The Lancet
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17 363
[Correspondence] Pregnancy as exclusion criterion in Ebola research: not again
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)01367-X/fulltext?rss=yes
As the 2026 Bundibugyo virus (Orthoebolavirus bundibugyoense) Public Health Emergency of International Concern progresses,1 we draw attention to key lessons from the 2014–16 Ebola (Orthoebolavirus zairense) outbreak in Guinea, Liberia, and Sierra Leone.2 One crucial learning was that women and gender-diverse people who were pregnant or breastfeeding were systematically excluded from most interventional trials.2 Exclusion has historically been the norm for protecting fetuses and those who are pregnant,3 however, if applied without contextualised justification, exclusion can harm instead of protect.
17 363
[Articles] Empirical treatment with valganciclovir in infants living with HIV and hospitalised with severe pneumonia in Africa: a multicentre, open-label, factorial, randomised, controlled, superiority trial
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00754-3/fulltext?rss=yes
Empirical valganciclovir treatment appeared to be associated with a lower hazard of death in infants with severe HIV-associated pneumonia than SOC alone or SOC plus empirical tuberculosis treatment, and there was little evidence of associated harms.
17 363
[Articles] 1-month versus 12-month dual antithrombotic therapy after percutaneous coronary intervention in patients with atrial fibrillation (OPTIMA-AF): a multicentre, open-label, hybrid non-inferiority and superiority, randomised, controlled trial
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00665-3/fulltext?rss=yes
Among patients with atrial fibrillation and predominantly chronic coronary syndrome undergoing PCI with intravascular imaging guidance, 1-month dual antithrombotic therapy followed by DOAC monotherapy was non-inferior to 12-month therapy for death or thromboembolic events and reduced major or clinically relevant non-major bleeding at 12 months, suggesting an overall favourable net clinical profile. Efficacy findings should be interpreted with appropriate caution in light of the lower-than-anticipated event rates and fixed absolute non-inferiority margin.
17 363
[Comment] Combination antithrombotic therapy in atrial fibrillation after coronary interventions: shorter duration, more safety?
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00747-6/fulltext?rss=yes
Patients with atrial fibrillation are at high risk of stroke and bleeding, and as coronary artery disease commonly coexists, such patients can present with chronic coronary syndrome or acute coronary syndromes including unstable angina, often requiring percutaneous coronary intervention (PCI) with coronary stenting.1 In such patients with atrial fibrillation, there are four factors that have to be carefully balanced: stroke prevention with the use of oral anticoagulant (nowadays usually a direct oral anticoagulant [DOAC]), given the high thromboembolic risk; antiplatelets for reducing recurrent cardiac ischaemia, especially in association with unstable angina; antiplatelets to reduce stent thrombosis; and bleeding risks when oral anticoagulant is combined with one or more antiplatelets, with the risk increasing with one and even greater with two antiplatelets.
17 363
[Perspectives] Embracing neurodiversity in medicine: insights from the history of psychiatry
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)01422-4/fulltext?rss=yes
At a time when political leaders in the USA still invoke an “autism epidemic” and recycle discredited theories of causation, it is important to reflect on what it means to be autistic. Despite the politics of autism, there has been an increasing drive to recognise autism as a form of neurodivergence over recent years. In line with the neurodiversity paradigm, to be autistic may be seen as both a disability and a difference—one that may manifest in positive and challenging ways depending on broader, external factors.
17 363
[Correspondence] Bundibugyo ebolavirus from the 2026 Ebola outbreak in Uganda and DR Congo: a new variant
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)01079-2/fulltext?rss=yes
Bundibugyo ebolavirus (BDBV) is one of three species members of the genus Orthoebolavirus (family Filoviridae) that cause disease in humans. The first BDBV outbreak was in the western Uganda district of Bundibugyo (2007–08) and involved 149 cases with 42 fatalities (37 confirmed and five suspected), resulting in a case-fatality rate (CFR) of 36%.1 The second BDBV outbreak was in Orientale Province, DR Congo, in 2012 and resulted in 38 laboratory-confirmed infections, with 13 laboratory-confirmed fatalities (CFR 34%), and 62 suspected infections, with 34 suspected deaths (CFR 47%).
