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[World Report] Lebanese health care racked by medicine shortages

Sab, 14/08/2021 - 00:00
Doctors and patients have described how an inability to acquire drugs is threatening care. Saleyha Ahsan reports.

[World Report] Focusing on island health

Sab, 14/08/2021 - 00:00
The first global health summit for Small Island Developing States has put the spotlight on the challenges these nations face. Jacqui Thornton reports.

[Perspectives] Chiquita Brooks-LaSure: innovative US federal health director

Sab, 14/08/2021 - 00:00
In her first job after graduate school, Chiquita Brooks-LaSure was working at the White House Office of Management and Budget when she ventured from Washington, DC, USA, to see health policy in action at a community health centre in Montana. Parents had brought their children to the clinic to enrol them into a new health insurance plan called the Children's Health Insurance Program (CHIP). The visit made a lasting impression and “really excited me about the possibilities of what this would mean for children that have no health insurance”, she recalled almost 20 years later.

[Perspectives] Min Mehta: surgeon who helped children with scoliosis

Sab, 14/08/2021 - 00:00
The orthopaedic surgeon Mini Hoshang Mehta, known to all as Min, once said in an interview how she saw infants with early-onset scoliosis as “drooping flowers” who with the right care could be helped to grow straight without radical surgery such as spinal fusion. Scoliosis is typically diagnosed in young people older than 10 years, but more rarely it can occur in the first months of life. For these very young patients, there is a risk that the curvature will increase to the point that the heart and lungs can no longer function efficiently.

[Correspondence] Voriconazole pharmacogenetics

Sab, 14/08/2021 - 00:00
In their Article, Johan Maertens and colleagues1 showed the results of a randomised, controlled, phase 3 trial comparing posaconazole versus voriconazole for the primary treatment of invasive aspergillosis. Mortality up until day 42 (the primary endpoint) was 44 (15%) of 288 patients for posaconazole versus 59 (21%) of 287 patients for voriconazole.1 The overall incidence of treatment-related adverse events was 10% higher with voriconazole than with posaconazole.1

[Correspondence] Voriconazole pharmacogenetics – Authors' reply

Sab, 14/08/2021 - 00:00
Nicolas Pallet and Marie Anne Loriot postulate that the CYP2C19 metaboliser phenotype might contribute to lower therapeutic response, or to more treatment-related adverse events, or both, with posaconazole than with voriconazole.1

[Correspondence] Trends in population health and demography

Sab, 14/08/2021 - 00:00
Stein Vollset and colleagues forecasted that population increase in sub-Saharan Africa will continue until 2100. Consequently, three of the region's countries will join Nigeria among the ten most populous countries globally: DR Congo, Ethiopia, and Tanzania.1 Although we applaud the authors for including alternative scenarios based on change in educational attainment and access to contraception, the Article neglects safe childbirth as a co-driver of decreasing fertility rates.

[Correspondence] Trends in population health and demography

Sab, 14/08/2021 - 00:00
Stein Vollset and colleagues concluded that the global population would most likely peak around 2064 with 9·7 billion people.1 The media have focused on their claims of economic challenges from “inverted age pyramids”. Both the projections and the prognosis are highly questionable and are doing a great disservice to women's reproductive rights and the global prospects for environmental security by undermining political will for eliminating unwanted births and ending population growth sooner rather than later.

[Correspondence] Trends in population health and demography

Sab, 14/08/2021 - 00:00
As scientists and stakeholders in the field of population, we are concerned that the highly publicised population forecasts by Stein Vollset and colleagues,1 and their models, data, and underlying assumptions, have not received enough critical scrutiny.

[Correspondence] Trends in population health and demography

Sab, 14/08/2021 - 00:00
New population forecasts by Stein Vollset and colleagues1 predict lower global population growth than do other forecasts—for instance, the one published by the UN.2 Vollset and colleagues assume relatively low fertility in the future compared with UN and other forecasts, which leads to low population growth.

