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Drjlnarvaez Dec 14, 2014 Dear Gentlemen, the Latest Issue of The

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Drjlnarvaez Dec 14, 2014 Dear Gentlemen, the Latest Issue of The DrJLNarvaez Dec 14, 2014 Dear Gentlemen, The latest issue of the New England Journal of Medicine contains a relevant article on the subject of 'the need for better management of fluid and electrolytes in Ebola patients'. That article is the third of a series dealing with electrolyte imbalance. Its title is "Disorders of Fluids and Electrolytes: Lactic Acidosis", the reference is N Engl J Med 371:2309-2319 | December 11, 2014. Sincerely, Dr. Jose Luis Narvaez Moreno email address: [email protected] thomasdk Dec 15, 2014 @DrJLNarvaez The list of signs and symptoms of lactic acidosis includes the following • Nausea • Vomiting • Hyperventilation • Abdominal pain • Lethargy • Anxiety • Severe anemia • Hypotension • Irregular heart rate • Tachycardia Kabuonji Dec 8, 2014 Ebola is deadly, but could be minimised through surveillance and with rigorous hygiene and sanitation campaign at the village level. This will be a huge benefit for prevention thus minimising current rate of infection and deaths. thomasdk Dec 8, 2014 @Kabuonji Which Ebola virus type affect people in the current outbreak? CDC has not yet revealed this. Having this knowledge would enable the ability to identify the reservoir and appropriate treatment. Fruit bats are obvious candidates. But so are African pygmy tenrecs. R.I.P. Mr. Marcel Kanyankore Rudasingwa. http://www.newtimes.co.rw/section/article/2014-11-18/183175/ gwenn Dec 13, 2014 @thomasdk @Kabuonji What I read is the Zaire type thomasdk Dec 3, 2014 Bradycardia is a unique symptom of severe infections. Like Typoid Fever and Ebola like diseases. J Infect.1996 Nov;33(3):185-91. thomasdk Dec 3, 2014 If typhoid fever is a serious complication to Ebola, the way tuberculosis is to AIDS, a simple way to identify victims is to check people for bradycardia nstorm Dec 19, 2014 @thomasdk It was recently shown that most Ebola-infected patients in Guinea presented with tachycardia and not bradycardia (Bah et al 2014 - NEJM). I don't think this would be a reliable indicator of infection. Similarly, earlier studies have indicated that low blood pressure was common during filovirus infection, however, in the current outbreak, hypertension seems to be prevalent among infected patients. Also, bleeding is very uncommon in patients affected in the current outbreak. The virus seems to be doing a lot of things differently this time around. thomasdk Dec 19, 2014 @nstorm Yes I agree -totally- that the current virus infection is acting / affecting people differently than those we have previously experienced. I tried to bring this subject up to be discussed but my post was deleted immediately. Thank you so much for your feedback and making this point clear so that simple and straightforeward measures can be be used/ implemented to identify possible victims. Your point is VERY important since neither WHO nor CDC seems to be aware of your findings. engjb2010 Dec 1, 2014 I‘m a china students,and I'm curious the trouble of developping Ebola vaccine.Can someone share it with me ? Cyclosilicate Dec 1, 2014 @fengjb2010 Mostly about money. Rosa Manson Nov 29, 2014 Last Sunday, six doctors from Kenya were sent to Sierra Leone, but local people fear Non- Governmental Organisations (NGO's), the Government and the Health Care System, that is why they stay and die at home. It is a difficult situation due to the fact that there is lack of communication with local pastoral and local people communities on the ground. There are five specific viruses to do with the Ebola Virus and the Ebola Virus Disease (EVD), at the moment this one is the most virulent as it is the Zaire type of Ebola Virus. By communicating with local pastors and the locals on the ground, there would be less fear and more people would be able to be educated about the Ebola Virus, and this would reduce the spread of the Ebola Virus Disease, and would make people believe that they have a role to play in their own wellbeing. Food prices and Commodities have gone up by 75% and therefore there is a shortage of Vitamin A, although not a cure is a preventative measure is being denied to the people who need it the most. The Liberian Health Ministry and Social Welfare has said that there is a shortage of 1,000 beds not just in Liberia but Guinea and Sierra Leone, and this has hampered efforts to get people to the local clinics. This is also spread by diseased bush meat which is the local produce and by contact with diseased animals which are the staple diet of these countries. More equipment is needed to reduce the spread of the disease as well as the reduction of Food prices and Commodities for people to eat a nutritional balanced diet, especially where food is already scarce. More Education Awareness needs to be made available to the local pastoral and tribal communities in order for the spread of this disease to be reduced. urbanx_f Dec 1, 2014 @Rosa Manson Hi