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[Comment] Tofacitinib in juvenile idiopathic arthritis

Me, 10/11/2021 - 00:30
Biological therapies have made a huge contribution to treatment of juvenile idiopathic arthritis (JIA) over the past two decades. However, their use does pose challenges in paediatric practice as they are exclusively injectable formulations. Therefore, an urgent unmet need for efficacious oral treatments for children with JIA who do not respond adequately to methotrexate remains. Tofacitinib was the first JAK inhibitor to be licensed for rheumatoid arthritis in 2012, and since then JAK inhibitors have been increasingly used for immune-mediated disorders in adults.

[Articles] Tofacitinib in juvenile idiopathic arthritis: a double-blind, placebo-controlled, withdrawal phase 3 randomised trial

Me, 10/11/2021 - 00:30
The results of this pivotal trial show that tofacitinib is an effective treatment in patients with polyarticular course JIA. New oral therapies are particularly relevant for children and adolescents, who might prefer to avoid injections.

[Health Policy] How an outbreak became a pandemic: a chronological analysis of crucial junctures and international obligations in the early months of the COVID-19 pandemic

Ma, 09/11/2021 - 00:30
Understanding the spread of SARS-CoV-2, how and when evidence emerged, and the timing of local, national, regional, and global responses is essential to establish how an outbreak became a pandemic and to prepare for future health threats. With that aim, the Independent Panel for Pandemic Preparedness and Response has developed a chronology of events, actions, and recommendations, from December, 2019, when the first cases of COVID-19 were identified in China, to the end of March, 2020, by which time the outbreak had spread extensively worldwide and had been characterised as a pandemic.

[Department of Error] Department of Error

Ma, 09/11/2021 - 00:30
Fleming KA, Horton S, Wilson ML, et al. The Lancet Commission on diagnostics: transforming access to diagnostics. Lancet 2021; published online Oct 6. https://doi.org/10.1016/S0140-6736(21)00673-5—In this Commission, in the section about using governance to make diagnostics more affordable, the sixth sentence of the fourth paragraph should have read “The Treatment Action Group was key in the movement to getting equitable pricing for antiretrovirals for HIV/AIDS and, more recently, has applied similar efforts to diagnostics, such as the Time for $5 campaign for GeneXpert cartridges.” This correction has been made to the online version as of Nov 8, 2021, and will be made to the printed version.

[Department of Error] Department of Error

Ma, 09/11/2021 - 00:30
Jardine J, Walker K, Gurol-Urganci I, et al. Adverse pregnancy outcomes attributable to socioeconomic and ethnic inequalities in England: a national cohort study. Lancet 2021; 398: 1905–12—In figure 3 of this Article, the lower bounds of two 95% CIs were incorrect. These corrections have been made to the online version as of Nov 8, 2021, and the printed version is correct.

[Department of Error] Department of Error

Ma, 09/11/2021 - 00:30
Grange Z, Buelo A, Sullivan C, et al. Characteristics and risk of COVID-19-related death in fully vaccinated people in Scotland. Lancet 2021; published online Oct 28. https://doi.org/10.1016/S0140-6736(21)02316-3—The appendix of this Correspondence has been corrected as of Nov 8, 2021.

[Comment] Offline: The myth of “decolonising global health”

Sa, 06/11/2021 - 00:00
The Lancet's inaugural issue was published on Oct 5, 1823. In his opening editorial, Thomas Wakley, our founding Editor, described the journal's intended audience: London's physicians and surgeons; country practitioners; medical students; and, rather ambitiously, “every individual in these realms”. Wakley also hoped to reach a fifth category of readers—“Colonial Practitioners”. The Lancet was born as a product of colonialism and, at least in part, as an instrument to support and advance British imperial objectives.

[World Report] Health experts welcome Brazil COVID-19 inquiry findings

Sa, 06/11/2021 - 00:00
A senate investigation has recommended indictment of officials including President Jair Bolsonaro over the handling of the COVID-19 pandemic. Lise Alves reports from São Paulo.

[World Report] WHO's Tedros set to be re-elected unopposed

Sa, 06/11/2021 - 00:00
Nominated by 28 member states, he is the sole candidate for the post of director-general of WHO. John Zarocostas reports from Geneva.

[World Report] New budget and strategy for ACT-A

Sa, 06/11/2021 - 00:00
The WHO-led pandemic response coalition plans to focus on the countries worst hit by inequities in COVID-19 resources. Ann Danaiya Usher reports.

