Search Medical Journals & Research Articles

[Correspondence] Innovation in neonatology

In the Lancet Child & Adolescent Health Commission on the future of neonatology,1 Daniele De Luca and colleagues present a robust vision for research, partnerships, and care. However, to achieve more equitable outcomes for all newborns, especially those born preterm, in-depth focus on the social determinants of health is essential.2

[Correspondence] Training, values, and youth outcomes in adolescent and youth engagement in research – Authors' reply

We appreciate the thoughtful feedback from Clementine Jarrett and colleagues based on their experiences in engaging adolescents and youth in research. We recognise that there is no single ideal way for youth engagement to fit within research processes, and we celebrate the different ways that researchers are innovatively involving adolescents and youth in their research. Although our Comment1 was specifically for research reporting purposes, we acknowledge there are many other considerations that researchers undertake that might not be formally reported in research publications.

[Correspondence] Training, values, and youth outcomes in adolescent and youth engagement in research

We commend Jason M Nagata and colleagues on their checklist, adapted from GRIPP2, to report youth and adolescent engagement in research.1 As the Youth Voice Lead for Youth and Family Specific Engagement in Research (UNITE; Toronto, ON, Canada)—a research programme focused on meaningful youth and family engagement in health research—I contribute lived expertise to advancing youth-engaged research practice.2 Based on our programme of research, the UNITE team would propose three additions to the checklist to further strengthen reporting standards: training, values and principles, and outcomes for youth partners.

[Comment] Uncertainty in brain imaging after therapeutic hypothermia

After the TOBY trial, which enrolled 325 neonates with hypoxic ischaemic encephalopathy (HIE) and found that total body therapeutic hypothermia improved neurologic outcome in survivors, the implementation of therapeutic hypothermia in neonates with moderate to severe HIE has become a standard of care in many settings, reducing the extent of cerebral lesions and substantially improving clinical outcomes.1,2 Cerebral MRI is a key tool for assessing the extent and pattern of brain injury in infants with moderate-to-severe HIE who underwent therapeutic hypothermia,3 although the clinical interpretation of MRI findings in this group might be challenging.

[Comment] Children with disabilities are missing from global efforts to address violence

In November, 2024, the first Global Ministerial Conference on ending violence against children was held in Bogotá, Colombia, and was a landmark event for violence prevention. 101 countries and 21 organisations made commitments to address violence against children at home, in schools, in communities, and online.1 However, despite efforts to get disability on the agenda for the conference by civil society organisations, there was a notable gap in commitments on preventing and responding to violence against children with disabilities.

[Comment] Childhood tuberculosis: robust funding and integrated solutions needed now

The USA has led the world in global health activities, providing US$278 billion to low-income and middle-income countries (LMICs) for health since 2000.1 Despite being only 0·3% of US Government spending in 2023, these investments contributed 29% of the total development assistance for health provided by all donor countries.1 The sudden withdrawal of US foreign assistance has led to ubiquitous dismantling of critical health programmes supporting vulnerable children and adolescents globally—most notably maternal and child health, tuberculosis, HIV, and malaria programmes.

[Comment] Long-term sequelae in survivors of high-risk neuroblastoma: the price of success

Until 2000, neuroblastoma was one of the deadliest tumours of childhood, with probabilities of long-term survival not exceeding 30%. In the past two decades, children with high-risk neuroblastoma have shown remarkable improvements in event-free survival with a multimodal strategy based on induction chemotherapy, surgery, consolidation with single or tandem autologous stem-cell transplantation (ASCT), radiotherapy, and maintenance therapies with anti-GD2 antibodies plus cis-retinoic acid.1 Nowadays, through this approach, survival exceeds 50%, but, unfortunately, this improvement comes at the price of long-term sequelae for survivors.

[Editorial] Surviving and thriving after childhood cancer

Without treatment, childhood cancer is fatal. However, in regions and settings with access to safe and effective therapies and supportive care, it is eminently survivable. But survival comes at the cost of multi-system, short-term and long-term toxicity and adverse effects. Ensuring that young people with cancer do not just survive, but also thrive, requires the development of less toxic treatments and a better understanding of the unique experiences and needs of the estimated 400 000 children and adolescents who are newly diagnosed with cancer globally each year.

