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[Clinical Picture] Hydroxychloroquine-induced cardiomyopathy accelerated after gastric banding

Sa, 20/11/2021 - 00:00
A 51-year-old woman was admitted to our hospital for investigation of blackouts occurring in the context of worsening breathlessness (New York Heart Association [NYHA] class IV) and swelling of her legs. 14 months earlier she had a gastric banding operation.

[Department of Error] Department of Error

Ve, 19/11/2021 - 00:30
Thornton J. The Global Drug Policy Index: tracking national drug policies. Lancet 2021; 398: 1788–89—This World Report has been corrected to state that the International Drug Policy Consortium, not the Harm Reduction Consortium, is a group of 192 organisations. It has also been clarified to explain that the Global Commission on Drug Policy was not directly involved in the production of the Index. These changes have been made to the online version as of Nov 18, 2021.

[Comment] Studying the coagulopathy of COVID-19

Gi, 18/11/2021 - 00:30
The coagulopathy caused by SARS-CoV-2 seen in patients hospitalised with COVID-19, especially those with severe or critical illness, is by now well established. Early reports in relatively small studies showing multifold elevated rates of both venous and arterial thromboembolism have given way to more sober estimates from much larger populational studies and systematic reviews or meta-analyses. Overall rates of venous thromboembolism, including in-situ pulmonary thrombosis, are approximately three-times higher than historical matched controls of hospitalised populations, whereas rates of arterial thromboembolism, including acute coronary syndromes and stroke, although still elevated, are lower than previously described.

[Articles] Aspirin in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Gi, 18/11/2021 - 00:30
In patients hospitalised with COVID-19, aspirin was not associated with reductions in 28 day mortality or in the risk of progressing to invasive mechanical ventilation or death, but was associated with a small increase in the rate of being discharged alive within 28 days.

[World Report] Reaching net zero carbon emissions in health systems

Gi, 18/11/2021 - 00:30
14 countries have now pledged to develop a carbon-neutral health system. The question now is: how will they do it? Emma Wilkinson reports.

[Comment] Long-acting amylin analogue for weight reduction

Me, 17/11/2021 - 00:30
Because the causes of obesity involve genetic, epigenetic, biological, environmental, sociocultural, dietary, and behavioural factors and their interactions,1 weight management interventions manifest considerable treatment response heterogeneity. For decades, anti-obesity drug development primarily targeted central neurotransmitters regulating appetite and food intake. Although orlistat, a gastric and pancreatic lipase inhibitor approved in 1999, was an exception, its weight loss efficacy is marginal.

[Articles] Once-weekly cagrilintide for weight management in people with overweight and obesity: a multicentre, randomised, double-blind, placebo-controlled and active-controlled, dose-finding phase 2 trial

Me, 17/11/2021 - 00:30
Treatment with cagrilintide in people with overweight and obesity led to significant reductions in bodyweight and was well tolerated. The findings support the development of molecules with novel mechanisms of action for weight management.

[Health Policy] Promoting COVID-19 vaccine acceptance: recommendations from the Lancet Commission on Vaccine Refusal, Acceptance, and Demand in the USA

Ma, 16/11/2021 - 00:30
Since the first case of COVID-19 was identified in the USA in January, 2020, over 46 million people in the country have tested positive for SARS-CoV-2 infection. Several COVID-19 vaccines have received emergency use authorisations from the US Food and Drug Administration, with the Pfizer–BioNTech vaccine receiving full approval on Aug 23, 2021. When paired with masking, physical distancing, and ventilation, COVID-19 vaccines are the best intervention to sustainably control the pandemic. However, surveys have consistently found that a sizeable minority of US residents do not plan to get a COVID-19 vaccine.

[Comment] Improving gastric balloons to treat obesity

Ma, 16/11/2021 - 00:30
The understanding of the causes, implications, and available treatments for obesity is increasing rapidly. This knowledge gain has been partly driven by the increasing proportion of people affected.1 Addressing the obesity epidemic is complex, requiring population-based approaches as well as effective treatments to prevent or manage the effect of obesity on an individual level.

[Articles] Adjustable intragastric balloon for treatment of obesity: a multicentre, open-label, randomised clinical trial

Ma, 16/11/2021 - 00:30
When aIGB was combined with lifestyle modification, significant weight loss was achieved and maintained for 6 months following removal. Balloon volume adjustability permitted individualised therapy, maximising weight loss and tolerance.

[Comment] PCI versus CABG for left main coronary artery disease: is the jury still out?

Lu, 15/11/2021 - 14:32
The left main coronary artery supplies blood to 75% or more of the left ventricle. Therefore, if this artery is acutely occluded, patients are at high risk of dire outcomes and researchers have focused on evaluating therapeutic approaches to treat left main coronary artery disease. In an individual patient data meta-analysis of seven randomised trials that included a total of 2649 patients and 345 deaths, 10·2% of the patients randomly assigned to coronary artery bypass grafting (CABG) versus 15·8% of those randomly assigned to medical therapy (eg, antiplatelets and β blockers) died within 5 years (absolute risk difference 5·6%, 95% CI 3·0–8·2).

[Articles] Percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass grafting in left main coronary artery disease: an individual patient data meta-analysis

Lu, 15/11/2021 - 14:32
Among patients with left main coronary artery disease and, largely, low or intermediate coronary anatomical complexity, there was no statistically significant difference in 5-year all-cause death between PCI and CABG, although a Bayesian approach suggested a difference probably exists (more likely than not <0·2% per year) favouring CABG. There were trade-offs in terms of the risk of myocardial infarction, stroke, and revascularisation. A heart team approach to communicate expected outcome differences might be useful to assist patients in reaching a treatment decision.

[Comment] A novel risk score for contrast-associated acute kidney injury: the heart of the matter

Lu, 15/11/2021 - 14:24
Given the hundreds of thousands of contrast medium doses that are injected every day, contrast-associated acute kidney injury is an important issue. However, it is fraught with controversy. The first reports of acute kidney injury after contrast administration date from the 1950s, but who is at risk and the risk itself are still being debated. Identifying kidney injury caused by contrast media is a challenge because it is not characterised by specific symptoms; contrast-associated acute kidney injury is an indirect, biochemical diagnosis based on absolute or relative increases in serum creatinine within a few days after contrast medium administration.

[Articles] A contemporary simple risk score for prediction of contrast-associated acute kidney injury after percutaneous coronary intervention: derivation and validation from an observational registry

Lu, 15/11/2021 - 14:24
A contemporary simple risk score based on readily available variables from patients undergoing PCI can accurately discriminate the risk of contrast-associated acute kidney injury, the occurrence of which is strongly associated with subsequent death.

[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.