Evening Ebola Update, Wed, 12/17: Sierra Leone in terrible shape/Let trainees serve in West Africa via CDC/Big names to West Africa   1 comment

12/17/14

Dear Colleagues:

l.  NY Times reports that  Ban Ki-moon will visit Liberia, Sierra Leone, and Guinea soon with Dr. Chan of WHO and Dr. Nabarrro of UN to access what more can be done to stop the continuing EBOV epidemic.  Ban Ki-moon’s request to UN members for money to combat EBOV remains underfunded.

2.  NEJM 17 December on-line only has a Perspective by Dr. Lisa Rosenbaum, a Journal Correspondent, presenting the case for and against trainees at academic medical centers (AMC) being ‘released’ to deliver care to EBOV patients in West Africa.  The Perspective is fair to both sides of the question.  See the Perspective at: http://www.nejm.org/doi/full/10.1056/NEJMp1415192?query=TOC

3.  PLoS ‘Speaking of Medicine’ has a very similar editorial on ‘serving’ in West Africa by Mello, et. al. from Stanford Law School posted today.  See the PLoS editorial at: http://blogs.plos.org/speakingofmedicine/2014/12/17/supporting-go-fight-ebola/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+plos%2FMedicineBlog+%28Blogs+-+Speaking+of+Medicine%29.  In my opinion, trainees should be ‘transferred’ to the CDC for training, deployment, and post-deployment isolation.  With the ‘transfer’ would come health care insurance, stipend, malpractice insurance, etc.  Certainly there is federal money available for this project; HHS will receive > $2.0 Billion for EBOV prevention and treatment in the U.S. in the omnibus spending act just passed by Congress.

4.  Fogerty International Center at the NIH reports today on NIH efforts in sub-Saharan Africa to train junior faculty.  This program has been successful according to this report.  This program needs to be expanded along with increased efforts to train medical students and nurses in West Africa.  See the Fogarty report at: http://www.fic.nih.gov/news/pages/2014-mepi-progress-african-medical-education.aspx?utm_campaign=news&utm_medium=email&utm_source=top2014

5.  ACAPS issued today a Country Profile on Sierra Leone.  The profile is 12 pages; nothing is left out.  Sierra Leone’s economy is supported by other countries’ donations or in-kind ‘gifts’, particularly by China.  Family size averages 6 people; most toilets are shared between families.  Water is a precious commodity and not guaranteed all hours of the day or night.  Large percentage of women have been raped in the civil war which was ended by UN action.  Medical services outside of the urban areas are not supported by the government.  Seventy percent of the population lives in poverty; 40% of young people have no jobs.  Girls are usually married between 15-19 y.o. and often pregnant.  Female genital mutilation occurs in nearly 90% of girls and women.  The government is run by a tribe accounting for only 2% of the population.  The situation is much worse than we have been led to believe.  Read this report at: http://www.acaps.org/img/documents/c-acaps-country-profile-sierra-leone.pdf

6.  NIH reports today that the nurse at the Clinical Center is still being observed.  No information on her EBOV status.

RGL, MD

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Posted December 18, 2014 by levittrg in Ebola

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One response to “Evening Ebola Update, Wed, 12/17: Sierra Leone in terrible shape/Let trainees serve in West Africa via CDC/Big names to West Africa

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  1. Review
    D-penicillamine in the neonatal period: A cost-effective approach to HIV- or Ebola-positivity due to vertical transmission
    Lakatos L, Balla Gy, Pataki I, Vekerdy Zs, Oroszlán Gy
    D-penicillamine (DPA) was first recognized as a potential benefit for neonatal hyperbilirubinemia in the Department of Neonatology in the Medical University, Debrecen, Hungary. During this time there was a remarkedly low incidence of retinopathy of prematurity in the infants treated with DPA (Cochrane Database Syst Rev 2001 (1): CD001073). Later, our studies were replicated in other institutes in Hungary, and in the U.S., India and Mexico. It is important to note that there was no intolerance or short- or long-term toxicity of the medication, in spite of the fact that in the newborn period DPA was used 10-20 times higher doses than those in adult (IJERD 2013, 2: 225-227). On the basis of an American research work (Am. J. Med. 1987, 83: 591-608) concerning the beneficial effects of DPA-therapy in adult AIDS-patients (although in these cases there were many unpleasant, adverse effects), it would be reasonable to treat neonatal HIV- or Ebola-positivity (www.ibtimes.co.uk/ebola-crisis-liberia-doctor-treats-patients-hiv-drugs-most- survive-1467487) due to vertical transmission with short-term DPA therapy (300 mg/kg.bw/day for 5-7 days). In addition, neonates born to mothers with Ebola virus disease have not survived yet (Obstet Gynecol. 2014 Nov;124(5):1005-10. doi: 10.1097/AOG.0000000000000533), i.e., the lethality of this disease is 100 %. Therefore, we have a moral obligation to help the fight against HIV and EBOLA with this inexpensive (~30 US Dollar/baby) drug in the neonatal period.

    Key words: D-penicillamine, neonatal icterus, retinopathy of prematurity, HIV and Ebola vertical infection.

    Reason: West Africa is currently in the midst of the largest Ebola outbreak in history and HIV prevalence in sub saharan Africa is also very high.

    Please, send this letter to the most influential persons or journals in the fight against ebola or Hiv vertical infection. Thank you in advance,
    Lajos Lakatos MD
    professor of pediatrics and neonatology
    Debrecen, HUNGARY

    Like

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