Development of the PREDS score to predict in-hospital mortality of patients with Ebola virus disease under advanced supportive care: Results from the EVISTA cohort in the Democratic Republic of the Congo.

Background: As mortality remains high for patients with Ebola virus disease (EVD) despite new treatment options, the ability to level up the provided supportive care and to predict the risk of death is of major importance. This analysis of the EVISTA cohort aims to describe advanced supportive care provided to EVD patients in the Democratic Republic of the Congo (DRC) and to develop a simple risk score for predicting in-hospital death, called PREDS. Methods: In this prospective cohort (NCT04815175), patients were recruited during the 10th EVD outbreak in the DRC across three Ebola Treatment Centers (ETCs). Demographic, clinical, biological, virological and treatment data were collected. We evaluated factors known to affect the risk of in-hospital death and applied univariate and multivariate Cox proportional-hazards analyses to derive the risk score in a training dataset. We validated the score in an internal-validation dataset, applying C-statistics as a measure of discrimination. Findings: Between August 1st 2018 and December 31th 2019, 711 patients were enrolled in the study. Regarding supportive care, patients received vasopressive drug (n = 111), blood transfusion (n = 101), oxygen therapy (n = 250) and cardio-pulmonary ultrasound (n = 15). Overall, 323 (45%) patients died before day 28. Six independent prognostic factors were identified (ALT, creatinine, modified NEWS2 score, viral load, age and symptom duration). The final score range from 0 to 13 points, with a good concordance (C = 86.24%) and calibration with the Hosmer-Lemeshow test (p = 0.12). Interpretation: The implementation of advanced supportive care is possible for EVD patients in emergency settings. PREDS is a simple, accurate tool that could help in orienting early advanced care for at-risk patients after external validation. Funding: This study was funded by ALIMA.

[Why does the Ebola virus epidemic continue to plague the Democratic Republic of the Congo?] / Pourquoi l'épidémie à virus Ebola continue-t-elle à sévir en République démocratique du Congo ?

Why does the ebola virus epidemic continue to plague the democratic republic Of the congo?Ebola virus disease outbreak continues in North Kivu and Ituri provinces in the Democratic Republic of the Congo, despite a marked improvement in management of medical care and prevention of the disease. Since August 2018, the disease has been evolving in a complex epidemic field, forgotten by the international press. In the sensitive geopolitic context with this area of armed conflicts more than 20 years, we describe the socio-cultural and geopolitic parameters that have an impact on the evolution of disease in the eastern of Democratic Republic of the Congo.

Pourquoi l'épidémie à virus ebola continue-t-elle à sévir en république démocratique du congo ?Malgré une avancée certaine dans la prise en charge médicale et préventive de la maladie depuis le second semestre 2019, l'épidémie de la maladie à virus Ebola continue de sévir dans les provinces du Nord-Kivu et de l'Ituri en République démocratique du Congo. Débutée en août 2018, cette maladie évolue sur un terrain épidémique complexe et oublié des médias internationaux. Nous décrivons les paramètres socioculturels et géopolitiques qui impactent l'évolution de l'épidémie de la maladie à virus Ebola dans cette région orientale de la République démocratique du Congo en proie à des menaces armées et à une instabilité politique depuis plus de deux décennies.

Furuncular myiasis for the Western dermatologist: treatment in outpatient consultation.

BACKGROUND: Furuncular myiasis is likely to be seen by Western dermatologists because of the increasing number of international travelers but remains unfamiliar to most of them, who tend to refer these patients to hospitals. Different treatments have been proposed, but many of them are not achievable in outpatient consultation. METHODS: We reported three typical cases of furuncular myiasis, according to each species involved, and proposed diagnostic and therapeutic guidelines for dermatologists in outpatient consultation. RESULTS: One patient, complaining of an inflammatory nodule of the leg with a central punctum, was diagnosed with Dermatobia hominis infection, after a forest walk in French Guiana. One woman returned from Senegal with a nodule of the left buttock. She had been infected by a Cordylobia anthropophaga larva after drying her underwear under a mango tree. One woman living in Cameroon presented with scalp nodules, pain, fatigue, and facial edema. She had been infected by more than 40 larvae of Cordylobia rodhaini after drying her sheets under a mango tree. Manual extraction ensured complete healing in the three patients. We used neither doppler ultrasound nor occlusive dressing. Diagnosis was immediately made thanks to the typical clinical stories. CONCLUSIONS: The diagnosis of furuncular myiasis requires only clinical skills and basic knowledge of life cycles. The treatment varies slightly depending on the species involved but is achievable in outpatient consultation and does not require occlusive dressing.

[Outbreak of influenza pandemic virus A(H1N1) 2009 infections in Emergency Department, Saint-Pierre, Reunion Island. July-August 2009]. / Prise en charge dans un service d'urgence de l'épidémie à virus pandémique A(H1N1) 2009 à Saint-Pierre, île de La Réunion. Juillet-Août 2009.

INTRODUCTION: The 2009 pandemic influenza A (H1N1) virus has emerged to cause the first pandemic of the 21st century. On July 3, 2009, novel swine-origin influenza A (H1N1) virus (S-OIV) was identified in Reunion Island, French overseas department located in the southern hemisphere. The present study describes the characteristics and the impact of the epidemic on the activity of an emergency department (ED) from July 3 to August 31, 2009. METHOD: Patients consulting the ED with a discharge diagnosis of influenza-like illness were analyzed. RESULTS: The ED activity in 2009, compared to 2008, increased by 0.5% in July and 9.7% in August. In July and August, respectively 7.1 and 20.0% cases of S-OIV infection were hospitalized. For the 394 patients studied (186 males, 36.2+/-18.5 years), 199 (50.5%) were reported to have comorbidity or risk factor (RF) for complications. Complications occurred in 112 patients (28.4%). The most common complications were bronchospasme (52.7%), pneumonia (32.1%), decompensation caused by comorbidity (17.9%). Seventy-three patients (18.5%) required hospitalization. Patients aged 65 and over accounted for 10.9% of all patients, 31.5% of hospitalized patients and 21.4% of complicated S-OIV infection. Regardless of age, comorbidity and / or RF was reported in 80.2% of complicated S-OIV infection and 86.3% of hospitalized patients. The circuit of patients with S-OIV infection was initially focused on "consultation S-OIV" localized in ED. This organization mobilized several health professionals, disorganized the various medical departments involved, and was unsuitable for the childcare or patient's monitoring with signs of poor tolerance. This organization, even identifying S-OIV patients at their arrival, referred patients to different areas of the hospital and various consultation rooms in ED. CONCLUSION: Recommendations for surveillance, prevention and policy for persons with RF, particularly respiratory disease, are justified. This feedback can raise questions about the patient's circulation in hospital and adjust plans for the organization.