2011 Sep 17 - Management of an acute outbreak of diarrhoea-associated haemolytic uraemic syndrome with early plasma exchange in adults from southern Denmark: an observational study

Edin Colic MD a, Hans Dieperink MD a, Kjell Titlestad MD b, Dr Martin Tepel MD a c  The Lancet, Volume 378, Issue 9796, Pages 1089 - 1093, 17 September 2011. Published Online: 25 August 2011
Background
Diarrhoea-associated haemolytic uraemic syndrome in adults is a life-threatening, but rare multisystem disorder that is characterised by acute haemolytic anaemia, thrombocytopenia, and renal insufficiency. We aimed to assess the success of management of this disorder with plasma exchange therapy.

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2011 Sep 5 - Treatment of severe neurological deficits with IgG depletion through immunoadsorption in patients with Escherichia coli O104:H4-associated haemolytic uraemic syndrome: a prospective trial

Prof Andreas Greinacher MD a *, Sigrun Friesecke MD b *, Peter Abel MD b, Alexander Dressel MD c, Sylvia Stracke MD d, Michael Fiene MD d, Friedlinde Ernst MD d, Kathleen Selleng MD a, Karin Weissenborn MD e, Bernhard MW Schmidt MD f, Mario Schiffer MD f, Prof Stephan B Felix MD b, Prof Markus M Lerch MD d, Jan T Kielstein MD f †, Prof Julia Mayerle MD d †The Lancet, Early Online Publication, 5 September 2011
Background
In May 2011, an outbreak of Shiga toxin-producing enterohaemorrhagic E coli O104:H4 in northern Germany led to a high proportion of patients developing post-enteritis haemolytic uraemic syndrome and thrombotic microangiopathy that were unresponsive to therapeutic plasma exchange or complement-blocking antibody (eculizumab). Some patients needed ventilatory support due to severe neurological complications, which arose 1 week after onset of enteritis, suggesting an antibody-mediated mechanism. Therefore, we aimed to assess immunoadsorption as rescue therapy.

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2011 Aug 20 - Intravenous enoxaparin or unfractionated heparin in primary percutaneous coronary intervention for ST-elevation myocardial infarction: the international randomised open-label ATOLL trial

Prof Gilles Montalescot MD a , Uwe Zeymer MD c, Johanne Silvain MD a, Bertrand Boulanger MD d, Marc Cohen MD f, Patrick Goldstein MD g, Patrick Ecollan MD b, Xavier Combes MD h, Kurt Huber MD j, Charles Pollack MD k, Jean-François Bénezet MD l, Olivier Stibbe MD n, Emmanuelle Filippi MD e, Emmanuel Teiger MD i, Guillaume Cayla MD m, Simon Elhadad MD o, Frédéric Adnet MD p, Tahar Chouihed MD q, Sébastien Gallula MD r, Agnès Greffet MD s, Mounir Aout PhD t, Jean-Philippe Collet MD a, Eric Vicaut MD t, for the ATOLL Investigators. The Lancet, Volume 378, Issue 9792, Pages 693 - 703, 20 August 2011
Background
Primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction has traditionally been supported by unfractionated heparin, which has never been directly compared with a new anticoagulant using consistent anticoagulation and similar antiplatelet strategies in both groups. We compared traditional heparin treatment with intravenous enoxaparin in primary PCI.

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2011 Jul 25 - Lancet Comment: Tigecycline - benefits and risks

Yun Cai, Rui Wang. The Lancet Infectious Diseases, Early Online Publication, 25 July 2011
“Antimicrobial resistance: no action today, no cure tomorrow”, the theme for World Health Day 2011, shows the helplessness of the human predicament. Thus, any new antibiotics effective against strains resistant to existing drugs would gain worldwide attention. Tigecycline is one such antibiotic, with efficacy against many multidrug-resistant pathogens widely reported.

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2011 Jul 25 - Efficacy and safety of tigecycline for the treatment of infectious diseases: a meta-analysis

Efthimia Tasina MSc a, Dr Anna-Bettina Haidich PhD b , Stamatia Kokkali MD b, Prof Malamatenia Arvanitidou MD b. The Lancet Infectious Diseases, Early Online Publication, 25 July 2011
Background
Multidrug resistance among bacteria increases the need for new antimicrobial drugs with high potency and stability. Tigecycline is one candidate drug, and a previous meta-analysis of only published randomised controlled trials suggested that it might as effective as comparator treatments; we did a meta-analysis to include new and unpublished trials to assess its efficacy for the treatment of adult patients with serious bacterial infection.

