the most effective antimalarials to date. Although extrapolation of animal reprotoxicology data to human beings is ambiguous, it suggests that artemisinin derivatives could cause birth defects or pregnancy loss when used in the early first trimester of pregnancy.

[Errata] Erratum

Zachariah R, Ford N, Maher D, et al. Is operational research delivering the goods? The journey to success in low-income countries. Lancet Infect Dis 2012; published online Feb 9. DOI:10.1016/S1473-3099(11)70309-7—In both the author list and author affiliations, Christian Lienhardt's name was misspelled. The online version was corrected on March 9, 2012.

[Correspondence] Lyme disease antiscience

Paul Auwaerter and colleagues' Personal View outlines an extremely uncomfortable situation in the USA, but this report should not lead anyone to believe that the situation in the UK is the same. Dissection of this opinion piece only adds to the divisiveness. Instead it should be pointed out that, in the UK, doctors rather than patients are misusing science.

[Correspondence] Lyme disease antiscience

Paul Auwaerter and colleagues compare some Lyme disease activists who use non-evidence-based arguments with anti-HIV or antivaccination extremists. Their Personal View shows that unscientific thinking and malpractice occur in many specialties. Such a focus has unfortunately resulted in suppression of legitimate and necessary scientific debate about the management of syndromes of unclear aetiology, which sometimes occur after a previously proven episode of Lyme disease or tick bites. Public health recommendations should rely on strong evidence-based data and not on expert opinion, as Lee and Vielmeyer's review of the Infectious Disease Society of America guidelines shows is the case with Lyme disease.

[Correspondence] Lyme disease antiscience

Paul Auwaerter and colleagues are among the handful of individuals who have controlled the Lyme disease research agenda for decades and ultimately which data have been reported. Why is it that, in my experience, many people in New Hampshire have been severely debilitated by Lyme disease or know someone who has, whereas Auwaerter and co-workers claim that the disease is easily diagnosed and treated with a short course of antibiotics? Seven states have now passed legislation to protect clinicians who treat late-stage Lyme disease with long-term antibiotics (CT, MA, MN, NY, NH, RI, and TX) and support groups exist in nearly every state, with 19 in Pennsylvania alone.

[Correspondence] Lyme disease antiscience – Authors' reply

Although we support efforts to educate clinicians and the public alike with high-quality, evidence-based information about infection with Borrelia burgdorferi, the comments from Stella Huyshe-Shires regarding our Personal View misleadingly suggest that the UK is untainted by antiscience concerns. A report by Cottle and colleagues showed that most patients referred to an infectious diseases unit in Liverpool, UK, for Lyme disease (n=115) did not have the disorder. Of 38 patients with chronic fatigue syndrome, 45% were incorrectly labelled as having chronic Lyme disease by alternative practitioners.

[Correspondence] Post-disaster assessment in Brazzaville, Congo

According to several corroborating witness statements, on March 4, 2012, between 0800 h and 1100 h, explosions from the arms depot of the armoured regiment of the Congolese Armed Forces razed to the ground hundreds of houses in Brazzaville. The power of the shock wave, propagated by the Congo River, shook buildings 8·5 km away in Kinshasa. The explosions caused extensive damage. Troops from the Congolese armed forces are securing the most sensitive sites. The entire neighbourhood of Mpila and surrounding areas including Ouenze are devastated ().

[Correspondence] Research into transmissibility of influenza A H5N1: a practical response to the controversy

The controversy between influenza virologists and biosecurity experts about whether to publish the experimental details of research into the transmissibility of H5N1 viruses misses the point. Influenza viruses can and do develop efficient transmissibility on their own; we have known this for decades. A pandemic caused by a virus similar to the one that caused the 1918 pandemic might kill 62 million people worldwide. In view of this possibility, understanding what we might do if and when this happens is far more important.

[Newsdesk] Global rabies elimination: are we stepping up to the challenge?

A 1 year assessment of the Rabies Blueprint website, a detailed online guide developed to support countries aiming to eliminate canine rabies in an effort to prevent human rabies, shows that it has been successful in terms of outreach. “We know that visitors have come from virtually all continents, including 150 countries or territories and 1827 cities”, reports lead author Tiziana Lembo (University of Glasgow, UK, and the Global Alliance for Rabies Control, USA). “We are also aware that this toolkit is being used as a guide for the implementation of canine rabies control programmes in various places, for example the Philippines, Uganda, Benin, Afghanistan, Peru, Bolivia, Haiti, and Indonesia.

