Lancet
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Malaria is resurging in many African and South American countries, exacerbated by COVID-19-related health service disruption. In 2021, there were an estimated 247 million malaria cases and 619 000 deaths in 84 endemic countries. Plasmodium falciparum strains partly resistant to artemisinins are entrenched in the Greater Mekong region and have emerged in Africa, while Anopheles mosquito vectors continue to evolve physiological and behavioural resistance to insecticides. ⋯ Timely blood transfusion, renal replacement therapy, and restrictive fluid therapy can improve survival in severe malaria. Rigorous use of intermittent preventive treatment in pregnancy and infancy and seasonal chemoprevention, potentially combined with pre-erythrocytic vaccines endorsed by WHO in 2021 and 2023, can substantially reduce malaria morbidity. Improved surveillance, better access to effective treatment, more labour-efficient vector control, continued drug development, targeted mass drug administration, and sustained political commitment are required to achieve targets for malaria reduction by the end of this decade.
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The Lancet Countdown is an international research collaboration that independently monitors the evolving impacts of climate change on health, and the emerging health opportunities of climate action. In its eighth iteration, this 2023 report draws on the expertise of 114 scientists and health practitioners from 52 research institutions and UN agencies worldwide to provide its most comprehensive assessment yet. In 2022, the Lancet Countdown warned that people’s health is at the mercy of fossil fuels and stressed the transformative opportunity of jointly tackling the concurrent climate change, energy, cost-of-living, and health crises for human health and wellbeing. This year’s report finds few signs of such progress. At the current 10-year mean heating of 1·14°C above pre-industrial levels, climate change is increasingly impacting the health and survival of people worldwide, and projections show these risks could worsen steeply with further inaction. However, with health matters gaining prominence in climate change negotiations, this report highlights new opportunities to deliver health-promoting climate change action and a safe and thriving future for all. ⋯ With the world currently heading towards 3°C of heating, any further delays in climate change action will increasingly threaten the health and survival of billions of people alive today. If meaningful, the prioritisation of health in upcoming international climate change negotiations could offer an unprecedented opportunity to deliver health-promoting climate action and pave the way to a thriving future. However, delivering such an ambition will require confronting the economic interests of the fossil fuel and other health-harming industries, and delivering science-grounded, steadfast, meaningful, and sustained progress to shift away from fossil fuels, accelerate mitigation, and deliver adaptation for health. Unless such progress materialises, the growing emphasis on health within climate change negotiations risks being mere healthwashing; increasing the acceptability of initiatives that minimally advance action, and which ultimately undermine—rather than protect—the future of people alive today and generations to come. Safeguarding people’s health in climate policies will require the leadership, integrity, and commitment of the health community. With its science-driven approach, this community is uniquely positioned to ensure that decision makers are held accountable, and foster human-centred climate action that safeguards human health above all else. The ambitions of the Paris Agreement are still achievable, and a prosperous and healthy future still lies within reach. But the concerted efforts and commitments of health professionals, policy makers, corporations, and financial institutions will be needed to ensure the promise of health-centred climate action becomes a reality that delivers a thriving future for all.
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Endogenous Cushing's syndrome results from excess glucocorticoid secretion, which leads to a myriad of clinical manifestations, comorbidities, and increased mortality despite treatment. Molecular mechanisms and genetic alterations associated with different causes of Cushing's syndrome have been described in the last decade. Imaging modalities and biochemical testing have evolved; however, both the diagnosis and management of Cushing's syndrome remain challenging. ⋯ Nevertheless, several comorbidities remain even after patient remission, which can affect quality of life. Accurate and timely diagnosis and treatment are essential for mitigating chronic complications of excess glucocorticoids and improving patient quality of life. In this Seminar, we aim to update several important aspects of diagnosis, complications, and treatment of endogenous Cushing's syndrome of all causes.
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Deferred (also known as delayed) cord clamping can improve survival of infants born preterm (before 37 weeks of gestation), but the optimal duration of deferral remains unclear. We conducted a systematic review and individual participant data network meta-analysis with the aim of comparing the effectiveness of umbilical cord clamping strategies with different timings of clamping or with cord milking for preterm infants. ⋯ Australian National Health and Medical Research Council.
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Umbilical cord clamping strategies at preterm birth have the potential to affect important health outcomes. The aim of this study was to compare the effectiveness of deferred cord clamping, umbilical cord milking, and immediate cord clamping in reducing neonatal mortality and morbidity at preterm birth. ⋯ Australian National Health and Medical Research Council.