The Lancet

Condividi contenuti
The Lancet RSS feed.
Aggiornato: 19 ore 27 min fa

[Comment] Offline: Medicine and Marx

Sa, 04/11/2017 - 00:00
When President Xi Jinping addressed the 19th National Congress of the Communist Party of China last month, he spoke of “the scientific truth of Marxism-Leninism”. Marxism (with Chinese characteristics), as President Xi went on to set out, is to be the foundation for a Healthy China. Who would dare today in the West to praise Karl Marx as the saviour of our wellbeing? Marx is long dead. He died physically on March 14, 1883. He died metaphysically in 1991, as the Soviet Union ebbed away into a newly independent Russian state.

[World Report] Health commissioners under the Trump administration

Sa, 04/11/2017 - 00:00
City health commissioners look to the federal government for support, but increasingly feel they are working at cross purposes. Ted Alcorn reports.

[Perspectives] Inspiration

Sa, 04/11/2017 - 00:00
Recently married Robin (Andrew Garfield) and Diana (Clare Foy) Cavendish lead charmed lives. Robin imports tea from Kenya, and both enjoy the trappings of a 1950s' colonial lifestyle. There are weekend safaris with chums and tea and tennis at the British ambassador's. Then, suddenly, Robin is taken seriously ill with polio. This leaves him tetraplegic and unable even to breathe for himself. It is, as Robin puts it, “a bit of a bugger”. Breathe is a relentlessly cheerful film about how Robin and his family don't accept that tragedy necessarily follows this disaster.

[Perspectives] The CRASH-2 randomised controlled trial: a retrospective

Sa, 04/11/2017 - 00:00
Trauma with subsequent death from exsanguination is a global killer. As most deaths from haemorrhage occur in the first few hours after injury, the need to treat patients as soon as possible is imperative. With more than 90% of trauma deaths occurring in low and middle-income countries, it is clear that even a moderate decrease in these high death rates could have an important impact on global health outcomes. This line of thought underpinned the work of the CRASH-2 (Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage) randomised controlled trial (RCT), undertaken by the Clinical Trials Unit at the London School of Hygiene & Tropical Medicine (LSHTM).

[Obituary] Per Fugelli

Sa, 04/11/2017 - 00:00
Norwegian general practitioner, professor of social medicine, and icon for his compatriots. Born in Stavanger, Norway, on Dec 7, 1943, he died from cancer on Sept 13, 2017, at his country house in Jæren, Norway, aged 73 years.

[Correspondence] Extending survival for people with hepatitis C using tobacco dependence treatment

Sa, 04/11/2017 - 00:00
The availability of direct-acting antiviral (DAA) therapies for hepatitis C virus (HCV) has led WHO to advocate for the elimination of HCV. However, a 2017 Cochrane review1 suggests that DAA treatment might not improve morbidity and mortality in people living with HCV: trials have shown no benefit on these endpoints, despite a sustained virological response. Stefan Wiktor and John Scott (July 8, p 107)2 state that longer term observational data are needed to assess mortality in people receiving DAA treatment for HCV.

[Correspondence] Diet, atherosclerosis, and helmintic infection in Tsimane

Sa, 04/11/2017 - 00:00
In The Lancet, Hillard Kaplan and colleagues (March 17, p 1730)1 noted that more than two-thirds of Tsimane adults suffer from intestinal helminths. Despite such a high inflammatory burden, the authors found a very low prevalence of coronary atherosclerosis, as measured by coronary artery calcium. Preclinical and clinical studies show that inflammation is involved in the pathogenesis of atherosclerosis and reductions in inflammatory processes could result in cardiovascular benefits. Furthermore, autoimmune diseases are associated with an increased cardiovascular risk and a worse outcome following cardiovascular events.

[Correspondence] Diet, atherosclerosis, and helmintic infection in Tsimane

Sa, 04/11/2017 - 00:00
We examined the Tsimane population at the same time as Hillard Kaplan and colleagues.1,2 We disagree with the authors' description of the Tsimane diet as consisting mostly of non-processed carbohydrates, high amounts of fibre, and very low amounts of simple sugars, as stated in their Article.1

[Correspondence] Diet, atherosclerosis, and helmintic infection in Tsimane – Authors' reply

Sa, 04/11/2017 - 00:00
We thank Robert H Howland, and Erin E Masterson and colleagues for their interest in our Article1 that reported low levels of coronary artery calcium among Tsimane horticulturalists of the Bolivian Amazon. In the Article,1 we hypothesised that, despite a high inflammatory burden, low coronary artery calcium in the Tsimane population could be due to a combination of low lifetime blood lipids, largely traditional diets, and high physical activity.

[Correspondence] Syphilis in children

Sa, 04/11/2017 - 00:00
The Seminar on syphilis by Edward W Hook 3rd (April 15, p 1550)1 is interesting; however, it does not adequately address the disease characteristics and management in children and therefore should rather have been entitled “syphilis in adults”.

[Correspondence] Stillbirth caused by syphilis remains a major global health problem

Sa, 04/11/2017 - 00:00
We read with interest the Seminar by Edward W Hook 3rd (April 15, p 1550),1 but were disappointed that the major public health importance of mother-to-child transmission of syphilis was not mentioned. According to WHO estimates, syphilis caused 350 000 adverse pregnancy outcomes in 2012,2 and The Lancet Series3 on ending preventable stillbirths highlighted that syphilis causes 200 000 stillbirths annually. These adverse outcomes can be prevented with a single dose of penicillin,4 which is one of the most cost-effective health interventions available.

