The Lancet

ImportanceRecent reports have highlighted an intense influenza activity related to the circulation of the influenza A(H3N2) subclade k variant. There is no data available on the impact of the emergence of H3N2 subclade k on the severity of the 2025-2026 epidemic or on the clinical phenotype of patients requiring admission to the intensive care unit (ICU). ObjectiveTo compare the clinical presentation, hospital mortality and virological characteristics of patients with laboratory-confirmed influ...

BackgroundDeath certificates record both an underlying cause and contributing conditions, yet mortality statistics predominantly report only the underlying cause. We quantify this "hidden burden" across all ICD-10 conditions in Australian mortality data using the multiple-to-underlying ratio (MUR): total death certificate mentions divided by underlying cause deaths. MethodsWe analysed Australian Bureau of Statistics Causes of Death 2023 data (N = 187,268 registered deaths) to compute the ratio ...

BackgroundSmoking, unhealthy nutrition, alcohol consumption, and physical inactivity (SNAP behaviours) are major risk factors for multimorbidity but are often studied in isolation. Using longitudinal data, Suhag et al. identified clusters of older adults (aged [≥]50) with common SNAP behaviour patterns and distinct sociodemographic profiles and multimorbidity prevalence; whether and how these patterns generalise across adulthood remains unclear. AimTo conceptually replicate Suhag et al. acro...

BackgroundClimate change is increasingly recognised as a threat to population health and healthcare systems, yet the effects of environmental variability on pharmaceutical prescribing remain poorly characterised in the UK. Using a wide array of open-source datasets, we examine the effect of environmental, geographic and socioeconomic factors on prescribing habits in England. MethodsWe linked monthly, practice-level prescribing data for England (2010-2025) to meteorological, air-quality, floodin...

BackgroundAustralia is experiencing its worst syphilis epidemic in decades, driven by two distinct outbreaks -- a heterosexual epidemic disproportionately affecting Aboriginal and Torres Strait Islander communities in northern Australia, and a predominantly MSM-associated epidemic in urban centres. We examined the spatial dynamics of this dual epidemic, including geographic clustering, service accessibility associations, and COVID-19 impacts. MethodsWe analysed publicly available aggregate surv...

BackgroundHeartland virus (HRTV) is an emerging tick-borne virus capable of causing severe illness and death. The burden of disease is likely underestimated due to limited seroprevalence studies, lack of commercially available diagnostic tests, and an overlapping clinical syndrome with more commonly diagnosed bacterial diseases such as spotted fever group rickettsiosis or ehrlichiosis. MethodsActive surveillance for Heartland virus disease was conducted at a large academic center from March to ...

BackgroundAfrica continues to have a significant public health problem with mpox, where endemic transmission persists and overlaps with a high burden of other infectious diseases. Although their epidemiology and clinical impact are still poorly understood throughout the continent, coinfections with human immunodeficiency virus (HIV) and varicella-zoster virus (VZV) can affect the clinical picture, severity of the disease, and accuracy of the diagnosis. MethodsFollowing PRISMA criteria, we regis...

ObjectiveCongenital syphilis remains a preventable cause of fetal and neonatal morbidity and mortality, despite the availability of inexpensive diagnostics and effective treatment. We aimed to evaluate the maternal and congenital syphilis burden at the Instituto Nacional Materno Perinatal, Perus national referral center for maternal and perinatal care. MethodsWe conducted a retrospective analysis of aggregated, de-identified surveillance data from January 2023 to December 2025. Maternal prevale...

Infection with pnuemococcus bacteria is generally mild but can be more severe in the young and elderly, causing invasive pneumococcal disease (IPD) and community-acquired pneumonia (CAP). Although paediatric pneumococcal conjugate vaccine (PCV) programmes and elderly pneumococcal polysaccharide vaccine (PPV) programmes have reduced cases, we estimate that pneumococcal infection still leads to direct health care costs of around {pound}68M and approximately 16 thousand QALY losses in England per y...

BackgroundHigh-dose inactivated influenza vaccination (HD-IIV) demonstrates superior effectiveness versus standard-dose vaccination (SD-IIV) in adults aged [≥]60 years. A recent meta-analysis integrated complementary evidence sources of representing over 85 million individuals across 14 influenza seasons. MethodsA previously developed model was updated using life-time horizon and societal perspective. Updated parameters included demographics, costs, hospitalization rates, and relative vaccin...

