Medical Journal News

It has been almost 1 year since the detection of an unprecedented spread of highly pathogenic avian influenza A(H5N1) in dairy cows in the USA. Although there is still no evidence of human-to-human transmission and human deaths have been rare, concern over the potential impacts on human health remains high. The B3.13 genotype has predominated in cattle and human beings, causing largely mild disease, but there have been worrying recent developments. In the past couple of months a new genotype, D1.1, resulted in the death of a person in Louisiana—the first death in the USA from H5N1—while a teenager in Canada was critically ill for several months.

Timely access to critical care saves lives in any health-care context. In high-income settings, the term critical care is associated with a geographically defined location within a hospital, equipped with advanced technologies requiring substantial financial resourcing. However, technology-driven care delivered in critical care units is not the same as providing timely and appropriate care to critically ill patients regardless of location, especially in resource-limited settings.1 Broadening this concept to people at risk of, or having developed, critical illness, allows the focus to move to acute management strategies which can be delivered to critically ill people across heath-care settings.

Venous thromboembolism, comprising pulmonary embolism and deep vein thrombosis, is a common disease with considerable mortality and morbidity, such as post-thrombotic and post-pulmonary-embolism syndrome.1,2 Anticoagulation is the main treatment for venous thromboembolism, although the decision on how, and for how long, anticoagulant treatment should be administered is increasingly complex. Despite the improved safety profile of direct oral anticoagulants compared with vitamin K antagonists, even with direct oral anticoagulants a substantial residual bleeding risk remains.

To secure his confirmation as Health and Human Services chief, Kennedy made commitments to undecided senators that are already being put to the test. Susan Jaffe reports from Washington, DC.

In the first part of a new series on medicine in unusual settings, Talha Burki puts the medicine of film and television in the spotlight.

Strategies to improve cardiovascular health are at the heart of Nancy Brown's work as Chief Executive Officer (CEO) of the American Heart Association (AHA). The AHA funds research, advocates for the public's health, and shares life-saving resources. Under her leadership, it has advanced public policies to create healthier communities across the USA. “The AHA was one of the first organisations to sign on in support of the Affordable Care Act against many headwinds, because of our commitment to ensuring access to high-quality health care for all.

What does it mean for a computer to think like a doctor? This question has vexed physicians working on clinical reasoning artificial intelligence (AI) for more than 70 years. The first generation of physicians to tackle this question disagreed with the premise; humans were too intuitive, often relying on a “feeling about the case”. Instead, they advanced “computerised” reasoning, based on large-scale epidemiology, standardised data collection, and probabilistic inference. These technologies, rebranded as clinical decision support by Tim De Dombal in the 1970s, are a daily part of medical life; they triage patients with pulmonary embolism, help determine whether a sore throat needs antibiotics, and provide patients and their doctors with important information about cancer prognosis.

I was diagnosed with chronic inflammatory demyelinating polyneuropathy at the age of 16 years as I began training in Indian classical dance. This rare neurological condition resulted in partial paralysis of my lower limbs and shattered my dream to become a professional dancer. It also paved a pathway for me to become a health justice scholar driven by lived realities of marginalisation and resilience. While I am grateful to walk with assistive devices, my gait is far from perfect in the eyes of society.

Respiratory physician and pioneer in adolescent health. Born on Nov 2, 1948, in Melbourne, VIC, Australia, he died there from complications of a recurrence of cholangiocarcinoma on Jan 16, 2025, aged 76 years.

The Comment by Patricia J García and colleagues,1 calling for the creation of a new health agency for Latin America, pays no justice to the role of the Pan American Health Organization (PAHO). For more than 120 years, PAHO has served the countries and territories of the Americas to benefit the people of the region without political boundaries or vested interests.2 The oldest international public health agency in the world has a proven record of helping countries to prevent, control, and eliminate diseases such as smallpox, poliomyelitis, rubella and congenital rubella syndrome, measles, and neonatal tetanus.