[Newsdesk] H5N1 research unleashed, almost

On Feb 10, we reported the tale of two research articles in which the authors had generated viruses based on highly pathogenic avian influenza H5N1 that were transmissible in mammals. The publication of these papers was put on hold at the request of the US National Science Advisory Board for Biosecurity (NSABB) on the basis of concerns about biosafety and bioterrorism. The board advised that redacted research papers reporting only the aims and conclusions without details of the methods and results be published, with more technical details being supplied to only a select group of influenza researchers.

[Newsdesk] Infectious disease surveillance update

More than two-thirds of the population of an Indonesian village is believed to be infected with filarial nematodes, which are spread by mosquito vectors and can cause elephantiasis. Of 300 people living in the village of Sebakung Jaya, in East Kalimantan province, 210 are suspected to have the infection. Health officials have sent samples to Samarinda, the province capital, to confirm the infection and are planning to order enough anthelmintic drugs to treat everyone in the village. Lymphatic filariasis is endemic in many regions of the country.

[Newsdesk] Highlights from the 22nd ECCMID

The 22nd annual European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) was held on March 31 to April 3, 2012, in London, UK. More than 10 000 infectious diseases experts gathered in the ExCel Exhibition Centre, London. Special emphasis was given to emerging infections, including influenza, antibiotic resistance, infection control, and sexually transmitted infections.

[Newsdesk] Research brief

In the RV144 clinical trial, a prime-boost vaccine regimen reduced HIV-1 infection by 31·2% compared with placebo. Examination of immune variables in postimmunisation samples taken from 41 vaccinated people who became infected and from 205 vaccinated people who remained uninfected reveals that, in this trial, IgG antibody binding to variable regions 1 and 2 of HIV-1 envelope proteins (env) correlated inversely with the rate of HIV-1 infection and binding of IgA antibodies to env directly correlated with the rate of infection.

[Media Watch] Eradication: ridding the world of diseases forever?

In this well researched and well written book, historian Nancy Leys Stepan uses the diaries and aspirations of Fred Soper—former Director General of the Pan American Health Organization, described in the book as an arch-eradicationist—to recount a social history of public health. In so doing, she critically analyses the very idea of eradication, exposes the weak scientific basis of many of the past century's greatest battles against disease, and provides lessons for the challenges that lie ahead.

[Media Watch] Advances in virus research 79: research advances in rabies

Tragically, half of people infected with rabies are children aged younger than 15 years. Most tragic is that all of these deaths could have been prevented by appropriate postexposure prophylaxis consisting of wound cleaning, active immunisation with a safe rabies vaccine, and passive immunisation with a rabies immunoglobulin. The high cost of this prophylaxis prevents its use in low-income countries and, as a result, people die. The 486 page book with its 21 chapters written by experts is thus a welcome reminder that research into rabies has to continue to reduce its deadly toll.

[Articles] Head-to-head comparison of accuracy of a rapid point-of-care HIV test with oral versus whole-blood specimens: a systematic review and meta-analysis

Although Oraquick had a high PPV in high-prevelence settings in oral specimens, the slightly lower sensitivity and PPV in low-prevalence settings in oral specimens should be carefully reviewed when planning worldwide expanded initiatives with this popular test.

[Articles] Intraoperative versus extended antimicrobial prophylaxis after gastric cancer surgery: a phase 3, open-label, randomised controlled, non-inferiority trial

Elimination of postoperative antimicrobial prophylaxis did not increase the incidence of surgical-site infections after a gastrectomy. Therefore, this treatment is not recommended after gastric cancer surgery.

[Articles] Adverse effects of falciparum and vivax malaria and the safety of antimalarial treatment in early pregnancy: a population-based study

A single episode of falciparum or vivax malaria in the first trimester of pregnancy can cause miscarriage. No additional toxic effects associated with artesunate treatment occurred in early pregnancy. Prospective studies should now be done to assess the safety and efficacy of artemisinin combination treatments in early pregnancy.

[Review] Passive immunity in the prevention of rabies

Prevention of clinical disease in those exposed to viral infection is an important goal of human medicine. Using rabies virus infection as an example, we discuss the advances in passive immunoprophylaxis, most notably the shift from the recommended polyclonal human or equine immunoglobulins to monoclonal antibody therapies. The first rabies-specific monoclonal antibodies are undergoing clinical trials, so passive immunisation might finally become an accessible, affordable, and routinely used part of global health practices for rabies.

