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671
36
2
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Historically, the discovery of the sulfa drugs in the 1930s and the subsequent development of penicillin during World War II ushered in a new era in the treatment of infectious diseases. Infections that were common causes of death and disease in the pre-
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antibiotic era - rheumatic fever, syphilis, cellulitis and bacterial pneumonia - became treatable, and over the next 20 years most of the classes of antibiotics that find clinical use today were discovered and changed medicine in a profound way. The availability of antibiotics enabled revolutionary medical interventions such as cancer chemotherapy, organ transplants and essentially all major invasive surgeries from joint replacements to coronary bypass. Antibiotics, though, are unique among drugs in that their use precipitates their obsolescence. Paradoxically, these cures select for organisms that can evade them, fueling an arms race between microbes, clinicians and drug discoverers.
Wright BMC Biology 2010, 8:123 http://www.biomedcentral.com/1741-7007/8/12
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After 100 years of chemotherapy with impractical and toxic drugs, an oral cure for human African trypanosomiasis (HAT) is available: Fexinidazole. In this case, we review the history of drug discovery for HAT with special emphasis on the discovery,
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pre-clinical development, and operational challenges of the clinical trials of fexinidazole. The screening of the Drugs for Neglected Diseases initiative (DNDi) HAT-library by the Swiss TPH had singled out fexinidazole, originally developed by Hoechst (now Sanofi), as the most promising of a series of over 800 nitroimidazoles and related molecules. In cell culture, fexinidazole has an IC50 of around 1 µM against Trypanosoma brucei and is more than 100-fold less toxic to mammalian cells. In the mouse model, fexinidazole cures both the first, haemolymphatic, and the second, meningoencephalitic stage of the infection, the latter at 100 mg/kg twice daily for 5 days. In patients, the clinical trials managed by DNDi and supported by Swiss TPH mainly conducted in the Democratic Republic of the Congo demonstrated that oral fexinidazole is safe and effective for use against first- and early second-stage sleeping sickness. Based on the positive opinion issued by the European Medicines Agency in 2018, the WHO has released new interim guidelines for the treatment of HAT including fexinidazole as the new therapy for first-stage and non-severe second-stage sleeping sickness caused by Trypanosoma brucei gambiense (gHAT). This greatly facilitates the diagnosis and treatment algorithm for gHAT, increasing the attainable coverage and paving the way towards the envisaged goal of zero transmission by 2030.
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Guidelines for the management of asthma in adults and adolescents: Position statement of the South African Thoracic Society – 2021 update
Lalloo, U.G.; Kalla, I.S.; Abdool-Gaffar, S. et al.
African Journal of Thoracic and Critical Care Medicine
(2021)
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sthma prevalence is increasing worldwide, and surveys indicate that most patients in developed and developing countries, including South Africa, do not receive optimal care and are therefore not well controlled. Standard management guidelines adapted to in-country realities are important to support
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optimal care. The South African Thoracic Society (SATS) first published a guideline for the management of chronic persistent asthma in 1992, which has subsequently been revised several times.
The main aim of the present document was to revise and update SATS’ statement on the suggested management of chronic asthma, based on the need to promote optimal care and control of asthma, together with the incorporation of new concepts and drug developments. This revised document reinforces optimal care and incorporates the following primary objectives to achieve the recent advances in asthma care:
• continued emphasis on the use of inhaled corticosteroids (ICS) as the foundation of asthma treatment
• to reduce the reliance on short-acting beta-2 agonist (SABA) monotherapy for asthma symptoms
• to incorporate the evidence and strategy for the use of the combination of an ICS and formoterol for acute symptom relief (instead of a SABA)
• to incorporate the evidence and strategy for the use of as-needed ICS-long-acting beta agonists (LABA) for patients with infrequent symptoms or ‘mild’ asthma
• to incorporate the evidence and strategy for the use of a long-acting muscarinic antagonist (LAMA) in combination with ICS-LABA; and
• to incorporate the evidence and strategy for the use of and management with a biologic therapy in severe asthma.
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In many low- and middle-income countries, there is a wide gap between evidencebased recommendations and current practice. Treatment of major CVD risk factors remains suboptimal, and only a minority of patients who are treated reach their target levels for blood pressure, blood sugar and blood choles
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terol.
In other areas, overtreatment can occur with the use of non-evidence-based
protocols. The aim of using standard treatment protocols is to improve the quality
of clinical care, reduce clinical variability and simplify the treatment options,
particularly in primary health care. Standard treatment protocols can be developed by preparing new national treatment guidelines or by adapting or adopting international guidelines.
