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[Articles] Cost-effectiveness of targeted next-generation sequencing (tNGS) for detection of tuberculosis drug resistance in India, South Africa and Georgia: a modeling analysis
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00582-0/fulltext?rss=yes
tNGS may be cost-effective in India, South Africa and Georgia when comprehensive DST is not routinely performed. Thus, existing DST practice and healthcare infrastructure should be considered before implementation and scale-up of tNGS.
[Viewpoint] Beyond bronchial thermoplasty – where to now?
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00596-0/fulltext?rss=yes
With the impending ‘retirement’ of bronchial thermoplasty (BT) for the treatment of patients with asthma, there is much to learn from this real-world experiment that will help us develop more effective future therapies with the same primary target i.e., airway smooth muscle (ASM) remodelling. This viewpoint discusses initial controversy surrounding BT (lack of an effect on forced expiratory volume in 1 s), its underutilisation, and importantly how non-standard diagnostics successfully demonstrated therapeutic response which escaped traditional lung function metrics.
[Review] The effectiveness of community-wide screening for pulmonary tuberculosis: a systematic review
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00589-3/fulltext?rss=yes
This systematic review evaluated the effectiveness of community-wide screening for pulmonary tuberculosis (TB) in high-burden areas by analysing randomised controlled trials (RCTs). The review focused on interventions offering TB screening to entire communities, comparing them to standard care or alternative approaches. The main outcome assessed was microbiologically confirmed TB diagnoses, including rates and prevalence. We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, WHO Global Index Medicus, Web of Science, and trial registries up to 27 May 2024, without language restrictions.
[Correspondence] Sanctions and the right to health in post-Assad Syria
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02790-9/fulltext?rss=yes
Dec 8, 2024, marked the end of the five-decade long regime of Bashir al-Assad and the Assad family in Syria, characterised by systemic repression, human rights abuses, and crimes against humanity.1 After the protests of 2011, Assad's response involved indiscriminate bombings, targeting of health-care facilities and health-care workers, and the use of internationally prohibited chemical weapons, triggering one of the worst humanitarian crises since World War 2.1
[Correspondence] Syria's Bashar al-Assad: the crimes of a physician
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02791-0/fulltext?rss=yes
Bashar al-Assad, an ophthalmologist who graduated from Damascus University (Syria) and specialised at the Western Eye Hospital in London (UK), had a sudden career shift to politics and became Syria's President in 2000 following the death of his father, Hafez al-Assad.1 Despite his medical training, which undoubtedly included ethics education, his actions while at the helm of a 24-year presidency reflected a complete abandonment of any medical ethics he once learned. His leadership was marked by authoritarian rule and a 13-year long civil war, concluding with the Fall of Damascus by a coalition of opposition groups on Dec 8, 2024.
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[Correspondence] Pandemic financing should learn from revolving funds
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02633-3/fulltext?rss=yes
On Nov 22, 2024, WHO identified that mpox remains a global health crisis.1 Meanwhile, financing for pandemic preparedness and response is in a permanent state of emergency. A revolving fund model could offer an alternative solution. The current approach embodied in The Pandemic Fund has three main limitations. First, most beneficiaries are not investors in the fund. The Pandemic Fund has attracted new donors, such as China, India, and Indonesia, and requires the countries receiving funds to match resources; however, the absence of direct investment from beneficiaries reduces their sense of ownership and the impetus for domestic resource mobilisation.
[Correspondence] Declaration of martial law in South Korea: a threat to democracy
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02792-2/fulltext?rss=yes
On Dec 3, 2024, at 2223 h, South Korean President Yoon Suk Yeol unexpectedly declared nationwide martial law during a televised address. In his brief speech, he alleged that the National Assembly of South Korea had devolved into a “den of pro-North Korean forces and anti-democratic criminals”, justifying the imposition of martial law as a necessary measure to “restore liberal democracy”.1 Despite police and military forces obstructing access to the National Assembly, lawmakers convened and passed a resolution annulling martial law at 0100 h on Dec 4.
[Correspondence] The first 100 days of the mpox response in Africa
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02681-3/fulltext?rss=yes
Africa's low COVID-19 mortality rates concealed important vulnerabilities, including poor health infrastructure and manufacturing constraints,1 highlighting the need for a proactive, continent-wide pandemic response. The emphasis on local solutions to global health challenges was a crucial reason for the Africa Centres for Disease Control and Prevention (CDC) to declare mpox a Public Health Emergency of Continental Security.2 A coordinated and cost-effective continental response platform was created to achieve the 6-month pandemic control goal,3 adopting the Coalition for Epidemic Preparedness Innovations' 100 Days Mission monitoring framework.
[Articles] Identifying biomarker-driven subphenotypes of cardiogenic shock: analysis of prospective cohorts and randomized controlled trials
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00592-3/fulltext?rss=yes
Subphenotypes with the highest concentration of biomarkers of endothelial dysfunction and inflammation (inflammatory) or myocardial injury/fibrosis (cardiopathic) were associated with mortality independently from the SCAI shock stages.
