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[Comment] Primary aldosteronism and plasma renin targets

Over the past two decades there have been tremendous advancements in the understanding of both the prevalence and the clinical significance of primary aldosteronism. Where previously only the most extreme cases were likely to be diagnosed and referred for management, primary aldosteronism is now known to be common, though it often remains under-recognised, with a 5–14% prevalence of primary aldosteronism in patients with hypertension who are seen in primary care settings.1 The relative risk of cardiovascular and renal disease in people with primary aldosteronism compared with primary hypertension is well described, and even subclinical primary aldosteronism has been associated with an increased rate of major adverse cardiovascular events.

[Comment] The road towards standardisation in cyclic Cushing's syndrome

Endogenous Cushing's syndrome is a severe, potentially lethal, endocrine condition. It is well known for its pleomorphic clinical manifestations that often overlap with those of frequent endocrine and non-endocrine disorders like arterial hypertension, type 2 diabetes, obesity, polycystic ovary syndrome, or postmenopausal osteoporosis.1 The absence of specific signs and symptoms leads to both over-testing and delayed diagnosis in patients with metabolic syndrome. Most clinical and biochemical manifestations are produced by excessive cortisol production from the adrenal glands, driven by autonomous adrenal tumours or by adrenocorticotropic hormone of pituitary or ectopic origin.

[Comment] Empagliflozin in chronic kidney disease: evidence for early, inclusive, and confident use

The scenario of chronic kidney disease (CKD) management has been transformed by the advent of sodium glucose co-transporter-2 (SGLT2) inhibitors, a class of drugs with benefits extending well beyond glycaemic control. In The Lancet Diabetes & Endocrinology, William G Herrington and colleagues1 present an individual participant-level meta-analysis encompassing 23 340 participants from four landmark placebo-controlled empagliflozin trials, representing a step forward in our understanding of the renal effects of empagliflozin across a spectrum of populations.

[Editorial] Diabetes support at work: an unmet need

According to the latest edition of the IDF Diabetes Atlas, 589 million people around the world were living with diabetes in 2024, with 70% being of working age. People with diabetes face many challenges in the workplace and have specific needs; however, these are often overlooked, and available support structures are either inadequate or absent. Aiming to close this critical gap, World Diabetes Day, 2025, continues the theme of diabetes and wellbeing with a specific focus on diabetes in the workplace, and calls on employers and employees to “Know more and do more for diabetes at work”.

[Correspondence] Nafithromycin in CABP: promise and precaution

We read with interest the recent phase III trial comparing nafithromycin with moxifloxacin for community-acquired bacterial pneumonia (CABP).1 The investigators are to be commended for conducting a large, multicentre, double-blind study of a novel oral macrolide. The evaluation of a short-course regimen against an established comparator adds important data to the field and highlights the potential role of new macrolides in CABP management.

“Ear Pressed to My Heart”: Sharing Poetry With Patients

Although most readers encounter poetry now as written text, it is fundamentally an oral and aural art form, meant to be spoken and heard. In ancient Greece, poetry was typically recited, accompanied by the strains of a lyre; in many Indigenous cultures, poetry and storytelling is incantatory, often with the specific intent of healing psychic injury. Such means of sharing poetry summon its visceral power, with rhythmic language mimicking our heartbeats and forging both physical and spiritual communion. Thus, it should seem unsurprising that sharing poetry with patients in medical contexts might interest clinicians. “Reading Emily Dickinson in the NICU” describes just such a human interaction, occurring inside a highly medicalized space. The poem depicts an intimate moment, as a newborn patient rests, ear to the speaker’s heartbeat, as she reads Dickinson’s poetry. Whether she reads aloud or not is almost irrelevant as we feel together the “hymnal cadence” of language, with Dickinson’s poem (perhaps “Once more, my now bewildered Dove”) echoed in the lulling meter and undergirding internal off-rhymes. This healing effect, re-encapsulated by the Dickinsonian reference to “a nested dove,” arises from and illuminates the layered connections that often intertwine with care: voiced poetry becomes another form of skin-to-skin contact, known to be therapeutic for NICU patients. Yet not only the patient is healed through this poetic touch, as the speaker, in feeling herself so profoundly adjoined to her patient, in the end recognizes “Together…we two survive.”

As Measles Cases Climb in the Americas, Vaccination Urged

As of September 12, more than 11 300 measles cases were confirmed in 10 countries in the Americas this year, a major increase from the 358 cases reported over the same period the previous year. Canada, Mexico, and the US contributed about 96% of the total cases in the region. The Pan American Health Organization (PAHO) urged countries to bolster vaccination efforts, enhance surveillance, and accelerate outbreak response amid these rising measles cases.

Mediterranean Diet May Offer Psoriasis Benefits

Extra virgin olive oil, plant-based foods, and moderate meat consumption may help with psoriasis, according to a recent study published in JAMA Dermatology. The randomized clinical trial found that a 16-week Mediterranean diet reduced psoriasis severity, possibly due to anti-inflammatory benefits. Current psoriasis dietary advice focuses on weight loss for patients who are overweight, but these findings suggest an option for all patients.

