Medical Journal News

GBD 2021 Diabetes Collaborators. Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2023; 402: 203–34—In this Article, the map in figure 1 has been updated to correct boundary lines and shading in selected regions. This correction has been made to the online version as of Jan 16, 2025.

Based on cumulative failure rates and a 20% non-inferiority margin, antibiotic management of non-perforated appendicitis was inferior to appendicectomy.

A 4-year-old boy in a collision with a speeding motorcycle as he crossed the road was referred to our hospital from a peripheral clinic. The child had injuries to his left leg, left arm, chest, and head; there was no history of loss of consciousness.

Acute kidney injury (AKI) is a common, heterogeneous, multifactorial condition, which is part of the overarching syndrome of acute kidney diseases and disorders. This condition's incidence highest in low-income and middle-income countries. In the short term, AKI is associated with increased mortality, an increased risk of complications, extended stays in hospital, and high health-care costs. Long-term complications include chronic kidney disease, kidney failure, cardiovascular morbidity, and an increased risk of death.

Multidrug-resistant Gram-negative bacterial infections cause significant morbidity and mortality globally. These pathogens easily acquire antimicrobial resistance (AMR), further highlighting their clinical significance. Third-generation cephalosporin-resistant and carbapenem-resistant Enterobacterales (eg, Escherichia coli and Klebsiella spp), multidrug-resistant Pseudomonas aeruginosa, and carbapenem-resistant Acinetobacter baumannii are the most problematic and have been identified as priority pathogens.

白居易曾云：“生人莫作妇人身，百年苦乐由他人。”, 道尽了封建女性的辛酸。值得庆幸的是当下人们愿意平等的对待女性。可我学医以来的经历，似乎又在告诉我，在女性健康方面，一些传统观念仍好似蚕茧一般束缚着女性本身。

Prioritising keyworkers for vaccinationGiving evidence to the inquiry on 15 January, Jean Rossiter, who set up the group Covid-19 Bereaved Families for Justice UK, questioned if key workers such as teachers and transport workers should have been prioritised for early access to vaccination.1Rossiter’s son Peter was a music teacher who only received his first vaccine dose in May 2021, five months after the first vaccine was given in the UK. He contracted covid-19 soon after a delay in receiving his second dose in July. He was admitted to intensive care in hospital and died on 11 August.Covid inquiry chair Heather Hallet said, “You had a fit and healthy young son, under 40, and so it helps to remind people that we’re not just about protecting people who some may think have had a good innings, we’re about protecting the whole population.”Concern about delivery of vaccines in ScotlandMelanie Newdick, from Scottish...

All US women over 65 should be screened for osteoporosis to identify those needing treatment to prevent fractures, the US Preventive Services Task Force has recommended.1The task force also recommends screening postmenopausal women younger than 65 who are at risk for osteoporotic fractures because of risk factors such as low weight, parental history of hip fracture, cigarette smoking, or excess alcohol consumption.But the final recommendation concluded that more research was needed to determine whether men should be screened for osteoporosis.Esa Davis, task force member and professor of medicine and family and community medicine at the University of Maryland School of Medicine, said, “Too often, the first sign of osteoporosis is a broken bone, which can lead to serious health issues.” In the US about 27.1% of women over 65 and 5.7% of men over 65 have osteoporosis.The recommendation is based on a review, published in JAMA,2 which evaluated the evidence...

Medical organisations have welcomed an initial six week ceasefire agreement in the Gaza Strip that should end 15 months of war and allow the territory’s broken health system to be rebuilt.On 15 January Israel and Hamas agreed for hostilities to cease, hostages to be released, and eventually, for Israeli forces to withdraw from Gaza. The provisional agreement also stipulates that 600 trucks of humanitarian aid will enter Gaza each day from 19 January, when the agreement is initiated.1In a statement the humanitarian organisation Plan International said that the arrival of aid will help meet urgent medical needs and is a “moment of hope.” In the longer term it should lay the groundwork for the huge task of rebuilding essential infrastructure, such as hospitals.2“The destruction of homes, infrastructure, hospitals, schools, and essential services by the Israeli military has left Gaza in an unliveable condition,” the organisation said. “The few remaining hospitals...

by Lorenz von Seidlein

In this Perspective article, Lorenz von Seidlein outlines the promise of two malaria vaccines, and discusses some of the considerations for their roll out.

by Abhishek Bhatia, Alexander J. Preiss, Xuya Xiao, M. Daniel Brannock, G. Caleb Alexander, Robert F. Chew, Hannah Davis, Megan Fitzgerald, Elaine Hill, Elizabeth P. Kelly, Hemalkumar B. Mehta, Charisse Madlock-Brown, Kenneth J. Wilkins, Christopher G. Chute, Melissa Haendel, Richard Moffitt, Emily R. Pfaff, the N3C Consortium