[Clinical Picture] Candida albicans fungal ball in the eyeball

A 70-year-old man with diabetes and gastrinoma presented to the Department of Ophthalmology at Kochi Medical School Hospital with a 2-month history of decreased visual acuity (20/1000) in his right eye. 2 months earlier, he had received a posterior sub-Tenon's injection of 20 mg of triamcinolone for uveitis without improvement. Slit-lamp examination revealed anterior chamber inflammation with hypopyon. Fundus examination showed vitreous haze and a large white lesion in the temporal retina (figure A).

[Grand Round] Haemophagocytic lymphohistiocytosis (HLH) secondary to measles in an adult with a loss of post-vaccination humoral immunity following rituximab

Measles is an important re-emergent infectious disease globally. Vaccine immunity at the population level is key to the prevention of outbreaks, as unvaccinated or immunosuppressed adults are particularly vulnerable to severe infection. With the increasing use of immunomodulatory treatments for autoimmune and malignant conditions, the long-term effects of CD20-expressing cell-depleting therapies on the vaccine-induced humoral immunity to measles remain unclear. Haemophagocytic lymphohistiocytosis (HLH) is a hyperinflammatory syndrome with high mortality commonly triggered by infection and is possibly under-reported in association with measles.

[Personal View] The health impact of identifying a person with tuberculosis through systematic screening

Screening populations at high risk for tuberculosis might improve clinical outcomes and reduce transmission, but the value and cost-effectiveness of population-based screening depend on the uncertain health impact of early tuberculosis detection. In this Personal View, we propose a framework for estimating the incremental health impact of systematic screening, including effects on tuberculosis morbidity, mortality, sequelae, and transmission. Our framework accounts for the timing of screening, relative to when routine diagnosis might occur and when health effects become inevitable.

[Review] Tetanus: recognition and management

Currently a rarity in high-income countries, tetanus is a diagnosis not to miss. Deaths from tetanus fell by almost 90% between 1990 and 2019, largely reflecting the success of WHO's Maternal and Neonatal Tetanus Elimination campaign. However, deaths among children and adults have plateaued, and tetanus remains an important vaccine-preventable cause of morbidity and mortality, notably in southern Asia, southeast Asia, and sub-Saharan Africa. Tetanus results from infections with spore-forming Clostridium tetani bacteria, usually acquired via contaminated wounds and burns.

[Review] The (Re)-emerging And ePidemic Infectious Diseases (RAPID) Stigma Scales: a cross-outbreak scale development and psychometric validation study

Reducing stigma during infectious disease outbreaks is crucial for delivering an effective response. However, no validated stigma scales exist for use across outbreaks, and outbreak-specific scales are developed too slowly to guide timely interventions. To enable more real-time monitoring and mitigation of stigma across outbreak contexts, we developed and validated the (Re)-emerging and ePidemic Infectious Diseases (RAPID) Stigma Scales. Field testing and psychometric validation were conducted in communities affected by Ebola disease in Uganda, mpox in the UK, and Nipah virus disease in Bangladesh.

[Articles] Delpazolid in combination with bedaquiline, delamanid, and moxifloxacin for pulmonary tuberculosis (PanACEA-DECODE-01): a prospective, randomised, open-label, phase 2b, dose-finding trial

The pharmacokinetic–pharmacodynamic modelling results suggest that delpazolid adds efficacy on top of bedaquiline, delamanid, and moxifloxacin; and that a dose of 1200 mg once daily would result in exposures with maximum efficacy. That dose was shown to be safe, raising hope that linezolid toxicities could be averted in long-term treatment. Delpazolid is a promising drug for future tuberculosis treatment regimens and could be widely usable if safety and efficacy are confirmed in larger trials.

[Articles] Sutezolid in combination with bedaquiline, delamanid, and moxifloxacin for pulmonary tuberculosis (PanACEA-SUDOCU-01): a prospective, open-label, randomised, phase 2b dose-finding trial

Sutezolid, combined with bedaquiline, delamanid, and moxifloxacin, was shown to be efficacious and added activity to the background drug combination, although we cannot make a final dose recommendation yet. This study provides valuable information for the selection of sutezolid doses for future studies, and described no oxazolidinone class toxicities at the doses used.