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[Comment] A short cut to prevent postoperative atrial fibrillation

Do, 14/11/2021 - 14:28
Postoperative atrial fibrillation is a common complication of cardiac surgery and increases the risk of mortality, stroke, morbidity, and extended stay in hospital.1–3 Although other researchers have shown, mostly in small studies and meta-analyses,4 that this simple surgical procedure reduces the risk of cardiac tamponade, a randomised comparison between posterior left pericardiotomy and standard of care, with postoperative atrial fibrillation as a primary outcome measure, had not been performed until now.

[Articles] Posterior left pericardiotomy for the prevention of atrial fibrillation after cardiac surgery: an adaptive, single-centre, single-blind, randomised, controlled trial

Do, 14/11/2021 - 14:28
Posterior left pericardiotomy is highly effective in reducing the incidence of atrial fibrillation after surgery on the coronary arteries, aortic valve, or ascending aorta, or a combination of these without additional risk of postoperative complications.

[Editorial] 100 years of insulin: a technical success but an access failure

Sa, 13/11/2021 - 00:00
The isolation of insulin in 1921 and its subsequent delivery to a 14-year-old boy in a diabetic coma in Toronto in 1922 was a ground-breaking scientific and clinical achievement that has transformed diabetes care and is celebrated in this themed issue of The Lancet. But despite the altruistic sentiments of the discoverers—Banting, Best, Collip, and Macleod—that “insulin belongs to the world”, the lack of access to insulin over the past 100 years reflects an appalling policy and implementation failure.

[Comment] Blood pressure lowering in the prevention of type 2 diabetes

Sa, 13/11/2021 - 00:00
Hypertension increases the risk for many conditions, including ischaemic heart disease, heart failure, stroke, and kidney disease.1 Hypertension frequently coexists with diabetes as obesity increases the risk of developing both conditions. In patients with diabetes, two-thirds also have hypertension.2,3 In the USA, four of the top ten causes of death are associated with hypertension (ie, heart disease, stroke, diabetes, and renal disease).4 Thus, strategies that reduce comorbidities associated with hypertension are important.

[Comment] By any means necessary: why lowering insulin prices is relevant to racial health equity

Sa, 13/11/2021 - 00:00
When young revolutionaries in the 1960s sought to free Black people in the USA from lives of structured racism (ie, the differential access to opportunity, goods, and services by race) “by any means necessary”,1 few people imagined this movement might one day include efforts to overcome exorbitant insulin prices. Yet organisations such as the Black Panther Party (BPP) understood long ago how poverty and other structural inequities lead to worse health, and were instrumental in creating a framework for cross-sector collaboration to address health disparities in low-income Black communities.

[Comment] Insulin, the patient, and the health professional

Sa, 13/11/2021 - 00:00
Before 1921 the diagnosis of diabetes was a death sentence, with an average life expectancy of less than 2 years in young people, who were only kept alive by a starvation regimen that reduced them to walking skeletons.1 The discovery of insulin in 1921 was transformative and many patients with diabetes went on to live full and productive lives.

[Comment] Offline: Decolonisation and the demand for a just memory

Sa, 13/11/2021 - 00:00
According to Kehinde Andrews in The New Age of Empire, the deceit of modern science is its claim to stand for a set of universal values in the service of human progress. Andrews is the UK's first Professor of Black Studies. In his view “Whiteness is at the heart of Enlightenment thinking”. The values that science affirms are not based on the universal but, instead, on a purely white particular. Today's western descendants of the Enlightenment “are fundamentally incapable of even naming the racism that is the basis of the global political and economic system”.

[World Report] The Global Drug Policy Index: tracking national drug policies

Sa, 13/11/2021 - 00:00
A new index on global drug policy aims to increase accountability and guide reform, but will it have the influence it desires? Jacqui Thornton reports.

[World Report] Sudan coup prompts fresh health and humanitarian fears

Sa, 13/11/2021 - 00:00
Medicine and food could run short as donors halt aid following the military‘s seizure of power. Sharmila Devi reports.

[World Report] Cold comfort: getting insulin to those who need it

Sa, 13/11/2021 - 00:00
Cold-chain requirements hamper diabetes care in many countries. Organisations such as Direct Relief are trying to bridge the gap. Sharmila Devi reports.

[Perspectives] Monica Peek: addressing diabetes health disparities

Sa, 13/11/2021 - 00:00
Monica Peek's diverse research portfolio has included diabetes, breast cancer, and COVID-19. The common thread running through her work is the impact of structural and interpersonal racism on people's lives and health. “Fighting racism…this is part of my core, essential to who I am”, says Peek, Professor of Medicine in the Section of General Internal Medicine at the University of Chicago, IL, USA. Her research has been instrumental in improving shared decision making between clinicians and low-income Black patients with diabetes.

[Perspectives] Origins of the insulin crisis: how a century of price-fixing controversies affects the cost of care today

Sa, 13/11/2021 - 00:00
At the age of 45 years, Josephine Tomasovic could no longer afford her insulin, and took to selling alcohol without a licence to pay for it. Her arrest made the New Jersey newspapers, highlighting the lengths people in the USA who were living with diabetes would go to access a life-saving drug once it was priced out of their reach. The original insulin patents were still in effect at the time of Tomasovic's arrest in 1939. Yet the affordability of insulin remains a concern today, long after all insulin product patents have expired.