Background

Nirmatrelvir with ritonavir (Paxlovid) is indicated for patients with Coronavirus Disease 2019 (COVID-19) who are at risk for progression to severe disease due to the presence of one or more risk factors. Millions of treatment courses have been prescribed in the United States alone. Paxlovid was highly effective at preventing hospitalization and death in clinical trials. Several studies have found a protective association in real-world data, but they variously used less recent study periods, correlational methods, and small, local cohorts. Their estimates also varied widely. The real-world effectiveness of Paxlovid remains uncertain, and it is unknown whether its effect is homogeneous across demographic strata. This study leverages electronic health record data in the National COVID Cohort Collaborative’s (N3C) repository to investigate disparities in Paxlovid treatment and to emulate a target trial assessing its effectiveness in reducing severe COVID-19 outcomes.

Methods and findings

This target trial emulation used a cohort of 703,647 patients with COVID-19 seen at 34 clinical sites across the United States between April 1, 2022 and August 28, 2023. Treatment was defined as receipt of a Paxlovid prescription within 5 days of the patient’s COVID-19 index date (positive test or diagnosis). To emulate randomization, we used the clone-censor-weight technique with inverse probability of censoring weights to balance a set of covariates including sex, age, race and ethnicity, comorbidities, community well-being index (CWBI), prior healthcare utilization, month of COVID-19 index, and site of care provision. The primary outcome was hospitalization; death was a secondary outcome. We estimated that Paxlovid reduced the risk of hospitalization by 39% (95% confidence interval (CI) [36%, 41%]; p < 0.001), with an absolute risk reduction of 0.9 percentage points (95% CI [0.9, 1.0]; p < 0.001), and reduced the risk of death by 61% (95% CI [55%, 67%]; p < 0.001), with an absolute risk reduction of 0.2 percentage points (95% CI [0.1, 0.2]; p < 0.001). We also conducted stratified analyses by vaccination status and age group. Absolute risk reduction for hospitalization was similar among patients that were vaccinated and unvaccinate, but was much greater among patients aged 65+ years than among younger patients. We observed disparities in Paxlovid treatment, with lower rates among black and Hispanic or Latino patients, and within socially vulnerable communities. This study’s main limitation is that it estimates causal effects using observational data and could be biased by unmeasured confounding.

Conclusions

In this study of Paxlovid’s real-world effectiveness, we observed that Paxlovid is effective at preventing hospitalization and death, including among vaccinated patients, and particularly among older patients. This remains true in the era of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Omicron subvariants. However, disparities in Paxlovid treatment rates imply that the benefit of Paxlovid’s effectiveness is not equitably distributed.

“We need more activity, and less waste,” says Wes Streeting in his introduction to NHS England’s plan to reform elective care.1 The recently published proposals set out how this will be achieved via: “productivity-boosting tools,” a “focus on improving experience and convenience,” and paying £20 to GPs who use the advice and guidance system to seek a secondary care opinion before, or instead of, making a formal onwards referral. The plan was illustrated by the story of a patient named Sarah, whose convoluted route to receiving a diagnosis of rhinitis and a hearing aid exposes the risks of focusing on itemisable activity instead of solutions to the deeper problems overwhelming the health service.The case study featuring Sarah was quietly removed from the document after a flurry of GPs pointed out that her treatment managed to be both idealistic and wholly inappropriate. But the most bemusing fact about her meandering clinical...

In mid-March 2020 and into April 2020, paediatric wards in England—usually full with children needing medical care due to respiratory diseases and other illnesses—were empty. The UK, and other countries in the world, were in a covid-19 lockdown. Schools were closing and children were staying at home and not mingling. The usual infectious disease mix that would result in children needing hospital care had a break. Paediatricians expected a quiet few months while NHS resources were directed towards the mounting wave of covid-19 hospital admissions, which were expected to be largely in the older and middle-aged population.And then incredibly unwell children started showing up in hospital.1 First one, then another one, and then several more. The children all had symptoms similar to the rare Kawasaki disease, an autoimmune disease, which can cause cardiac arrest and result in children being admitted to intensive care (ICU). Within the span of 10 days...

Médecins Sans Frontières (MSF) has withdrawn from a key hospital in Sudan’s capital Khartoum following months of violent attacks on patients and staff.1The aid organisation announced the “very difficult decision to suspend all medical activities” at Bashair Teaching Hospital—which is in an area controlled by the paramilitary Rapid Support Forces—on 9 January. It said extensive engagement with all sides in the conflict regarding keeping the hospital safe had failed.In November a patient was shot and killed inside the hospital, and in December attackers fired weapons inside the emergency ward and threatened medical staff. Bashair Teaching Hospital is one of the last functioning hospitals left in south Khartoum that offers free medical care. MSF has had a team working there since May 2023, the month after the civil war between the Sudanese Armed Forces and the Rapid Support Forces began.Claire San Filippo, MSF emergency coordinator, said, “Intense and extreme violence continues...