I am curious why this virus has not spread to local animals, including domestic. It has me wondering, due to the zoonotic nature of this disease. thomasdk Dec 2, 2014 @urbanx_f @Rosa Manson African pygmy tenrecs have not been considered. Their use for food make them a possible source of the spreading of Ebola. Tenrecs are native to Mount Nimba, which rests along the border of Liberia, Guinea, and Ivory Coast in west Africa. Tenrecs exist from Kenya in East Africa to Guinea and Liberia, etc. http://commons.wikimedia.org/wiki/File:Atelerix_albiventris_range_map.png Mark_Booth_Durham Nov 25, 2014 Home based triage for suspected Ebola patients Could a diagnostic algorithm designed for domestic use slow down transmission within families? Efforts to curb Ebola are now attempting to empower affected individuals to take appropriate action. UNICEF is distributing household protection kits for care outside of the formal health care setting (1), CDC-designed public health posters emphasise self-referral to health practitioners (2) and the BBC World Service offers podcasts and regular broadcasts to increase public awareness (3). W.H.O offers a verbal-autopsy tool for Ebola (4), but there is currently no algorithm available for diagnosis of Ebola amongst the living that can be used in the home by friends and family of someone who has fallen ill. In the case of suspected Ebola, any delay in approaching health services is risky for both the affected person and caregiver. Delay may be caused by doubt that the underlying cause is potentially fatal, particularly if previous symptomatic episodes of a similar nature have resolved with basic care and/or treatment. Previous research on malaria illustrates that financial outlay is also common reason for not approaching health services during periods of sickness (5). My suggestion is to develop an algorithm suitable for household use that combines epidemiological, symptomatic and behavioural indicators to help family members reach a decision on next actions. Although symptoms may overlap amongst potential causal infections, the epidemiology, ecology, socio-cultural aspects of disease may vary widely across the infection spectrum. Some infections may be seasonal, geographically restricted or related to specific behaviours. Eliminating competing infections on this basis may help family members come to a quick and potentially life-saving decision to act. To ensure the algorithm contains generalisable and locally-sensitive components, that it can be used by family members and/or health practitioners with limited training, and that it addresses issues associated with false-positivity and false-negativity, I further suggest that it is developed by multi-disciplinary consortium of clinical, social, ecological and epidemiological experts prepared to pool their expertise. The algorithm could also contain recommendations for no-touch care in the event that Ebola is a likely cause of the symptoms. One important question will be, of course, what defines ‘likely cause’, hence the need for widespread consultation. 1. http://www.unicef.org/media/media_76030.html 2. http://www.cdc.gov/vhf/ebola/resources/posters.html 3.http://www.who.int/csr/resources/publications/ebola/Corrected%20CoverEboladoc1.p df?ua=1 4. http://www.bbc.co.uk/podcasts/series/ebola 5. Hill, Z., Kendall, C., Arthur, P., Kirkwood, B. and Adjei, E. (2003), Recognizing childhood illnesses and their traditional explanations: exploring options for care-seeking interventions in the context of the IMCI strategy in rural Ghana. Tropical Medicine & International Health, 8: 668?676. doi: 10.1046/j.1365-3156.2003.01058.x morekersunil Nov 21, 2014 Natural Immunity against Ebola/Genetics and treatment trials/resource allocation and preparedness Certain studies by Centre International de Recherches Médicales de Franceville in Gabon were reported to have found that a high proportion of the Gabonese population is immunized against the disease with an estimated 15.3% possessing antibodies against Ebola, even in areas where no epidemic has ever been recorded (1) There have been published reports where it has been postulated that there may be a genetic cause for immunity to Ebola which may be responsible for different responses in animal model (2) Earlier reports have pointed out that by conducting sequence-based HLA-B typing using leukocytes isolated from human patients it is possible to hypothesize that Alleles B67 and B15 could be associated with fatal outcomes, whereas B07 and B14 could be associated with nonfatal outcomes and that HLA-B alleles associated with either fatal or nonfatal outcomes of Ebola Virus disease can be identified and can be used in a predictive model.(3) This could only mean that genetic categorization of populations may be useful for preparedness for epidemics so that resource allocation may be logical and need based. Besides that it may be useful to determine which patients need the vaccines whenever they are rolled out and which patients are naturally immune or may have non fatal outcomes.
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