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[Comment] Offline: What is the UK for?

Sab, 20/02/2021 - 00:00
The UK Government this year hosts two important events—the G7 (June 11–13) and COP26 (Nov 1–12). The priorities set out by Prime Minister Boris Johnson for his G7 presidency are four-fold: fighting against and recovering from COVID-19; climate action; free and fair trade; and shared values as open societies. Global health will indeed be a concern for the US, Canada, Japan, France, Germany, and Italy. Some G7 countries have performed poorly in responding to the pandemic. What should be the UK's approach to global health? Last week, Lord Nigel Crisp convened the All-Party Parliamentary Group on Global Health, which he co-chairs, to define a G7 agenda.

[World Report] von der Leyen admits to COVID-19 vaccine failures

Sab, 20/02/2021 - 00:00
EU Commission President Ursula von der Leyen's comments come after much scrutiny of the EU vaccination programme. Rob Hyde reports.

[World Report] Severe mental illness: reassessing COVID-19 vaccine priorities

Sab, 20/02/2021 - 00:00
As evidence mounts that patients with severe mental illness are at increased risk of severe COVID-19, some countries are reassessing their vaccine priority strategies. Nayanah Siva reports.

[World Report] Research Focus: The Cleveland Clinic at 100

Sab, 20/02/2021 - 00:00
As the Cleveland Clinic, in Cleveland, Ohio, marks its centenary, Talha Burki looks at how it became a world-renowned centre for cardiology.

[Perspectives] Sharrelle Barber: at the intersection of place, race, and health

Sab, 20/02/2021 - 00:00
Sharrelle Barber's research focuses on the intersection of place, race, and health. As Assistant Professor of Epidemiology at the Department of Epidemiology and Biostatistics and the Urban Health Collaborative at Drexel University Dornsife School of Public Health in Philadelphia, PA, USA, her work has been crucial in assessing the impact of structural racism on racial health inequities among Black people in the USA and Brazil. She sees segregation as a symbol of the economic, social, political, and racial divide in a city: “From Jackson, Mississippi, to Rio de Janeiro, segregation is one of the most visible manifestations of structural racism in our society”, she says.

[Perspectives] Healthy because you deserve it, unhealthy because you don't?

Sab, 20/02/2021 - 00:00
“Men at some time are masters of their fates;/ The fault, dear Brutus, is not in our stars,/But in ourselves, that we are underlings.” We have only ourselves to blame for being “petty men”, explains Cassius to Brutus in William Shakespeare's Julius Caesar. By contrast, Julius Caesar has someone remind him that he is mortal. His hubris comes at the expense of others’ humiliation.

[Obituary] Gordon John McVie

Sab, 20/02/2021 - 00:00
Oncologist and tireless champion of cancer research. He was born in Glasgow, UK, on Jan 13, 1945, and died in Bristol, UK, with non-Hodgkin lymphoma and COVID-19 on Jan 20, 2021, aged 76 years.

[Correspondence] The Health Index for England

Sab, 20/02/2021 - 00:00
In the Chief Medical Officer for England's 2018 independent annual report, we called for the development of a composite health index.1,2 We are delighted that the UK Office for National Statistics (ONS) has developed and published a beta version of such an index,3 alongside a useful Health Index Explorer tool.

[Correspondence] Global need: including rehabilitation in health system strengthening

Sab, 20/02/2021 - 00:00
We read with great enthusiasm Alarcos Cieza and colleagues’1 analysis of data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to estimate that 2·41 billion people (95% uncertainty interval 2·34–2·50 billion) worldwide would benefit from rehabilitation services. This comprehensive work quantifies an increasing burden of non-fatal health losses potentially addressed by rehabilitation services. Cieza and colleagues’ work complements findings from our series of secondary analyses of GBD 2017,2–4 in which we focused on an extensive set of health conditions that could benefit from physical rehabilitation (excluding mental health and sensory impairments).

[Correspondence] Why the global health community should support the EndSARS movement in Nigeria

Sab, 20/02/2021 - 00:00
In the past year, more Nigerians have been killed by state-sanctioned security forces than by COVID-19, according to data on the Nigeria Security Tracker and Worldometers.1 Formed in 1992, the Special Anti-Robbery Squad (SARS) has become the public threat the squad was created to prevent. Killings of young adults by the SARS has spurred peaceful demonstrations across Nigeria calling for disbandment of the SARS.2 On Oct 20, 2020, peaceful protesters were murdered by state-sanctioned forces at the Lekki Toll Gate in Lagos, Nigeria's most populous city.

[Correspondence] Iron deficiency in PREVENTT

Sab, 20/02/2021 - 00:00
Toby Richards and colleagues1 suggest that current guidelines on preoperative iron therapy should be reviewed after reporting non-superiority of preoperative intravenous iron over placebo in reducing the need for blood transfusion in adults with anaemia before elective major abdominal surgery. We strongly urge for caution, favouring a more nuanced approach that considers individual circumstances and clinical context when actively managing anaemia before surgery. Similarly to other studies,2,3 we showed benefits of administering preoperative intravenous iron (including a reduced need for subsequent transfusion of red blood cells [RBCs]) to patients with proven iron deficiency anaemia (ferritin <30 μg/L, or where C-reactive protein is elevated >5 mg/L, ferritin <100 μg/L or transferrin saturation of <20%).

