Medical Journal News

Kidney stones and the systemic conditions associated with them have a major impact on health and the economy in the US and worldwide.12 In recent years, the prevalence of kidney stones has increased in parallel with the epidemics of obesity and metabolic syndrome, as well as cardiorenal disease. Since 1988, when the US Food and Drug Administration approved potassium citrate to prevent recurrent nephrolithiasis, no other drug has been introduced for the secondary prevention of this chronic illness. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors are an accepted treatment for type 2 diabetes and have also emerged as a novel therapeutic class with beneficial cardiorenal effects.3In a linked paper, McCormick and colleagues (doi:10.1136/bmj-2024-080035) report a target trial emulation study evaluating SGLT-2 inhibitors in adults with recurrent nephrolithiasis and type 2 diabetes using the general Canadian population database.4 After inverse probability weighting or propensity score overlap weighting to balance the study groups, the authors...

AbstractObjectiveTo investigate the association between sodium-glucose cotransporter-2 (SGLT-2) inhibitor use and risk of all cause mortality among patients with heart failure with reduced ejection fraction.DesignLinked database study.SettingNational registers in Denmark, July 2020 to June 2023.ParticipantsPatients with heart failure, aged ≥45 years, with left ventricular ejection fraction ≤40%.Main outcome measuresThe primary outcome was all cause mortality comparing initiation and continued treatment with SGLT-2 inhibitors versus continued treatment with other standard-of-care heart failure drugs and non-use of SGLT-2 inhibitors; secondary outcomes were the composite of cardiovascular mortality or admission to hospital with heart failure and its individual components. Hazard ratios were estimated using Cox regression adjusted using inverse probability of treatment weighting based on propensity scores.ResultsThe study included 6776 patients who started SGLT-2 inhibitors (79% dapagliflozin; 21% empagliflozin) and 14 686 patients who remained on other standard-of-care heart failure drugs and did not use SGLT-2 inhibitors. Most SGLT-2 inhibitor users were male (70%), the mean age was 71.2 (standard deviation 10.6) years, and 20% had type 2 diabetes. During follow-up, 374 deaths occurred among SGLT-2 inhibitor users (incidence rate 5.8 per 100 person years) and 1602 among non-users (8.5 per 100 person years). The weighted hazard ratio for all cause mortality was 0.75 (95% confidence interval 0.66 to 0.85); the weighted incidence rate difference was −1.6 (95% confidence interval −2.5 to −0.8) per 100 person years. Secondary outcomes showed a weighted hazard ratio of 0.94 (0.85 to 1.04) for cardiovascular mortality or hospital admission with heart failure, 0.77 (0.64 to 0.92) for cardiovascular mortality, and 1.03 (0.92 to 1.15) for hospital admission with heart failure. The weighted hazard ratios for all cause mortality were consistent in patients with and without diabetes (0.73 (0.58 to 0.91) and 0.73 (0.63 to 0.85); P=0.99).ConclusionsIn this large database study among patients with heart failure with reduced ejection fraction, SGLT-2 inhibitor use was associated with a 25% lower risk of all cause mortality, supporting their effectiveness in routine clinical practice.

Heart failure is increasing in prevalence and is a major cause of morbidity and mortality worldwide,1 with prevalence ranging from 1% to 3% of the general adult population in high income countries.1 Limited data from low and middle income countries suggest high heart failure disease burden.23 Heart failure with reduced ejection fraction, defined as a left ventricular ejection fraction of ≤40%, accounts for around 30-60% of heart failure in epidemiological studies.1 Increasing evidence of the effectiveness of certain drugs to reduce mortality and morbidity in heart failure with reduced ejection fraction has led to strong recommendations for their use in clinical practice guidelines.45 The foundational therapeutic agents for heart failure with reduced ejection fraction have been shown to improve survival, reduce the risk of readmission to hospital, and improve symptoms by targeting the renin-angiotensin-aldosterone and sympathetic nervous systems. These include angiotensin converting enzyme inhibitors, angiotensin receptor blockers, angiotensin receptor-neprilysin inhibitors,...

Almost a third of children who live in the most deprived areas of England have obesity by the time they leave primary school—twice as many as those who live in the least deprived areas, an analysis has shown.Data covering 2023-24 from the annual national child measurement programme1 show that childhood obesity rates in England rose last year from 9.2% to 9.6% in reception year children (ages 4-5) and fell slightly in children in year 6 (ages 10-11) from 22.7% to 22.1%.But an analysis of the data by the Institute for Public Policy Research (IPPR) showed variation within these figures, as children in the most deprived parts of England in 2023-24 were twice as likely to have obesity as those in the least deprived areas. The think tank highlighted that this gap had widened since 2009-10, when children in the most deprived areas were 1.7 times as likely to have obesity.The...

The prolonged wearing of a tight waist cord, which is traditionally used to keep the underskirt of a sari in place, can cause friction on the skin that may lead to “petticoat” cancer, doctors from India have reported.Writing in BMJ Case Reports,1 the doctors described two cases of women developing Marjolin ulcers that were associated with continued wearing of tight saris. A Marjolin ulcer is a rare and aggressive squamous cell carcinoma that may develop in burn scars, venous ulcers, and other chronic wounds. The authors said that constant pressure on the skin can cause chronic inflammation that may lead to ulceration and progress to skin cancer.They explained that although the phenomenon had previously been described as “sari cancer,” the tightness of the waist cord was the problem. A type of squamous cell carcinoma in the waistline has also been observed in rural Indian men who wear dhotis tightly.2“Constant pressure...

