• Amoxicillin for Severe Acute Malnutrition in Children

      Isanaka, S; Adehossi, E; Grais, R (Massachusetts Medical Society, 2016-07-14)
    • The battle for access--health care in Afghanistan.

      Reilley, B; Puertas, G; Coutin, A S; Médecins sans Frontières, New York, USA. (Massachusetts Medical Society, 2004-05-06)
    • Bedaquiline Microheteroresistance after Cessation of Tuberculosis Treatment

      de Vos, M; Ley, SD; Wiggins, KB; Derendinger, B; Dippenaar, A; Grobbelaar, M; Reuter, A; Dolby, T; Burns, S; Schito, M; et al. (Massachusetts Medical Society, 2019-05-30)
    • Clinical Presentation of Patients with Ebola Virus Disease in Conakry, Guinea

      Bah, Elhadj Ibrahima; Lamah, Marie-Claire; Fletcher, Tom; Jacob, Shevin T; Brett-Major, David M; Sall, Amadou Alpha; Shindo, Nahoko; Fischer, William A; Lamontagne, Francois; Saliou, Sow Mamadou; et al. (Massachusetts Medical Society, 2014-11-05)
      Background In March 2014, the World Health Organization was notified of an outbreak of Zaire ebolavirus in a remote area of Guinea. The outbreak then spread to the capital, Conakry, and to neighboring countries and has subsequently become the largest epidemic of Ebola virus disease (EVD) to date. Methods From March 25 to April 26, 2014, we performed a study of all patients with laboratory-confirmed EVD in Conakry. Mortality was the primary outcome. Secondary outcomes included patient characteristics, complications, treatments, and comparisons between survivors and nonsurvivors. Results Of 80 patients who presented with symptoms, 37 had laboratory-confirmed EVD. Among confirmed cases, the median age was 38 years (interquartile range, 28 to 46), 24 patients (65%) were men, and 14 (38%) were health care workers; among the health care workers, nosocomial transmission was implicated in 12 patients (32%). Patients with confirmed EVD presented to the hospital a median of 5 days (interquartile range, 3 to 7) after the onset of symptoms, most commonly with fever (in 84% of the patients; mean temperature, 38.6°C), fatigue (in 65%), diarrhea (in 62%), and tachycardia (mean heart rate, >93 beats per minute). Of these patients, 28 (76%) were treated with intravenous fluids and 37 (100%) with antibiotics. Sixteen patients (43%) died, with a median time from symptom onset to death of 8 days (interquartile range, 7 to 11). Patients who were 40 years of age or older, as compared with those under the age of 40 years, had a relative risk of death of 3.49 (95% confidence interval, 1.42 to 8.59; P=0.007). Conclusions Patients with EVD presented with evidence of dehydration associated with vomiting and severe diarrhea. Despite attempts at volume repletion, antimicrobial therapy, and limited laboratory services, the rate of death was 43%.
    • Crisis in Niger--outpatient care for severe acute malnutrition.

      Tectonidis, M; Medical Department of Médecins sans Frontières, Paris. (Massachusetts Medical Society, 2006-01-19)
    • Demedicalizing AIDS prevention and treatment in Africa

      Ellman, Tom (Massachusetts Medical Society, 2015-01-22)
    • Detection of drug-resistant tuberculosis by Xpert MTB/RIF in Swaziland

      Sanchez-Padilla, E; Merker, M; Beckert, P; Jochims, F; Dlamini, T; Kahn, P; Bonnet, M; Niemann, S (Massachusetts Medical Society, 2015-03-19)
    • Ebola

      Feldmann, H; Sprecher, A; Geisbert, TW (Massachusetts Medical Society, 2020-05-07)
    • Ebola Virus Disease in West Africa - Clinical Manifestations and Management

      Chertow, Daniel S; Kleine, Christian; Edwards, Jeffrey K; Scaini, Roberto; Giuliani, Ruggero; Sprecher, Armand (Massachusetts Medical Society, 2014-11-05)
      In resource-limited areas, isolation of the sick from the population at large has been the cornerstone of control of Ebola virus disease (EVD) since the virus was discovered in 1976.(1) Although this strategy by itself may be effective in controlling small outbreaks in remote settings, it has offered little hope to infected people and their families in the absence of medical care. In the current West African outbreak, infection control and clinical management efforts are necessarily being implemented on a larger scale than in any previous outbreak, and it is therefore appropriate to reassess traditional efforts at disease management. Having . . .
    • Efficacy of a Low-Cost, Heat-Stable Oral Rotavirus Vaccine in Niger

