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  • Association Between Vitamin A Supplementation and Mortality Among Patients with Ebola Virus Disease: An International Multisite Cohort Study
  • Adam Aluisio, Derrick Yam, Jillian L. Peters, Daniel K. Cho, Shiromi M. Perera, Stephen B. Kennedy, Foday Sahr, Stephanie Garbern, Tao Liu, Adam C. Levine
  • Journal: Prehospital and Disaster Medicine / Volume 34 / Issue s1 / May 2019
  • Published online by Cambridge University Press: 06 May 2019, pp. s15-s16
  • Print publication: May 2019
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    Introduction:

    Micronutrient supplementation is recommended in Ebola Virus Disease (EVD). However, there is limited data on its therapeutic impacts. This study evaluated the association between vitamin A supplementation and mortality outcomes in EVD patients.

    Methods:

    This retrospective cohort study accrued patients with EVD admitted to five International Medical Corps run Ebola Treatment Units (ETU) in two countries from 2014-2015. Protocolized treatments with antimicrobials and micronutrients were used at all ETUs. However, due to resource limitations and care variations, only a subset of patients received vitamin A. Standardized data on demographics, clinical characteristics, malaria status, and Ebola virus RT-PCR cycle threshold (CT) values were collected. The outcome of interest was mortality compared between cases treated with 200,000 International Units of vitamin A on care days one and two and those not. Propensity scores (PS) based on the first 48-hours of care were derived using the covariates of age, duration of ETU function, malaria status, CT values, symptoms of confusion, hemorrhage, diarrhea, dysphagia, and dyspnea. Treated and non-treated cases were matched 1:1 based on nearest neighbors with replacement. Covariate balance met predefined thresholds. Mortality proportions between cases treated and untreated with vitamin A were compared using generalized estimating equations to calculate relative risks (RR) with associated 95% confidence intervals (CI).

    Results:

    There were 424 cases analyzed, with 330 (77.8%) being vitamin A-treated cases. The mean age was 30.5 years and 57.0% were female. The most common symptoms were diarrhea (86%), anorexia (81%), and vomiting (77%). Mortality proportions among cases untreated and treated with vitamin A were 71.9% and 55.0%, respectively. In a propensity-matched analysis, mortality was significantly lower among cases receiving vitamin A (RR = 0.77 95%; CI:0.59-0.99; p = 0.041).

    Discussion:

    Early vitamin A supplementation was associated with reduced mortality in EVD patients and should be provided routinely during future epidemics.

  • The relationship of endotoxaemia to peripheral and central nervous system inflammatory responses in Human African Trypanosomiasis
  • LORNA MACLEAN, ELTAYB A. ABOUBAKER, PETER G. E. KENNEDY, JEREMY M. STERNBERG
  • Journal: Parasitology / Volume 144 / Issue 4 / April 2017
  • Published online by Cambridge University Press: 29 November 2016, pp. 557-562
  • Print publication: April 2017
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    Endotoxaemia has been described in cases of Human African trypanosomiasis (HAT), but it is unclear if this phenomenon influences inflammatory pathology either in the periphery or central nervous system (CNS). We studied endotoxin concentrations in the plasma and cerebrospinal fluid (CSF) of Trypanosoma brucei rhodesiense patients using the chromogenic Limulus Amoebocyte lysate assay. The relationship of endotoxin concentration to the presentation of gross signs of inflammation and the inflammatory/counter-inflammatory cytokine profile of the relevant compartments were analysed. We demonstrate that HAT patients exhibit parasitaemia-independent plasma endotoxaemia, and that this is associated with splenomegaly and lymphadenopathy. Endotoxin concentrations normalize rapidly after treatment. There was no evidence of endotoxin release in the CNS. A rapid normalization of endotoxin levels after treatment and lack of association with parasitaemia suggest that gut leakage is the main source of endotoxin in the circulation. Low CSF endotoxin concentrations and a lack of any association with neuroinflammatory markers or neurological sequelae suggest that endotoxin does not play a role in the pathogenesis of the disease in the CNS.

Strategy and the Sea
  • Strategy and the Sea
  • Essays in Honour of John B. Hattendorf
  • Benjamin Darnell, Evan Wilson Wilson, J. Ross Dancy
  • Edited by N.A.M. Rodger,
  • Published by: Boydell & Brewer
  • Published online: 05 July 2016
  • Print publication: 16 June 2016
  • View description
    This book presents a wide range of new research on many aspects of naval strategy in the early modern and modern periods. Among the themes covered are the problems of naval manpower, the nature of naval leadership and naval officers, intelligence, naval training and education, and strategic thinking and planning. The book is notable for giving extensive consideration to navies other than those ofBritain, its empire and the United States. It explores a number of fascinating subjects including how financial difficulties frustrated the attempts by Louis XIV's ministers to build a strong navy; how the absence of centralised power in the Dutch Republic had important consequences for Dutch naval power; how Hitler's relationship with his admirals severely affected German naval strategy during the Second World War; and many more besides. The book is a Festschrift in honour of John B. Hattendorf, for more than thirty years Ernest J. King Professor of Maritime History at the US Naval War College and an influential figure in naval affairs worldwide.

    N.A.M. Rodger is Senior Research Fellow at All Souls College, Oxford.

    J. Ross Dancy is Assistant Professor of Military History at Sam Houston State University.

    Benjamin Darnell is a D.Phil. candidate at New College, Oxford.

    Evan Wilson is Caird Senior Research Fellow at the National Maritime Museum, Greenwich.

    Contributors: Tim Benbow, Peter John Brobst, Jaap R. Bruijn, Olivier Chaline, J. Ross Dancy, Benjamin Darnell, James Goldrick, Agustín Guimerá, Paul Kennedy, Keizo Kitagawa, Roger Knight, Andrew D. Lambert, George C. Peden, Carla Rahn Phillips, Werner Rahn, Paul M. Ramsey, Duncan Redford, N.A.M. Rodger, Jakob Seerup, Matthew S. Seligmann, Geoffrey Till, Evan Wilson

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