Objectives: Convalescent plasma (CP) as a passive source of neutralizing antibodies and immunomodulators is a century-old therapeutic option used for the management of viral diseases. We investigated its effectiveness for the treatment of COVID-19. Design: Open-label, parallel-arm, phase II, multicentre, randomized controlled trial. Setting: Thirty-nine public and private hospitals across India. Participants: Hospitalized, moderately ill confirmed COVID-19 patients (PaO2/FiO2: 200-300 or respiratory rate > 24/min and SpO2 ≤ 93% on room air). Intervention: Participants were randomized to either control (best standard of care (BSC)) or intervention (CP + BSC) arm. Two doses of 200 mL CP was transfused 24 hours apart in the intervention arm. Main Outcome Measure: Composite of progression to severe disease (PaO2/FiO2<100) or all-cause mortality at 28 days post-enrolment. Results: Between 22 nd April to 14 th July 2020, 464 participants were enrolled; 235 and 229 in intervention and control arm, respectively. Composite primary outcome was achieved in 44 (18.7%) participants in the intervention arm and 41 (17.9%) in the control arm [aOR: 1.09; 95% CI: 0.67, 1.77]. Mortality was documented in 34 (13.6%) and 31 (14.6%) participants in intervention and control arm, respectively [aOR) 1.06 95% CI: -0.61 to 1.83]. Interpretation: CP was not associated with reduction in mortality or progression to severe COVID-19. This trial has high generalizability and approximates real-life setting of CP therapy in settings with limited laboratory capacity. A priori measurement of neutralizing antibody titres in donors and participants may further clarify the role of CP in management of COVID-19.

This article examines the limitations of existing classification systems from the historical, cultural, political, and legal perspectives. It covers the evolution of classification systems with particular emphasis on the DSM and ICD systems. While pointing out the inherent Western bias in these systems, it highlights the potential of misuse of these systems to subserve other agendas. It raises concerns about the reliability, validity, comorbidity, and heterogeneity within diagnostic categories of contemporary classification systems. Finally, it postulates future directions in alternative methods of diagnosis and classification factoring in advances in artificial intelligence, machine learning, genetic testing, and brain imaging. In conclusion, it emphasizes the need to go beyond the limitations inherent in classifications systems to provide more relevant diagnoses and effective treatments.

Introduction:  The ARTISTIC trial was set up within the NHS Cervical Screening Programme in Greater Manchester to evaluate the effectiveness of human papillomavirus (HPV) testing in primary cervical screening. Here we present preliminary final results. Methods:  24 510 women aged 25–64 were enrolled in the study after consenting to be tested for high‐risk human papillomavirus infection (HR–HPV) in addition to liquid‐based cytology. Participants were randomised to HPV revealed or HPV concealed results arms in a 3:1 ratio. HPV testing was carried out using the Hybrid Capture‐II test (HC‐II) and all HC‐II positive samples were genotyped using the Roche line blot assay (LBA). Those in the revealed arm who had negative cytology and were HPV positive at entry were recalled every other 12 months for repeated HPV tests. Results:  1675 women showed no abnormality on cytology and tested positive for HPV at entry. At the time of analysis, 1200 (72%) of them had returned for a second HC‐II test. The overall HR‐HPV persistence rate by HC‐II was 43% in women who were retested less than 6 months after a positive entry sample, 40% between 16–24 months and 29% after more than 24 months. The prevalence of infections with HPV16 and HPV18 were 15%, and 7% at entry, and 38% and 32% of these infections were persistent at second screening. Among women with negative cytology and HPV positive test at entry, there were 1 and 12 cases of CIN3+ at the second visit and six and nine at exit in the concealed and revealed arm respectively. Discussion:  These preliminary data suggests that the combination of liquid‐based cytology with additional HPV testing over two screening rounds is not more sensitive than cytology alone.