In response to Marcos A Espinal and colleagues, and their challenge to our call for the creation of a dedicated Latin American Regional Centre for Disease Control and Prevention (LATAM-CDC).1 Although we acknowledge the substantial contributions of the Pan American Health Organization (PAHO) over its century-long history, PAHO is the office of WHO for the Americas, and thus is only accountable to Member States. A LATAM-CDC could function as a specialised agency with a focused mandate, and would benefit from a broader funding base and a different governance structure, enabling collaboration with and accountability to a wider range of stakeholders, including governments, civil society, academia, and the private sector.

The recent study by Holger Thiele and colleagues1 offers an extensive meta-analysis on the use of mechanical circulatory support (MCS) in acute myocardial infarction-related cardiogenic shock (AMICS). Although the study is comprehensive, there are aspects that could benefit from further discussion. Clarification of these points could help refine clinical practice in the management of AMICS and guide future research efforts.

Holger Thiele and colleagues1 have provided an important meta-analysis of trials of temporary mechanical circulatory support (MCS) in acute myocardial infarction-related cardiogenic shock (AMICS). As the authors discuss, all trials of temporary MCS in AMICS had been neutral until the DanGer Shock trial of the microaxial flow pump, which was the first to show a survival benefit.2 Notably, DanGer Shock was also the first trial to introduce more selective recruitment by aiming to exclude patients with irretrievable neurological injury at baseline.

We read with great interest the meta-analysis of individual patient data by Holger Thiele and colleagues,1 which suggests that judicious patient selection for mechanical circulatory support (MCS) is essential to achieving true clinical benefit for patients with acute myocardial infarct-related cardiogenic shock. We appreciate the valuable insights provided by the authors into the indications for MCS use and wish to offer some additional guidance. Device type (ie, unloading vs venoarterial extracorporeal membrane oxygenation [VA-ECMO]) was not a key outcome determinant, and there was no group with combined use of VA-ECMO and unloading devices in the meta-analysis.

We read with great interest the meta-analysis of trials of temporary mechanical circulatory support (MCS) in acute myocardial infarction-related cardiogenic shock (AMICS) by Holger Thiele and colleagues.1 We have some suggestions that, we hope, could enhance interpretation of the study results and enable readers to more easily understand the findings.

In the meta-analysis by Holger Thiele and colleagues,1 mechanical circulatory support (MCS) improved outcome in acute myocardial infarct-related cardiogenic shock only in patients with ST elevation and without risk of hypoxic brain injury.

We thank our colleagues for their interest in our Article.1 We agree with Zaoqu Liu and colleagues that in addition to mortality assessment, quality of life and long-term functional outcomes are important determinants for survivors of acute myocardial infarct-related cardiogenic shock (AMICS). Unfortunately, this information has not been kept in the case report forms of most of the trials included in this meta-analysis.1 However, other long-term follow-up studies of randomised trials, as well as registries, have shown relatively good quality of life and functional outcomes in survivors of AMICS.

André T, Elez E, Lenz H-J,et al. Nivolumab plus ipilimumab versus nivolumab in microsatellite instability-high metastatic colorectal cancer (CheckMate 8HW): a randomised, open-label, phase 3 trial. Lancet 2025; 405: 383–95—The appendix of this Article has been corrected as of Feb 27, 2025.

Baumbach A, van Royen N, Amat-Santos IJ, et al. LANDMARK comparison of early outcomes of newer-generation Myval transcatheter heart valve series with contemporary valves (Sapien and Evolut) in real-world individuals with severe symptomatic native aortic stenosis: a randomised non-inferiority trial. Lancet 2024; 403: 2695–708—In the appendix for this Article, the spelling of Dario Pellegrini's name in the LANDMARK trial investigators list was incorrect.The appendix of this Article has been corrected as of Feb 27, 2025.

One in eight patients in hospitals in Africa are critically ill, of whom one in five dies within 7 days. Most critically ill patients are cared for in general wards, and most do not receive the essential emergency and critical care treatments they require. Our findings suggest a high burden of critical illness in Africa and that improving the care of critically ill patients would have the potential to save many lives.