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[World Report] Concerns raised about NHS gender identity service

Sa, 20/04/2019 - 00:00
The Tavistock and Portman NHS Foundation Trust service draws controversy for prescribing hormone blockers to adolescents, others support the approach. Talha Burki reports.

[Perspectives] Climate Armageddon

Sa, 20/04/2019 - 00:00
David Wallace-Wells opens his book, The Uninhabitable Earth: Life After Warming, with “It is worse, much worse, than you think.” And within the first 36 pages, the American writer races through evidence of damage already caused by climate change and forecasts humanity's future, peppering sentences with words like annihilation, Armageddon, extinction, and “existential crisis”. There are no safe zones of optimism or passages of hope in Wallace-Wells' book, even in his closing chapter where he avers “The emergent portrait of suffering is, I hope, horrifying.

[Perspectives] Alzheimer's disease

Sa, 20/04/2019 - 00:00
In his genre-defining Encyclopédie (1765), the French philosopher Denis Diderot defined dementia as “a disease consisting in a paralysis of the spirit characterised by abolition of the reasoning faculty“. For Diderot's generation, dementia (from the Latin demens, “without mind“) was a new frame for an old and diverse set of labels—imbecility, fatuitas, dotage—denoting a progressive and irreversible decline in what we'd now call cognitive and social functioning, typically associated with old age.

[Obituary] Margaret Susan Povey

Sa, 20/04/2019 - 00:00
Molecular geneticist and early gene mapper. She was born in Leeds, UK, on April 24, 1942, and died of ovarian cancer in Cheddington, UK, on Jan 11, 2019, aged 76 years.

[Correspondence] Awareness of the link between obesity and cancer in UK school curricula

Sa, 20/04/2019 - 00:00
In 2016, a panel of international experts, under the sponsorship of the International Agency for Research in Cancer, concluded that there was sufficient evidence for causal links between body fatness, commonly approximated as body-mass index of 25 kg/m2 or more and increased risk of incidence of 13 cancer types.1 In parallel, Arnold and colleagues2 estimated that elevated body-mass index is responsible for 3·2–7·8% of the burden of new cancers in countries with a very high Human Development Index, making obesity the second commonest cause of cancer after smoking.

[Correspondence] Functional capacity and preoperative risk evaluation

Sa, 20/04/2019 - 00:00
I wish to draw attention to two methodological issues that might affect the interpretation of findings in Duminda Wijeysundera and colleagues' Measurement of Exercise Tolerance before Surgery (METS) study (June 30, 2018, p 2631).1

[Correspondence] Functional capacity and preoperative risk evaluation

Sa, 20/04/2019 - 00:00
Duminda Wijeysundera and colleagues' prospective cohort study1 challenges concepts of preoperative risk assessment, showing that neither subjective assessments of fitness nor exercise testing were correlated with important cardiopulmonary outcomes. Instead, the structured Duke Activity Status Index (DASI) questionnaire and the predictive assessment of complications through measuring serum concentrations of N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) were better correlated with the outcomes.

[Correspondence] Functional capacity and preoperative risk evaluation

Sa, 20/04/2019 - 00:00
We commend Duminda Wijeysundera and colleagues1 for testing the prognostic value conferred by assessment of subjective functional capacity in non-cardiac surgery and read the results with interest. We raise two issues with the published data.

[Correspondence] Functional capacity and preoperative risk evaluation – Authors' reply

Sa, 20/04/2019 - 00:00
We thank the correspondents for their interest in our study.1

[Correspondence] Orphan drugs

Sa, 20/04/2019 - 00:00
Lucio Luzzatto and colleagues1 (Sept 1, 2018, p 791) have called for collaboration from EU member states on negotiation of orphan drug prices to take advantage of the fact that with 500 million inhabitants, the EU is the largest customer for any new drug. Low-income and middle-income countries (LMICs), with more than 6 billion inhabitants and 360–480 million patients with rare diseases,2 are in need of orphan drugs and should join forces in this area.

[Correspondence] Orphan drugs

Sa, 20/04/2019 - 00:00
The Viewpoint by Luzzatto and colleagues1 on drug pricing addresses a very crucial issue because an increasing number of orphan drugs have been marketed in the past decade, and genetic treatments costing more than €300 000 are being made available. Among the determinants of drug pricing reported in the Viewpoint,1 benefit to the patient is the main factor that is typically examined in cost-effectiveness analyses; disease-specific factors are already recognised to influence drug prices because an inverse association exists between treatment cost and disease prevalence.

