Rolling back malaria in Africa – challenges and opportunities to winning the elimination battle.

A high-level review was conducted of the literature pertaining to the challenges and opportunities for eliminating malaria on the African continent. Although malaria mortality and morbidity are on the decline, the disease remains one of public health importance. Africa has invariably borne the brunt of the disease, recording the highest number of cases and deaths. However, with greater emphasis being placed on the disease by the international community, partnerships have developed to boost malaria elimination efforts on the continent. One such initiative is the Roll Back Malaria (RBM) partnership which aims to facilitate malaria elimination through increasing resources and awareness. Many cross-border initiatives have been established which treat malaria as a regional problem rather than a country-specific one. Accelerated malaria control efforts have led to a 37% decrease in cases and 60% reduction in deaths. Multi-country efforts have resulted in marked reductions of transmission in the region. Although there have been noteworthy gains in curtailing the disease, new challenges have arisen. The main among these are residual malaria and outdoor biting. One of the main drivers of residual malaria is insecticide resistance. Adding to the burden of residual transmission is the discovery of new vectors that may exist at low densities. To exacerbate these issues is the challenge of malaria imported from high- to low-transmission areas. Nevertheless, compared with the historical picture, we are winning the battle against malaria. Countries in Africa are being certified malaria-free. Partnerships have been developed to take forward the RBM Global Malaria Action Plan. Elimination agendas can only be successful if funding remains sustainable, with greater reliance on domestic funding

Guidelines for the Management of Severe Traumatic Brain Injury: 2020 Update of the Decompressive Craniectomy Recommendations

© Congress of Neurological Surgeons 2020. When the fourth edition of the Brain Trauma Foundation\u27s Guidelines for the Management of Severe Traumatic Brain Injury were finalized in late 2016, it was known that the results of the RESCUEicp (Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension) randomized controlled trial of decompressive craniectomy would be public after the guidelines were released. The guideline authors decided to proceed with publication but to update the decompressive craniectomy recommendations later in the spirit of living guidelines, whereby topics are updated more frequently, and between new editions, when important new evidence is published. The update to the decompressive craniectomy chapter presented here integrates the findings of the RESCUEicp study as well as the recently published 12-mo outcome data from the DECRA (Decompressive Craniectomy in Patients With Severe Traumatic Brain Injury) trial. Incorporation of these publications into the body of evidence led to the generation of 3 new level-IIA recommendations; a fourth previously presented level-IIA recommendation remains valid and has been restated. To increase the utility of the recommendations, we added a new section entitled Incorporating the Evidence into Practice. This summary of expert opinion provides important context and addresses key issues for practitioners, which are intended to help the clinician utilize the available evidence and these recommendations. The full guideline can be found at: https://braintrauma.org/guidelines/guidelines-for-the-management-of-severe-tbi-4th-ed#/

Perspective of the Surviving Sepsis Campaign on the Management of Pediatric Sepsis in the Era of Coronavirus Disease 2019

Severe acute respiratory syndrome coronavirus 2 is a novel cause of organ dysfunction in children, presenting as either coronavirus disease 2019 with sepsis and/or respiratory failure or a hyperinflammatory shock syndrome. Clinicians must now consider these diagnoses when evaluating children for septic shock and sepsis-associated organ dysfunction. The Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-associated Organ Dysfunction in Children provide an appropriate framework for the early recognition and initial resuscitation of children with sepsis or septic shock caused by all pathogens, including severe acute respiratory syndrome coronavirus 2. However, the potential benefits of select adjunctive therapies may differ from non-coronavirus disease 2019 sepsis