[Review] Hepatitis C virus clearance, reinfection, and persistence, with insights from studies of injecting drug users: towards a vaccine

Hepatitis C virus (HCV) was discovered more than two decades ago, but progress towards a vaccine has been slow. HCV infection will spontaneously clear in about 25% of people. Studies of spontaneous HCV clearance in chimpanzees and human beings have identified host and viral factors that could be important in the control of HCV infection and the design of HCV vaccines. Although data from studies of chimpanzees suggest that protection against reinfection is possible after spontaneous clearance, HCV is a human disease.

[Personal View] Is operational research delivering the goods? The journey to success in low-income countries

Operational research in low-income countries has a key role in filling the gap between what we know from research and what we do with that knowledge—the so-called know–do gap, or implementation gap. Planned research that does not tangibly affect policies and practices is ineffective and wasteful, especially in settings where resources are scarce and disease burden is high. Clear parameters are urgently needed to measure and judge the success of operational research. We define operational research and its relation with policy and practice, identify why operational research might fail to affect policy and practice, and offer possible solutions to address these shortcomings.

[Clinical Picture] Skin infection and progressive paraparesis

A 35-year-old female agricultural worker presented with a 4 month history of productive cough, fever, and left subcostal pain, followed by progressive paraparesis and urinary incontinence. 10 years previously, she had been treated for a skin infection on her back at another centre for 3 years, without further follow-up. Examination showed more than one irregular scars, hyperpigmented papules, and few skin sinuses with scanty purulent discharge, without erythema, on the middle and left side of the upper back.

[Editorial] Sinusitis and antibiotics

Few would now disagree that inappropriate use of antibiotics leads to emergence of antibiotic-resistant bacteria. Thus, new sinusitis clinical practice guidelines from the Infectious Diseases Society of America (IDSA) are to be welcomed, because one of their aims is “to reduce excessive or inappropriate use of antimicrobial agents in patients with acute viral rhinosinusitis or self-limited bacterial infection”.

[Comment] Rapid HIV tests: from meta-analysis to field application

In The Lancet Infectious Diseases, Nitika Pant Pai and colleagues concluded, in a systematic review and meta-analysis, that a rapid point-of-care HIV test, Oraquick, had a slightly lower sensitivity for oral specimens (98·03%) than blood specimens (99·68%), but specificities were similar (99·74% vs 99·91%). Although the positive predictive values (PPVs) were similar (98·65% vs 98·50%) in high-prevalence settings (HIV prevalence >1%), they identified a lower PPV for oral specimens (88·55%) than blood specimens (97·65%) in lower-prevalence settings.

[Comment] The end of postoperative antimicrobial prophylaxis?

In The Lancet Infectious Diseases, Hiroshi Imamura and colleagues report data from a randomised controlled trial of antimicrobial prophylaxis in patients having distal gastrectomy for cancer. Patients were randomly assigned to receive 1 g of cefazolin before the incision only or an additional dose once after closure and twice daily for 2 days after surgery. The rates of surgical-site infection were much the same between groups: 9% in the extended treatment group and 5% in the intraoperative alone group.

[Comment] Effects of malaria and its treatment in early pregnancy

Malaria can have devastating consequences for pregnant women and their developing fetuses. The lack of information on the effect of malaria in the first trimester has been previously identified as an important knowledge gap in estimating the burden of malaria in pregnancy. Similarly, few data are available on the safety in early pregnancy of the artemisinin class of compounds, alone or as combination therapies, the most effective antimalarials to date. Although extrapolation of animal reprotoxicology data to human beings is ambiguous, it suggests that artemisinin derivatives could cause birth defects or pregnancy loss when used in the early first trimester of pregnancy.

[Errata] Erratum

Zachariah R, Ford N, Maher D, et al. Is operational research delivering the goods? The journey to success in low-income countries. Lancet Infect Dis 2012; published online Feb 9. DOI:10.1016/S1473-3099(11)70309-7—In both the author list and author affiliations, Christian Lienhardt's name was misspelled. The online version was corrected on March 9, 2012.

[Correspondence] Lyme disease antiscience

Paul Auwaerter and colleagues' Personal View outlines an extremely uncomfortable situation in the USA, but this report should not lead anyone to believe that the situation in the UK is the same. Dissection of this opinion piece only adds to the divisiveness. Instead it should be pointed out that, in the UK, doctors rather than patients are misusing science.

[Correspondence] Lyme disease antiscience

Paul Auwaerter and colleagues compare some Lyme disease activists who use non-evidence-based arguments with anti-HIV or antivaccination extremists. Their Personal View shows that unscientific thinking and malpractice occur in many specialties. Such a focus has unfortunately resulted in suppression of legitimate and necessary scientific debate about the management of syndromes of unclear aetiology, which sometimes occur after a previously proven episode of Lyme disease or tick bites. Public health recommendations should rely on strong evidence-based data and not on expert opinion, as Lee and Vielmeyer's review of the Infectious Disease Society of America guidelines shows is the case with Lyme disease.

