The Lancet

Condividi contenuti
The Lancet RSS feed.
Aggiornato: 20 ore 54 min fa

[Editorial] India at 75 years: progress, challenges, and opportunities

Sa, 13/08/2022 - 00:00
On Aug 15, 2022, India will commemorate its 75th year of independence from British rule. In this week's issue, a Comment by Vikram Patel and commissioners of The Lancet's Citizens’ Commission on Reimagining India's Health System reflects on the country's journey to achieving universal health coverage. The authors outline that although India has seen substantial improvements in many health indicators since independence, such as infant mortality, progress in other areas have lagged behind, although huge variations exist between and within states.

[Comment] An energy booster for thalassaemic red blood cells

Sa, 13/08/2022 - 00:00
Haemoglobinopathies are the most common monogenic disorders with worldwide distribution. Our knowledge on the mechanisms leading to the intramedullary apoptosis of red blood cell precursors and decreased lifespan of red blood cells in thalassaemia has evolved substantially over the past three decades and is guiding the advent of novel therapeutic approaches. Agents targeting different steps of the pathogenesis—namely, the globin chain imbalance, ineffective erythropoiesis, deranged iron homoeostasis, and increased haemolysis—are being developed and studied in the clinical setting.

[Comment] Biologic therapies for asthma in underserved populations

Sa, 13/08/2022 - 00:00
Black and Hispanic children living in disadvantaged urban environments in the USA face a disproportionate burden of asthma, experiencing the highest rates of morbidity and mortality in the country.1 The repeated exacerbations that accompany severe eosinophilic asthma in these populations can lead to loss of lung function, increased asthma severity, and progression to a pattern of fixed obstructive lung disease by early adulthood.2,3 Worryingly, in a substantial proportion of these children, conventional guideline-directed therapies, such as corticosteroids and long-acting β agonists, do not improve asthma control.

[Comment] Participation in phase 1 trials for patients with cancer

Sa, 13/08/2022 - 00:00
By any estimate, targeted therapies and immuno-oncology agents have been among the most noteworthy advances in cancer medicine in the past two decades. Non-small-cell lung cancer (NSCLC) is an example of this progress. In the early 2000s, the therapeutic armamentarium for this disease was limited to platinum-based chemotherapy regimens but recognition of the crucial role of EGFR mutations as predictors of anti-EGFR drugs in patients with advanced NSCLC1 highlighted that better knowledge of tumour biology would allow the development of better anticancer agents.

[Comment] A historic opportunity for universal health coverage in India

Sa, 13/08/2022 - 00:00
The milestone of India's 75th anniversary of independence on Aug 15, 2022, offers an opportunity to reassert the country's commitment to realising universal health coverage (UHC). The first such effort predates independence, with the 1946 Bhore Committee report.1 India's colonial ruler, the UK Government, had simultaneously commissioned the Beveridge Report (1942), which led to the birth of the UK National Health Service in 1948. The Bhore Committee recommended a similar national health-care system for India with guiding principles that have stood the test of time (panel).

[World Report] Botswana's HIV/AIDS success

Sa, 13/08/2022 - 00:00
Botswana has become only the third country to surpass the UN's 95-95-95 goals on HIV and says it is on target to end AIDS as a public health threat. Jacqui Thornton asks how it was done.

[World Report] Turkish doctors emigrate amid low pay and rising violence

Sa, 13/08/2022 - 00:00
The number of physicians leaving Türkiye has surged in the past decade over concerns about working conditions. Kaya Genc reports from Istanbul.

[Perspectives] Poornima Prabhakaran: advocate for health in a changing climate

Sa, 13/08/2022 - 00:00
Poornima Prabhakaran, Head of Environmental Health and Deputy Director of the Public Health Foundation of India's Centre for Environmental Health, grew up in Bangalore and followed in the footsteps of her physician father. After her medical degree at Bangalore Medical College, she moved to New Delhi, where she worked as a Senior Medical Officer, before her “first foray into research” in the Department of Endocrinology at the All India Institute of Medical Sciences. She began thinking of working in preventive and social medicine, “but I was never convinced”, she recalls, until “I got really interested in epidemiology”.

[Perspectives] “You have not remained the same, nor have I”

Sa, 13/08/2022 - 00:00
Now that we are in the third year of the COVID-19 pandemic, it is easy to forget the intense emotions, including fear of contagion and managing uncertainty and disruption, among health professionals and the public early in the pandemic. Amid that fear, front-line workers were recognised as “heroes” by the public. Some of those new-found heroes, while following their vocation to care for others, were simultaneously struggling with the challenges of being international medical graduates (IMGs) in the UK's National Health Service (NHS) and in health systems in other high-income countries (HICs).

[Perspectives] The power of Jatra

Sa, 13/08/2022 - 00:00
The thought of the difficult working conditions in many factories in the Bengal region brings to mind Taslima Akhter's heartbreaking photograph of two dead workers, holding each other in the rubble after the collapse of the Rana Plaza, a building that housed garment factories in Savar, Bangladesh, on April 24, 2013. Cracks that had appeared in the walls of the building before the industrial accident were ignored by the owners and the collapse resulted in the death of more than 1130 people. Different cracks and factory conditions feature in Sonali Bhattacharyya's play Chasing Hares, at the Young Vic in London, UK.