      Isanaka, S; Guindo, O; Langendorf, C; Matar Seck, A; Plikaytis, BD; Sayinzoga-Makombe, N; McNeal, MM; Meyer, N; Adehossi, E; Djibo, A; et al. (Massachusetts Medical Society, 2017-03-23)
      Background Each year, rotavirus gastroenteritis is responsible for about 37% of deaths from diarrhea among children younger than 5 years of age worldwide, with a disproportionate effect in sub-Saharan Africa. Methods We conducted a randomized, placebo-controlled trial in Niger to evaluate the efficacy of a live, oral bovine rotavirus pentavalent vaccine (BRV-PV, Serum Institute of India) to prevent severe rotavirus gastroenteritis. Healthy infants received three doses of the vaccine or placebo at 6, 10, and 14 weeks of age. Episodes of gastroenteritis were assessed through active and passive surveillance and were graded on the basis of the score on the Vesikari scale (which ranges from 0 to 20, with higher scores indicating more severe disease). The primary end point was the efficacy of three doses of vaccine as compared with placebo against a first episode of laboratory-confirmed severe rotavirus gastroenteritis (Vesikari score, ≥11) beginning 28 days after dose 3. Results Among the 3508 infants who were included in the per-protocol efficacy analysis, there were 31 cases of severe rotavirus gastroenteritis in the vaccine group and 87 cases in the placebo group (2.14 and 6.44 cases per 100 person-years, respectively), for a vaccine efficacy of 66.7% (95% confidence interval [CI], 49.9 to 77.9). Similar efficacy was seen in the intention-to-treat analyses, which showed a vaccine efficacy of 69.1% (95% CI, 55.0 to 78.7). There was no significant between-group difference in the risk of adverse events, which were reported in 68.7% of the infants in the vaccine group and in 67.2% of those in the placebo group, or in the risk of serious adverse events (in 8.3% in the vaccine group and in 9.1% in the placebo group); there were 27 deaths in the vaccine group and 22 in the placebo group. None of the infants had confirmed intussusception. Conclusions Three doses of BRV-PV, an oral rotavirus vaccine, had an efficacy of 66.7% against severe rotavirus gastroenteritis among infants in Niger. (Funded by Médecins sans Frontières Operational Center and the Kavli Foundation; ClinicalTrials.gov number, NCT02145000 .).
    • Emergence of extensive drug resistance during treatment for multidrug-resistant tuberculosis.

      Cox, H; Sibilia, K; Feuerriegel, S; Kalon, S; Polonsky, J; Khamraev, A K; Rüsch-Gerdes, S; Mills, C; Niemann, S (Massachusetts Medical Society, 2008-11-27)
    • Emergence of Zaire Ebola Virus Disease in Guinea - Preliminary Report

      Baize, Sylvain; Pannetier, Delphine; Oestereich, Lisa; Rieger, Toni; Koivogui, Lamine; Magassouba, N'faly; Soropogui, Barrè; Sow, Mamadou Saliou; Keïta, Sakoba; De Clerck, Hilde; et al. (Massachusetts Medical Society, 2014-04-16)
      In March 2014, the World Health Organization was notified of an outbreak of a communicable disease characterized by fever, severe diarrhea, vomiting, and a high fatality rate in Guinea. Virologic investigation identified Zaire ebolavirus (EBOV) as the causative agent. Full-length genome sequencing and phylogenetic analysis showed that EBOV from Guinea forms a separate clade in relationship to the known EBOV strains from the Democratic Republic of Congo and Gabon. Epidemiologic investigation linked the laboratory-confirmed cases with the presumed first fatality of the outbreak in December 2013. This study demonstrates the emergence of a new EBOV strain in Guinea.
    • An Epidemic of Suspicion - Ebola and Violence in the DRC

