6888. The escalating tuberculosis crisis in central and South American prisons.
作者: Katharine S Walter.;Leonardo Martinez.;Denise Arakaki-Sanchez.;Victor G Sequera.;G Estigarribia Sanabria.;Ted Cohen.;Albert I Ko.;Alberto L García-Basteiro.;Zulma Vanessa Rueda.;Rafael A López-Olarte.;Marcos A Espinal.;Julio Croda.;Jason R Andrews.
来源: Lancet. 2021年397卷10284期1591-1596页
In the past decade, tuberculosis incidence has declined in much of the world, but has risen in central and South America. It is not yet clear what is driving this reversal of progress in tuberculosis control. Since 2000, the incarcerated population in central and South America has grown by 206%, the greatest increase in the world. Over the same period, notified tuberculosis cases among the incarcerated population (hereinafter termed persons deprived of their liberty [PDL], following the Inter-American Commission on Human Rights) have risen by 269%. In both central and South America, the rise of disease among PDL more than offsets tuberculosis control gains in the general population. Tuberculosis is increasingly concentrated among PDL; currently, 11% of all notified tuberculosis cases in central and South America occur among PDL who comprise less than 1% of the population. The extraordinarily high risk of acquiring tuberculosis within prisons creates a health and human rights crisis for PDL that also undermines wider tuberculosis control efforts. Controlling tuberculosis in this region will require countries to take urgent measures to prioritise the health of PDL.
6889. US-China health exchange and collaboration following COVID-19.
Strong US-China collaboration on health and medicine is a crucial element of the global effort against COVID-19. We review the history of health collaboration and exchanges between the public and private sectors in the USA and China, including the long-lasting collaboration between governmental public health agencies of the two countries. Academic and scientific exchanges should be reinvigorated and the increasing valuable role of non-profit foundations acknowledged. The shared interests of the two countries and the magnitude of the pandemic necessitate both countries to collaborate and cooperate. We provide recommendations to the two governments and the global health community to control the ongoing COVID-19 pandemic and prepare for future threats. TRANSLATION: For the Chinese translation of the abstract see Supplementary Materials section.
6895. Eliminating postnatal HIV transmission in high incidence areas: need for complementary biomedical interventions.
作者: Philippe Van de Perre.;Ameena Goga.;Nobubelo Ngandu.;Nicolas Nagot.;Dhayendre Moodley.;Rachel King.;Jean-Pierre Molès.;Beatriz Mosqueira.;Witness Chirinda.;Gabriella Scarlatti.;Thorkild Tylleskär.;François Dabis.;Glenda Gray.
来源: Lancet. 2021年397卷10281期1316-1324页
The rate of mother-to-child transmission (MTCT) of HIV from breastfeeding is increasing relative to other causes of MTCT. Early effective preconception and antenatal antiretroviral therapy (ART) reduces intrauterine and intrapartum MTCT, whereas maternal post-partum HIV acquisition, untreated maternal HIV, and suboptimal postnatal maternal ART adherence increase the risk of MTCT through breastfeeding. Although the absolute number of cases of MTCT acquired through breastfeeding is decreasing, the rate of decrease is less than the decrease in intrauterine and intrapartum MTCT. Unless current strategies are universally applied, they might not be sufficient to eliminate MTCT due to breastfeeding. Urgent action is needed to evaluate and implement additional preventive biomedical strategies in high HIV prevalence and incidence settings to eliminate MTCT from breastfeeding. Preventive strategies include: pre-exposure prophylaxis in breastfeeding women who have an increased risk of acquiring HIV; postnatal reinforcement strategies, such as maternal retesting for HIV, maternal care reinforcement, and prophylaxis in infants exposed to HIV via breastmilk; and active (vaccine) or passive immunoprophylaxis with long-acting broadly neutralising antibodies.
6896. Psoriasis.
作者: Christopher E M Griffiths.;April W Armstrong.;Johann E Gudjonsson.;Jonathan N W N Barker.
