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[Seminar] Infective endocarditis

Infective endocarditis occurs worldwide, and is defined by infection of a native or prosthetic heart valve, the endocardial surface, or an indwelling cardiac device. The causes and epidemiology of the disease have evolved in recent decades with a doubling of the average patient age and an increased prevalence in patients with indwelling cardiac devices. The microbiology of the disease has also changed, and staphylococci, most often associated with health-care contact and invasive procedures, have overtaken streptococci as the most common cause of the disease.

News briefs

New evidence suggests Zika virus can cross placental barrier

Zika virus has been detected in the amniotic fluid of two pregnant women whose fetuses had been diagnosed with microcephaly, according to a study published in The Lancet Infectious Diseases last month. The report suggests that Zika virus can cross the placental barrier, but does not prove that the virus causes microcephaly. “The number of reported cases of newborn babies with microcephaly in Brazil in 2015 has increased 20-fold compared with previous years. At the same time, Brazil has reported a high number of Zika virus infections, leading to speculation that the two may be linked. The two women presented with symptoms of Zika infection including fever, muscle pain and a rash during their first trimester. Ultrasounds taken at approximately 22 weeks of pregnancy confirmed the fetuses had microcephaly. Samples of amniotic fluid were taken at 28 weeks and analysed for potential infections. Both patients tested negative for dengue virus, chikungunya virus and other infections such as HIV, syphilis and herpes. Although the two women’s blood and urine samples tested negative for Zika virus, their amniotic fluid tested positive for Zika virus genome and Zika antibodies.”

Eighth retraction for former Baker IDI researcher

Anna Ahimastos, a former heart researcher with Baker IDI Heart and Diabetes Institute in Melbourne, has recorded her eighth retraction after faking patient records. “The [Baker IDI] investigation found fabricated patients records in some papers; in other papers, such as the newly retracted 2010 study in Atherosclerosis, the original data source could not be verified,” Retraction Watch reports. “The latest retraction — A role for plasma transforming growth factor-β and matrix metalloproteinases in aortic aneurysm surveillance in Marfan syndrome? — followed up on a previous clinical trial, examining how a blood pressure drug might help patients with a life-threatening genetic disorder. That previous trial — which also included 17 patients with Marfan syndrome treated with either placebo or perindopril — has been retracted from JAMA; the New England Journal of Medicine has also retracted a related letter.” A spokesperson for Baker IDI was quoted as saying: “In total, this brings the number of retractions arising from our investigations to eight and concludes the process of correcting the public record in relation to three studies with which the researcher was associated. We are not aware of Miss Ahimastos’ current whereabouts.”

Is dementia in decline? NEJM urges caution

A perspective published in the New England Journal of Medicine (doi: 10.1056/NEJMp1514434) warns that research in the same issue showing a 20% decrease in dementia incidence each decade from 1975 to the present should cause physicians and researchers to “think carefully”. “Faced with choices between equally defensible epidemiologic projections, physicians and researchers must think carefully about what stories they emphasise to patients and policymakers. The implications, especially for investment in long-term care facilities, are enormous. Our explanations of decline are equally important, since they guide investments in behavior change, medications, and other treatments. Optimism about dementia is more justified than ever before. Even if death and taxes remain inevitable, cancer, coronary artery disease (CAD), and dementia may not. But cautious optimism should not become complacency. If we can elucidate the changes that have contributed to these improvements, perhaps we can extend them. Today, the dramatic reductions in CAD-related mortality are under threat. The incipient improvements in dementia are presumably even more fragile. The burden of disease, ever malleable, can easily relapse.”

WHO releases “R&D Blueprint” in search for Zika vaccine

The World Health Organization (WHO) has set in motion a “rapid R&D response” to the Zika virus outbreak in Brazil, learning from its Ebola virus experience in West Africa. Writing on WHO’s website, Dr Marie-Paule Kieny, Assistant Director-General, Health Systems and Innovation, said “our relatively poor knowledge of the Zika virus presents a series of challenges for research and development”. “Numerous groups are looking at the feasibility of initiating animal or human testing, particularly for vaccines and diagnostics. For vaccines, the landscape is evolving swiftly, and numbers change daily. About 15 companies and research groups have been identified so far. Two vaccine candidates seem to be at a more advanced stage: a DNA vaccine from the US and an inactivated product from India. Although the landscape is encouraging, it will be at least 18 months before vaccines could be tested in large-scale trials. For diagnostics, 10 biotech companies have been identified so far that can provide nucleic acid or serological tests. Ebola taught the global R&D community many valuable lessons, and proved that when we work together, we can develop new medical products much faster than we thought possible. Although we know even less about Zika than we did about Ebola, we are learning more every day and are much better prepared to advance much-needed research to blunt the threat of Zika.”