[Articles] Maternal and neonatal complications of pregnant women with bipolar disorder: a systematic review and meta-analysis
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00586-8/fulltext?rss=yes
Despite substantial heterogeneity observed, our findings suggest the presence of a broad spectrum of complications that may affect both pregnant women with bipolar disorder and their newborns. These results can serve as a basis for the development of guidelines for the prevention and management of these complications. We need additional data from other countries, particularly from low-to-moderate income countries.
[Articles] Prevalence of post-acute sequelae of SARS-CoV-2 infection in people living with HIV: a systematic review with meta-analysis
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00572-8/fulltext?rss=yes
Current evidence indicates that the prevalence of Long COVID in adults living with HIV may be high, suggesting the need for increased awareness and education of healthcare providers and policy makers. Evidence on whether HIV positivity increases the risk of Long COVID is limited and inconclusive, highlighting a need for further research to clarify this potential association.
[Articles] Guselkumab in patients with moderately to severely active ulcerative colitis (QUASAR): phase 3 double-blind, randomised, placebo-controlled induction and maintenance studies
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01927-5/fulltext?rss=yes
Guselkumab was effective and safe as induction and maintenance therapy in patients with moderately to severely active ulcerative colitis.
[Articles] Global, regional, and national trends in drug use disorder mortality rates across 73 countries from 1990 to 2021, with projections up to 2040: a global time-series analysis and modelling study
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00564-9/fulltext?rss=yes
An increasing trend in global DUD mortality was observed from 1990 to 2021, especially in HICs. Future DUD deaths were also predicted to increase until 2040 at the global level. Therefore, these findings suggest urgent and proactive strategies for DUD to reduce the mortality rates related to DUD are needed. However, further prospective research that accounts for potential confounding factors, such as socioeconomic variables and the quality of reporting data from individual countries, is imperative for more accurate estimation.
[Comment] Assisted dying, complex systems, and global equity in palliative care
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02717-X/fulltext?rss=yes
In November, 2024, the UK Parliament voted to support the Terminally Ill Adults (End of Life) Bill.1 The bill would allow terminally ill adults with a prognosis of less than 6 months to request and be provided with assistance to end their lives. This bill is now at the Committee Stage of the parliamentary process and is expected to continue its passage to eventually become law. This change to UK law will have far-reaching impacts for death, dying, and palliative and end-of-life care for UK citizens.
[Articles] Impact of antiparasitic therapy on cardiovascular outcomes in chronic Chagas disease. A systematic review and meta-analysis
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00551-0/fulltext?rss=yes
We found compelling evidence that antiparasitic treatment significantly reduces the risk of ECG changes, disease progression, cardiovascular death, and overall mortality in chronic Chagas disease. Although the quality of evidence ranges from low to intermediate, with considerable heterogeneity across studies, the potential benefits are substantial. These findings support the broader use of trypanocidal therapy in the management of Chagas disease, though further research remains necessary.
[Articles] Outcomes of endometrial cancer prevention strategies in patients with Lynch syndrome: a nationwide cohort study in the Netherlands
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00585-6/fulltext?rss=yes
In a nation-wide cohort of Lynch syndrome carriers, nearly one-third of eligible carriers did not undergo gynaecological surveillance. Endometrial carcinomas diagnosed during surveillance were slightly more often stage FIGO IA, but this did not seem to substantially decrease the requisite for adjuvant therapy or affect overall survival, questioning effectiveness of current gynaecological management. Prospective research should further assess this, as well as patient preferences.
[Comment] Inorganic nitrates to prevent in-stent restenosis. Is nitric oxide the Philosopher's stone?
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00594-7/fulltext?rss=yes
Cardiovascular diseases remain the leading cause of mortality worldwide with coronary artery disease (CAD) representing the largest disease burden.1 Percutaneous coronary interventions (PCI) with implantation of drug-eluting stents (DES) represent the most frequent form of coronary revascularization worldwide.1,2 DES provide a drastic reduction in neointimal proliferation but, due to the ever-increasing complexity of patients, in-stent restenosis (ISR) still represents an major problem and unmet clinical need.
[Comment] Integrating environmental outcomes in randomised clinical trials: a call to action
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02666-7/fulltext?rss=yes
The use of the Earth's resources has overstepped several planetary boundaries. We are at risk of destabilising the planet with devastating consequences on the climate and other aspects of the environment.1 This process will adversely affect human health through interconnected effects such as food insecurity, extreme weather events, and the spread of infectious diseases.2 WHO has declared climate change the defining issue for public health and labelled the Paris Agreement the potentially strongest health-care agreement of this century.
[Correspondence] New undiagnosed disease in DR Congo: urgent action needed
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02794-6/fulltext?rss=yes
The outbreak of an undiagnosed disease in DR Congo, reported by WHO on Dec 8, 2024,1 is a pressing global health concern that demands swift and coordinated action. As of Dec 5, 406 cases and 31 deaths have been reported in the Panzi health zone in Kwango province, with influenza-like symptoms and anaemia. Most affected individuals are children aged younger than 5 years, many of whom are severely malnourished.
