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[Correspondence] HIV and overdoses: diversifying therapies for opioid use disorder – Authors' reply

Sab, 28/08/2021 - 00:00
We thank Richard C Waters and colleagues for their interest and commentary on our Series paper.1 Although we agree it is important that new medications for opioid use disorder (MOUD) emerge to combat the opioid epidemic, the major obstacles to an effective response in the USA remain the considerable structural barriers that limit programmatic adoption and scale up. Although initiatives have increased MOUD programmes in some areas of the USA, it is estimated that more than one million people with opioid use disorder do not receive MOUD.

[Correspondence] Ending HIV in the USA: integrating social determinants of health

Sab, 28/08/2021 - 00:00
In the Lancet Series on HIV in the USA, Chris Beyrer and colleagues’1 call for action to end the US HIV epidemic is welcome. Yet the principal policy to fulfil this charge, Ending the HIV Epidemic in the US,2 remains predicated on treatment and prevention—an approach that has failed to end HIV in the USA, as elsewhere.3 In taking action, it is essential to stretch beyond a biomedical approach and to fully integrate social determinants of health into the response. Although biological factors contribute, much of HIV transmission is underpinned by social determinants of health, or the “circumstances in which people grow, live, work, and age”.

[Correspondence] Ending HIV in the USA: integrating social determinants of health – Authors' reply

Sab, 28/08/2021 - 00:00
In their response to our call to action1 in the Lancet Series on HIV in the USA, Courtenay Sprague and Sara E Simon argue that biomedical solutions alone have failed, and will continue to fail, to control the HIV epidemic in the USA and that policy must include efforts to address the social determinants of health. We concur, and believe that the Series on HIV in the USA highlights these important concerns.2 Sprague and Simon note that the health disparities and structural barriers that have characterised the US health-care system since its inception, which we reviewed in the Series as correlates of HIV prevalence and incidence,1 have also been drivers of poor outcomes in the COVID-19 response.

[Correspondence] Making miscarriage matter

Sab, 28/08/2021 - 00:00
Miscarriage, defined as the loss of a pregnancy before viability, affects more than 10% of women. Although the effect differs between women, it can have major physical and psychological effects. Providing effective personalised care is important. Reliable information on the effectiveness of interventions used to manage miscarriage is therefore essential.

[Correspondence] Making miscarriage matter

Sab, 28/08/2021 - 00:00
We read with interest Siobhan Quenby and colleagues’1 interesting discussion on the epidemiological, physical, psychological, and economic costs of early pregnancy loss. We are surprised that there is no mention of second-trimester sepsis, ascending infection, and maternal death. Sepsis re-emerged as an important cause of UK maternal deaths in 2006–08; of the 29 maternal deaths due to sepsis, eight occurred in women who died from complications of infections arising before 24 weeks’ gestation.2 Globally, pregnancy-related sepsis accounts for 11% of maternal deaths, including sepsis following miscarriage and abortion, with the burden being particularly high in low-income and middle-income countries.

[Correspondence] Making miscarriage matter

Sab, 28/08/2021 - 00:00
Siobhan Quenby and colleagues1 estimated the risk of miscarriage as 15·3% (95% CI 12·5–18·7) based on nine large cohort studies. This evidence synthesis does not include data from low-income and middle-income countries (LMICs), probably because there are insufficient large-scale studies and secondary datasets.2 Furthermore, in most of the studies that are included, the study population is defined at the time of pregnancy outcome; they are therefore cross-sectional rather than cohort in nature. Most importantly, not reporting gestational age-specific miscarriage rates in the articles included in the review might grossly underestimate the miscarriage rates.

[Correspondence] Making miscarriage matter – Authors' reply

Sab, 28/08/2021 - 00:00
The Correspondence in relation to our Lancet Series on miscarriage has raised several important points.

[Correspondence] When a young hepatobiliary surgeon faces his own liver lesions diagnosis

Sab, 28/08/2021 - 00:00
As a newly trained hepatobiliary and pancreatic surgeon, I (MT) am able to study my own disease. A low-density shadow was found in my liver during an orientation health check on my first day in clinic. This 5 cm by 5 cm shadow switched me from a surgeon to a patient. Admission was arranged by my new colleagues, and space-occupying lesions in the liver was diagnosed.

[Department of Error] Department of Error

Sab, 28/08/2021 - 00:00
Reich K, Teixeira HD, de Bruin-Weller M, et al. Safety and efficacy of upadacitinib in combination with topical corticosteroids in adolescents and adults with moderate-to-severe atopic dermatitis (AD Up): results from a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2021; 397: 2169–81—In this Article, the key was incorrect in figure 4. In the Discussion, the first sentence of the second paragraph should have read “A higher proportion of patients given placebo in combination with topical corticosteroids in this study had a response than did patients given placebo in the Measure Up 1 and Measure Up 2 studies”; and the fifth sentence of the fourth paragraph should have read “AD Up is ongoing and will provide more than 5 years of efficacy and safety data for upadacitinib in combination with topical corticosteroids when complete”.