[Correspondence] Lyme disease antiscience

Paul Auwaerter and colleagues are among the handful of individuals who have controlled the Lyme disease research agenda for decades and ultimately which data have been reported. Why is it that, in my experience, many people in New Hampshire have been severely debilitated by Lyme disease or know someone who has, whereas Auwaerter and co-workers claim that the disease is easily diagnosed and treated with a short course of antibiotics? Seven states have now passed legislation to protect clinicians who treat late-stage Lyme disease with long-term antibiotics (CT, MA, MN, NY, NH, RI, and TX) and support groups exist in nearly every state, with 19 in Pennsylvania alone.

[Correspondence] Lyme disease antiscience – Authors' reply

Although we support efforts to educate clinicians and the public alike with high-quality, evidence-based information about infection with Borrelia burgdorferi, the comments from Stella Huyshe-Shires regarding our Personal View misleadingly suggest that the UK is untainted by antiscience concerns. A report by Cottle and colleagues showed that most patients referred to an infectious diseases unit in Liverpool, UK, for Lyme disease (n=115) did not have the disorder. Of 38 patients with chronic fatigue syndrome, 45% were incorrectly labelled as having chronic Lyme disease by alternative practitioners.

[Correspondence] Post-disaster assessment in Brazzaville, Congo

According to several corroborating witness statements, on March 4, 2012, between 0800 h and 1100 h, explosions from the arms depot of the armoured regiment of the Congolese Armed Forces razed to the ground hundreds of houses in Brazzaville. The power of the shock wave, propagated by the Congo River, shook buildings 8·5 km away in Kinshasa. The explosions caused extensive damage. Troops from the Congolese armed forces are securing the most sensitive sites. The entire neighbourhood of Mpila and surrounding areas including Ouenze are devastated ().

[Correspondence] Research into transmissibility of influenza A H5N1: a practical response to the controversy

The controversy between influenza virologists and biosecurity experts about whether to publish the experimental details of research into the transmissibility of H5N1 viruses misses the point. Influenza viruses can and do develop efficient transmissibility on their own; we have known this for decades. A pandemic caused by a virus similar to the one that caused the 1918 pandemic might kill 62 million people worldwide. In view of this possibility, understanding what we might do if and when this happens is far more important.

[Newsdesk] Global rabies elimination: are we stepping up to the challenge?

A 1 year assessment of the Rabies Blueprint website, a detailed online guide developed to support countries aiming to eliminate canine rabies in an effort to prevent human rabies, shows that it has been successful in terms of outreach. “We know that visitors have come from virtually all continents, including 150 countries or territories and 1827 cities”, reports lead author Tiziana Lembo (University of Glasgow, UK, and the Global Alliance for Rabies Control, USA). “We are also aware that this toolkit is being used as a guide for the implementation of canine rabies control programmes in various places, for example the Philippines, Uganda, Benin, Afghanistan, Peru, Bolivia, Haiti, and Indonesia.

[Newsdesk] H5N1 research unleashed, almost

On Feb 10, we reported the tale of two research articles in which the authors had generated viruses based on highly pathogenic avian influenza H5N1 that were transmissible in mammals. The publication of these papers was put on hold at the request of the US National Science Advisory Board for Biosecurity (NSABB) on the basis of concerns about biosafety and bioterrorism. The board advised that redacted research papers reporting only the aims and conclusions without details of the methods and results be published, with more technical details being supplied to only a select group of influenza researchers.

[Newsdesk] Infectious disease surveillance update

More than two-thirds of the population of an Indonesian village is believed to be infected with filarial nematodes, which are spread by mosquito vectors and can cause elephantiasis. Of 300 people living in the village of Sebakung Jaya, in East Kalimantan province, 210 are suspected to have the infection. Health officials have sent samples to Samarinda, the province capital, to confirm the infection and are planning to order enough anthelmintic drugs to treat everyone in the village. Lymphatic filariasis is endemic in many regions of the country.

[Newsdesk] Highlights from the 22nd ECCMID

The 22nd annual European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) was held on March 31 to April 3, 2012, in London, UK. More than 10 000 infectious diseases experts gathered in the ExCel Exhibition Centre, London. Special emphasis was given to emerging infections, including influenza, antibiotic resistance, infection control, and sexually transmitted infections.

