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donderdag 9 november 2017

The Lancet: [Articles] Oral fexinidazole for late-stage African Trypanosoma brucei gambiense trypanosomiasis: a pivot...

[Articles] Oral fexinidazole for late-stage African Trypanosoma brucei gambiense trypanosomiasis: a pivotal multicentre, randomised, non-inferiority trial
Our findings show that oral fexinidazole is effective and safe for the treatment of T b gambiense infection compared with nifurtimox eflornithine combination therapy in late-stage HAT patients. Fexinidazole could be a key asset in the elimination of this fatal neglected disease.
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[Comment] Tranexamic acid: is it about time?
For decades, the antifibrinolytic drug tranexamic acid has been used for indications such as dental extractions in patients with haemophilia. Additionally, tranexamic acid has been widely used, although not routinely across the world, to reduce blood loss in surgery. More recently, the potential of tranexamic acid in trauma and post-partum haemorrhage has been of interest.1 In two large, randomised controlled trials, CRASH-22 and WOMAN,3 tranexamic acid reduced mortality from bleeding in patients with these conditions.
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[Department of Error] Department of Error
Landrigan PJ, Fuller R, Acosta NJR, et al. The Lancet Commission on pollution and health. Lancet 2017; published online Oct 19. http://dx.doi.org/10.1016/S0140-6736(17)32345-0—In this Commission, the y-axis of figure 11 was "Estimated global DALYs" but did not include the multiplier "(millions)". This correction has been made to the online version as of Nov 7, 2017.
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[Articles] Effect of treatment delay on the effectiveness and safety of antifibrinolytics in acute severe haemorrhage: a meta-analysis of individual patient-level data from 40 138 bleeding patients
Death from bleeding occurs soon after onset and even a short delay in treatment reduces the benefit of tranexamic acid administration. Patients must be treated immediately. Further research is needed to deepen our understanding of the mechanism of action of tranexamic acid.
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[Comment] Nutrition in the ICU: sometimes route does matter
The NUTRIREA-2 trial by Jean Reignier and colleagues1 in The Lancet provides an important piece in the puzzle of intensive-care unit (ICU) nutrition management. This pragmatic multicentre study done at 44 French ICUs randomly assigned patients aged 18 years or older requiring invasive mechanical ventilation and vasopressors (median 0·5 μg/kg per min) to receive either enteral nutrition (n=1202) or parenteral nutrition (n=1208), both targeting normocaloric goals (20–25 kcal/kg per day), within 24 h after intubation or ICU admission.
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