Learning from Ebola Virus: How to Prevent Future Epidemics

The recent Ebola virus disease (EVD) epidemic in Guinea, Liberia and Sierra Leone demonstrated that the World Health Organization (WHO) is incapable to control outbreaks of infectious diseases in less developed regions of the world. This essay analyses the causes for the failure of the international response and proposes four measures to improve resilience, early detection and response to future outbreaks of infectious diseases.     

Neurocognition in Adult Congenital Heart Disease: How to Monitor and Prevent Progressive Decline

Children born with congenital heart disease (CHD) are now living to adulthood in unprecedented numbers and many will eventually live to become senior citizens. As care goals shift from surviving to thriving, a new focus on quality of life has emerged. Neurocognition and the ability to participate fully in society, form meaningful relationships, and collaborate effectively with the health care system are important considerations. As adults with CHD age, research regarding their cognitive function becomes prescient. The focus is now shifting from defining neurocognitive deficits in children with CHD to preventing neurocognitive decline in adults living with CHD. In this review, we describe the possible etiologies and predictors of neurocognitive decline in adults with CHD. We performed a comprehensive literature review to identify all of the current data available on neurocognitive function in adults with CHD. We summarize the available evidence by describing common deficits in this patient population and the potential effects of these deficits on adult functioning, health care decision-making, and long-term relationships with care providers. We review potential modifiable etiologies for progressive neurocognitive decline and suggest strategies for surveillance and prevention of the potential decline. We conclude that the current information available regarding the aging brain of adults with CHD and the effect of neurocognitive decline on morbidity and mortality is woefully insufficient. This review, therefore, provides a roadmap for future research endeavours to study neurocognition in older adults with CHD.     

Resistance to what, does it matter? How do we study it?

The importance of platelets and thrombosis in the pathophysiologyof acute ischaemic coronary syndromes has been well appreciated.This information has formed the backbone of the guidelines onboth sides of the Atlantic that patients with acute as wellas chronic coronary artery disease be treated with aspirin asa long-term strategy     

Herpes zoster-related pain in aged individuals: How to manage it safely

Varicella-Zoster virus, an exclusively human herpes virus is responsible for chickenpox and herpes zoster. After the primary infection, the virus becomes permanently latent in the dorsal-root sensory ganglias and may be reactivated several decades later causing a vesicular dermatomal rash, traditionally metameric. Old adults can present severe pain during the acute phase, and late complications, such as postherpetic neuralgia that can be trying and crippling. Initiated within the first 72 hours of the rash, antivirals accelerate rash healing, reducing both rash and acute pain severity as well as avoiding the onset of other complications. The combination of antivirals and corticosteroids may further alleviate short-term zoster pain, increasing the risk of serious adverse effects, especially among older adults. Recently, some therapeutic recommendations focused on analgesic treatments (NSAIDs, opioid agonists, antidepressive drugs, calcium channel α2-δ ligands, corticosteroids and even antiviral agents) were published. However, their applications in old, frail, comorbid and often polymedicated patients have to be consciously pondered and are sometimes contraindicated (as tricyclic antidepressants). Specific recommendations for the therapeutic management of acute and post herpes zoster-related neuralgias, in older adults are proposed.