Providing calorie information labels on menus and food products has a small but important effect at a population level on the choices that people make, a large Cochrane review has concluded.1UK researchers analysed findings from 25 studies and found that calorie labels on supermarket products and on menus in restaurants lead people to select food with a smaller number of calories. They identified a 1.8% reduction in calories selected when labelling was in place, which they calculated meant 11 fewer kilocalories for a 600 kilocalorie (2.5 MJ) meal.Their results indicated that there may be a bigger effect of labelling on the food that people actually consumed (rather than just selected), with a 5.9% reduction, but the evidence to support this finding was weaker.A previous Cochrane review published by the same team suggested a bigger effect of calorie labelling,2 but more high quality research has been done since then. If sustained...

Wilkinson and colleagues1 and Simpson2 argue that the General Medical Council should overlook criminal behaviour when it aligns with their personal beliefs. Wilkinson and colleagues question the fairness of suspending a doctor involved in unlawful protests, while Simpson advocates sabotaging infrastructure. Both letters downplay the importance of professional accountability and public trust, prioritising personal views over professional obligations.The GMC’s role is to uphold public confidence in doctors, not to excuse criminal activity because it aligns with a specific cause. Activism does not require unlawful behaviour, and public trust in the medical profession depends on adherence to ethical and legal standards. Excusing criminal acts for any kind of activism sets a dangerous precedent. Would the public accept doctors going unsanctioned by the GMC for engaging in illegal activity while protesting against the tobacco industry, for example, despite its demonstrable harm to public health?Wilkinson and colleagues and Simpson must also recognise that...

In the UK, 2.8 million people are economically inactive and in receipt of health related welfare benefits.1 Almost a million young people aged 18-24 years are not in education, employment, or training, and one in five of those receives health related benefits, largely for mental health conditions.2 Following a decade of austerity, and exacerbated by the covid-19 pandemic, ill health and health inequalities have worsened in the UK such that it is the “sick (wo)man of Europe.”3The UK has far higher rates of health related worklessness than most other comparable economies (including Germany, Sweden, and France).4 It faces a serious economic challenge because of stagnating growth and widening inequalities in productivity, which contribute to rising rates of poverty and further inequalities in health.5Health related worklessness became a problem for the UK in the 1980s when rapid deindustrialisation led to mass unemployment, particularly in the north of England, Scotland, and Wales.1...

A nurse forced to change an incontinent patient with dementia beside a vending machine and a patient dying from a cardiac arrest who couldn’t be given adequate cardiopulmonary resuscitation (CPR) because of overcrowding in the corridor are just two examples from a stark new report from the Royal College of Nursing.1The report is based on a survey of 5408 UK nursing staff carried out from 18 December to 11 January 2025, in which more than two thirds (66.8%) said they had on a daily basis treated patients in inappropriate settings such as a corridor, bathroom, cloakroom, bereavement room, or converted cupboard. More than nine in 10 of those surveyed believed that patients’ safety was being compromised. Nurses reported caring for up to 40 patients in a corridor but unable to access oxygen, cardiac monitors, and other vital equipment.The report also highlights serious concerns about infection prevention and control. One nurse...

bmj;388/jan16_7/r92/FAF1faWhile he was a senior house officer in Ashington, Northumberland, Mike Snow developed open tuberculosis. He had a considerable amount of time off work, including 100 days of intramuscular injections of streptomycin.This experience may have coloured his choice of career. Despite infectious diseases being prevalent in the 1970s the specialty was in its infancy and most patients, apart from the most serious cases, were treated by general physicians.In 1978 Snow was appointed to a new post at Newcastle General Hospital, where most of the serious infectious diseases were treated. There was a small isolation unit to which any consultant in Newcastle could refer patients for nursing care, while their medical care would be delivered by the referring consultant. Snow took a strong interest in developing the unit.He completed his training as a physician and then spent six months in Birmingham with Alastair Geddes, a specialist in infectious diseases. HIV and...

Next week the US president elect, Donald Trump, will take office with a mandate to make radical changes to the government’s approach to medicine and public health.Health insurance coverage in particular faces massive, potentially harmful, reform (doi:10.1136/bmj.q2801).1 Republicans in Washington plan to shrink Medicaid, the programme for people on low incomes, potentially leaving millions of Americans uninsured. Traditional Medicare (for people over 65 and those with disabilities) could also reduce to the point that it covers only a small fraction of the current Medicare population.In the meantime, public frustration with insurers has been evident after the murder of Brian Thompson, chief executive of UnitedHealthcare (UHC) (doi:10.1136/bmj.q2879).2 It has exposed the healthcare giant’s high rate of insurance coverage denial and the misery this has caused. The fact that Luigi Mangione, who is accused of the murder, left a note accusing the US healthcare system of corruption and greed has been widely...