[Perspectives] Insulin's centenary: complexity and collaboration

Sa, 13/11/2021 - 00:00
Biochemist James Bertram Collip was working at his bench in the still hours of the night in January, 1922. At home, his wife, young daughter, new baby, and sister-in-law were all sick with influenza so Collip had been dispatched to spend his nights in the laboratory at the University of Toronto, Canada. He was working there while on sabbatical from the University of Alberta. For the past 6 weeks, Collip had been immersed in the problem of diabetes. Unlike the infectious diseases that were prevalent at the time, diabetes was rare and stemmed from a fault in the body's own metabolism, specifically in the functioning of the pancreas.

[Obituary] Stephen Warren

Sa, 13/11/2021 - 00:00
Geneticist who researched fragile X syndrome. Born on Nov 30, 1953, in what was then East Detroit, MI, USA, he died on June 6, 2021, in Atlanta, GA, USA, aged 67 years.

[Correspondence] Just how common is TTS after a second dose of the ChAdOx1 nCov-19 vaccine?

Sa, 13/11/2021 - 00:00
Prakash Bhuyan and colleagues1 suggest that thrombosis with thrombocytopenia syndrome (TTS) can occur after the second dose of the ChAdOx1 nCoV-19 vaccine (AZD1222). We feel it is necessary to distinguish TTS, which can have a number of causes, from vaccine-induced immune thrombocytopenia and thrombosis (VITT), which has a very specific immune pathophysiology (appendix). None of the 13 individuals reported in their Correspondence1 can be categorised as having definite or probable VITT, using the UK Expert Haematology Panel criteria.

[Correspondence] Just how common is TTS after a second dose of the ChAdOx1 nCov-19 vaccine? – Authors’ reply

Sa, 13/11/2021 - 00:00
We agree with Sue Pavord and colleagues about our analysis1 of very rare cases of potential thrombosis with thrombocytopenia syndrome (TTS) after a second dose of ChAdOx1 nCoV-19 vaccine (AZD1222)—that is, that most of the 13 cases do not fulfil the criteria to be catagorised as definite or probable vaccine-induced thrombosis with thrombocytopenia (VITT), as defined by the UK Expert Haematology Panel criteria.2 This failure to meet the criteria for definite or probable VITT is because crucial information regarding clinical and laboratory parameters was missing, which remains the key limitation of assessing spontaneous passive case reports.

[Articles] Blood pressure lowering and risk of new-onset type 2 diabetes: an individual participant data meta-analysis

Sa, 13/11/2021 - 00:00
Blood pressure lowering is an effective strategy for the prevention of new-onset type 2 diabetes. Established pharmacological interventions, however, have qualitatively and quantitively different effects on diabetes, likely due to their differing off-target effects, with angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers having the most favourable outcomes. This evidence supports the indication for selected classes of antihypertensive drugs for the prevention of diabetes, which could further refine the selection of drug choice according to an individual's clinical risk of diabetes.

[Clinical Picture] A pruritic psoriatic plaque develops at the donor site of an autologous skin graft: Koebner phenomenon

Sa, 13/11/2021 - 00:00
A 64-year-old man attended our dermatology clinic with a rectangular-shaped pruritic rash on the upper part of his right thigh and oval pink plaques on his right forearm. The patient said that the lesions had developed gradually over the previous few weeks. 3 months earlier, he had developed necrotising fasciitis of his right forearm after a fishing trip; tissue cultures had grown Vibrio vulnificus and an emergency fasciotomy had been done by plastic surgery colleagues. To repair the wound on his arm, a split-thickness rectangular patch of skin had been harvested from the upper part of the patient's right thigh and grafted onto the lesion on his right forearm.

[Review] A century past the discovery of insulin: global progress and challenges for type 1 diabetes among children and adolescents in low-income and middle-income countries

Sa, 13/11/2021 - 00:00
Type 1 diabetes is on the rise globally; however, the burden of mortality remains disproportionate in low-income and middle-income countries (LMICs). As 2021 marks 100 years since the discovery of insulin, we revisit progress, global burden of type 1 diabetes trends, and understanding of the pathogenesis and management practices related to the disease. Despite much progress, inequities in access and availability of insulin formulations persist and are reflected in differences in survival and morbidity patterns related to the disease.

[Comment] Global surveillance, research, and collaboration needed to improve understanding and management of long COVID

Gi, 11/11/2021 - 00:30
The scale of chronic ill health and disability after COVID-19 has been described as the next big global health challenge.1 Prevalence estimates of a post-COVID-19 condition, long COVID, or post-acute sequelae of SARS-CoV-2 vary according to definition, methodology, and population. A recent systematic review reported persistent symptoms at 3–6 months in a median of 57% (range 13–92) of hospitalised patients (six studies) and 26% (2–62) of non-hospitalised patients (ten studies).2 This study and other reviews identified few studies from low-income settings,3 but with more than 245 million SARS-CoV-2 infections reported globally,4 millions of people are likely to already be experiencing long-term illness.