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2011 Jul 27 - Lancet Comment: Ventilator-associated pneumonia: are we winning the war?

Mark J Rumbak a, David Solomon a. The Lancet Infectious Diseases, Early Online Publication, 27 July 2011
Patients in intensive care units are at high risk for nosocomial infections because they are the most critically ill, might be receiving immunosuppressive drugs, and are often monitored invasively with tube insertion. Mortality, morbidity, and cost are increased with ventilator-associated pneumonia. 1 Findings from studies of both single and combination interventions for preventing ventilator-associated pneumonia have shown a reduction in disease incidence. 1 , 2

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2011 Jul 27 - Prevention of ventilator-associated pneumonia with oral antiseptics: a systematic review and meta-analysis

Sonia O Labeau MNSc a b ‡, Katrien Van de Vyver MNSc b ‡, Nele Brusselaers PhD c, Prof Dirk Vogelaers PhD a b c, Prof Stijn I Blot PhD a b c The Lancet Infectious Diseases, Early Online Publication, 27 July 2011
Background
We did a systematic review and random effects meta-analysis of randomised trials to assess the effect of oral care with chlorhexidine or povidone-iodine on the prevalence of ventilator-associated pneumonia versus oral care without these antiseptics in adults.

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2011 Aug - Meticillin-resistant Staphylococcus aureus with a novel mecA homologue in human and bovine populations in the UK and Denmark: a descriptive study

Laura García-Álvarez PhD a, Matthew TG Holden PhD b, Heather Lindsay BSc a, Cerian R Webb PhD a, Derek FJ Brown PhD c, Martin D Curran PhD c, Enid Walpole FIMLS c, Karen Brooks BSc b, Derek J Pickard PhD b, Christopher Teale MRCVS d, Prof Julian Parkhill PhD b, Stephen D Bentley PhD b, Giles F Edwards FRCPath e, E Kirsty Girvan MSc e, Angela M Kearns PhD f, Bruno Pichon PhD f, Robert LR Hill PhD f, Anders Rhod Larsen PhD g, Robert L Skov MD g, Prof Sharon J Peacock PhD h, Prof Duncan J Maskell PhD a, Dr Mark A Holmes VetMB a. The Lancet Infectious Diseases, Volume 11, Issue 8, Pages 595 - 603, August 2011. Published Online: 03 June 2011
Background
Animals can act as a reservoir and source for the emergence of novel meticillin-resistant Staphylococcus aureus (MRSA) clones in human beings. Here, we report the discovery of a strain of S aureus (LGA251) isolated from bulk milk that was phenotypically resistant to meticillin but tested negative for the mecA gene and a preliminary investigation of the extent to which such strains are present in bovine and human populations.

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2011 Jun 23 - Escherichia coli O104, Germany 2011

Hugh Pennington a. The Lancet Infectious Diseases, Early Online Publication, 23 June 2011
In The Lancet Infectious Diseases , Helge Karch and colleagues 1 characterise the virulence profiles of E coli O104:H4 isolates from 80 patients in the large outbreak in Germany.

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2011 Jun 23 - Characterisation of the Escherichia coli strain associated with an outbreak of haemolytic uraemic syndrome in Germany, 2011: a microbiological study

Martina Bielaszewska MD a, Alexander Mellmann MD a, Wenlan Zhang MD a, Robin Köck MD a, Angelika Fruth PhD b, Andreas Bauwens PhD a, Georg Peters MD c, Prof Helge Karch PhD a. The Lancet Infectious Diseases, Early Online Publication, 23 June 2011
Background
In an ongoing outbreak of haemolytic uraemic syndrome and bloody diarrhoea caused by a virulent Escherichia coli strain O104:H4 in Germany (with some cases elsewhere in Europe and North America), 810 cases of the syndrome and 39 deaths have occurred since the beginning of May, 2011. We analysed virulence profiles and relevant phenotypes of outbreak isolates recovered in our laboratory.

