Malaria continues to have a high morbidity rate associated among European travelers. Thorough recording of epidemiological and clinical aspects of imported malaria has been helpful in the detection ...of new outbreaks and areas of developing drug resistance. Sentinel surveillance of data collected prospectively since 1999 has begun within TropNetEurop, a European network focusing on imported infectious diseases. TropNetEurop appears to cover ∼10% of all patients with malaria seen in Europe. Reports of 1659 immigrants and European patients with Plasmodium falciparum malaria were analyzed for epidemiological information and data on clinical features. Regional data were quite diverse, reflecting local patterns of immigration and international travel. By far, the most infections were imported from West Africa. Europeans had more clinical complications; consequently, all deaths occurred in this group. Compared with European standards, the mortality rate was low (0.6% in Europeans). Data from TropNetEurop member sites can contribute to our understanding of the epidemiological and clinical findings regarding imported falciparum malaria.
The purpose of this prospective study was to update epidemiological data on cutaneous larva migrans (CLM) and to assess the therapeutic efficacy of ivermectin. We performed the study between June ...1994 and December 1998 at our travel clinic. Ivermectin (a single dose of 200 g/kg) was offered to all the patients with CLM, and its efficacy and tolerability were assessed by a questionnaire. Sixty-four patients were enrolled. All were European and had stayed in tropical areas. After the patients had returned from their destinations, 55% had lesions occur within a mean of 16 days (range, 1-120 days; >1 month in 7 patients). The initial diagnosis was wrong in 55% of patients. The mean number of lesions was 3 (range, 1-15), and the main sites were the feet (48%) and buttocks (23%). The cure rate after a single dose of ivermectin was 77%. In 14 patients, 1 or 2 supplementary doses were necessary, and the overall cure rate was 97%. The median time required for pruritus and lesions to disappear was 3 and 7 days, respectively. No systemic adverse effects were reported. Physicians' knowledge of CLM, which can have a long incubation period, is poor. Single-dose ivermectin therapy appears to be effective and well tolerated, even if several treatments are sometimes necessary.
Recent guidelines have emphasized actively avoiding fever to improve outcomes in patients who are comatose following resuscitation from cardiac arrest (ie, out-of-hospital cardiac arrest). However, ...whether targeted temperature management between 32 °C and 36 °C (TTM32-36) can improve neurologic outcome in some patients remains debated.
Is there an association between the use of TTM32-36 and outcome according to severity assessed at ICU admission using a previously derived risk score?
Data prospectively collected in the Sudden Death Expertise Center (SDEC) registry (France) between May 2011 and December 2017 and in the Resuscitation Outcomes Consortium Continuous Chest Compressions (ROC-CCC) trial (United States and Canada) between June 2011 and May 2015 were used for this study. Severity at ICU admission was assessed through a modified version of the Cardiac Arrest Hospital Prognosis (mCAHP) score, divided into tertiles of severity. The study explored associations between TTM32-36 and favorable neurologic status at hospital discharge by using multiple logistic regression as well as in tertiles of severity for each data set.
A total of 2,723 patients were analyzed in the SDEC data set and 4,202 patients in the ROC-CCC data set. A favorable neurologic status at hospital discharge occurred in 728 (27%) patients in the French data set and in 1,239 (29%) patients in the North American data set. Among the French data set, TTM32-36 was independently associated with better neurologic outcome in the tertile of patients with low (adjusted OR, 1.63; 95% CI, 1.15-2.30; P = .006) and high (adjusted OR, 1.94; 95% CI, 1.06-3.54; P = .030) severity according to mCAHP at ICU admission. Similar results were observed in the North American data set (adjusted ORs of 1.36 95% CI, 1.05-1.75; P = .020 and 2.42 95% CI, 1.38-4.24; P = .002, respectively). No association was observed between TTM32-36 and outcome in the moderate groups of the two data sets.
TTM32-36 was significantly associated with a better outcome in patients with low and high severity at ICU admission assessed according to the mCAHP score. Further studies are needed to evaluate individualized temperature control following out-of-hospital cardiac arrest.
Background & Aims: The outcome of chronic hepatitis B and the efficacy of interferon alfa (IFN-α) remain controversial in human immunodeficiency virus (HIV)-positive patients. We analyzed the ...influence of HIV coinfection on the response to IFN-α therapy, long-term virologic status, progression to cirrhosis, and mortality. Methods: This was a retrospective follow-up cohort study of 141 consecutive hepatitis B e antigen–positive patients (69 HIV positive) followed up for 45 months. Results: The short-term response to IFN-α therapy was not significantly different in HIV-positive and HIV-negative patients (28% vs. 51%; P = 0.06) but was poorer in cases of low CD4 cell count (P = 0.038). The hepatitis B virus (HBV) reactivation rate was higher in HIV-positive patients (P = 0.033) and was associated with low CD4 cell count. The risk of cirrhosis was higher in HIV-positive patients with a CD4 cell count <200/mm3 (relative risk RR, 4.57; P = 0.007), in IFN-α–untreated patients (RR, 2.63; P = 0.041), in patients older than 33 years (RR, 4.59; P = 0.008), and in cases of high necroinflammatory score at baseline (RR, 1.27; P = 0.010). Cirrhosis-related death was more frequent in HIV-positive patients with low CD4 cell count at baseline (P = 0.041), in alcohol consumers (P = 0.001), in IFN-α–untreated patients (P = 0.052), and in patients with high histology activity index at baseline (P = 0.005). Conclusions: HIV coinfection was associated with poorer response to IFN-α therapy, more frequent HBV reactivations, and increased incidence of cirrhosis and cirrhosis-related death in cases of low CD4 count. IFN-α therapy decreased the incidence of HBV cirrhosis regardless of HIV status or serologic response.
