B Acad Nat Med Paris
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B Acad Nat Med Paris · Apr 2015
Review[The Emergence of Ebola virus in humans: a long process not yet fully understood].
Since 1976 Ebola virus regularly has caused small deadly outbreaks in Central Africa, usually controlled in a few months. For the first time, an Ebola epidemic of exceptional magnitude dramatically engulfed several countries in West Africa since December 2013. Major failures of implementing measures to prevent human-to-human transmissions are the main cause of this large-scale Ebola outbreak. ⋯ Thus, according to the diversity of concerned animals and their clinical infectionform, modalities of human contamination can be multiple and are still largely unknown. In this context, all efforts that could be made to unravel the mystery of the Ebola virus emergence in humans and clarify modalities of the virus transmission, would allow for predicting or for anticipating the future occurrence of epidemics. This review aims to provide an exhaustive inventory of the Ebola ecology to highlight events governing the virus transmission to humans that still remain unsolved.
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Adverse drug reactions are a major cause of illness and death. They cause 5-10% of general practice consultations and 5 to 10% of hospital admissions and would be the third or fourth cause of death (after heart attack, stroke and cancer). It is a failure of contemporary medicine. ⋯ Observational epidemiological research has shaped second generation pharmacovigilance, providing incidence and relative and absolute risks which are essential for public health decision taking. The meta-analysis of clinical trials would be third-generation pharmacovigilance: it has contributed to the understanding of relatively common adverse drug reactions with great impact on public health. Research on big data will surely be the basis of the fourth generation of pharmacovigilance.
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Accomplishment of therapeutic clinical trials in the midst of an uncontrolled and devasta- ting epidemic in resource-poor communities is complex and challenging. Key issues rely to close collaboration between research and clinical teams involved in care in the field. ⋯ Research was integrated into care to inform clinical management of patients. This pioneer trial illustrates challenging inputs for producing scientific and ethical gains for the benefit of vulnerable populations in the context of an international emerging or re-emerging infectious disease event.
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Despite a decrease in stroke mortality, the global burden of stroke is increasing worldwide, hence the importance of improving prevention, acute treatment and rehabilitation. Nume- rous randomized clinical trials have been performed in the acute treatment of the three main varieties of stroke, namely acute cerebral ischemia, intracerebral hemorrhage and suba- rachnoid hemorrhage. ⋯ Stroke, however, is only the tip of the iceberg: MRI studies have shown the frequency of silent ischemic and hemorrhagic lesions contributing to cognitive impairment and eventually to dementia. This again underlines the needfor effective prevention strategies to reduce the incidence of stroke.