[Department of Error] Department of Error

Sab, 28/08/2021 - 00:00
Abed SN, Al Attar S, Shaikh Khalil B, et al. Quality of early essential newborn care in hospitals in Gaza: a pre-intervention and post-intervention study. Lancet 2021; 398 (suppl): S2—In this Abstract, the spelling of author Luca Ronfani's name was incorrect. This correction has been made to the online version as of Aug 26, 2021.

[Articles] 1-year outcomes in hospital survivors with COVID-19: a longitudinal cohort study

Sab, 28/08/2021 - 00:00
Most COVID-19 survivors had a good physical and functional recovery during 1-year follow-up, and had returned to their original work and life. The health status in our cohort of COVID-19 survivors at 12 months was still lower than that in the control population.

[Articles] Pembrolizumab plus chemotherapy versus chemotherapy alone for first-line treatment of advanced oesophageal cancer (KEYNOTE-590): a randomised, placebo-controlled, phase 3 study

Sab, 28/08/2021 - 00:00
Compared with placebo plus chemotherapy, pembrolizumab plus chemotherapy improved overall survival in patients with previously untreated, advanced oesophageal squamous cell carcinoma and PD-L1 CPS of 10 or more, and overall survival and progression-free survival in patients with oesophageal squamous cell carcinoma, PD-L1 CPS of 10 or more, and in all randomised patients regardless of histology, and had a manageable safety profile in the total as-treated population.

[Articles] Global, regional, and national estimates and trends in stillbirths from 2000 to 2019: a systematic assessment

Sab, 28/08/2021 - 00:00
Progress in reducing the rate of stillbirths has been slow compared with decreases in the mortality rate of children younger than 5 years. Accelerated improvements are most needed in the regions and countries with high stillbirth rates, particularly in sub-Saharan Africa. Future prevention of stillbirths needs increased efforts to raise public awareness, improve data collection, assess progress, and understand public health priorities locally, all of which require investment.

[Clinical Picture] Adult-onset ornithine transcarbamylase deficiency as a rare cause of fatal hyperammonaemia

Sab, 28/08/2021 - 00:00
A 27-year-old man presented to an emergency department with vomiting and an altered mental state. He had a history of possible Gilbert's syndrome as a child and previous opiate use disorder, but with no evidence of recent use. He gave a family history of a maternal grandfather who had developed seizures during a hospital admission for asthma. The patient had otherwise been fit and well and physically active—including playing hockey. While in the emergency department he became combative and left the hospital against medical advice.

[Therapeutics] Current and future status of JAK inhibitors

Sab, 28/08/2021 - 00:00
An enhanced understanding of the importance of Janus kinase (JAK) and signal transducer and activator of transcription (STAT) signalling in multiple disease states has led to an increasing applicability of therapeutic intervention with JAK inhibitors. These agents have revolutionised treatments for a heterogeneous group of disorders, such as myeloproliferative neoplasms, rheumatoid arthritis, inflammatory bowel disease, and multiple immune-driven dermatological diseases, exemplifying rapid bench-to-bedside translation.

[Comment] Truth and reconciliation in Canada's health system

Ven, 27/08/2021 - 00:30
The discoveries in 2021 of the remains of children on the grounds of former Indian residential schools across Canada has unearthed a truth about these schools that has long been known by Indigenous peoples in Canada. Many non-Indigenous peoples, including health-care providers, were shocked by the horrific findings and have a new understanding of the urgency for reconciliation.

[Comment] Urgent health and humanitarian needs of the Afghan population under the Taliban

Ven, 27/08/2021 - 00:30
During August, 2021, provincial capitals in Afghanistan and Kabul fell into the hands of the Taliban. For many Afghans within Afghanistan and in diaspora communities, the psychological trauma is palpable as they relive painful, unforgotten memories of 1996 onwards and face uncertainty about the country's future. Afghans who have fought to bring health and justice to the country in their roles as officials, health professionals, non-governmental workers, activists, artists, and journalists are being persecuted once again through the Taliban's door-to-door and social media searches.

[Editorial] Health in a world of extreme heat

Sab, 21/08/2021 - 00:00
The heatwaves and wildfires that swept across southern Europe and the USA this summer have been traumatic and deadly. 600 excess deaths were reported in the Pacific Northwest in the USA alone. According to the Sixth Assessment Report of Working Group I of the Intergovernmental Panel on Climate Change, which synthesises the latest scientific evidence on climate change, global temperature is expected to reach or exceed 1·5°C of warming, averaged over the next 20 years. The report predicts that these record-breaking temperatures will be more frequent, intense, and last longer because of human-induced climate change.

[World Report] Health leaders criticise limited ACT-A review

Sab, 21/08/2021 - 00:00
A review of the Access to COVID-19 Tools Accelerator will be a “mid-course correction” rather than substantive, drawing criticism from health leaders and civil society. Ann Danaiya Usher reports.

[World Report] Vectura shareholders consider tobacco giant's takeover bid

Sab, 21/08/2021 - 00:00
Cigarette manufacturer Philip Morris International's bid to buy respiratory health company Vectura has prompted outcry. Talha Burki reports.