[Comment] Addressing unmet needs of adolescents to prevent unintended pregnancy in the Asia Pacific region

The World Health Organization (WHO) recently published an updated guideline on preventing early pregnancy in low- and middle income countries.1 This is an urgent reminder that adolescent pregnancy remains a global public health concern with serious and lasting consequences for young people, and that continued investment in adolescent pregnancy prevention will create healthier, more equitable societies where young people can thrive, now and into the future.1

A Global Perspective to Improving Mammogram Completion Among Women Overdue for Breast Cancer Screening

In this issue of JAMA Internal Medicine, Lee and colleagues report results of a randomized clinical trial evaluating reminder strategies for women overdue for breast cancer screening in Singapore. Screening mammography is widely recommended to reduce breast cancer morbidity and mortality, but adherence to recommended screening guidelines remains suboptimal. To improve population screening rates, trials have shown that a variety of primary care-based interventions, including mailed reminders, behavioral interventions, and community health worker/patient navigator outreach, increase screening adherence. However, almost all population-based cancer screening studies have been performed in high-income, Western countries in North America, Europe, and Australia.

Childhood Cholesterol Screening Is Not Cost-Effective

Childhood cholesterol screening is controversial. For decades, clinician-scientists have disagreed on the questions of whether, when, and how to screen for hypercholesterolemia in youths. For example, 2 members (myself and 1 other) of the 2011 National Heart, Lung, and Blood Institute (NHLBI) Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents agreed on the factual answers to the questions the panel addressed, but differed on their interpretation and thus recommendations for childhood lipid screening in clinical practice.

Broader Adoption of SGLT2 Inhibitors in Clinical Practice

Over the past decade, the indications for sodium-glucose cotransporter 2 (SGLT2) inhibitors for kidney and cardiovascular risk reduction have expanded, driven by clinical trial evidence demonstrating their efficacy among individuals with chronic kidney disease (CKD), heart failure, diabetes, and atherosclerotic cardiovascular disease. Current clinical practice guidelines for people with CKD recommend their use for individuals with an estimated glomerular filtration rate (eGFR) greater than or equal to 20 mL/min/1.73 m2 who also have type 2 diabetes, heart failure, or a urine albumin to creatinine ratio (UACR) greater than 200 mg/g. A major unanswered question is whether SGLT2 inhibitors would improve kidney outcomes among those with lower degrees of albuminuria or more advanced CKD than recommended by current guidelines. To address this crucial knowledge gap, the SGLT2 Inhibitor Meta-Analysis Cardio-Renal Trialists’ Consortium (SMART-C) conducted 2 companion meta-analyses of randomized placebo-controlled SGLT2 inhibitor trials to assess the effect on kidney outcomes among key subgroups of patients and report their results in this issue of JAMA.

Divergent GFR Estimates and Clinical Implications

Chronic kidney disease (CKD) affects more than 800 million people worldwide, significantly increasing the risk for kidney failure, cardiovascular disease, and all-cause mortality. Accurate assessment of glomerular filtration rate (GFR) is essential for identifying and managing CKD. Although GFR is most accurately measured by analyzing the rate of kidney excretion of infused exogenous substances, such as inulin or iohexol, this is not practical in most cases. Therefore, estimated glomerular filtration rates (eGFRs) have become important for CKD diagnosis and management.

Prerenalism—A Gap That Costs Lives, Hearts, and Kidneys

Chronic kidney disease (CKD) is a powerful risk enhancer for cardiovascular disease (CVD) and exhibits a dose association for higher rates of death and adverse cardiovascular outcomes by declining strata of estimated glomerular filtration rate (eGFR) and increasing albuminuria. The recently defined cardiovascular-kidney-metabolic (CKM) syndrome highlights the overlapping pathophysiological mechanisms between obesity, diabetes, and CKD, which amplify CVD risk in tandem with adverse socio-ecological factors. The emerging array of highly efficacious therapies for CKM conditions represents a vast opportunity to modify the global burden of CVD by identifying and treating CKD, given their congruent cardiovascular-kidney benefits. Importantly, CVD and premature mortality are the major competing risks for kidney failure in individuals with diabetes and CKD, and cardiovascular and survival benefits may precede protection from kidney failure with CKM therapies in high-risk CKD populations.

[Personal View] Zoonotic infections due to avian Chlamydia abortus: what are we missing?

Chlamydia abortus is an obligate intracellular bacterium primarily affecting ruminants and causing reproductive failures in sheep and goats. As a recognised zoonotic pathogen, C abortus can cause obstetric and respiratory infections in humans, with severe consequences in pregnant women and immunocompromised individuals. Previous studies have identified novel C abortus strains in avian species, closely related to the zoonotic Chlamydia psittaci, with some strains associated with cases of human pneumonia.