[Correspondence] Trends in population health and demography – Authors' reply

Sab, 14/08/2021 - 00:00
We appreciate the opportunity to respond to comments regarding our Article.1

[Department of Error] Department of Error

Sab, 14/08/2021 - 00:00
Borobia AM, Carcas AJ, Pérez-Olmeda M, et al. Immunogenicity and reactogenicity of BNT162b2 booster in ChAdOx1-S-primed participants (CombiVacS): a multicentre, open-label, randomised, controlled, phase 2 trial. Lancet 2021; 398: 121–30—For this Article, Judit Riera-Arnau's name was misspelt. The CombiVacS Study Group list and the appendix have been updated. This correction has been made to the online version as of Aug 12, 2021.

[Correspondence] Broaden the narrative this World Humanitarian Day: honour those who comfort the dying

Ven, 13/08/2021 - 00:30
Every humanitarian worker should be guided to comfort the dying, as much as they are dedicated to, and trained in, how to save a life. On annual World Humanitarian Day, we honour humanitarian workers who save lives during crises and commemorate those who have been killed or injured carrying out their work. As COVID-19 continues to ravage the world, we recognise the workers who provide life-saving support during the pandemic, navigating extreme circumstances and with the very real fear of contracting, suffering, and dying from COVID-19 itself.

[Correspondence] Pharmaceutical companies should pay for raiding nature's medicine cabinet

Gio, 12/08/2021 - 00:30
In 2019, the pharmaceutical industry profited from US$1·2 trillion of global spending on medicines.1 Most of this is simply a cut of the $125 trillion worth of services provided by nature every year.2 Almost two-thirds of all small molecules approved by the US Food and Drug Administration between 1981 and 2014 were either inspired by, derived from, or mimicked natural resources or consisted of natural products.3 Even the COVID-19 pandemic solution could be derived from nature, with a vaccine developed from the blue blood of a living fossil—the horseshoe crab.

[Correspondence] The costs of PEPFAR's leadership vacuum

Gio, 12/08/2021 - 00:30
The President's Emergency Plan for AIDS Relief (PEPFAR), the largest funder of HIV efforts in the world,1 has saved millions of lives since its 2003 launch. With COVID-19 disrupting the HIV response, PEPFAR is needed more than ever to assist more than 50 high HIV burden countries as they struggle to regain momentum against AIDS. Over the past 18 months, maintaining a continuity of HIV services—particularly for marginalised communities—has been an arduous challenge as the HIV and COVID-19 pandemics collided.

[Correspondence] A Lebanese physician's dilemma: not how, but with what?

Gio, 12/08/2021 - 00:30
Lebanon is well renowned for its good and advanced medical practices. Lebanon served as a well recognised destination for medical tourism, though mainly for neighbouring countries. The presence of several globally acclaimed medical faculties with state-of-the-art medical curricula and wide network of internationally distinguished graduates serve to enforce Lebanon's role in various health and medical disciplines.1

[Comment] The use of inhaled corticosteroids in early-stage COVID-19

Mer, 11/08/2021 - 00:30
The desperation of clinicians when faced with COVID-19 and the dearth of therapeutic options for its treatment have led clinical practice to reach for last-resort approaches, supported by tenuous data or hypotheses. The need for data-based clinical practice is clear from the initial wide use of hydroxychloroquine, shown subsequently to be harmful,1,2 and the initial avoidance of oral corticosteroids, shown subsequently to be beneficial.3 Now practice is changing toward the usual measured approach of gathering data and using restraint, trying above all to do no harm in this viral illness.

[Correspondence] Serial intervals in SARS-CoV-2 B.1.617.2 variant cases

Mer, 11/08/2021 - 00:30
The SARS-CoV-2 lineage B.1.617.2, also known as the delta variant, was declared a variant of concern by WHO on the basis of preliminary evidence suggesting faster spread relative to other circulating variants.1 However, the epidemiological factors contributing to this difference remain unclear. In particular, an increase in observed growth rate of COVID-19 cases could be the result of a shorter generation interval (ie, the delay from one infection to the next) or an increase in the effective reproduction number, R, of an infected individual (ie, the average number of secondary cases generated by an infectious individual), or both.

[Articles] Inhaled budesonide for COVID-19 in people at high risk of complications in the community in the UK (PRINCIPLE): a randomised, controlled, open-label, adaptive platform trial

Mer, 11/08/2021 - 00:30
Inhaled budesonide improves time to recovery, with a chance of also reducing hospital admissions or deaths (although our results did not meet the superiority threshold), in people with COVID-19 in the community who are at higher risk of complications.