Relationship Between Viremia and Specific Organ Damage in Ebola Patients: A Cohort Study

Background Pathogenesis of Ebola virus disease remains poorly understood. We used concomitant determination of routine laboratory biomarkers and Ebola viremia to explore the potential role of viral replication in specific organ damage. Methods We recruited patients with detectable Ebola viremia admitted to the EMERGENCY Organizzazione Non Governativa Organizzazione Non Lucrativa di Utilità Sociale (ONG ONLUS) Ebola Treatment Center in Sierra Leone. Repeated measure of Ebola viremia, alanine aminotransferase (ALT), aspartate aminotransferase (AST), bilirubin, creatine phosphokinase (CPK), lactate dehydrogenase (LDH), activated prothrombin time (aPTT), international normalized ratio (INR), creatinine, and blood urea nitrogen (BUN) were recorded. Patients were followed up from admission until death or discharge. Results One hundred patients (49 survivors and 51 nonsurvivors) were included in the analysis. Unadjusted analysis to compare survivors and nonsurvivors provided evidence that all biomarkers were significantly above the normal range and that the extent of these abnormalities was generally higher in nonsurvivors than in survivors. Multivariable mixed-effects models provided strong evidence for a biological gradient (suggestive of a direct role in organ damage) between the viremia levels and either ALT, AST, CPK LDH, aPTT, and INR. In contrast, no direct linear association was found between viremia and either creatinine, BUN, or bilirubin. Conclusions This study provides evidence to support that Ebola virus may have a direct role in muscular damage and imbalance of the coagulation system. We did not find strong evidence suggestive of a direct role of Ebola virus in kidney damage. The role of the virus in liver damage remains unclear, but our evidence suggests that acute severe liver injury is not a typical feature of Ebola virus disease

Cognitive Dysfunction Is Sustained after Rescue Therapy in Experimental Cerebral Malaria, and Is Reduced by Additive Antioxidant Therapy

Neurological impairments are frequently detected in children surviving cerebral malaria (CM), the most severe neurological complication of infection with Plasmodium falciparum. The pathophysiology and therapy of long lasting cognitive deficits in malaria patients after treatment of the parasitic disease is a critical area of investigation. In the present study we used several models of experimental malaria with differential features to investigate persistent cognitive damage after rescue treatment. Infection of C57BL/6 and Swiss (SW) mice with Plasmodium berghei ANKA (PbA) or a lethal strain of Plasmodium yoelii XL (PyXL), respectively, resulted in documented CM and sustained persistent cognitive damage detected by a battery of behavioral tests after cure of the acute parasitic disease with chloroquine therapy. Strikingly, cognitive impairment was still present 30 days after the initial infection. In contrast, BALB/c mice infected with PbA, C57BL6 infected with Plasmodium chabaudi chabaudi and SW infected with non lethal Plasmodium yoelii NXL (PyNXL) did not develop signs of CM, were cured of the acute parasitic infection by chloroquine, and showed no persistent cognitive impairment. Reactive oxygen species have been reported to mediate neurological injury in CM. Increased production of malondialdehyde (MDA) and conjugated dienes was detected in the brains of PbA-infected C57BL/6 mice with CM, indicating high oxidative stress. Treatment of PbA-infected C57BL/6 mice with additive antioxidants together with chloroquine at the first signs of CM prevented the development of persistent cognitive damage. These studies provide new insights into the natural history of cognitive dysfunction after rescue therapy for CM that may have clinical relevance, and may also be relevant to cerebral sequelae of sepsis and other disorders

Nursing diagnoses for the elderly using the International Classification for Nursing Practice and the activities of living model

OBJECTIVE: To develop nursing diagnosis statements for the elderly based on the Activities of Living Model and on the International Classification for Nursing Practice. METHOD: Descriptive and exploratory study, put in practice in two stages: 1) collection of terms and concepts that are considered clinically and culturally relevant for nursing care delivered to the elderly, in order to develop a database of terms and 2) development of nursing diagnosis statements for the elderly in primary health care, based on the guidelines of the International Council of Nurses and on the database of terms for nursing practice involving the elderly. RESULTS: 414 terms were identified and submitted to the content validation process, with the participation of ten nursing experts, which resulted in 263 validated terms. These terms were submitted to cross mapping with the terms of the International Classification for Nursing Practice, resulting in the identification of 115 listed terms and 148 non-listed terms, which constituted the database of terms, from which 127 nursing diagnosis statements were prepared and classified into factors that affect the performance of the elderly's activities of living - 69 into biological factors, 19 into psychological, 31 into sociocultural, five into environmental, and three into political-economic factors. CONCLUSIONS: After clinical validation, these statements can serve as a guide for nursing consultations with elderly patients, without ignoring clinical experience, critical thinking and decision-making

Reelaborando o viver: o papel do grupo no cotidiano de mulheres idosas Rediseñando el vivir: el papel de los grupos en el cotidiano de mujeres ancianas Redrawing the living: the role of groups in the quotidian of elderly women

Objetiva-se compreender a motivação que impulsiona mulheres idosas a procurarem grupos de convivência, analisar e pontuar a apreensão de estratégias que contribuam para a reelaboração e reinvenção de saberes e fazeres em seus cotidianos. Estudo descritivo-exploratório com abordagem qualitativa realizado durante o primeiro semestre de 2007, com 14 mulheres de 60 anos ou mais, participantes há mais de 1 ano do grupo de convivência para idosos denominado Projeto Gugu, ofertado na cidade de Niterói/RJ. O trabalho de campo efetivou-se por meio de observação participante e de entrevistas. Os dados gerados possibilitaram a produção de categorias que expressam a significância do grupo como cenário de redimensionamento do processo de envelhecimento, de resgate e ampliação da sociabilidade e de vínculos afetivos. Conclui-se que cenários como o estudado podem recriar formas de conceber e viver o envelhecimento, tornando-o ativo e alargando a possibilidade de inclusão social.<br>El objetivo es comprender la motivación que impulsa a las mujeres mayores a buscar grupos de apoyo, analizar y puntuar la toma de estrategias que contribuyan a la reconversión y la reinvención de conocimientos y prácticas en sus vidas cotidianas. Estudio descriptivo-exploratorio con enfoque cualitativo realizado durante el primer semestre de 2007, con 14 mujeres de 60 años o más, participantes de más de 1 año de grupo de apoyo para la tercera edad llamado Proyecto Gugu, ofrecido en la ciudad de Niterói, RJ. El trabajo de campo se llevó a cabo a través de la observación participante y entrevistas. Los datos obtenidos permitieron la producción de las categorías que expresan la importancia del grupo como una configuración para redimensionar el proceso de envejecimiento, de recuperación y expansión de la sociabilidad y lazos afectivos. Concluye-se que, los escenarios estudiados pueden volver a crear formas de diseño y el envejecimiento, lo que activa y amplía la posibilidad de la inclusión social.<br>It aims to understand the motivation that drives elderly women to seek support groups, analyze and score the seizure of strategies that contribute to the redevelopment and reinvention of knowledge and practices in their daily lives. A descriptive and exploratory qualitative approach performed during the first half of 2007, with 14 women aged 60 years or more, participants for more than 1 year of support group for seniors called Project Gugu, offered in the city of Niterói, RJ. The field work was accomplished through participant observation and interviews. Data generated enabled the production of categories that express the significance of the group as a setting for resizing of the aging process, of recovery and expansion of sociability and bonds. It is concluded that as the scenarios studied can recreate forms of design and the aging, making it active and expanding the possibility of social inclusion