Medical Journal News

The government is to boost the day-to-day NHS budget by £22.6bn over two years and will inject more funding into the NHS capital budget, new equipment, more capacity for tests and surgical hubs, upgrading general practices, and social care.The average annual growth of 3.8% in real terms, when comparing 2025-26 with 2023-24, in NHS resources across the UK was revealed in the government’s autumn statement, announced on 30 October in the House of Commons.1Health service leaders and representatives cautiously welcomed the announcement, saying much more would be needed to repair an overstretched NHS.In her first UK budget since taking over as chancellor of the exchequer, Rachel Reeves said there would be a £22.6bn increase in the day-to-day health budget and a £3.1bn increase in the capital budget over this year and next—a combined boost to NHS money of £25.7bn.Reeves said these increases were the “highest since before 2010, excluding covid-19...

A man in his 40s presented to the dermatology outpatient department with a two month history of a painful black, gangrenous tip to his left middle finger, which initially had been dry but progressed to a serous discharge (fig 1). The patient reported a one month history of erythema, along with pain and mild numbness, of the finger tip before the gangrene had developed. No other fingers, or toes, were involved. The patient did not report any systemic disease or history of trauma. He was a current smoker with a 20 pack year history.bmj;387/oct31_5/e081084/F1F1f1Fig 1Gangrene on tip of fingerKey findings on examination included normal brachial pulses but reduced radial and ulnar pulses. Laboratory data showed normal coagulation and autoimmune profiles, with no evidence of cryoglobulinaemia or antiphospholipid syndrome. Duplex ultrasonography indicated patent artery flow without signs of proximal atherosclerotic disease. Angiography showed gradual tapering of the left ulnar artery with...

New England Journal of Medicine, Ahead of Print.

New England Journal of Medicine, Ahead of Print.

New England Journal of Medicine, Ahead of Print.

Nearly 80 years after the end of the National Socialist (Nazi) regime, its legacies persist with the continued use of anatomical atlases whose precise origins remain unknown.1 Although previous investigations on the history of anatomy during the Nazi era have revealed unsettling evidence concerning the Pernkopf atlas and other publications of knowledge gained from the bodies of Nazi victims in life and death,2 there remains poor insight into the origins of other anatomical atlases of this period.

The global public health burden of depression is extensively documented and is particularly challenging in low-income and middle-income countries (LMICs), where medical resources are scarce and health services need to manage the dual burden of high-prevalence communicable and non-communicable disorders. Creative solutions are needed, and work in the growing field of global mental health, including work on collaborative care and task-sharing, has made important advances in developing these solutions.

Integrated care for people with major depressive disorder and chronic health conditions is effective at reducing depressive symptoms, improving functioning, and reducing the odds of depression, and facilitates expansion of services through existing infrastructure.

AbstractObjectiveTo emulate target trials comparing recurrence of nephrolithiasis among patients with pre-existing nephrolithiasis (overall and stratified by concomitant gout) initiating sodium-glucose cotransporter-2 (SGLT-2) inhibitors versus an active comparator.DesignTarget trial emulation studies.SettingCanadian population database, January 2014 to June 2022.Participants20 146 patients with nephrolithiasis and type 2 diabetes, including those with concomitant gout at baseline, a high risk group.InterventionsInitiation of an SGLT-2 inhibitor or glucagon-like peptide-1 (GLP-1) receptor agonist, with a dipeptidyl peptidase-4 (DPP-4) inhibitor as alternative comparator.Main outcome measuresThe primary outcome was recurrent nephrolithiasis events ascertained from diagnoses during emergency department visits, hospital admissions, or outpatient visits. Secondary outcomes included nephrolithiasis resulting in hospital admission or emergency department visits and flare-up of gout, as well as a positive control outcome (genital infection) and negative control outcomes (osteoarthritis encounter and appendicitis). Poisson and Cox proportional hazards regression models were used (primary analyses), as well as overlap weighting.ResultsAfter inverse probability of treatment weighting, 1924 recurrent nephrolithiasis events occurred among the 14 456 weighted patients who used an SGLT-2 inhibitor (105.3 per 1000 person years), compared with 853 events among the 5877 weighted patients who used a GLP-1 receptor agonist (156.4 per 1000 person years). The adjusted rate ratio was 0.67 (95% confidence interval (CI) 0.57 to 0.79) and rate difference was −51 (95% CI −63 to −40) per 1000 person years, with a number needed to treat (NNT) of 20. Among those with recently active nephrolithiasis, the absolute rate difference was 219 per 1000 person years (NNT of 5). Protective associations persisted for nephrolithiasis events that required emergency department visits, hospital admissions, or procedures, and when an SGLT-2 inhibitor was compared with a DPP-4 inhibitor (rate ratio 0.73 (0.68 to 0.78), rate difference −38 (−46 to −29) per 1000 person years (NNT of 26)). Protective associations also persisted among patients with nephrolithiasis and concomitant gout, with a rate ratio of 0.67 (0.57 to 0.79) and rate difference of –53 (95% CI –78 to –27) per 1000 person years versus a GLP-1 receptor agonist (NNT of 19), and 0.63 (0.55 to 0.72) and–62 (–81 to –42) per 1000 person years, respectively, versus a DPP-4 inhibitor (NNT of 16). Furthermore, SGLT-2 inhibitor use was associated with a lower rate of gout flare-ups (rate ratio 0.72, 0.54 to 0.95, rate difference –16, –31 to –1 per 1000 person years) compared with GLP-1 receptor agonists (0.65, 0.52 to 0.82, and –21, –33 to –9 per 1000 person years) compared with DPP-4 inhibitors. SGLT-2 inhibitor initiators showed higher risk of genital infection (eg, hazard ratio 2.21, 95% CI 1.68 to 2.90, and rate difference 13 per 1000 person years), but no altered risk of osteoarthritis encounter (0.87, 0.68 to 1.1, and –2 per 1000 person years) or appendicitis (1.07, 0.69 to 1.67, and 1 per 1000 person years). Results were similar when propensity score overlap weighting was applied.ConclusionsThe benefits associated with SGLT-2 inhibitor for patients with nephrolithiasis in these target trial emulations suggest they may be a useful addition to current treatments to simultaneously manage nephrolithiasis recurrence and comorbidities, including gout.