[Correspondence] Orphan drugs

Sa, 20/04/2019 - 00:00
Luzzatto and colleagues1 give three recommendations for pricing orphan drugs. We will focus on the first recommendation (European price negotiation) and on the first part of the second (cost-based pricing).

[Correspondence] Orphan drugs – Authors' reply

Sa, 20/04/2019 - 00:00
We agree with Francesca Cainelli and Sandro Vento that patients with orphan diseases, regardless of location, ought to receive the best treatment available. We share their appeal on behalf of low-income and middle-income countries for access to orphan drugs.

[Department of Error] Department of Error

Sa, 20/04/2019 - 00:00
Hanley DF, Thompson RE, Rosenblum M, et al. Efficacy and safety of minimally invasive surgery with thrombolysis in intracerebral haemorrhage evacuation (MISTIE III): a randomised, controlled, open-label, blinded endpoint phase 3 trial. Lancet 2019; 393: 1021–32—In the webappendix of this Article, Colin P Derdeyn's name was spelled incorrectly. This correction has been made to the online version as of April 18, 2019.

[Department of Error] Department of Error

Sa, 20/04/2019 - 00:00
Norman JE, Marlow N, Messow C-M, et al, for the OPPTIMUM study group. Vaginal progesterone prophylaxis for preterm birth (the OPPTIMUM study): a multicentre, randomised, double-blind trial. Lancet 2016; 387: 2106–16—In this Article, in table 2, the upper 95% CI of the unadjusted odds ratio for the primary outcome of neonatal morbidity or death should be 1·07; in table 3, the p value of the treatment effect in the neonatal outcome in women with history of spontaneous preterm birth should be 0·033.

[Department of Error] Department of Error

Sa, 20/04/2019 - 00:00
Adepoju P. Mali announces far-reaching health reform. Lancet 2019; 393: 1192—In this World Report, it was reported that a reform carried out by Mali will not be rolled out until 2020, but the reform is planned to begin in 2019 through a phased roll-out. The text now reads: “will not become fully effective until 2022 because of the numerous changes needed to ensure smooth roll-out”, and the title of the paragraph now reads: “Not fully rolled out until 2020”. These corrections have been made to the online version as of April 18, 2019.

[Clinical Picture] A kidney changes size: first increasing and then decreasing

Sa, 20/04/2019 - 00:00
A 39-year-old man was admitted to our department with a 1-day history of pain in his left flank and dizziness. His medical history included poorly controlled diabetes mellitus and a stone in the left upper ureter. On admission to the hospital, he appeared to be in septic shock. His temperature was 38·1°C and his blood pressure was 66/35 mm Hg. Laboratory investigations showed a leucocytosis of 16·58 × 109 per L with 93·6% neutrophils. His renal function was abnormal: blood concentrations of creatinine and urea nitrogen were 0·499 mg/dL and 15·4 mmol/L, respectively.

[Articles] Clinical outcomes after ABO-incompatible renal transplantation: a systematic review and meta-analysis

Ve, 19/04/2019 - 00:30
Despite progress in desensitisation protocols and optimisation of ABOi-rTx procedures, excess mortality and loss of kidney grafts was found compared with ABOc-rTx within the first 3 years after transplantation. Only long-term outcomes after 5 years yielded equivalent survival rates and organ function. Awareness of the increased risks of infection, organ rejection, and bleeding could improve care of patients and promote efforts towards paired kidney exchange programmes.

[Comment] Community-wide soil-transmitted helminth treatment is equity-effective

Ve, 19/04/2019 - 00:30
Among the 20 diseases included on the WHO list of neglected tropical diseases, the soil-transmitted helminths (Ascaris lumbricoides, hookworm, and Trichuris trichiura) are the most prevalent (>1 billion people infected) and the most burdensome (global burden of 3 million disability-adjusted life years).1,2 At the turn of the new millennium, preventive chemotherapy—the periodic administration of donated anthelmintic drugs to pre-school-age and school-age children—had been embraced as the global strategy for morbidity control of soil-transmitted helminths.

[Comment] ABO-incompatible renal transplantation

Ve, 19/04/2019 - 00:30
The shortfall between organ donors and a growing population with end-stage kidney disease has resulted in increased transplant waiting times for patients, with increased mortality as a consequence.1 Strategies to reduce this deficit include expanding the live donor pool by crossing the blood group barrier with ABO-incompatible live donor pairs. ABO-incompatible renal transplantation (ABOi-rTx) has been in practice worldwide for over three decades. Initially regarded as having similar outcomes to ABO-compatible renal transplantation (ABOc-rTx),2 more recent registry reports have suggested otherwise.