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[Correspondence] Targeted radioactive therapy for prostate cancer

Sab, 07/08/2021 - 00:00
Progressive metastatic castration-resistant prostate cancer is a highly lethal disorder. In the randomised trial reported by Michael Hofman and colleagues,1 lutetium-177 [177Lu]Lu-PSMA-617, a small molecule delivering targeted radiation by binding to prostate-specific membrane antigen (PSMA), led to a higher proportion of patients having a 50% or more decrease in prostate-specific antigen (PSA) compared with cabazitaxel (66% vs 37% by intention to treat; p<0·0001) and fewer grade 3 or 4 adverse events.

[Correspondence] Targeted radioactive therapy for prostate cancer

Sab, 07/08/2021 - 00:00
Michael Hofman and colleagues1 report more frequent prostate-specific antigen response and prolonged progression-free survival with lutetium-177 [177Lu]Lu-PSMA-617, compared with cabazitaxel, in patients with metastatic castration-resistant prostate cancer with high prostate-specific membrane antigen (PSMA) expression. Nevertheless, the median progression-free survival was 5·1 months in both arms, but a subpopulation of 19% of patients had a 1-year progression-free survival with [177Lu]Lu-PSMA-617 versus 3% with cabazitaxel.

[Correspondence] Targeted radioactive therapy for prostate cancer – Authors' reply

Sab, 07/08/2021 - 00:00
Elif Hindié and colleagues ask about optimal radionuclides for use with prostate-specific membrane antigen (PSMA)-targeted approaches in the treatment of prostate cancer, and whether radionuclides other than lutetium-177 (177Lu) might deepen and extend the duration of responses. The TheraP trial1 used [177Lu]Lu-PSMA-617, a radiolabelled small molecule that binds to PSMA to deliver beta particles resulting in double stranded DNA damage and subsequent cell death. Therapies using beta emissions require a relatively high number of particles to enter a cell to be effective.

[Correspondence] Lung health in LMICs: tackling challenges ahead

Sab, 07/08/2021 - 00:00
We welcome Jamilah Meghji and colleagues' Review1 about improving lung health in low-income and middle-income countries (LMICs), and we are particularly encouraged by the focus on the frequently neglected field of chronic respiratory diseases. However, we find that insufficient attention was paid to the role of primary care, which is the keystone for universal health coverage and, therefore, the route to improved prevention, diagnosis, and individualised and holistic treatment for most of the population.

[Correspondence] Lung health in LMICs: tackling challenges ahead

Sab, 07/08/2021 - 00:00
Jamilah Meghji and colleagues1 deliver a welcome wake-up call about chronic respiratory diseases in stretched health systems. However, the proposed solutions in their Review could be strengthened by a preventive approach addressing crucial contributors of chronic respiratory diseases. In short, we expected a stronger plea for clean air to improve lung health in low-income and middle-income countries (LMICs).

[Correspondence] Lung health in LMICs: tackling challenges ahead – Authors' reply

Sab, 07/08/2021 - 00:00
We thank Ee Ming Khoo and colleagues for welcoming our Review on improving lung health in low-income and middle-income countries (LMICs).1 We entirely agree that high quality primary care is a key component for the successful delivery of universal health coverage and has a particularly crucial role in the provision of health services for people with chronic respiratory diseases in LMICs. We applaud the efforts of the International Primary Care Respiratory Group in championing this cause. Health systems are complex and adaptive, functioning at multiple interconnected levels; therefore, improving quality of care will require system-wide action.

[Department of Error] Department of Error

Sab, 07/08/2021 - 00:00
Maertens JA, Rahav G, Lee D-G, et al. Posaconazole versus voriconazole for primary treatment of invasive aspergillosis: a phase 3, randomised, controlled, non-inferiority trial. Lancet 2021; 397: 499–509—In this Article, in the sixth paragraph of the Discussion, the percentage of study drug discontinuations as a result of treatment-emergent adverse events in the posaconazole group should have said 32% and the treatment difference “−10·2%; 95% CI −17·9 to −2·4” should have referred to the proportion of participants with treatment-related adverse events, not to study drug discontinuations.

[Department of Error] Department of Error

Sab, 07/08/2021 - 00:00
Danovaro-Holliday MC, Kretsinger K, Gacic-Dobo M. Measuring and ensuring routine childhood vaccination coverage. Lancet 2021; 398: 468–69—This Comment had incorrect copyright information. This correction has been made to the online version as of Aug 5, 2021, and the printed version is correct.

[Department of Error] Department of Error

Sab, 07/08/2021 - 00:00
Fisseha S, Sen G, Ghebreyesus TA, et al. COVID-19: the turning point for gender equality. Lancet 2021; 398: 471–74—In this Comment, part of the fourth sentence of the first paragraph is corrected to read “increasing risk of child marriages and female genital mutilation” and the Mexican Government is now included at the start of the first sentence of the sixth paragraph to read “The UN and the Mexican and French Governments convened the Generation Equality Forum, with the most recent held in Paris…” These corrections have been made to the online version as of Aug 5, 2021, and the printed version is correct.