The Evidence-based protocols module uses hypertension and diabetes screening
and treatment as an entry point to control cardiovascular risk factors, prevent target organ damage, and reduce premature morbidity and mortality. A comprehensive risk- based approach for integrated management of hypertension, diabetes, and high cholesterol is included in the Risk-based CVD management module.
This module includes clinical practice points and sample protocols for:
1. hypertension detection and treatment
2. type 2 diabetes detection and treatment
3. identifying basic emergencies – care and referral.
HEARTS emphasizes adaptation, dissemination, and use of a standardized set of
simple clinical-management protocols, which should be drug- and dose-specific,
and include a core set of medications. The simpler the protocols and management tools, the more likely they are to be used correctly, and the higher the likelihood that a programme will achieve its goals.
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The larval stage of the parasite Taenia solium can encyst in the central nervous system causing neurocysticercosis, which is the main cause of acquired epilepsy in the countries in which the parasite is endemic. Endemic areas are those with the presence (or likely presence) of the full life cycle of
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Taenia solium. The parasite is most prevalent in poor and vulnerable communities in which pigs roam free, open defecation is practiced, basic sanitation is deficient, and health education is absent or limited. Several tools are available for the control of Taenia solium. Preventive chemotherapy for Taenia solium taeniasis, which is directed at the adult tapeworm, is one of them. Other tools focus on pig management, pig vaccination and treatment, sanitation and hygiene, and community education. Three potential drugs—niclosamide, praziquantel, and albendazole—have been considered for use for preventive chemotherapy in Taenia solium taeniasis control programs through mass drug administration or targeted chemotherapy. In this Guideline, we provide recommendations for preventive chemotherapy in Taenia solium-endemic areas using niclosamide, praziquantel, or albendazole, including at which dose and in which population groups.
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Cardiovascular disease (CVD) is the leading cause of global deaths, with the majority occurring in low- and middle-income countries (LMIC). The primary and secondary prevention of CVD is suboptimal throughout the world, but the evidence-practice gaps are much more pronounced in LMIC. Barriers at the
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patient, health-care provider, and health system level prevent the implementation of optimal primary and secondary prevention. Identification of the particular barriers that exist in resource-constrained settings is necessary to inform effective strategies to reduce the identified evidence-practice gaps. Furthermore, targeting modifiable factors that contribute most significantly to the global burden of CVD, including tobacco use, hypertension, and secondary prevention for CVD will lead to the biggest gains in mortality reduction. We review a select number of novel, resource-efficient strategies to reduce premature mortality from CVD, including: (1) effective measures for tobacco control; (2) implementation of simplified screening and management algorithms for those with or at risk of CVD, (3) increasing the availability and affordability of simplified and cost-effective treatment regimens including combination CVD preventive drug therapy, and (4) simplified delivery of health care through task-sharing (non-physician health workers) and optimizing self-management (treatment supporters). Developing and deploying systems of care that address barriers related to the above, will lead to substantial reductions in CVD and related mortality.
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This study was aimed to ascertain the clinical profile and management of patients with ischemic heart disease (IHD) and/or peripheral artery disease (PAD). In this observational and cross-sectional study developed in 80 hospitals throughout Spain, consecutive adults with stable IHD and/or PAD were i
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ncluded. A total of 1089 patients were analyzed, of whom 65.3% had only IHD, 17.8% PAD and 16.9% both. A total of 80.6% were taking only one antiplatelet agent, and 18.2% were on dual antiplatelet therapy (mainly aspirin/clopidogrel). Almost all patients were taking ≥1 lipid lowering drug, mainly moderate-to-high intensity statins. IHD patients took ezetimibe more commonly than PAD (43.9% vs. 12.9%; p < 0.001). There were more patients with IHD that achieved blood pressure targets compared to PAD (<140/90 mmHg: 67.9% vs. 43.0%; p < 0.001; <130/80 mmHg: 34.1% vs. 15.7%; p < 0.001), LDL-cholesterol (<70 mg/dL: 53.1% vs. 41.5%; p = 0.033; <55 mg/dL: 26.5% vs. 16.0%; p = 0.025), and diabetes (HbA1c < 7%, with SGLT2i/GLP1-RA: 21.7% vs. 8.8%; p = 0.032). Modifications of antihypertensive agents and lipid-lowering therapy were performed in 69.0% and 82.3% of patients, respectively, without significant differences between groups. The use of SGLT2i/GLP1-RA was low. In conclusion, cardiovascular risk factors control remains poor among patients with IHD, PAD, or both. A higher use of combined therapy is warranted.