[Newsdesk] Research brief

In the RV144 clinical trial, a prime-boost vaccine regimen reduced HIV-1 infection by 31·2% compared with placebo. Examination of immune variables in postimmunisation samples taken from 41 vaccinated people who became infected and from 205 vaccinated people who remained uninfected reveals that, in this trial, IgG antibody binding to variable regions 1 and 2 of HIV-1 envelope proteins (env) correlated inversely with the rate of HIV-1 infection and binding of IgA antibodies to env directly correlated with the rate of infection.

[Media Watch] Eradication: ridding the world of diseases forever?

In this well researched and well written book, historian Nancy Leys Stepan uses the diaries and aspirations of Fred Soper—former Director General of the Pan American Health Organization, described in the book as an arch-eradicationist—to recount a social history of public health. In so doing, she critically analyses the very idea of eradication, exposes the weak scientific basis of many of the past century's greatest battles against disease, and provides lessons for the challenges that lie ahead.

[Media Watch] Advances in virus research 79: research advances in rabies

Tragically, half of people infected with rabies are children aged younger than 15 years. Most tragic is that all of these deaths could have been prevented by appropriate postexposure prophylaxis consisting of wound cleaning, active immunisation with a safe rabies vaccine, and passive immunisation with a rabies immunoglobulin. The high cost of this prophylaxis prevents its use in low-income countries and, as a result, people die. The 486 page book with its 21 chapters written by experts is thus a welcome reminder that research into rabies has to continue to reduce its deadly toll.

[Articles] Head-to-head comparison of accuracy of a rapid point-of-care HIV test with oral versus whole-blood specimens: a systematic review and meta-analysis

Although Oraquick had a high PPV in high-prevelence settings in oral specimens, the slightly lower sensitivity and PPV in low-prevalence settings in oral specimens should be carefully reviewed when planning worldwide expanded initiatives with this popular test.

[Articles] Intraoperative versus extended antimicrobial prophylaxis after gastric cancer surgery: a phase 3, open-label, randomised controlled, non-inferiority trial

Elimination of postoperative antimicrobial prophylaxis did not increase the incidence of surgical-site infections after a gastrectomy. Therefore, this treatment is not recommended after gastric cancer surgery.

[Articles] Adverse effects of falciparum and vivax malaria and the safety of antimalarial treatment in early pregnancy: a population-based study

A single episode of falciparum or vivax malaria in the first trimester of pregnancy can cause miscarriage. No additional toxic effects associated with artesunate treatment occurred in early pregnancy. Prospective studies should now be done to assess the safety and efficacy of artemisinin combination treatments in early pregnancy.

[Review] Passive immunity in the prevention of rabies

Prevention of clinical disease in those exposed to viral infection is an important goal of human medicine. Using rabies virus infection as an example, we discuss the advances in passive immunoprophylaxis, most notably the shift from the recommended polyclonal human or equine immunoglobulins to monoclonal antibody therapies. The first rabies-specific monoclonal antibodies are undergoing clinical trials, so passive immunisation might finally become an accessible, affordable, and routinely used part of global health practices for rabies.

[Review] Hepatitis C virus clearance, reinfection, and persistence, with insights from studies of injecting drug users: towards a vaccine

Hepatitis C virus (HCV) was discovered more than two decades ago, but progress towards a vaccine has been slow. HCV infection will spontaneously clear in about 25% of people. Studies of spontaneous HCV clearance in chimpanzees and human beings have identified host and viral factors that could be important in the control of HCV infection and the design of HCV vaccines. Although data from studies of chimpanzees suggest that protection against reinfection is possible after spontaneous clearance, HCV is a human disease.

[Personal View] Is operational research delivering the goods? The journey to success in low-income countries

Operational research in low-income countries has a key role in filling the gap between what we know from research and what we do with that knowledge—the so-called know–do gap, or implementation gap. Planned research that does not tangibly affect policies and practices is ineffective and wasteful, especially in settings where resources are scarce and disease burden is high. Clear parameters are urgently needed to measure and judge the success of operational research. We define operational research and its relation with policy and practice, identify why operational research might fail to affect policy and practice, and offer possible solutions to address these shortcomings.

[Clinical Picture] Skin infection and progressive paraparesis

A 35-year-old female agricultural worker presented with a 4 month history of productive cough, fever, and left subcostal pain, followed by progressive paraparesis and urinary incontinence. 10 years previously, she had been treated for a skin infection on her back at another centre for 3 years, without further follow-up. Examination showed more than one irregular scars, hyperpigmented papules, and few skin sinuses with scanty purulent discharge, without erythema, on the middle and left side of the upper back.