17 363
[Clinical Rounds] Massive bilateral perirenal infiltration in Erdheim-Chester disease
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00864-0/fulltext?rss=yes
A 63-year-old man with a reported history of sarcoidosis, without histological confirmation, was referred for evaluation of persistent fever of unknown origin. Laboratory investigations showed microcytic anaemia (haemoglobin 9·1 g/dL, mean corpuscular volume 70 fL), elevated C-reactive protein (173 mg/L), hypergamma-globulinaemia (23% of total gamma globulins), and a trace monoclonal IgG λ component. Kidney function was normal (serum creatinine 0·7 mg/dL, estimated glomerular filtration rate 97 mL/min per 1·73 m2).
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[Comment] Our commitment to early-career clinicians and academics
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)01379-6/fulltext?rss=yes
The first years of medical research or practice are, arguably, the most important. This is the stage when experience and confidence develop, specialist interests flourish, and professional identity takes shape. But it is also, increasingly, a time of challenge. Workforce pressures and staffing shortages, funding constraints and cuts, and growing demands on universities and health-care systems are creating conditions that are particularly disruptive for those at the start of their careers.
17 363
[Articles] Oral antibiotic exposure and urinary tract infection risk in adults: a self-controlled case series study
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00313-5/fulltext?rss=yes
Oral antibiotic treatment was associated with a modest increase in UTI incidence in both sexes, with the highest risk observed within 30 days. These findings may be considered when prescribing antibiotics in primary care, particularly in otherwise healthy individuals.
17 363
[Articles] Risk of adverse pregnancy outcomes following inadvertent exposure to ivermectin during the periconception period: findings from two cluster-randomized trials in Mozambique and Kenya
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00322-6/fulltext?rss=yes
Among women exposed to ivermectin or albendazole between two weeks pre-conception and the first four weeks of pregnancy, this study found broad confidence intervals do not exclude a clinically meaningful difference in either direction. It does however add meaningful data to a small cumulative evidence base on inadvertent ivermectin exposure in early pregnancy, even if the number of exposures documented to date remains too small to support policy or regulatory conclusions.
17 363
[Articles] Compression systems for venous leg ulcers: a network meta-analysis and cost-effectiveness analysis
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00318-4/fulltext?rss=yes
These findings suggest potential small differences in the clinical effectiveness of 4LB/2LH, 2LB, SSB, and CW, but there is uncertainty in the estimates. In the UK, 4LB/2LH emerges as cost-effective.
17 363
[Articles] Clinical outcomes of invasive versus conservative strategies for very high-risk patients with non-ST-elevation acute coronary syndrome: an observational cohort study in a real-world population of China
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00324-X/fulltext?rss=yes
For very high-risk patients with NSTE-ACS, IS was associated with a lower risk of in-hospital and long-term all-cause death compared to conservative strategy. However, among patients who underwent invasive management, mortality outcomes were broadly similar across different timings of IS. Further randomised controlled trials are warranted to verify this finding.
17 363
[Perspectives] Alison Holmes: sustaining global attention on AMR
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)01384-X/fulltext?rss=yes
Alison Holmes is making plans. As the Director of the Fleming Initiative, a global partnership led by Imperial College London and Imperial College Healthcare NHS Trust, to combat antimicrobial resistance (AMR), she wants to use the 2028 centenary of Sir Alexander Fleming's discovery of penicillin “to reflect upon it and honour its legacy. But also as a focus to make sure that, in spite of the geopolitical changes related to funding, that we keep on shining a spotlight on AMR as a major global challenge that disproportionately effects the vulnerable and leaves people behind, and that research funding remains largely unrepresentative of who it most affects.” Holmes, who is also Professor of Infectious Diseases at Imperial College London and the David Price Evans Chair in Infectious Diseases and Global Health at the University of Liverpool in the UK, explains, “We need to maintain a sustained focus, ensuring the attention of policy and political leaders, and also embedding awareness in civil society and the young, so they can drive it.
