Lancet

Although acute hearing loss is known to be a warning sign for posterior circulation strokes,1 our experience suggests that hearing assessments remain rare in suspected cases of stroke—even when patients report hearing issues. This gap illustrates a failure to integrate research findings into routine stroke evaluations. One issue is that hearing loss has drifted away from being recognised as a focal neurological sign. This issue is particularly concerning for anterior inferior cerebellar artery stroke, in which hearing loss and vertigo often precede more obvious stroke symptoms, such as hemiparesis or aphasia, and carry a higher mortality than in other stroke types.

We applaud Trisha Greenhalgh and colleagues for their comprehensive Review on post-COVID-19 condition (also known as long COVID).1 However, children are insufficiently acknowledged. In the USA, approximately 20% of COVID cases were children, with estimates stating up to 5·8 million (20%) children in the USA could have long COVID.2 The potential effect of what we have termed Generation C is immense. This group is relatively understudied and outcome studies focused mainly on severely affected groups (ie, acute COVID-19 or multisystem inflammatory syndrome in children).

The findings from the SELECT trial offer crucial insights into the cardiovascular benefits of semaglutide in patients with obesity and prevalent heart failure.1 However, upon examining the discussion, specific interpretations warrant closer scrutiny. First, while the study reports improvements in major adverse cardiovascular events and composite heart failure outcomes in patients with and without heart failure, the differentiation between heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) could benefit from deeper exploration.

We read with interest the paper by John Deanfield and colleagues on the effects of semaglutide in patients with obesity and heart failure.1 We recently published a Trial Perspectives article in the Journal of the American College of Cardiology based on data from the SELECT trial presented at the Heart Failure Congress, in which we dispute the findings of Deanfield and colleagues with respect to patients with heart failure and reduced ejection fraction (HFrEF).2 As we highlight, the analyses of Deanfield and colleagues’ data do not show that semaglutide is safe for patients with HFrEF.

We are pleased that both Jiashu Han and Dan Shan, and João Sérgio Neves and colleagues have read our Article with interest. The SELECT trial1 represents the largest report of a GLP-1 receptor agonist in patients with known cardiovascular disease and heart failure with overweight or obesity, but without diabetes.

We read with great interest the study by Kenneth Chan and colleagues.1 In particular, they use artificial intelligence (AI) visual recognition and prediction algorithms to combine perivascular fat attenuation index scores, atherosclerotic plaque burden, and patient clinical risk factors, thereby providing new insights into inflammatory status and cardiovascular risk in patients with non-obstructive coronary artery disease. However, we have several concerns about this trial.

Although high-sensitivity C-reactive protein (hsCRP) is used as a so-called thermometer for systemic inflammation,1 the search for specific markers for atherosclerotic (coronary) inflammation is ongoing.

I read with great interest the Article by Kenneth Chan and colleagues1 on the inflammatory risk and cardiovascular events in patients without obstructive coronary artery disease.1 Their findings offer crucial insights into the role of coronary inflammation, measured by the perivascular fat attenuation index (FAI) Score, in predicting cardiac mortality and major adverse cardiac events.

We thank our colleagues for their interest in our Article.1 In response to Kun Zhao and colleagues, the original method of measuring fat attenuation index (FAI) was corrected for scan parameters (ie, weighted attenuation).1 However, translation to a clinically applicable tool required rigorous standardisation2 for technical, anatomical, and biological factors, now captured by FAI Score,3 which is embedded into a prognostic model (AI-Risk).3 These algorithms were evaluated by the regulatory bodies in Europe, the UK, and Australia, and the locked algorithms were cleared as a medical device.

While nerinetide did not improve outcomes in patients with acute ischaemic stroke, it was not associated with excess adverse events. Further study is needed to identify the ideal timing of treatment and the sub-population of stroke patients who might benefit from treatment combined with current reperfusion therapies.

Prehospital nerinetide did not improve neurological functional outcomes in all patients with suspected ischaemic stroke in the mITT population. Nerinetide might benefit patients with acute ischaemic stroke who are selected for reperfusion therapies within 3 h of symptom onset. This finding should be confirmed in a future trial.

Atopic dermatitis is the most common chronic inflammatory skin disease globally. Key features include an eczematous eruption accompanied by intense itch, which can have an enormous negative effect on patients’ quality of life, especially in those with moderate-to-severe disease. Atopic dermatitis is part of a spectrum of atopic conditions that can also include several non-cutaneous organs such as respiratory (eg, allergic rhinitis and asthma) and gastrointestinal (eg, food allergy) systems. For decades, long-term disease control and maintenance were particularly challenging given that treatment options were limited to broad topical and systemic immunosuppressive agents.

The recently re-elected President of the USA's decision to withdraw the USA from WHO is highly regrettable on multiple levels, and hopefully will be quickly reconsidered.1,2 But if it holds, it nevertheless provides other countries with a unique opportunity, and even an obligation, to step up and take the lead in shaping global health policy.

Clinical trials have been pivotal to the improvements in public health and clinical care, leading to many millions of additional years of healthy life globally. Some examples of disease areas in which outcomes have improved include primary and secondary prevention of cardiovascular disease, breast cancer, some forms of leukaemia, and HIV treatment and prevention. In all of these disease domains, clinical practitioners have embraced the centrality of evidence from clinical trials and large-scale randomised clinical trial (RCT) collaborations have been implemented in partnership with patients, health systems, industry, and other partners.

Primary health care (PHC) was established as a global priority in the 1978 Alma-Ata Declaration.1 Four decades later, the 2018 Astana Declaration2 reaffirmed the call for universal health coverage for all individuals across the life course, emphasising essential public health functions, community engagement, and a multisectoral approach to health.