Iacobucci reports that “public health leaders and campaigners welcome the UK government’s announcement that it will legislate to ban advertisements for junk food on television before 9 pm as part of efforts to tackle childhood obesity.”1But the problem is less about TV than social media. In the United Kingdom, the average time that children aged 4-15 years spend watching broadcast TV decreased from 242 min a day in 2010 to 38 min in 2023.2 By contrast, the average time spent on social media platforms (such as YouTube, TikTok, Instagram, Facebook, and X) has skyrocketed. In the United States, it ranged from 4.1 hours a day for 13 year olds to 5.8 hours a day for 17 year olds.3How could the Advertising Standards Authority, the UK’s regulator of advertising, be happy with the decline in children’s exposure to age restricted TV adverts,4 failing to understand that is not caused by regulation...

Universal health coverage means that “all people have access to the full range of quality health services they need, when and where they need them, without financial hardship.”1 All United Nations member states have committed to make progress towards universal health coverage. Despite two high level meetings on the topic, a persistent gap remains between ambitious commitment and concrete actions.23 One challenge limiting progress is the fragmented and convoluted way by which advocates make the case for it.3 Advocates can reduce such confusion and simplify political arguments by focusing on four core elements for what implementing universal health coverage needs to look like in practice.The range of nuanced issues encompassed by universal health coverage can make its translation into digestible political action difficult.4 In a world of increasing demand, limited budgets, and short term political attention cycles, we need to attune the principles of universal health coverage to existing realities...

The BMA has criticised the framing of a BBC news report that said consultant doctors were being paid as much as £200 000 a year in overtime to tackle the NHS backlog.1The BBC’s investigation reported that some NHS trusts were paying some consultants more than £200 an hour to try to cut waiting lists, which could equate to £200 000 a year from additional work for some doctors.The BBC said that the data it obtained showed that the overall overtime bill for the NHS in England was almost £1bn in 2023-24, which compares with £512m 10 years ago. However, some of that rise relates to more consultants being employed.The BBC reported that six in 10 consultants were working beyond their contracted hours, with average extra pay topping £27 000 a year, and that at least half of the 41 hospital trusts that responded to the BBC News request said that...

A United Nations summit on biodiversity that aimed to halt the collapse of nature has ended largely in disappointment as countries failed to present plans on how to save the natural world or to reach consensus on funding.The 16th Conference of the Parties (COP16) to the Convention on Biological Diversity followed the historic COP15 in Montreal in 2022, where UN member nations agreed to take urgent action to save the world’s flora and fauna, including protecting 30% of land and seas by 2030. As part of that agreement 196 nations agreed to find $200bn (£155bn; €186bn) a year by 2030 to protect and restore nature, with $20bn of that pot to be banked by 2025.COP16 was dubbed the “implementation COP”: the moment for countries to agree on exactly how to reach the targets set two years previously. But negotiators failed to reach consensus on setting up a new biodiversity fund...

Neelika Malavige knows first hand the toll that dengue can take. As a junior doctor in Sri Lanka who worked in a paediatric unit at the height of the covid-19 pandemic, she has witnessed three children dying from dengue during her time as an intern house officer. These deaths motivated her to learn more about the immunological response to the vectorborne disease.In Sri Lanka, every patient with dengue who presents with symptoms is monitored carefully. Severe dengue can lead to serious complications: plasma leakage, fluid accumulation, respiratory distress, severe bleeding, and organ impairment.The four dengue virus serotypes have all been circulating in Sri Lanka for more than 30 years. Since 2019, Sri Lanka’s zero dengue death policy has been a large part of the health ministry’s national dengue action plan. Keeping your surroundings clean, spraying insecticide, and eliminating mosquito breeding sites are common practices for dengue control around the world....

The health and social care secretary, Wes Streeting, has asked the NHS to “look at the case for lowering the screening age on prostate cancer,” particularly for people with a family history of the disease, after comments made by the Olympic cyclist Chris Hoy.1Hoy, who revealed last month that he has terminal cancer,2 has called for the prostate specific antigen (PSA) test to be available to men at a younger age. He told the BBC, “If you’ve got family history of it like I have, if you’re over the age of 45, go and ask your doctor . . . To me it seems a no brainer. Reduce the age, allow more men to just go in and get a blood test.”3The UK National Screening Committee has not recommended a national screening programme for prostate cancer because the benefits do not outweigh the harms, but any man over 50 who...

New England Journal of Medicine, Volume 391, Issue 18, Page 1685-1695, November 7, 2024.

New England Journal of Medicine, Volume 391, Issue 18, Page 1757-1757, November 7, 2024.

New England Journal of Medicine, Volume 391, Issue 18, Page 1758-1760, November 7, 2024.

New England Journal of Medicine, Volume 391, Issue 18, Page 1754-1756, November 7, 2024.

New England Journal of Medicine, Volume 391, Issue 18, November 7, 2024.

New England Journal of Medicine, Volume 391, Issue 18, Page 1743-1744, November 7, 2024.