17 363
[Articles] Eye movement desensitisation and reprocessing for post-traumatic stress in survivors of critical illness (EMERALD): a mixed-methods, randomised, single-blind, parallel group-controlled, feasibility trial
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00335-4/fulltext?rss=yes
A staged trial pathway of symptom screening, clinician-rated PTSD assessment, randomisation, and EMDR delivery was feasible and broadly acceptable in survivors of critical illness with clinically significant post-traumatic stress symptoms. Exploratory clinician-rated PTSD outcome estimates were hypothesis-generating and support progression to a definitive multicentre trial, but should not be interpreted as evidence of treatment effectiveness.
17 363
[Articles] Multi-centre, randomised, open-label, blinded endpoint assessed, trial of corticosteroids plus intravenous immunoglobulin (IVIG) and aspirin, versus IVIG and aspirin for prevention of coronary artery aneurysms (CAA) in Kawasaki disease (KD): the KD-CAA prevention (KD-CAAP) trial
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00297-X/fulltext?rss=yes
Prednisolone reduced treatment escalation, with potential health economic benefits, but did not reduce CAA in unselected European children with KD. CAA rates remained high, particularly in infants.
17 363
[Articles] Multidomain lifestyle intervention for the prevention of cognitive decline in at-risk older adults in Latin America (LatAm-FINGERS): a single-blind, multicentre, randomised controlled trial
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)01278-X/fulltext?rss=yes
A culturally adapted multidomain lifestyle intervention was feasible across Latin America and resulted in greater cognitive improvements than a flexible health-advice intervention in older adults at risk of cognitive decline. These findings extend the evidence base for multidomain lifestyle interventions to populations historically under-represented in dementia research, supporting their feasibility and scalability as strategies to reduce cognitive decline risk amid the rapidly growing burden of dementia in low-income and middle-income countries.
17 363
[Comment] Dementia prevention in Latin America and the Global South
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)01373-5/fulltext?rss=yes
Dementia prevention is becoming a testable public health strategy. The 2024 Lancet Commission on dementia prevention, intervention, and care estimated that about 45% of dementia cases might be prevented or delayed by addressing 14 modifiable risk factors.1 Because the distribution and impact of these factors vary across populations and might be higher in Latin America,2 interventions based on diet, exercise, social engagement, and vascular care cannot simply be transferred from high-income settings to Latin America without cultural and contextual adaptation.
17 363
[Comment] The recurring Ebola virus disease outbreaks in Africa: the problem is not outbreak response, but failure to sustain preparedness between epidemics
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00327-5/fulltext?rss=yes
The persistence of Ebola virus disease (EVD) outbreaks in Africa does not reflect an absence of knowledge about containment; rather, it reflects repeated failure to sustain preparedness between epidemics. The ongoing EVD outbreak in the Democratic Republic of the Congo (DRC) and Uganda, highlights critical gaps in preparedness despite substantial investments in outbreak response capacity since the 2014–2016 West African epidemic. The 2026 EVD outbreak is caused by Bundibugyo virus (Orthoebolavirus bundibugyoense), an Ebolavirus species for which there is currently no licensed vaccine or approved therapeutic.
17 363
[Articles] Clinicopathological, multimodal treatment, and survival patterns for men with breast cancer in England and Wales: a population-based cohort study
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00319-6/fulltext?rss=yes
These findings show that men with breast cancer presented differently to women. Despite breast cancer-specific survival being comparable for men and women, there were notable differences in the management of men with ER-positive EIBC which require further exploration, including increased surgery among older men, reduced neo-adjuvant chemotherapy, and increased post-mastectomy radiotherapy for intermediate- and low-risk disease.
17 363
[Articles] Relative risk and risk factors of all-cause, natural-cause and external-cause mortality after psychiatric hospitalisation: a population-based electronic health-record study in Hong Kong
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00329-9/fulltext?rss=yes
The immediate post-discharge phase is a critical window for targeted and diagnosis-specific intervention, including psychiatric/social/financial support. Future research should prioritise the development of robust risk prediction models that incorporate key risk factors identified to facilitate personalised care and improves post-discharge outcomes for high-risk individuals.