GASTROENTEROLOGY 2002;123:1812-1822
Among populations living in areas endemic for malaria, repeated parasite exposure leads to a gradual increase in protective immunity to the disease. In contrast, this immunity is assumed to disappear ...after several years of non-exposure. This study was designed to investigate long-term immunity in subjects removed from the risk of exposure. Plasmodium falciparum malaria attacks occurring after short trips to sub-Saharan Africa were compared between 99 European patients and 252 African immigrants who had been resident in Europe for at least four years. Relative to the European patients, those originating from Africa had lower mean +/- SD parasite densities (0.8 +/- 1.5/100 red blood cells versus 1.4 +/- 2.8/100 red blood cells; P = 0.007), less frequent severe disease (4.4% versus 15.2%; P = 0.0005), accelerated parasite clearance and defervescence, and higher levels of antibodies to P. falciparum. These results suggest the persistence of acquired immunity to P. falciparum malaria after several years of non-exposure in African immigrants.
Sudden Cardiac Arrest in Young Women Weizman, Orianne; Sharifzadehgan, Ardalan; Bougouin, Wulfran ...
Circulation (New York, N.Y.),
02/2021, Volume:
143, Issue:
7
Journal Article
From the micro- to the mesoscale, water and energy budgets of mountainous catchments are largely driven by topographic features such as terrain orientation, slope, steepness, and elevation, together ...with associated meteorological forcings such as precipitation, solar radiation, and wind speed. Those topographic features govern the snow deposition, melting, and transport, which further impacts the overall water cycle. However, this microscale variability is not well represented in Earth system models due to coarse resolutions. This study explores the impact of precipitation, shortwave radiation, and wind speed on the water budget distribution over a 15.28 ha small, mid-elevation (2000–2200 m) alpine catchment at Col du Lautaret (France). The grass-dominated catchment remains covered with snow for 5 to 6 months per year. The surface–subsurface coupled distributed hydrological model ParFlow-CLM is used at a very high resolution (10 m) to simulate the impacts on the water cycle of meteorological variability at very small spatial and temporal scales. These include 3D simulations of hydrological fluxes with spatially distributed forcing of precipitation, shortwave radiation, and wind speed compared to 3D simulations of hydrological fluxes with non-distributed forcing. Our precipitation distribution method encapsulates the spatial snow distribution along with snow transport. The model simulates the dynamics and spatial variability of snow cover using the Common Land Model (CLM) energy balance module and under different combinations of distributed forcing. The resulting subsurface and surface water transfers are computed by the ParFlow module. Distributed forcing leads to spatially heterogeneous snow cover simulation, which becomes patchy at the end of the melt season and shows a good agreement with the remote sensing images (mean bias error (MBE) = 0.22). This asynchronous melting results in a longer melting period compared to the non-distributed forcing, which does not generate any patchiness. Among the distributed meteorological forcings tested, precipitation distribution, including snow transport, has the greatest impact on spatial snow cover (MBE = 0.06) and runoff. Shortwave radiation distribution has an important impact, reducing evapotranspiration as a function of the slope orientation (decreasing the slope between observed and simulated evapotranspiration from 1.55 to 1.18). For the primarily east-facing catchment studied here, distributing shortwave radiation helps generate realistic timing and spatial heterogeneity in the snowmelt at the expense of an increase in the mean bias error (from 0.06 to 0.22) for all distributed forcing simulations compared to the simulation with only distributed precipitation. Distributing wind speed in the energy balance calculation has a more complex impact on our catchment, as it accelerates snowmelt when meteorological conditions are favorable but does not generate snow patches at the end of our test case. This shows that slope- and aspect-based meteorological distribution can improve the spatio-temporal representation of snow cover and evapotranspiration in complex mountain terrain.
Previous studies have indicated that age is a risk factor for severe falciparum malaria in nonimmune patients. The objectives of this study were to reevaluate previous findings with a larger sample ...and to find out how strongly clinical outcomes for elderly patients differ from those for younger patients. Results of adjusted analyses indicated that the risks of death due to falciparum malaria, of experiencing cerebral or severe disease in general, and of hospitalization increased significantly with each decade of life. The case-fatality rate was almost 6 times greater among elderly patients than among younger patients, and cerebral complications occurred 3 times more often among elderly patients. Antimalarial chemoprophylaxis was significantly associated with a lower case-fatality rate and a lower frequency of cerebral complications. Women were more susceptible to cerebral complications than were men. Our study provides evidence that falciparum malaria is more serious in older patients and demonstrates that clinical surveillance networks are capable of providing quality data for investigation of rare events or diseases.
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