[Clinical Picture] Categorising myocardial infarction with advanced cardiovascular imaging

Sab, 07/08/2021 - 00:00
A 66-year-old man collapsed at home with chest pain. He was found by paramedics to be in ventricular fibrillation leading to a cardiac arrest. A post-resuscitation electrocardiogram showed sinus rhythm and inferolateral ST-segment elevation. On arrival at our department he had an emergency invasive coronary angiogram which showed an occluded left circumflex artery, confirming myocardial infarction (MI). We opened the artery using a balloon, and following recanalisation, we identified a substantial filling defect indicative of a large thrombus (figure).

[Viewpoint] Safeguarding and teleconsultation for abortion

Sab, 07/08/2021 - 00:00
In response to COVID-19 and measures implemented to control virus transmission, some governments adapted abortion law and policy to ensure access to abortion care through telemedicine.1,2 In Great Britain, approval orders were issued March 30–31, 2020, making fully remote, no-test, early medical abortion temporarily lawful.3 Professional guidelines were then issued to support providers in offering new remote services.4 Other Organisation for Economic Co-operation and Development countries have also temporarily amended policies to enable remote consultation and at-home use of abortion medications: France,1,2 Ireland,1 and the USA5 (panel).

[Department of Error] Department of Error

Ven, 06/08/2021 - 00:30
Hyde R. The slow road to atonement. Lancet 2021; 398: 105–08—In this World Report, the media, not experts, speculated that the remains found came from Auschwitz. The police were aware of the remains, but they were not briefed on their potential historical significance. Camp inmates were subjected to extreme cold and lack of oxygen by Nazis, but not by Josef Mengele. Membership of the Nazi party was encouraged but not compulsory for all physicians. Physicians' organisations were drastically reconfigured, not shut down entirely.

[Clinical Picture] Mucormycosis after COVID-19 in a patient with diabetes

Gio, 05/08/2021 - 00:30
A 44-year-old man attended our hospital reporting reduced vision in his left eye. 10 days earlier he had been started on treatment with supplemental oxygen, intravenous antibiotics, and corticosteroids because of a moderately severe pneumonia caused by SARS-CoV-2. The patient explained that a blackish patch—extending from just below his left eye to the left side of his face to the level of his mouth—had also developed 2 days earlier (figure).

[Comment] Addressing inequality in fertility treatment

Mar, 03/08/2021 - 00:30
Infertility, defined as the inability to conceive after 12 or more months of regular sexual intercourse,1 affects an estimated one in seven heterosexual couples in the UK wishing to conceive2 and 8–12% of reproductive aged couples worldwide.3 Ethnic Diversity in Fertility Treatment,4 a 2021 report by the UK Human Fertilisation and Embryology Authority (HFEA), showed, in particular, older age at presentation and poorer outcomes for Black women, fewer in-vitro fertilisation cycles performed, and limited options for ethnically matched egg and sperm donors.

[Comment] COVID-19 vaccines for children in LMICs: another equity issue

Sab, 31/07/2021 - 00:30
Given the success of COVID-19 vaccines in preventing death and severe disease in adults1 and their impact on community transmission,2 use in children and young people (CYP) inevitably requires consideration. Although severe COVID-19 is rare in CYP,3 they are affected by SARS-CoV-2 infection and the impacts of the COVID-19 pandemic, including education, mental health, and general wellbeing.4

[World Report] UK weighs up health reforms

Sab, 31/07/2021 - 00:00
The new Health and Care Bill aims to foster collaboration in the NHS, but analysts are concerned about expanded powers for the Health Secretary. Talha Burki reports.

[World Report] Health workers in Belarus facing repression

Sab, 31/07/2021 - 00:00
Doctors report being fired or assaulted for supporting protests against President Lukashenko. Ed Holt reports.

[World Report] Compensation for victims of sterilisation

Sab, 31/07/2021 - 00:00
After years of campaigning by Roma activists, a new law in the Czech Republic enables victims of coerced or unlawful sterilisation to claim compensation. Ed Holt reports.

[Perspectives] Claudia Andujar's solidarity with the Yanomami people

Sab, 31/07/2021 - 00:00
In 1972, when photographer Claudia Andujar caught malaria, she left the Catrimani river basin, where she had been sharing the life of a Yanomami extended family for many months, to receive treatment at her São Paulo home. The long journey back south was followed by a frustrating year trying to fully recover. It was during this time away from her Yanomami friends that Andujar perfected many of the visualisation and photographic techniques she brought with her when she finally was able to return. These techniques enabled her and the Yanomami artists she engaged with to create the treasures currently exhibited at the Barbican's Claudia Andujar: The Yanomami Struggle.

[Perspectives] The medical practice of silencing

Sab, 31/07/2021 - 00:00
Shortly after I became an HIV consultant, I was admitted to hospital. I had severe pelvic and lower back pain, 2 days after egg retrieval, in my third cycle of in-vitro fertility treatment (IVF). Having suffered from endometriosis and adenomyosis for some years, I was accustomed to pain and managing it with a heat pad and ibuprofen. But that evening the pain intensity made me realise something quite different was happening. It felt like someone was using a heavy shovel to scrape away the lining of my abdomen.