Association between multivitamin supplementation and mortality among patients with Ebola virus disease: an international multisite cohort study

Introduction: Micronutrient supplementation is recommended in Ebola Virus Disease (EVD) care; however, there is limited data on its therapeutic effects. Methods: This retrospective cohort study included patients with EVD admitted to five Ebola Treatment Units (ETU) in Sierra Leone and Liberia during September 2014 to December 2015. A uniform protocol was used to guide ETU care, however, due to supply limitations, only a subset of patients received multivitamins. Data on demographics, clinical characteristics, and laboratory testing was collected. The outcome of interest was facility based mortality and the primary predictor was multivitamin supplementation initiated within 48 h of admission. The multivitamin formulations included: thiamine, riboflavin, niacin and vitamins A, C, and D3. Propensity score models (PSM) were used to match patients based on covariates associated with multivitamin administration and mortality. Mortality between cases treated and untreated within 48 h of admission were compared using generalized estimating equations to calculate relative risk with bootstrap methods employed to assess statistical significance. Results: There were 424 patients with EVD who had sufficient treatment data for analysis, of which 261 (61.6%) had daily multivitamins initiated within 48 h of admission. The mean age of the cohort was 30.5 years and 59.4% were female. In the propensity score matched analysis, mortality was 53.5% among patients receiving multivitamins and 66.2% among patients not receiving multivitamins, resulting in a relative risk for mortality of 0.81 (p=0.03) for patients receiving multivitamins. Conclusion: Early multivitamin supplementation was associated with lower overall mortality. Further research on the impact of micronutrient supplementation in EVD is warranted

Ebola virus – from neglected threat to global emergency state / Vírus ébola – de ameaça negligenciada ao estado de emergência global

SUMMARY Objective: This review aims to update knowledge about Ebola virus disease (EVD) and recent advances in its diagnosis, treatment and prevention. Method: A literature review was performed using the following databases: ISI Web of Knowledge, PubMed, IRIS, Scopus and the websites of the CDC and the WHO. Additionally, we have included articles and reports referenced in the basic literature search, and news that were considered relevant. Results: The Ebola virus, endemic in some parts of Africa, is responsible for a severe form of hemorrhagic fever in humans; bats are probably its natural reservoir. It is an extremely virulent virus and easily transmitted by bodily fluids. EVD's complex pathophysiology, characterized by immunosuppression as well as stimulation of an intense inflammatory response, results in a syndrome similar to septic shock. The diagnosis is difficult due to the initial symptoms that mimic other diseases. Despite the high mortality rates that can amount to 90%, a prophylaxis (chemical or vaccine) or effective treatment does not exist. Two vaccines and experimental therapies are being developed for the prevention and treatment of EVD. Conclusion: Although the virus is known for about 40 years, the lack of knowledge obtained and the disinterest of government authorities in the countries involved justify the state of emergency currently exists regarding this infectious agent. Only the coordination of multiple entities and the effective commitment of the international community will facilitate the control and effective prevention of EVD.

RESUMO Objetivo: esta revisão tem como objetivo atualizar os conhecimentos sobre a doença do vírus ébola (DVE) e sobre os recentes avanços nos métodos de diagnóstico, tratamento e prevenção. Método: foi realizada uma revisão de literatura, utilizando as seguintes bases de dados: ISI Web of Knowledge, PubMed, IRIS, Scopus e os sites do Centers for Disease Control and Prevention (CDC) e da Organização Mundial da Saúde (OMS). Adicionalmente, foram incluídos artigos e relatórios referenciados na pesquisa bibliográfica de base e notícias consideradas relevantes. Resultados: o vírus ébola, endêmico de algumas regiões da África, é responsável por uma forma grave de febre hemorrágica no homem, e os morcegos são provavelmente o seu reservatório natural. É um vírus extremamente virulento e de fácil transmissão pelos fluidos corporais. A complexa fisiopatologia da doença, caracterizada pela imunossupressão e pelo estímulo a uma intensa resposta inflamatória, resulta em uma síndrome semelhante ao choque séptico. O seu diagnóstico é difícil, por causa da sintomatologia inicial, que mimetiza outras doenças. Apesar das altas taxas de mortalidade, que podem alcançar os 90%, não existe profilaxia (química ou vacinal) ou tratamento eficaz. Encontram-se em desenvolvimento duas vacinas e terapias experimentais para a prevenção e o tratamento da DVE. Conclusão: apesar de ser um vírus conhecido há cerca de 40 anos, o escasso conhecimento obtido e o desinteresse das entidades governamentais de países envolvidos justificam o estado de emergência que se vive atualmente em relação a esse agente infeccioso. A coordenação por múltiplas entidades e o empenho efetivo da comunidade internacional facilitarão o seu controle e a prevenção eficaz.