ObjectiveDespite substantial variability in the severity of post-anoxic encephalopathy, all comatose patients after cardiac arrest are usually treated according to the same standardized intensive care protocol, including sedation, mechanical ventilation, and targeted temperature management (TTM). We hypothesize that patients with a favourable EEG pattern (continuous EEG within 12 hours after cardiac arrest) may not benefit from prolonged sedation and TTM. We studied the feasibility and safety of...

BackgroundSepsis is a major public health challenge, and reliable biomarkers are essential for distinguishing sepsis from other conditions. Neutrophil Gelatinase-Associated Lipocalin (Neutrophil gelatinase-associated lipocalin (NGAL)) has shown promise as a diagnostic marker due to its role in the immune response. This study evaluates plasma NGAL as a diagnostic tool at the time of ICU admission. MethodsWe analysed plasma NGAL and C-reactive protein (CRP) levels in 4732 adult patients admitted ...

BackgroundReliable identification of early predictors of adverse outcomes was essential during the pre-vaccination phase of the COVID-19 pandemic. Few studies have comprehensively integrated clinical presentation, laboratory parameters including arterial blood gas analysis, and chest computed tomography (CT) findings within a single well-characterized cohort, particularly in underrepresented regions of Brazil. MethodsThis retrospective cohort study included 482 consecutive adults (median age 61...

ObjectiveThis study explored the recovery experiences of individuals who report having (largely) recovered from long covid and who attributed their improvement to mind-body approaches. Design, setting and participantsWe conducted an explorative qualitative study using purposive recruitment through social media and snowball sampling. Eighteen adult women (aged 37-62 years), who self-identified as having had long covid and having substantially recovered through mind-body approaches participated i...

IntroductionKidney biopsy reports contain rich information that is clinically actionable and useful for research. However, the narrative format hinders scalable reuse. We here investigated whether open-source large language models (LLMs) can extract relevant, standardized readouts from native kidney biopsy pathology reports. MethodsGerman free-text native kidney biopsy reports were parsed with three open-source LLMs (Llama3 70B, Llama3 8B, MedGemma) to generate structured JSON outputs covering ...

BackgroundHistologic descriptors such as lymphovascular invasion (LVI), visceral pleural invasion (VPI), spread through air spaces (STAS), and grading system have each been associated with adverse outcomes in lung adenocarcinoma (LUAD). However, with the exception of VPI, these features are not formally incorporated into the TNM staging system. We evaluated the prognostic value and incremental contribution of these histologic descriptors within the framework of the 9th edition TNM staging system...

RationaleObstructive sleep apnea (OSA) is linked to cardiovascular, metabolic, and cognitive morbidity. Although COVID-19 has been associated with long-term respiratory and neurological sequelae, its role in precipitating new-onset OSA remains unclear. ObjectivesTo evaluate whether SARS-CoV-2 infection increases risk of developing OSA up to 4.5 years post-infection and how risk varies by hospitalization status, demographics, comorbidities, and vaccination status. MethodsThis retrospective coho...

BackgroundHospital-acquired bacterial pneumonia (HABP) and ventilator-associated bacterial pneumonia (VABP), particularly those caused by multi-drug resistant organisms (MDROs), often require newer antibiotic treatment. The efficacy and safety of newer antibiotics compared to generic antibiotics in randomized controlled trials (RCTs) have not been evaluated before. MethodsIn this systematic review, we searched RCTs in the United States National Library of Medicine (PubMed), Cochrane Central Reg...

PuhrposeTo evaluate the short- and long-term cross-sectional associations between COVID-19 infection and multidimensional sleep health. MethodsData from the COVID-19 Outbreak Public Evaluation (COPE) initiative were used to examine the association between a novel multidimensional sleep health measure (COPE Multidimensional Sleep Health Scale, CMSHS) modeled from the RuSATED instrument and (1) COVID-19 infection and (2) post-acute sequelae of SARS-CoV-2 infection (PASC). ResultsData from 11,326...

BackgroundObstructive sleep apnea (OSA), as measured by the Apnea Hypopnea Index (AHI), is associated with adverse outcomes. Measures that characterize the temporal variability in events may provide information over and beyond a simple summary of event frequency as measured by the AHI. Research QuestionTo assess whether temporal variability in the occurrence of obstructive apnea/hypopneas during the night is associated with all-cause mortality or incident cardiovascular disease (CVD). Study De...