来源: Lancet. 2021年397卷10281期1301-1315页
Psoriasis is a common, chronic papulosquamous skin disease occurring worldwide, presenting at any age, and leading to a substantial burden for individuals and society. It is associated with several important medical conditions, including depression, psoriatic arthritis, and cardiometabolic syndrome. Its most common form, chronic plaque or psoriasis vulgaris, is a consequence of genetic susceptibility, particularly in the presence of the HLA-C*06:02 risk allele, and of environmental triggers such as streptococcal infection, stress, smoking, obesity, and alcohol consumption. There are several phenotypes and research has separated pustular from chronic plaque forms. Immunological and genetic studies have identified IL-17 and IL-23 as key drivers of psoriasis pathogenesis. Immune targeting of these cytokines and of TNFα by biological therapies has revolutionised the care of severe chronic plaque disease. Psoriasis cannot currently be cured, but management should aim to minimise physical and psychological harm by treating patients early in the disease process, identifying and preventing associated multimorbidity, instilling lifestyle modifications, and employing a personalised approach to treatment.
6897. Comparison of two delayed strategies for renal replacement therapy initiation for severe acute kidney injury (AKIKI 2): a multicentre, open-label, randomised, controlled trial.
作者: Stéphane Gaudry.;David Hajage.;Laurent Martin-Lefevre.;Saïd Lebbah.;Guillaume Louis.;Sébastien Moschietto.;Dimitri Titeca-Beauport.;Béatrice La Combe.;Bertrand Pons.;Nicolas de Prost.;Sébastien Besset.;Alain Combes.;Adrien Robine.;Marion Beuzelin.;Julio Badie.;Guillaume Chevrel.;Julien Bohé.;Elisabeth Coupez.;Nicolas Chudeau.;Saber Barbar.;Christophe Vinsonneau.;Jean-Marie Forel.;Didier Thevenin.;Eric Boulet.;Karim Lakhal.;Nadia Aissaoui.;Steven Grange.;Marc Leone.;Guillaume Lacave.;Saad Nseir.;Florent Poirson.;Julien Mayaux.;Karim Asehnoune.;Guillaume Geri.;Kada Klouche.;Guillaume Thiery.;Laurent Argaud.;Bertrand Rozec.;Cyril Cadoz.;Pascal Andreu.;Jean Reignier.;Jean-Damien Ricard.;Jean-Pierre Quenot.;Didier Dreyfuss.
来源: Lancet. 2021年397卷10281期1293-1300页
Delaying renal replacement therapy (RRT) for some time in critically ill patients with severe acute kidney injury and no severe complication is safe and allows optimisation of the use of medical devices. Major uncertainty remains concerning the duration for which RRT can be postponed without risk. Our aim was to test the hypothesis that a more-delayed initiation strategy would result in more RRT-free days, compared with a delayed strategy.
6898. Efficacy and safety of dolutegravir with emtricitabine and tenofovir alafenamide fumarate or tenofovir disoproxil fumarate, and efavirenz, emtricitabine, and tenofovir disoproxil fumarate HIV antiretroviral therapy regimens started in pregnancy (IMPAACT 2010/VESTED): a multicentre, open-label, randomised, controlled, phase 3 trial.
作者: Shahin Lockman.;Sean S Brummel.;Lauren Ziemba.;Lynda Stranix-Chibanda.;Katie McCarthy.;Anne Coletti.;Patrick Jean-Philippe.;Ben Johnston.;Chelsea Krotje.;Lee Fairlie.;Risa M Hoffman.;Paul E Sax.;Sikhulile Moyo.;Nahida Chakhtoura.;Jeffrey Sa Stringer.;Gaerolwe Masheto.;Violet Korutaro.;Haseena Cassim.;Blandina T Mmbaga.;Esau João.;Sherika Hanley.;Lynette Purdue.;Lewis B Holmes.;Jeremiah D Momper.;Roger L Shapiro.;Navdeep K Thoofer.;James F Rooney.;Lisa M Frenkel.;K Rivet Amico.;Lameck Chinula.;Judith Currier.; .
来源: Lancet. 2021年397卷10281期1276-1292页
Antiretroviral therapy (ART) during pregnancy is important for both maternal health and prevention of perinatal HIV-1 transmission; however adequate data on the safety and efficacy of different ART regimens that are likely to be used by pregnant women are scarce. In this trial we compared the safety and efficacy of three antiretroviral regimens started in pregnancy: dolutegravir, emtricitabine, and tenofovir alafenamide fumarate; dolutegravir, emtricitabine, and tenofovir disoproxil fumarate; and efavirenz, emtricitabine, and tenofovir disoproxil fumarate.
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