Día Mundial del Alzheimer - 21 de Septiembre

La enfermedad de Alzheimer es la causa más frecuente de demencia en Occidente, representa entre el 60 y el 75% del total.
Para los datos más recientes la enfermedad de Alzheimer afecta a 40 millones de personas en el mundo duplicándose las cifras cada 20 años.
Se estima que España contaba con unos 850.000 casos de demencia a finales de 2012, de los cuales alrededor de 500.000 serían casos de enfermedad de Alzheimer para las cifras más optimistas.
Posiblemente finales del año 2014 la cifra de pacientes con Alzheimer sea próxima a los 1.2 millones casos.
El efecto de la demencia en la esperanza de vida y la institucionalización en la población geriátrica es de gran importancia para la planificación de recursos, así como para los pacientes y sus cuidadores.
En España, el coste medio de la enfermedad de Alzheimer y las otras demencias para las familias cuidadoras se estima en 37.000 millones de euros al  año, en el cual están incluidos los gastos directos e indirectos. Las perspectivas futuras son preocupantes debido al incremento esperado en el número de casos y al previsible aumento de la demanda de institucionalización.

Factores de riesgo de la enfermedad de Alzheimer: 

http://www.researchgate.net/publication/7816159_Risk_factors_for_Alzheimer%27s_disease

Ebola Virus Disease: Controls for body temperature in airports?

Recently, the director of the Centers for Disease Control and Prevention (CDC) expressed confidence in screening measures being taken at the international airports in West Africa to prevent the spread of Ebola Virus Disease. Temperature checks for travelers in West Africa have emerged as the favored front-line, last-minute defense for containing the spread of Ebola Virus Disease.

Do we really believe that temperature checks for travelers could control the spread of Ebola Virus Disease?

In 2009, WHO recommended temperature checks for travelers at all national and international airports during influenza A(H1N1) pandemic.

Should we apply the same preventive measure to control the spread of Ebola Virus Disease?

Of no doubt, this measure could not be applied to control the spread of Ebola Virus Disease. Controls for body temperature in airports did not show to be effective to control the spread of influenza A(H1N1-2009) and alerted people more.

In 2009, a study was done at Narita International Airport (Japan) to retrospectively assess the feasibility of detecting influenza cases upon relying solely on fever screening. The results of the study showed that the sensitivity of fever for detecting influenza A(H1N1-2009) cases upon arrival was estimated to be 22.2% among confirmed influenza A(H1N1-2009) cases. Also, the study reported that about 55.6% of influenza A(H1N1-2009) cases were under antipyretic medications upon arrival.  

Should not we learn from previous mistakes?

Nishiura H, Kamiya K. Fever screening during the influenza (H1N1-2009) pandemic at Narita International Airport, Japan. BMC Infect Dis 2011;11:111.

Please check out this site: http://www.biomedcentral.com/1471-2334/11/111

Ebola Virus Disease: Case Fatality Ratio

According to the recent report of WHO [22 August 2014], Case Fatality Ratio (CFR) is of 55-60% (Total number of cases 2615 – Deaths 1427).

WHO Report included data of confirmed, probable, suspect and new patients:

- Confirmed: 1528 Cases and Deaths 844 (CFR 55.2%).
- Probable: 733 Cases and Deaths 440 (CFR 60%).
- Suspect: 354 Cases and Deaths 143 (CFR 40.4%).
- New: 142 Cases and Deaths 77 (CFR 54.2%); Too early to calculate CFR. 
- Total: 2615 Cases and Deaths 1427 (CFR 54.6%).

Considering only confirmed and probable cases (2261 Cases and 1284 Deaths), CFR will be of 56.8%. CFR could not be trustworthy based on these numbers, however this is the largest outbreak with valid number of cases we have.

Of no doubt, we cannot jump to conclusions based on simple calculation of CFR, however this raises an important question; why CFR in the current outbreak is much lower than previous out breaks of Ebola Virus Disease?

Several possible reasons could be the explanation:
1. Virus strain. The current strain could a less virulent than strains isolated from previous outbreaks.
2. The virus is adapting to the human host. Fruit bats are considered the natural hosts for Ebola virus.
3. Patient’s immune system and general health.
4. Early detection of patients and commencement of supportive treatment.

Treatment for Ebola Hemorrhagic Fever

Currently there is no specific treatment for Ebola Hemorrhagic Fever.

Till date, only supportive care is available (intravenous fluids; blood and platelet transfusions), although upcoming human vaccine trials may be promising. The National Institutes of Health (USA) will begin a human vaccine trial in September 2014.

The prospects of transfusing blood or plasma from those patients who have recently recovered from Ebola virus infection seem promising. This could be an effective treatment as Ebola prophylaxis or for use in early onset of Ebola symptoms.

Use of an experimental compound, referred to as BCX4430, was reported in the journal Nature in April 2014. The compound, an RNA-dependent RNA polymerase inhibitor, has proven successful in a nonhuman primate model, whereby postexposure prophylaxis to BCX4430 prevented death in 17 of 18 macaques studied. No human trials have yet been reported.

Ebola Virus is not that lethal as thought before!!!

Since 1976, all epidemiological studies about Ebola Hemorrhagic Fever reported case fatality rate of up to 90%.
According to the last report of WHO (1 August 2014) the case fatality rate is of 55-60% (Total number of cases 1603 – Deaths 887). It is clear that nonspecific treatment with oral rehydration with solutions containing electrolytes or intravenous fluids reduced the case fatality rate.
Could we save lives simply by using oral rehydration with solution containing electrolytes?
Is this the best treatment to avoid hepatic and/or renal failures?

Please check out this site: http://www.who.int/csr/don/2014_08_04_ebola/en/