[Obituary] Thomas Bewley

Sa, 13/08/2022 - 00:00
Psychiatrist and early specialist in addiction. He was born in Dublin, Ireland, on July 8, 1926 and died of respiratory failure in London, UK, on June 26, 2022 aged 95 years.

[Correspondence] Screening policies for cytomegalovirus in pregnancy in the era of antivirals

Sa, 13/08/2022 - 00:00
Cytomegalovirus is one of the most common congenital infections, affecting 0·67% of all livebirths globally.1 The rate of vertical transmission is 30–40% after maternal primary infection throughout pregnancy.2 40–60% of infants born with symptomatic congenital cytomegalovirus disease at birth will have long-term sequelae. Antenatal cytomegalovirus screening is offered in only a few countries and is not currently recommended in the UK, where, in addition, a decision against newborn screening was also recently upheld.

[Correspondence] Iran's burden of disease and burden of data collection

Sa, 13/08/2022 - 00:00
The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 Iran Collaborators presented burden of disease estimates (eg, disability-adjusted life-years [DALYs]) for back and neck pain in Iran's 31 provinces between 1999 and 2019.1 This level of detail surprised us as we are familiar with prevalence studies for both conditions.

[Correspondence] Iran's burden of disease and burden of data collection

Sa, 13/08/2022 - 00:00
The Global Burden of Diseases, Injuries, and Risk Factors Study 2019 Iran Collaborators1 analyse data from 1990 to 2019. Of particular focus was the effect of sanctions on the health of Iranians through diminished access to quality care. Recommendations described in the report included the necessity for evaluating policies, assessing needs, and setting priorities on the basis of disease burden. However, as the data series ends before the onset of the COVID-19 pandemic, the report does not address the global public health catastrophe that has forced many nations, including Iran, to reassess their preparedness.

[Correspondence] Iran's burden of disease and burden of data collection – Authors' reply

Sa, 13/08/2022 - 00:00
We thank Christopher G Maher and and Giovanni Ferreira, as well as Seyed M Hashemian and James Miller, for their interest in our work.1 Maher and Ferreira correctly discusses the inadequacy of primary data for neck and back pain at the provincial scale in Iran from 1990 to 2019; they also discuss the problem of data sparsity for other conditions such as Alzheimer's disease and hearing loss. It is important to note that data sparsity is a main limitation of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 overall, and the principle and rationale of the GBD is to overcome this limitation using validated statistical models.

[Correspondence] Data at 36 months for the Symplicity SPYRAL HTN-ON MED pilot

Sa, 13/08/2022 - 00:00
Felix Mahfoud and colleagues present 36-month data from the Symplicity SPYRAL HTN-ON MED pilot trial.1 Two important points need clarification. First, there was no difference in 24 h systolic or diastolic blood pressure at 12 months, the last point where patients were under single-blinded conditions. After unblinding, the difference widened at 24 months and 36 months and became significant, probably due to the placebo effect in the group that had been told they had renal denervation. Previous work has shown that the placebo effect for systolic blood pressure in hypertension was 6–8 mm Hg,2 which is the magnitude of the drop, after unblinding, in the renal denervation group.

[Correspondence] Data at 36 months for the Symplicity SPYRAL HTN-ON MED pilot – Authors' reply

Sa, 13/08/2022 - 00:00
Eric M Snyder and colleagues discuss the results of the 36-month Symplicity SPYRAL HTN-ON MED trial.1 They astutely point out that there was no difference in 24 h systolic or diastolic blood pressure at 12 months between the renal denervation and sham control groups and acknowledge that 12 months was the last point where patients remained under blinded conditions. It is worth noting that, although physicians were able to titrate antihypertensive medications following the 6-month visit, there was a higher medication burden at 12 months in the sham control group compared with the renal denervation group when patients and physicians were still under blind conditions (MEDINDEX2 and MEDINDEX3, table 2 in the Article's appendix [p 17]).

[Articles] Safety and efficacy of mitapivat, an oral pyruvate kinase activator, in adults with non-transfusion dependent α-thalassaemia or β-thalassaemia: an open-label, multicentre, phase 2 study

Sa, 13/08/2022 - 00:00
These efficacy and safety results support the continued investigation of mitapivat for the treatment of both α-thalassaemia and β-thalassaemia.

[Articles] Mepolizumab for urban children with exacerbation-prone eosinophilic asthma in the USA (MUPPITS-2): a randomised, double-blind, placebo-controlled, parallel-group trial

Sa, 13/08/2022 - 00:00
Phenotype-directed therapy with mepolizumab in urban children with exacerbation-prone eosinophilic asthma reduced the number of exacerbations.

[Articles] Early drug development in solid tumours: analysis of National Cancer Institute-sponsored phase 1 trials

Sa, 13/08/2022 - 00:00
During the past 20 years, the response rate in phase 1 trials nearly doubled without an increase in the treatment-related death rate. However, there is significant heterogeneity in overall response by various factors such as cancer type, investigational agent, and trial design. Therefore, informed decision making is crucial for patients before participating in phase 1 trials. This study provides updated encouraging outcomes of modern phase 1 trials in solid tumours.