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Non-communicable diseases (NCDs) pose a substantial threat to many health systems, especially in low-income and middle-income countries (LMICs) where they are already overstretched. In the past few decades, deaths from NCDs in LMICs have spiked, whereas numbers in high-income countries have stabilis
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ed. Worryingly, a large proportion of deaths from NCDs (29%) in LMICs occur among people younger than 60 years compared with the proportion in high-income countries (13%). This finding has been attributed to poor access to effective and equitable health-care services in most LMICs. The threat of NCDs in LMICs was recognised by the UN 2011 High-Level Meeting, and is now featured in Sustainable Development Goal 3 in the form of reducing premature mortality from NCDs by one-third before 2030. Cardiovascular diseases (CVDs) are the leading cause of deaths from NCDs (ie, 48% of all NCDs deaths). Therefore, substantial reductions in CVDs will have a major impact on reducing the overall burden of NCDs globally. The good news is that most CVDs can be prevented by addressing the key underlying behavioural risk factors, such as physical inactivity, unhealthy diet, tobacco use, and harmful use of alcohol, through population-wide approaches. Among individuals with or at high risk of CVD, early detection and effective management with appropriate counselling and medicines can reduce cardiovascular deaths substantially.
The importance of effective treatment for CVD has been recognised in the Global NCD Action Plan 2013–20, for which one of the nine global targets is that at least 50% of eligible individuals should receive drug therapy and counselling to prevent heart attacks and strokes by 2025.5 Although admirable, this is a hard target to achieve given that secondary prevention strategies in LMICs are often unaffordable or unavailable.
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The Sustainable Development Goals (SDGs) aim to transform our world. They are a call to action to end poverty and inequality, protect the planet, and ensure that all people enjoy health, justice and prosperity. It is critical that no one is left behind. In 2015, all the countries in the United
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Nations adopted the 2030 Agenda for Sustainable Development. It sets out 17 Goals, which include 169 targets. These wide-ranging and ambitious Goals interconnect. SDG 3 is to ensure healthy lives and promote well-being for all at all ages. It has 13 targets measured through 26 indicators. However, a person’s health and well-being are affected not only by disease and treatment, but also by social and economic factors such as housing, poverty and education. Health targets can therefore also be found across the other SDGs. This fact sheet shows how alcohol consumption undermines commitments to achieve 13 of the 17 SDGs, impacting on a range of health-related indicators, such as child health, infectious diseases and road injuries as well as much broader range of indicators related to economic and social development, environment and equality. The inclusion of a specific target on harmful use of alcohol (SDG 3.5: strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol) into the SDGs demonstrates the key role of alcohol within the global development agenda. The factsheet highlights positive examples of Member States’ experiences. It provides a short overview of the most cost-effective and feasible policy recommendations to reduce alcohol consumption and alcohol-attributable burden in the WHO European Region, in line with the European Action Plan to Reduce the Harmful Use of Alcohol. It also suggests some important resources for Member States. This factsheet was launched as part of the European Awareness Week on Alcohol Related Harm 2020.
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The document is a summary report by the World Health Organization (WHO) Regional Office for the Eastern Mediterranean, focusing on a capacity-building workshop held in Abu Dhabi in 2019. The workshop addressed the management and care of substance use
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disorders, aiming to improve technical and managerial capacities in areas such as policy development, treatment services, prevention, monitoring, and international collaboration. Participants included representatives from 12 countries, WHO collaborating centers, and other UN agencies.
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Welcome to the Global Information System on Resources for the Prevention and Treatment of Substance Use Disorders. These pages present data collected from WHO Member States in broad categories: governance, policy and financing, service organization
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and delivery, human resources and national information systems. The latest data were collected in 2014 with the WHO Global Survey on Resources for Prevention and Treatment of Substance Use Disorders (ATLAS-SU survey). The global information system presents all available data to monitor the progress in advancing treatment coverage for substance use disorders (health target 3.5 of the Sustainable Development Goals 2030)
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The IHME webpage discusses alcohol use as a significant global health risk, responsible for over 1.8 million deaths annually. It highlights age-related differences in alcohol's health impacts, with no benefits for individuals aged 15–39 and potent
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ial small benefits for those aged 40 and above under certain conditions. The page emphasizes the need to consider factors like age, disease patterns, and individual health in assessing alcohol-related risks.
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The Youth.gov webpage on "Substance Use/Misuse" provides information and resources about preventing and addressing substance abuse among youth. It highlights risk factors, prevention strategies, and support programs designed to reduce substance
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use and its negative impacts on young people. The site is part of a federal initiative to promote healthy and safe youth development.