Ebola virus disease and the search for a cure

Ebola virus disease (EVD) was first identified in 1976 in Yambuku, Zaire (now the Democratic Republic of Congo), and is caused by an RNA virus in the filovirus family (Feldmann & Geisbert). The current strain circulation in West Africa is very similar to the original strain (>95% homology). The origin of the current outbreak remains unknown, but it is suspected to be from an animal reservoir with intermediary species (Fauci). Randomized clinical trials with adaptive design are ongoing to evaluate potential new therapies for EVD...

A proposal for efficient rapid control of the Ebola hemorrhagic fever

A major catastrophe hit Western Africa and we would like to put a definite end to that nightmare. Ever since in its initial identification in 1976, the Ebola virus is endemic in Zaire (currently, Democratic Republic of the Congo – DRC), where it has exerted devastating effects. For many years now, the virus has mercilessly attacked our fellow men, killing entire families overnight and leaving thousands of children orphan.The current, being the seventh epidemic of Ebola hemorrhagic fever (EHF) in the RDC, also broke out in West Africa - Guinea, Liberia, Sierra Leone Nigeria and Senegal.The World Health Organization (WHO) called specialists from several countries and concentrated efforts that might result in a practical contribution to the control of cases. It is worth to observe that the epidemic has caused more than 1,400 deaths in 2014, being the fatality rate 60 to 90%.

La homeopatía tiene como enfrentar la infección por el virus del ebola / Homeopathy has means to face the ebola virus infection

Se describe las características clínicas mas resaltantes de la fiebre hemorrágica por el virus del ebola. Se hace hincapié en el conocimiento del cuadro clínico y la evolución de la enfermedad que debe tener todo médico homeópata por la facilidad con que puede propagarse esta enfermedad a partir de los focos de origen, pero sobretodo por poseer un recurso terapéutico que debería ensayarse como se efectúo con enfermedades parecidas como son el cólera, en épocas pasadas, y que fueron muy exitosas. Se dividió en cuadro evolutivo en tres fases y se repertorizaron los síntomas más frecuentes de cada una de ellas para buscar los remedios que podrían prescribirse individualizando cada caso en particular. El genio epidémico probable es el arsenicum album

Ebola: síndrome letal / Ebola: a fatal syndrome

No other clinical entity has attached more attention now-a-day than those precipitated by the infection with a Hemorrhagic Fever Virus. Potentially caused by Arena, Bunya, Flavi, and Filoviradae, only the latter has had such a major impact throughout the world. Two major genuses have been recognized since they become evident for the first time in 1967, the single-species Marburg, and the 3-species-Ebola (E. zaire, sudan and reston). With the exception of the 2 outbreaks of E. reston (Washington, USA 1989-1993), all of them have taken place in Africa, where the virus is still hiding among the wild-life of the Tropical Rain Forest. Currently (in April 1995) the reemergence of Ebola virus has once more proven its fatality, leaving around 170 deaths in Zaire, 250 miles from its capital, Kinshasa. There is worldwide alert, sponsored by the CDC in Atlanta, the World Health Organization and the authorities in Zaire regarding its potential spreading to naive regions, in and out of Africa. The characteristic clinical picture of a viral hemorrhagic fever has no match. After a 2-21 days incubation period a viral-like illness develops. As days go by, symptoms worsen, and by the 7th day, a severe and diffuse bleeding tendency ensues. The individual's death is the most likely outcome in the great majority of cases. As a lethal virus, without an available treatment and a possible airborne-route of transmission, Ebola virus will always be considered a persistent threat to the global health