      Nguyen, VK (Massachusetts Medical Society, 2019-04-04)
      Until the 2014 Ebola epidemic in West Africa, Ebola outbreaks had been sporadic, small, and largely confined to isolated rural villages in Central Africa. But the 2014 epidemic broke all the rules and killed more than 15,000 people; since then, more outbreaks have been reaching larger urban centers, sometimes resulting in uncontrolled spread. The current epidemic in the Democratic Republic of Congo (DRC) has triggered a massive international response, which has been met by violence, culminating in attacks at the end of February that partially destroyed Ebola treatment units in the regional hub of Butembo and its township, Katwa. This area is the epicenter of the epidemic, which is likely to be fueled by any breakdown of isolation and treatment efforts.
    • Face to Face with Ebola - An Emergency Care Center in Sierra Leone.

      Wolz, Anja (Massachusetts Medical Society, 2014-08-27)
      At 6 a.m., our medical team arrives at the Ebola case-management center in the Kailahun district of Sierra Leone to take blood samples. At our 80-bed center here near the borders of Liberia and Guinea, 8 new patients were admitted yesterday, 9 need to have a repeat test 72 hours after their symptoms began, and some we hope to discharge today: at least 18 blood samples to obtain. The center currently houses 64 patients in all, 4 of them children less than 5 years of age. We have already seen 2 patients die today. I have been here for 7 . . .
    • Global Burden of Rheumatic Heart Disease

      Rossi, G (Massachusetts Medical Society, 2018-01-04)
    • Handle Survivors with Care

      Sprecher, A (Massachusetts Medical Society, 2017-10-12)
    • Having and Fighting Ebola - Public Health Lessons from a Clinician Turned Patient

      Spencer, Craig (Massachusetts Medical Society, 2015-03-19)
    • HIV drug resistance.

      Calmy, A; Pascual, F; Ford, N (Massachusetts Medical Society, 2004-06-24)
    • Kashin-Beck osteoarthropathy in rural Tibet in relation to selenium and iodine status.

      Moreno-Reyes, R; Suetens, C; Mathieu, F; Begaux, F; Zhu, D; Rivera, M; Boelaert, M; Nève, J; Perlmutter, N; Vanderpas, J; et al. (Massachusetts Medical Society, 1998-10-15)
      BACKGROUND AND METHODS: Kashin-Beck disease is a degenerative osteoarticular disorder that is endemic to certain areas of Tibet, where selenium deficiency is also endemic. Because selenium is involved in thyroid hormone metabolism, we studied the relation among the serum selenium concentration, thyroid function, and Kashin-Beck disease in 575 subjects 5 to 15 years of age in 12 villages around Lhasa, Tibet, including 1 control village in which no subject had Kashin-Beck disease. Clinical, radiologic, and biochemical data were collected. RESULTS: Among the 575 subjects, 280 (49 percent) had Kashin-Beck disease, 267 (46 percent) had goiter, and 7 (1 percent) had cretinism. Of the 557 subjects in whom urinary iodine was measured, 66 percent had a urinary iodine concentration of less than 2 microg per deciliter (157 nmol per liter; normal, 5 to 25 microg per deciliter [394 to 1968 nmol per liter]). The mean urinary iodine concentration was lower in subjects with Kashin-Beck disease than in control subjects (1.2 vs. 1.8 microg per deciliter [94 vs. 142 nmol per liter], P<0.001) and hypothyroidism was more frequent (23 percent vs. 4 percent, P=0.01). Severe selenium deficiency was documented in all villages; 38 percent of subjects had serum concentrations of less than 5 ng per milliliter (64 nmol per liter; normal, 60 to 105 ng per milliliter [762 to 1334 nmol per liter]). When age and sex were controlled for in a multivariate analysis, low urinary iodine, high serum thyrotropin, and low serum thyroxine-binding globulin values were associated with an increased risk of Kashin-Beck disease, but a low serum selenium concentration was not. CONCLUSIONS: In areas where severe selenium deficiency is endemic, iodine deficiency is a risk factor for Kashin-Beck disease.
    • Outbreaks in a Rapidly Changing Central Africa — Lessons from Ebola

      Munster, VJ; Bausch, DG; de Wit, E; Fischer, R; Kobinger, G; Muñoz-Fontela, C; Olson, SH; Seifert, SN; Sprecher, A; Ntoumi, F; et al. (Massachusetts Medical Society, 2018-09-27)