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The World Health Organization's Eastern Mediterranean Regional Office (WHO EMRO) highlights the significant health and social consequences of harmful alcohol use. Excessive alcohol consumption is linked to over 200 diseases and injuries, including l
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iver cirrhosis, pancreatitis, various cancers, hemorrhagic stroke, and hypertension. Globally, it results in approximately 3.3 million deaths annually, surpassing fatalities from HIV/AIDS, violence, or tuberculosis. In the Eastern Mediterranean Region, while overall alcohol consumption is low, there is a concerning rise among adolescents and young adults, with patterns of heavy episodic drinking posing significant health risks. In response, the WHO has developed a global strategy to reduce the harmful use of alcohol, aiming to improve health and social outcomes by decreasing disease and death associated with alcohol consumption.
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The pamphlet "Marijuana" explains the effects and risks of cannabis use. It describes THC, the psychoactive compound in cannabis, which binds to cannabinoid receptors in the brain, causing effects like relaxation, altered perception, and euphoria. S
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hort-term effects include red eyes, hunger, and anxiety, while long-term effects may involve memory loss, lung problems, and slowed brain development, especially with early and frequent use. It highlights the potential for negative impacts on mental and physical health while noting there are no direct deaths solely from marijuana use. The pamphlet provides links to resources for further information and recovery options.
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Just under 2.5 million people die annually due to alcohol use. This global estimate, however, excludes most of the health burden
borne by others than the alcohol user. Alcohol’s harm to others includes a multitude of conditions, such as trauma fr
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om traffic crashes, fetal disorders due to prenatal exposure to alcohol, as well as interpersonal and intimate partner violence. While alcohol’s causal role in these conditions is well-established, alcohol’s harm to others’ contribution to the overall health burden of alcohol remains unknown. This knowledge gap leads to a situation in which alcohol policy and prevention strategies largely focus on the reduction of alcohol’s detrimental health harms on the alcohol users, neglecting affected others and population groups most vulnerable to these harms, including women and children. In this article, we seek to elucidate why estimates for alcohol’s harm to others are lacking and offer guidance for future research. We also argue that a full assessment of the alcohol health burden that includes the harm caused by others’ alcohol use would enhance the visibility and public awareness of such harms, and advancing the evaluation of policy interventions to mitigate them.
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The World Health Organization (WHO) launched the SAFER initiative in 2018 to address the global health and societal challenges posed by alcohol-related harm. The initiative outlines five key strategies aimed at reducing alcohol consumption and its associated consequences. These include strengthening
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restrictions on alcohol availability by implementing and enforcing policies to limit its accessibility and advancing drink-driving countermeasures, such as low blood alcohol concentration limits and random breath testing, to reduce alcohol-impaired driving incidents.
Additionally, SAFER emphasizes facilitating access to screening, brief interventions, and treatment for individuals with alcohol use disorders, ensuring that healthcare systems are equipped to provide effective support. Another core strategy is enforcing comprehensive bans or restrictions on alcohol advertising, sponsorship, and promotion to minimize its influence, particularly on vulnerable populations such as youth. Finally, the initiative advocates raising alcohol prices through excise taxes and pricing policies to make it less affordable and thereby reduce consumption.
By implementing these evidence-based, cost-effective measures, the SAFER initiative aims to reduce the global burden of alcohol-related deaths and disabilities, fostering healthier societies worldwide.
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The pamphlet "Alcohol and Depressants" explains the effects of depressants, including alcohol. Depressants slow brain activity by increasing the release of inhibitory neurotransmitters like GABA, leading to effects such as sedation, decreased anxiety, and reduced heart rate. Alcohol, a legal depress
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ant, causes short-term effects like impaired judgment, vomiting, and blackouts, while long-term use can result in alcoholism, liver disease, strokes, and cancer. Alcohol withdrawal can be life-threatening, causing seizures and heart complications. The pamphlet emphasizes the importance of safe usage and provides resources for treatment and further information.
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The World Health Organization (WHO) provides an overview of alcohol consumption and its global impact. Alcohol, containing ethanol, is a psychoactive and toxic substance that can lead to dependence. In 2019, alcohol consumption was responsible for approximately 2.6 million deaths worldwide, with 1.6
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million resulting from noncommunicable diseases, 700,000 from injuries, and 300,000 from communicable diseases. Men accounted for the majority of these deaths, totaling 2 million, compared to 600,000 among women. Additionally, an estimated 400 million people aged 15 and older were living with alcohol use disorders in 2019.
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