Evening Ebola Update, Sat, 12/13: Rx for cytokine surge in EBOV/Better PPE, skin protection/Proven Rx for Fluid/electrolyte losses   Leave a comment

12/13/14

Dear Colleagues:

l.  WHO Situation Report 10 December reports 17,492 EBOV cases with 6,388 deaths.  The WHO report contains graphics for Sierra Leone, Guinea, and Liberia which show where outbreaks are located by district, where EBOV treatment centers are by district, and where EBOV lab facilities are by district.  See: http://who.int/csr/disease/ebola/situation-reports/en/ for all the graphics and statistics.

2.  Al Jazeera reports that WHO payments to Cuban physicians in West Africa for housing/food in October and November were only recently made to them.  The U.S. banking embargo with Cuba prevented the WHO payments for housing/food (which pass through U.S. banks) to be made to the Cubans.  The WHO payments are important to the Cubans in West Africa because the WHO payments are larger than the Cuban payments to these physicians.  See: http://www.aljazeera.com/news/middleeast/2014/12/us-embargo-delays-ebola-doctors-pay-from-cuba-2014121312469991605.html

3.  The Lancet 6 December has a Comment by Roberts, et. al. from the London School of Hygiene and Tropical Medicine and from Copenhagen re: treatment of EBOV patients.  The authors counter the statement that there is no proven therapy for EBOV.  The authors say that fluid resuscitation and correction of electrolyte imbalances are proven therapies.  They urge WHO to begin randomized clinical trials (RCT) on how much hydration over how many hours is the proper fluid resuscitation.  It may be that administered fluids should be greater than fluid losses over a short period when patients are at the peak of their viremia.

4.  The authors state that patients are 2 weeks into their symptoms when they present to hospital, and death if it occurs usually occurs within 4 days of hospitalization.  Yet the cited reference re: EBOV in Guinea (author’s reference #2 ) says patients usually present to hospital by 7 days of symptoms and usually die by Day #8 of symptoms.  See the Roberts, et. al. Comment at: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)62316-3/fulltext,  See the authors’ reference #2 in the NEJM at: http://www.nejm.org/doi/full/10.1056/NEJMoa1411249.

5.  NY Times reports on the ‘contest’ by USAID to develop better tools to fight EBOV.  Johns Hopkins has won the prize for a better PPE; their suit has a zipper on the back of the suit and ‘peel-away’ leg coverings, a much larger face mask so patients can see the whole face of the HCW, a ‘cooling-element’ so that HCW can stay in the ‘hot zone’ longer.  Other new tools are a skin disinfectant called Zylast which remains antimicrobial for 6 hours, and a spray-on antimicrobial.  See the NY Times article at: http://www.nytimes.com/2014/12/13/health/ebola-contest-brings-ideas-for-cooling-suits-and-virus-repellents.html?_r=0.  See the Washington Post details of the Johns Hopkins PPE at:  http://www.washingtonpost.com/news/post-nation/wp/2014/12/13/johns-hopkins-team-wins-u-s-award-for-improved-suit-to-fight-ebola/

6.  Dr. Lai of the Hospital Authority of Hong Kong writes to us about his recommended treatment for the cytokine surge in EBOV and MERS-CoV and HIN1 influenza.  See his comment below:

BEGIN COMMENT:

My proposed strategy is not limited to Ebola virus but targeting all encapsulated RNA viruses such as avian influenza (H5N1/H7N9) and MersCoV. The cytokine dysregulation of many RNA viruses can be controlled with high dose N-acetylcysteine (e.g. influenza and RSV from the response of on my ICU patients). With slight modification of the regimen, it may perhaps be able to treat MersCoV. We have treated the cytokine dysregulation and fibrosis of SARS with a cocktail of oral pentoxifylline (PTX), vitamin E(alpha-tocopherol)  N-acetylcysteine (NAC) and Vitalux tablet (Each tablet of Vitalux contains beta-carotene 3mg, Vit C 60mg, Vit E 10mg, Nicotinamide 10mg, Zn 13.5mg, Manganese 1mg, Selenium 10ug, protides 146mg, lipids 190mg and glucides 45mg.)”

END COMMENT.

RGL, MD

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Posted December 14, 2014 by levittrg in Ebola

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