When the World Health Organization (WHO) announced the roster last December for its first guideline panel “on the health of trans and gender diverse people,” it seemed heavily weighted towards the “gender affirming” approach, which promotes patient led access to hormonal and surgical treatments.12 The endeavour quickly became mired in controversy, including a mass letter to WHO from more than 100 clinicians. Signatories charged that most of the panel’s 21 members favoured the affirming approach, reporting affiliations with organisations including Global Action for Trans Equality (GATE) and the World Professional Association for Transgender Health (WPATH). There was also concern over the degree to which the panel’s recommendations would be evidence based.WHO seemed to address some of those criticisms: it published an FAQ document in January, postponed a February meeting to interpret evidence and issue recommendations, and in June announced that it was adding six new members.23That same month, however, documents...

Shortages of a radioactive isotope required for diagnostic imaging and procedures, as well as some surgeries, have led to patients facing appointment cancellations throughout the UK, the Royal College of Radiologists has told The BMJ.In a national patient safety alert on 25 October the Department of Health and Social Care warned NHS providers about shortages of molybdenum-99 (Mo-99)—a radioactive isotope used to produce technetium-99m (Tc-99m), which is critical for nuclear medicine.1This comes after the British Nuclear Medicine Society’s president, Jilly Croasdale, published a letter last month warning that the UK was “facing an extremely significant shortage in Molybdenum availability starting from the 21st October and lasting for at least the next 4 weeks until the week beginning November 14th.”2The shortage has been caused by production problems in Europe and is affecting all customers of Curium, a radiopharmaceutical company. Croasdale wrote, “Around 75% of the UK buy their generators from Curium,...

Historically, visual assessment-guided revascularisation led to overestimation of stenosis severity, resulting in overtreatment and poorer long-term outcomes.1 With optimisation of stents, procedures, and medical therapy, some consider these prognostic disadvantages a thing of the past.2 However, prevention of overtreatment remains a current topic regardless of prognostic impact due to associated costs, complications, and the focus on minimally invasive medicine. Functional assessment of intermediate stenoses with pressure measurements during invasive coronary angiography (ICA) has therefore been guideline-recommended since 2005.

The results of the FAVOR III Europe trial do not support the use of QFR if FFR is available to guide revascularisation decisions in patients with intermediate coronary stenosis. This finding could have implications for current clinical guidelines recommending QFR for this purpose.

Unlike in previous US presidential elections, healthcare—aside from questions of access to abortion and gender affirming care—has not played a central role in the upcoming contest between former president Donald Trump and vice president Kamala Harris. Gone are the intense debates on the merits of the Affordable Care Act; even the more recent issue of government oversight of pharmaceutical pricing generated few headlines. Surprisingly, neither candidate has delved deeply into one of the issues most troubling average Americans—the rising cost of medical care.The lack of debate makes it harder to predict what health policies a President Harris or Trump will prioritise. But either president will be faced with difficult decisions about tackling voters’ concerns about affordability while controlling federal healthcare spending. Policy options that could deliver more affordable care to voters include those that ensure more people and/or more services are covered by public or private health insurance, limits on...

Doctors felt overwhelmed, frightened, undervalued, and disposable during the covid pandemic, the BMA’s chair of council has told the UK Covid-19 Inquiry.Appearing before the inquiry on 28 October, Philip Banfield was asked whether the medical profession as a whole had felt overwhelmed, both personally and professionally, during the pandemic.“The feedback that we’ve had is that many people did feel overwhelmed—sickness rates went up, and that sense of burnout lasts to this day. We’ve seen a large number of people leave the service early because of the effects of that,” said Banfield.He added that doctors had been exposed to the virus more readily than the general public, many had died, and many hundreds had acquired long covid. He said that many doctors on the front line had been “frightened of what was about to come and then frightened about being put in situations that they were unfamiliar with, untrained for, [that]...

A surge in cases of tuberculosis means that it has surpassed covid-19 to be the world’s number one infectious killer disease, the World Health Organization (WHO) has said.About 8.2 million people had TB diagnosed in 2023, the highest number since WHO began recording the world’s TB cases in 1995 and up from 7.5 million cases reported in 2022.The disruption to health services caused by the covid pandemic has been a major setback for efforts to eradicate TB. Patchy global progress and a lack of funding has allowed the disease, which typically attacks the lungs, to prosper, said WHO experts in the organisation’s Global Tuberculosis Report 2024.1“The fact that TB still kills and sickens so many people is an outrage, when we have the tools to prevent it, detect it, and treat it,” said WHO’s director general, Tedros Adhanom Ghebreyesus. “WHO urges all countries to make good on the concrete commitments...

New England Journal of Medicine, Volume 391, Issue 17, Page 1610-1620, October 31, 2024.

New England Journal of Medicine, Volume 391, Issue 17, Page 1573-1583, October 31, 2024.

New England Journal of Medicine, Volume 391, Issue 17, Page 1584-1596, October 31, 2024.

New England Journal of Medicine, Volume 391, Issue 17, Page 1621-1631, October 31, 2024.