‘Beer goggles’ a myth, says new research

Researchers from the University of Bristol in the UK have found that there is no association between the amount of alcohol consumed and perception of attractiveness, according to their study published in Alcohol and Alcoholism. The authors ran an “observational study conducted simultaneously across three public houses in Bristol”. “Excessive alcohol consumption is linked to unsafe sexual behaviours. This relationship may, at least in part, be mediated by increased perceived attractiveness of others after alcohol consumption, a relationship colloquially termed the ‘beer-goggles effect’,” the authors wrote. “Participants were required to rate the attractiveness of male and female face stimuli and landscape stimuli administered via an Android tablet computer application, after which their expired breath alcohol concentration was measured. Linear regression revealed no clear evidence for relationships between alcohol consumption and either overall perception of attractiveness for stimuli, for faces specifically, or for opposite-sex faces. The naturalistic research methodology was feasible, with high levels of participant engagement and enjoyment.”

[Correspondence] Pope Francis and the Italian scientific golden age

Guiseppe Remuzzi and Richard Horton (Jan 2, p 11)1 speculate that Pope Francis, in his encyclical Laudato Si’, expressed a “changing position of the Vatican” towards scientific research and hope that this attitude could “contribute to fostering a new scientific golden age for Italy”. This assertion is based on the idea that the decline of Italian science and medicine might be ascribed to the diffidence of the Vatican towards scientists and to its influence on submissive and consent-seeking politicians.

[Correspondence] INTERGROWTH-21st very preterm size at birth reference charts

In 2014, the INTERGROWTH-21st Consortium published international standards for newborn baby size, based on neonates with no major complications or ultrasound evidence of fetal growth restriction (FGR), who were born to healthy mothers without FGR risk factors.1 Despite our large sample size, very few neonates born at 33 weeks’ gestation or earlier met these prescriptive inclusion criteria. While implementing these standards, we have received many requests for very preterm, size at birth charts for clinical practice and research.

[Editorial] Iran: promises and prospects for health

Feb 26 marked a landmark election for Iranian Parliament and the top clerical body, the Assembly of Experts, coming only weeks after the historic lifting of sanctions. Health will continue to be important under President Rouhani’s Government who launched the national health transformation plan in May, 2014, in an effort to address the 52% out-of-pocket payments for health care. Last week, The Lancet was welcomed to Kish Island, Iran, to review progress in health research and to attend a collaborative research meeting led by University College London and Tehran University of Medical Sciences.

[Perspectives] Sexual science beyond the medical

The US television series Masters of Sex tells the story of how William H Masters and Virginia E Johnson began to work together in the 1960s to study, observe, and measure the physiology of human sexual response. The series depicts the couple as pioneers in applying clinical observation to the study of human sexuality and focuses on the challenges they faced in persuading medical authorities to accept the validity of their work. Masters of Sex presents a later chapter within a longer history of the 150-year struggle to establish sex research as a legitimate discipline.

[Perspectives] Brendan Crabb—making research work for development

Maybe it was Brendan Crabb’s upbringing in India and Papua New Guinea (PNG) that set him on the road to his current role. His father had worked for the United Nations establishing locally owned printing businesses in developing countries—a career that has unexpected parallels with what Crabb does today as Director of the Macfarlane Burnet Institute for Medical Research and Public Health. The institute has a dual role, linking medical research with public health action to improve the lives of poor and vulnerable communities worldwide.

[World Report] Profile: Burnet Institute, Melbourne, Australia

Burnet Institute in Australia is an unusual organisation; it is a medical research institute that is also designated as an accredited non-governmental overseas development organisation. Formed in 1986, the institute—now under the direction of Brendan Crabb—has close to 250 researchers and public health professionals in Melbourne and more than 160 across the Asia Pacific region and in east Africa. Burnet’s ethos includes its primary aim to sustainably improve the health of poor and vulnerable people.

[Health Policy] Moving towards universal health coverage: lessons from 11 country studies

In recent years, many countries have adopted universal health coverage (UHC) as a national aspiration. In response to increasing demand for a systematic assessment of global experiences with UHC, the Government of Japan and the World Bank collaborated on a 2-year multicountry research programme to analyse the processes of moving towards UHC. The programme included 11 countries (Bangladesh, Brazil, Ethiopia, France, Ghana, Indonesia, Japan, Peru, Thailand, Turkey, and Vietnam), representing diverse geographical, economic, and historical contexts.

[Comment] Reprogramming psychiatry: stem cells and bipolar disorder

Psychiatry continues to lag behind the rest of medicine in its ability to understand its disorders and develop new effective treatments. Hot on the tail of the increasingly robust and informative genetic leads provided by genome-wide association studies, hopes have been raised by two further developments. The first is a concerted research move away from current syndromal diagnoses towards identification of the underlying neural and cognitive processes, as exemplified by the US National Institute of Mental Health’s Research Domain Criteria initiative.