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General Medicine
29th Oct, 2025
The Lancet
“FACT: #COVID19 is NOT airborne”, declared a tweet from WHO in March, 2020. WHO did not officially accept until almost 2 years later that infection by SARS-CoV-2 could after all be caused by long-range airborne transmission. Throughout the worst ravages of the disease, WHO continued to insist that viral transmission happened either by fomites or by relatively large droplets emitted by people coughing and sneezing. Instead of focusing on ventilation, we (some of us) solicitously observed the 2 m distancing rule and, at least in the early days of the COVID-19 pandemic, assiduously washed the mail and groceries delivered at our door.
The World Health Summit has proved itself the premier global health event of the year. Under the banner “Taking responsibility for health in a fragmenting world”—symbolised by a giant stage globe cracking during a flamboyant evening “signature event”—summiteers, despite facing their biggest financing catastrophe for a generation, were remarkably upbeat. Perhaps they were all in denial. Or enjoying euphoric freedom from American hegemony. The star political guest was Germany's Federal Minister of Health, Nina Warken.
There is no equity in access to basic health care. The latest biennial report on universal health coverage reported that in 2021 4·5 billion people—about half the world's population—had no access to basic health services, and progress has stalled since 2019.1 The percentage of people facing catastrophic out-of-pocket expenditure for health care has risen from 11·9% in 2005 to 16·7% in 2019, with high expenditure on medicines being a major contributor.1
Since the egregious civilian massacre on Israeli civilians by Hamas on Oct 7, 2023, there have been grave concerns about the conduct of Israeli military operations in Gaza with regard to proportionality and breaches of humanitarian protocols, which a recent UN commission concluded met the legal definition of genocide.1 The most recent Integrated Food Security Phase Classification (IPC) report, issued in August, 2025, declared famine in the governorate of Gaza City (one of five governorates), comprising a quarter of the population, and stated that the remainder of the Gaza Strip is facing critical or emergency conditions,2 assessments that the Israeli Government continues to deny.
Obstructive sleep apnoea (OSA) affects up to 1 billion people worldwide and is defined by repeated upper airway collapse during sleep, leading to intermittent hypoxaemia and disrupted sleep. Although severity is measured by the Apnoea–Hypopnea Index (AHI), and OSA has been associated with many adverse cardiometabolic and neurocognitive outcomes, treatment indications primarily reflect proven benefits: improving symptoms—especially daytime sleepiness—and lowering blood pressure.1 Continuous positive airway pressure is the first-line therapy and effectively prevents airway collapse, but long-term discontinuation rates can be substantial.
For decades, evidence guiding the diagnosis of postpartum haemorrhage has been constrained by traditional aggregate data reviews that mask patient-level variation and rely on arbitrary thresholds. The WHO-led individual participant data (IPD) meta-analysis by Ioannis Gallos and colleagues represents a methodological breakthrough, assembling original, anonymised records from more than 312 000 women and reanalysing prognostic markers for adverse postpartum haemorrhage outcomes at the participant level, rather than through study-level summaries.
The integration of Bruton tyrosine kinase (BTK) inhibitors into first-line treatment regimens, in combination with immunochemotherapy, constitutes the new standard of care following the recent approval of ibrutinib and acalabrutinib for transplant-eligible and transplant-ineligible patients with mantle cell lymphoma, respectively.1–3 In younger and fitter patients, ibrutinib is administered in combination with R-CHOP (rituximab–cyclophosphamide, doxorubicin, vincristine, and prednisolone) alternating with R-DHAP (rituximab, dexamethasone, cytarabine, and cisplatin) as induction, followed by optional autologous haematopoietic stem-cell transplantation and time-limited maintenance.
The UK is facing a pharma exodus. Major pharmaceutical companies have withdrawn about £2 billion in proposed investment from the country, blaming insufficient government investment. Central to the dispute is the amount of money that the National Health Service (NHS) spends on medicines—the main argument being that without adequate reward, industry investment in research and development will evaporate. The standoff has been catalysed by Donald Trump's threats to place vast tariffs on US medicine imports if companies do not level the prices the USA pays for drugs.
Diabetes & Endocrinology
5th Nov, 2025
New disease-modifying therapies, such as teplizumab, offer opportunities to delay the clinical onset of type 1 diabetes but require islet autoantibody screening to identify individuals at increased risk of progression to diabetes. As type 1 diabetes screening programmes expand, clinicians will increasingly encounter a new group of people: adults who test positive for islet autoantibodies but have not yet been diagnosed with diabetes. Although international guidelines outline management for both children and adults, considerable uncertainties remain, particularly for adults.
Despite advances in targeted therapies, treatment with glucocorticoids remains a mainstay in the management of various immune-mediated diseases. High cumulative doses of exogenous glucocorticoids lead to a spectrum of side-effects, in particular increased fracture risk. Fragility fractures might result in immobility, frequent admission to hospitals, and loss of quality of life. Glucocorticoid excess impairs bone microarchitecture and bone strength and can cause multiple vertebral fractures. Fracture risk at other skeletal sites is also enhanced and triggered by an increased risk for falls.
Despite improvements over the past two decades, underdiagnosis and suboptimal glycaemic management of diabetes remain major challenges globally, particularly in low-income and middle-income countries. These findings highlight the urgent need for enhanced strategies and capacity building to improve the detection, treatment, and management of diabetes worldwide. Targeted interventions to bolster health-care systems' capacity to effectively diagnose and manage diabetes could lead to better health outcomes and reduce the burden of this growing disease.
Participants receiving monlunabant showed statistically significant and clinically meaningful weight loss compared with those receiving placebo for all tested doses. Only slightly greater weight loss was observed at higher doses, whereas adverse events appeared dose dependent. Further investigation is needed to assess the safety and efficacy of lower doses of monlunabant, to evaluate its potential as a medication for obesity.
Brandi ML, Pieterman CRC, English KA, et al. Multiple endocrine neoplasia type 1 (MEN1): recommendations and guidelines for best practice. Lancet Diabetes Endocrinol 2025; 13: 699–721—In this Review, the spelling of Camilla Schalin-Jäntti's name was incorrect in the appendix. This correction has been made to the online version as of Sept 18, 2025.
Type 1 diabetes is a lifelong condition requiring a multitude of tasks and constant adaptation to evolving physiological and lifestyle needs. Following a type 1 diabetes diagnosis, and throughout their life, people living with type 1 diabetes are empowered through regular care and structured education. Existing diabetes education programmes provide knowledge on carbohydrate counting, sick day rules, and exercise but they do not explore and address the varying and complex needs that emerge with ageing.
Education is a central pillar of type 1 diabetes care. Health-care professionals must educate people with type 1 diabetes and their carers to make numerous diabetes-related decisions per day pertaining to high-level medical concepts, including the effects of nutrition, exercise, and hormones on insulin needs. Self-management of type 1 diabetes affects glycaemia, which in turn influences acute and chronic type 1 diabetes-related complication risks and quality of life. As approaches to type 1 diabetes diagnosis and therapy rapidly evolve, the interprofessional teams caring for people with type 1 diabetes across the lifespan must absorb new information and incorporate it into practice.
Microbe / Infectious Research
11th Mar, 2026
Neurology
Rheumatology