[Correspondence] Iron deficiency in PREVENTT

Sab, 20/02/2021 - 00:00
Toby Richards and colleagues1 found no difference in the need for blood transfusions between the group receiving preoperative intravenous iron versus those receiving placebo. This finding is not surprising and was a consequence of poor study design that disregarded all knowledge on preoperative anaemia treatment, iron metabolism, and ferric carboxymaltose indications and contraindications.

[Correspondence] Iron deficiency in PREVENTT

Sab, 20/02/2021 - 00:00
We congratulate Toby Richards and colleagues1 for concluding the PREVENTT study, which sought to reduce the need for blood transfusion by giving preoperative intravenous iron to patients with anaemia before elective major abdominal surgery. Strategies to prevent transfusion need to be recognised and appropriately evaluated. The findings showed that preoperative iron infusion did not reduce the need for red blood cell transfusions; however, we disagree with the conclusion drawn that preoperative iron should not be recommended.

[Correspondence] Iron deficiency in PREVENTT – Authors' reply

Sab, 20/02/2021 - 00:00
We thank Bernd Froessler and colleagues, Axel Hofmann and colleagues, and Anastazia Keegan and colleagues for their comments. In the PREVENTT trial1 we addressed the association between preoperative anaemia and increased blood transfusion, hospital stay, morbidity, and mortality after surgery. We did not know whether these associations were causal, specifically whether intravenous iron could correct anaemia, mediating a reduction in the associated risks to patients.

[Department of Error] Department of Error

Sab, 20/02/2021 - 00:00
Baas P, Scherpereel A, Nowak AK, et al. First-line nivolumab plus ipilimumab in unresectable malignant pleural mesothelioma (CheckMate 743): a multicentre, randomised, open-label, phase 3 trial. Lancet 2021; 397: 375–86—The appendix for this Article has been corrected as of Feb 18, 2021.

[Department of Error] Department of Error

Sab, 20/02/2021 - 00:00
Li X, Mukandavire C, Cucunubà ZM, et al. Estimating the health impact of vaccination against ten pathogens in 98 low-income and middle-income countries from 2000 to 2030: a modelling study. Lancet 2021; 397: 398–408—In appendix 2, the table legends for appendix 3 p 1 (d–f) and p 2 (d–f) should have been for under-5s by calendar view, and the table legends for appendix 3 p 1 (g–i) and p 2 (g–i) should have been for all ages by cohort view. The titles of the tables have also been corrected. These corrections have been made as of Feb 18, 2021.

[Department of Error] Department of Error

Sab, 20/02/2021 - 00:00
Reich K, Papp KA, Blauvelt A, et al. Bimekizumab versus ustekinumab for the treatment of moderate to severe plaque psoriasis (BE VIVID): efficacy and safety from a 52-week, multicentre, double-blind, active comparator and placebo controlled phase 3 trial. Lancet 2021; 397: 487–98—In table 2 of this Article, the upper CI for the odds ratio versus placebo for Investigator's Global Assessment response at week 16 should have read 384·3. In figure 3, the proportion of patients who switched from placebo to bimekizumab 320 mg every 4 weeks with a DLQI score of 0 or 1 at week 52 should have read 71%.

[Department of Error] Department of Error

Sab, 20/02/2021 - 00:00
Logunov DY, Dolzhikova IV, Shcheblyakov DV, et al. Safety and efficacy of an rAd26 and rAd5 vector-based heterologous prime-boost COVID-19 vaccine: an interim analysis of a randomised controlled phase 3 trial in Russia. Lancet 2021; 397: 671–81—In this Article, the funder list has been updated by removing one that was incorrectly listed; in figure 2, the number at risk at the day 20 timepoint has been corrected to 15 117; in figure 3B, the number of male participants labelled on the graph has been corrected to 46; and in the legend of figure 3, the following sentence has been added for clarity: “Four participants are not included in the subgroup analysis by age because of missing date of birth on the case report form for this analysis”.

[Clinical Picture] Amiodarone and hypothyroidism

Sab, 20/02/2021 - 00:00
A 65-year-old man attended our outpatient clinic for diagnostic evaluation of abnormal blood tests detected during a routine check requested by his cardiologist. The investigations showed a raised serum gamma-glutamyl transferase (406 U/L; normal <60) and a raised serum thyroid-stimulating hormone (TSH) concentration of 99·20 μIU/mL (normal 0·27–4·20). The patient's free thyroxine and free tri-iodothyronine were low at 0·67 ng/dL (normal 0·93–1·70) and 1·5 pg/mL (normal 2·0–4·4) respectively. Anti-thyroid antibodies—including thyroid peroxidase antibodies and anti-thyroglobulin antibodies—were not detected.

[Comment] Cabozantinib: a new first-line option for papillary renal cell carcinoma?

Sab, 13/02/2021 - 19:00
Papillary renal cell carcinoma (PRCC) is the most frequent subtype of non-clear-cell renal cell carcinoma (RCC);1 however, it remains a rare and heterogeneous malignancy. PRCC is divided into type 1 and type 2, on the basis of different histological, molecular, and prognostic features.2 Alterations in the MET pathway are frequent in PRCC, mostly observed in type 1 tumours (80%), but have also been described in up to half of type 2 tumours.2,3