[Comment] Beyond repellents: spatial emanators for the control of malaria in Africa
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02754-5/fulltext?rss=yes
Spatial repellents have been used as commercial household bite prevention products since the early 1900s, but significant research into their application for public health only began in the 2000s. Spatial repellents have since evolved from formats requiring frequent replacement (daily or weekly) and external energy sources (such as mosquito coils, or fan–heat assisted release) to spatial emanator formats that passively dispense the active ingredient for months without heat or combustion. This makes them more suitable for public health use as they do not require electricity or regular compliance.
[Articles] Effect of a spatial repellent on malaria incidence in an area of western Kenya characterised by high malaria transmission, insecticide resistance, and universal coverage of insecticide treated nets (part of the AEGIS Consortium): a cluster-randomised, controlled trial
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02253-0/fulltext?rss=yes
Our trial provides the first evidence of a demonstrative spatial repellent protective efficacy in reducing risk of malaria infection in an African setting characterised by high malaria transmission, pyrethroid resistant malaria vectors, and high coverage of insecticide treated nets. Results support spatial repellent products as a beneficial component of malaria prevention.
[Correspondence] The perils of RFK Junior's anti-vaccine leadership for public health
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02603-5/fulltext?rss=yes
With global measles cases surging more than 20% in a year, the spectre of an anti-vaccine leader like Robert F Kennedy Junior at the helm of US health policy has alarmed public health experts. Kennedy, a well-known vaccine sceptic, has long promoted dangerous misconceptions about vaccines, and his influence could worsen an already dire situation.
[Articles] Effects of non-pharmacological interventions on depressive and anxiety symptoms in pregnant women: a systematic review and network meta-analysis
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00590-X/fulltext?rss=yes
Our findings indicate that mindfulness therapy significantly reduces the risk of depressive and anxiety symptoms in both high-risk pregnancy population and healthy populations. Therefore, when selecting non-pharmacologic therapies for managing depressive and anxiety symptoms during pregnancy, it is recommended that this therapy be considered. We cannot overlook the limitations of this study. For example, some interventions, such as muscle acupoint therapy for depressive symptoms and relaxation therapy for anxiety symptoms, have limited literature support.
[Review] Interventions used to reduce infectious aerosol concentrations in hospitals—a review
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00569-8/fulltext?rss=yes
The key finding is that infectious aerosol concentration improvement measures based on filtration, inactivation, improved air flow dynamics, and ventilation reduce the likelihood of nosocomial infections. However limitations of such approaches must be considered such as noise pollution and effects on ambient humidity. Whilst these efforts can contribute to improved air quality in hospitals, they should be considered with the other interacting factors such as microclimates, room dimensions and use of chemical products that effect air quality.
[Articles] Associations of dietary choline intake and kidney function with hyperuricemia in Chinese children and adolescents: a cross-sectional study
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00591-1/fulltext?rss=yes
Moderate to high intake of dietary choline (181.20–357.92 mg/d), particularly phosphatidylcholine (120.22–207.58 mg/d), and betaine (189.24–282.37 mg/d), may reduce the odds of HUA by improving glomerular filtration function. Further interventional studies are needed to establish causal relationships.
[Articles] Global assessment of leukemia care quality: insights from the quality of care index (QCI) from 1990 to 2021
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00575-3/fulltext?rss=yes
The QCI serves as an effective metric for evaluating the quality of leukemia care. Our findings reveal a strong association between leukemia QCI and regional economic and educational development. Age is a critical factor, with an aging population contributing to a potential decline in QCI. These results underscore the urgent need for targeted interventions to enhance health services for older adults and to improve care quality in economically disadvantaged regions.
[Comment] Guselkumab in the IL-23 inhibition landscape for ulcerative colitis
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02262-1/fulltext?rss=yes
The search for effective therapies in ulcerative colitis, a chronic inflammatory condition affecting the colon and rectum with a relapsing–remitting course, has been a long and challenging journey, especially for patients who do not reach remission with the current treatment options. Therapeutic limitations, such as the therapeutic ceiling, especially for bio-exposed patients, and the loss of response over time with long-term remission rates below 50% with advanced therapies, highlight the complexity of treating ulcerative colitis.
[Articles] Development and validation of a machine learning-based model to predict survival in patients with cirrhosis after transjugular intrahepatic portosystemic shunt
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00580-7/fulltext?rss=yes
This study developed a RF model that better predicted 1-year survival for patients with cirrhosis after TIPS placement than the other scores.
[Articles] Noninvasive respiratory support following extubation in critically ill adults with obesity: a systematic review and network meta-analysis
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00581-9/fulltext?rss=yes
The results suggest that compared to COT and HFNC, NIV alone or with HFNC reduces reintubation in critically ill patients with obesity after extubation. Compared to HFNC, NIV alone or with HFNC reduces mortality. The number needed to treat with NIV or NIV + HFNC to avoid one death was 15. These findings support the application of NIV to mitigate extubation failure in critically ill adults with obesity.