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2011 Jun 1 - Lancet Comment: Glucocorticoid treatment in community-acquired pneumonia

Marco Confalonieri a, G Umberto Meduri b. The Lancet, Early Online Publication, 1 June 2011. doi:10.1016/S0140-6736(11)60777-0Cite or Link Using DOI
Community-acquired pneumonia is a major public health problem. While mortality decreased sharply after the introduction of antibiotics in the 1940s, since 1950 the overall acute (hospital) mortality has either remained stable or increased. 1 Equally concerning, after clinical resolution of pneumonia, patients discharged from hospital have—after adjusting for age and comorbidities—a substantial, continuing excess mortality. 2 Despite concern about immunosuppression, glucocorticoid treatment in low-to ...

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2011 Jun 1 - Dexamethasone and length of hospital stay in patients with community-acquired pneumonia: a randomised, double-blind, placebo-controlled trial

Sabine CA Meijvis MD a , Hans Hardeman MD b, Hilde HF Remmelts MD e i, Rik Heijligenberg MD e, Ger T Rijkers PhD c, Heleen van Velzen-Blad MSc c, G Paul Voorn MD c, Ewoudt MW van de Garde PhD d f, Henrik Endeman MD g, Prof Jan C Grutters MD b h, Willem Jan W Bos MD a, Prof Douwe H Biesma MD a i. The Lancet, Early Online Publication, 1 June 2011. doi:10.1016/S0140-6736(11)60607-7Cite or Link Using DOI
Background
Whether addition of corticosteroids to antibiotic treatment benefits patients with community-acquired pneumonia who are not in intensive care units is unclear. We aimed to assess effect of addition of dexamethasone on length of stay in this group, which might result in earlier resolution of pneumonia through dampening of systemic inflammation.

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2011 Apr 23 - Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial

Dr Sanjit S Jolly MD a , Prof Salim Yusuf MBBS a, Prof John Cairns MD b, Prof Kari Niemelä MD c, Denis Xavier MD d, Prof Petr Widimsky MD e, Prof Andrzej Budaj MD f, Matti Niemelä MD g, Vicent Valentin MD h, Prof Basil S Lewis MD i, Alvaro Avezum MD j, Prof Philippe Gabriel Steg MD k, Sunil V Rao MD l, Peggy Gao MSc a, Rizwan Afzal MSc a, Prof Campbell D Joyner MD m, Susan Chrolavicius BScN a, Shamir R Mehta MD a, for the RIVAL trial group‡. The Lancet, Volume 377, Issue 9775, Pages 1409 - 1420, 23 April 2011. Published Online: 04 April 2011
Background
Small trials have suggested that radial access for percutaneous coronary intervention (PCI) reduces vascular complications and bleeding compared with femoral access. We aimed to assess whether radial access was superior to femoral access in patients with acute coronary syndromes (ACS) who were undergoing coronary angiography with possible intervention.

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2011 Mar 21 - Selective digestive tract decontamination and selective oropharyngeal decontamination and antibiotic resistance in patients in intensive-care units: an open-label, clustered group-randomised, crossover study

Dr Anne Marie GA de Smet MD a d , Prof Jan AJW Kluytmans MD e f, Hetty EM Blok MSc b, Ellen M Mascini MD g, Robin FJ Benus MD h, Alexandra T Bernards MD i, Ed J Kuijper MD i, Maurine A Leverstein-van Hall MD b, Arjan R Jansz MD j, Bartelt M de Jongh MD k, Gerard J van Asselt MD l, Ine HME Frenay MD m, Steven FT Thijsen MD n, Simon NM Conijn o, Jan A Kaan MD p, Jan P Arends MD h, Patrick DJ Sturm MD q, Martin CJ Bootsma PhD b, Prof Marc JM Bonten MD b c. The Lancet Infectious Diseases, Early Online Publication, 21 March 2011. doi:10.1016/S1473-3099(11)70035-4Cite or Link Using DOI
Background
Previously, we assessed selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) on survival and prevention of bacteraemia in patients in intensive-care units. In this analysis, we aimed to assess effectiveness of these interventions for prevention of respiratory tract colonisation and bacteraemia with highly resistant microorganisms acquired in intensive-care units.