[Perspectives] Cruelty and compassion

Sa, 06/11/2021 - 00:00
What guides the way a person feels and acts? Why do some people thrive in life, while others flounder? How are we to understand something so sinister as the urge to kill? As a forensic psychiatrist and psychotherapist Gwen Adshead has spent her career helping violent offenders approach answers to these questions. On occasions, she recounts, strangers ask her what she does for a living. If she tells them, the replies are often along the lines of: “you mean you actually talk to those people?”

[Perspectives] The choice to love

Sa, 06/11/2021 - 00:00
A decade ago, on a humid afternoon in southeast Texas, USA, I was packed into an auditorium with some 200 strangers on the sprawling acres of Camp Allen. It was my medical school's annual Henry Strobel Retreat, a storied rite of passage for first-year students in the days before their journeys in medicine. We were invited to meet our new classmates and dissipate some nervous energy through tug-o-war, water slides, and, in true Texas form, a mechanical bull. The cacophonous chatter in the room suddenly fell silent as Dr Strobel moved towards the podium.

[Obituary] Alan Frederick Hofmann

Sa, 06/11/2021 - 00:00
Gastroenterologist and authority on bile acids. He was born in Baltimore, MD, USA, on May 17, 1931, and died in La Jolla, CA, USA, on Sept 7, 2021, aged 90 years.

[Correspondence] Blood pressure treatment: how low should you go?

Sa, 06/11/2021 - 00:00
Kazem Rahimi and colleagues1 report a participant-level meta-analysis of 48 randomised trials and conclude that lowering systolic blood pressure (SBP) reduces risk of major cardiovascular events, independent of baseline SBP. We very much agree with their recommendation to use risk prediction tools when making treatment decisions, but have the following questions about the analysis.

[Correspondence] Blood pressure treatment: how low should you go? – Authors' reply

Sa, 06/11/2021 - 00:00
We thank Scott R Garrison and James McCormack for their interest in our study and for raising important questions concerning the study methodology.1

[Correspondence] Aspirin versus clopidogrel after percutaneous coronary intervention

Sa, 06/11/2021 - 00:00
Bon-Kwon Koo and colleagues report the results of the HOST-EXAM trial,1 in which clopidogrel 75 mg daily was superior to aspirin 100 mg daily in preventing the primary composite thrombotic endpoint and the bleeding endpoint after percutaneous coronary intervention, following the initial dual antiplatelet phase. The composite thrombotic endpoint and the major bleeding endpoint were both decreased in the clopidogrel group.

[Correspondence] Aspirin versus clopidogrel after percutaneous coronary intervention – Authors' reply

Sa, 06/11/2021 - 00:00
We appreciate the thoughtful letter by Manan Pareek and Christina Byrne regarding our recently published Article.1 Pareek and Byrne hypothesise that the clinical outcomes could have been influenced by the type of aspirin used (enteric-coated vs immediate-release) due to its potential influence on aspirin responsiveness. We agree that this is an important issue that needs to be clarified.

[Department of Error] Department of Error

Sa, 06/11/2021 - 00:00
Boxhoorn L, Voermans RP, Bouwense SA, et al. Acute pancreatitis. Lancet 2020; 396: 726–34—In this Seminar, the fifth sentence of paragraph 4 in the Management of local complications: necrotising pancreatitis section should have read “In a retrospective study of 193 patients, endoscopic intervention before the stage of walled-off necrosis did not increase complications. However, the early approach was associated with increased mortality when compared with the conventional approach (13% vs 4%).” This correction has been made to the online version as of Nov 4, 2021.

[Department of Error] Department of Error

Sa, 06/11/2021 - 00:00
Asher MI, Rutter CE, Bissell K, et al. Worldwide trends in the burden of asthma symptoms in school-aged children: Global Asthma Network Phase I cross-sectional study. Lancet 2021; 398: 1569–80—In this Article, the spelling of author Karen Bissell's name was incorrect. This correction has been made to the online version as of Nov 4, 2021.

[Clinical Picture] A high prostatic-specific antigen with a large pelvic mass indicates a prostatic cystadenocarcinoma

Sa, 06/11/2021 - 00:00
A 63-year-old man presented to our emergency department with a 1-year history of severe nocturia and straining to pass urine. Additionally, he reported having tenesmus and abdominal pain in the 2 weeks prior to attending. The patient had no significant medical history.