[Case Report] Recurrent ascites: a need to evaluate for hereditary angio-oedema

Sa, 04/11/2017 - 00:00
A 34-year-old housewife, in the 15th week of her first pregnancy, was referred to the Romanian Hereditary Angioedema Centre in January, 2015, because she was worried about potential risks to her pregnancy from symptoms she had had for the past 20 years. At age 14 years she began experiencing recurrent swelling of her limbs that would resolve spontaneously after 2–3 days. Over the next few years she started to develop genital and then recurrent facial swelling, each episode lasting 3–4 days. One episode of facial oedema was accompanied by swallowing and breathing difficulties.

[Comment] Ireland's Public Health Bill: crucial to reduce alcohol harm

Ve, 03/11/2017 - 00:30
Ireland has become the fourth heaviest drinking nation in the Organisation for Economic Co-operation and Development in terms of quantity of alcohol consumed,1 and ranked joint third for binge drinking in an analysis of 194 nations by WHO.2 Irish adults consume on average 11·5 L of pure alcohol per person every year, an increase of more than 100% compared with 60 years ago.3 Most alcohol in Ireland is now consumed at home and alcohol retailing off licences have increased by five-fold since 1990.

[Comment] Last nail in the coffin for PCI in stable angina?

Gi, 02/11/2017 - 16:50
Interventional cardiology began in Switzerland in 1977, when Andreas Gruentzig performed the first successful percutaneous transluminal coronary angioplasty (PTCA) on a 38-year-old man with angina and a focal proximal stenosis of the left anterior descending coronary artery. Despite numerous subsequent randomised trials and meta-analyses of these trials, which have shown no reduction in death or myocardial infarction,1 the use of percutaneous coronary intervention (PCI) has grown exponentially. Some of this growth was driven by data from clinical trials suggesting that PCI was more effective in relieving angina than medical therapy alone.

[Articles] Percutaneous coronary intervention in stable angina (ORBITA): a double-blind, randomised controlled trial

Gi, 02/11/2017 - 16:50
In patients with medically treated angina and severe coronary stenosis, PCI did not increase exercise time by more than the effect of a placebo procedure. The efficacy of invasive procedures can be assessed with a placebo control, as is standard for pharmacotherapy.

[Comment] A SENIOR moment? Bare-metal stents in elderly patients

Me, 01/11/2017 - 18:00
The WHO International Day of Older Persons1 was on Oct 1, 2017, and saw the release of guidelines on integrated care and equality of care for older people. Now, 40 years since the first percutaneous coronary intervention (PCI),2 we still do not know the optimal revascularisation strategy in elderly patients. Interventionalists face two important questions when considering PCI in elderly patients. First, should drug-eluting stents (DES) be mandated in elderly patients since they tend to have greater numbers of complex coronary lesions with calcification, tortuosity, and bifurcations than do younger patients3 and DES have been shown to be better than bare-metal stents (BMS), particularly in complex lesions?4 Second, since DES require a longer duration of dual antiplatelet therapy (6–12 months) than do BMS (1 month), does the benefit of DES outweigh the risk associated with extended DAPT (dual antiplatelet therapy; risk of life-threatening bleeding) or should patients have shortened DAPT with its attendant risk of myocardial infarction and stent thrombosis?5

[Articles] Drug-eluting stents in elderly patients with coronary artery disease (SENIOR): a randomised single-blind trial

Me, 01/11/2017 - 18:00
Among elderly patients who have PCI, a DES and a short duration of DAPT are better than BMS and a similar duration of DAPT with respect to the occurrence of all-cause mortality, myocardial infarction, stroke, and ischaemia-driven target lesion revascularisation. A strategy of combination of a DES to reduce the risk of subsequent repeat revascularisations with a short BMS-like DAPT regimen to reduce the risk of bleeding event is an attractive option for elderly patients who have PCI.

[Comment] Targeting Crohn's disease

Ma, 31/10/2017 - 01:01
There are many similarities between Crohn's disease and rheumatoid arthritis, such as in pathogenesis; in disconnect between symptoms, biological inflammatory activity, and structural damage; and in effective therapies (such as corticosteroids, conventional immunomodulators, and inhibitors of tumour necrosis factor). However, one area of divergence is the concept of disease modification in rheumatoid arthritis by cessation or stabilisation of structural damage to joints, which is assessed by simple x-rays of hands and calculation of joint space narrowing and erosions as a so-called “sharp score”.

[Articles] Effect of tight control management on Crohn's disease (CALM): a multicentre, randomised, controlled phase 3 trial

Ma, 31/10/2017 - 01:01
CALM is the first study to show that timely escalation with an anti-tumour necrosis factor therapy on the basis of clinical symptoms combined with biomarkers in patients with early Crohn's disease results in better clinical and endoscopic outcomes than symptom-driven decisions alone. Future studies should assess the effects of such a strategy on long-term outcomes such as bowel damage, surgeries, hospital admissions, and disability.

[Review] The Lancet Countdown on health and climate change: from 25 years of inaction to a global transformation for public health

Ma, 31/10/2017 - 00:30
The Lancet Countdown tracks progress on health and climate change and provides an independent assessment of the health effects of climate change, the implementation of the Paris Agreement,1 and the health implications of these actions. It follows on from the work of the 2015 Lancet Commission on Health and Climate Change,2 which concluded that anthropogenic climate change threatens to undermine the past 50 years of gains in public health, and conversely, that a comprehensive response to climate change could be “the greatest global health opportunity of the 21st century”.