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2011 Apr 7 - Society's failure to protect a precious resource: antibiotics

Dr Jean Carlet MD a , Prof Peter Collignon MB b, Don Goldmann MD c d, Herman Goossens MD e, Inge C Gyssens MD f g, Stephan Harbarth MD h, Vincent Jarlier MD i, Stuart B Levy MD j, Babacar N'Doye MD k, Prof Didier Pittet MD h, Rosana Richtmann MD l, Prof Wing H Seto MD m, Jos WM van der Meer MD f, Andreas Voss MD g. The Lancet, Early Online Publication, 7 April 2011. doi:10.1016/S0140-6736(11)60401-7Cite or Link Using DOI
Since their discovery last century, antibiotics have served society well by saving tens of millions of lives. Too many individuals—including illustrious composers and writers such as Schubert, Mahler, Mozart, and Wilde—died prematurely in the pre-antibiotic era from bacterial infections that are now treatable.

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2011 Mar 23 - Viral pneumonia

Prof Olli Ruuskanen MD a , Elina Lahti MD a, Lance C Jennings PhD b, Prof David R Murdoch MD b. The Lancet, Early Online Publication, 23 March 2011
About 200 million cases of viral community-acquired pneumonia occur every year—100 million in children and 100 million in adults. Molecular diagnostic tests have greatly increased our understanding of the role of viruses in pneumonia, and findings indicate that the incidence of viral pneumonia has been underestimated. In children, respiratory syncytial virus, rhinovirus, human metapneumovirus, human bocavirus, and parainfluenza viruses are the agents identified most frequently in both developed and developing countries.

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2011 Mar - Guidelines for hospital-acquired pneumonia and health-care-associated pneumonia: a vulnerability, a pitfall, and a fatal flaw

Prof Victor L Yu MD a. The Lancet Infectious Diseases, Volume 11, Issue 3, Pages 248 - 252, March 2011
The 2005 American Thoracic Society and Infectious Disease Society of America's guidelines for pneumonia introduced the new category of health-care-associated pneumonia, which increased the number of people to whom the guidelines for multidrug-resistant pathogens applied.

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2011 Mar - Clinical management of Staphylococcus aureus bacteraemia

Dr Guy E Thwaites PhD a , Jonathan D Edgeworth PhD b c, Effrossyni Gkrania-Klotsas FRCP d e, Andrew Kirby MBChB e, Robert Tilley MBChB f, M Estée Török FRCP d, Sarah Walker PhD g h, Heiman FL Wertheim PhD i j, Peter Wilson FRCPath k, Martin J Llewelyn PhD l, for the UK Clinical Infection Research Group‡. The Lancet Infectious Diseases, Volume 11, Issue 3, Pages 208 - 222, March 2011
Staphylococcus aureus bacteraemia is one of the most common serious bacterial infections worldwide. In the UK alone, around 12 500 cases each year are reported, with an associated mortality of about 30%, yet the evidence guiding optimum management is poor. To date, fewer than 1500 patients with S aureus bacteraemia have been recruited to 16 controlled trials of antimicrobial therapy.

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2011 Feb 11 - Lowering blood pressure in acute stroke: the SCAST trial

Graeme J Hankey. The Lancet, Early Online Publication, 11 February 2011
In The Lancet , Else Sandset and colleagues 1 report the results of the Scandinavian Candesartan Acute Stroke Trial (SCAST), in which they aimed to find out whether careful lowering of blood pressure, with the angiotensin-receptor blocker candesartan, would be beneficial in patients with acute ischaemic and haemorrhagic stroke.

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2011 Feb 11 - The angiotensin-receptor blocker candesartan for treatment of acute stroke (SCAST): a randomised, placebo-controlled, double-blind trial

Else Charlotte Sandset MD a b d, Prof Philip MW Bath FRCP e, Prof Gudrun Boysen DMSc f, Dalius Jatuzis MD g, Janika Kõrv MD h, Stephan Lüders MD i, Prof Gordon D Murray PhD j, Przemyslaw S Richter MD k, Prof Risto O Roine MD l, Prof Andreas Terént MD m, Vincent Thijs MD n, Dr Eivind Berge MD a c , on behalf of the SCAST Study Group. The Lancet, Early Online Publication, 11 February 2011doi:10.1016/S0140-6736(11)60104-9
Background
Raised blood pressure is common in acute stroke, and is associated with an increased risk of poor outcomes. We aimed to examine whether careful blood-pressure lowering treatment with the angiotensin-receptor blocker candesartan is beneficial in patients with acute stroke and raised blood pressure.

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