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Pulmonary immersion oedema is a frequent diving accident. Although its outcome is generally favourable within 72 h, it can nonetheless lead to heart failure or sudden death. Cases of transient myocardial dysfunction have been reported in the literature. This phenomenon is similar to Takotsubo syndrome in many ways. It is characterised by transient myocardial hypokinesia, without associated coronary lesions.We report on 20 cases of patients who showed transient alteration of left ventricular kinetics with normal coronary angiography over the course of an immersion pulmonary oedema.The echocardiographic localisation of the myocardial damage was generally focal and not centred on the apex with an average left ventricular ejection fraction of 45%. The main anomalies in the electrocardiographic repolarisation were T wave inversion with corrected QT interval prolongation. We also observed a moderate increase in troponin levels, with discordance between the enzymatic peak and the severity of the left ventricle segmental dysfunction.These cases suggest the incidence of a clinical entity strongly reminiscent of Takotsubo phenomenon of atypical topography as a consequence of diving accidents.

Introduction : dans le cadre de la participation francaise a la lutte contre l’epidemie de maladie a virus Ebola en Afrique de l’Ouest, un centre de traitement des soignants a ete deploye a Conakry, Guinee. Bien que des cas de bradycardies inappropriees aient ete decrits des les premieres epidemies, ils n’ont a notre connaissance pas ete documentes. Nous avons etudie le rythme cardiaque des patients hospitalises pour Ebola, analyse les bradycardies inappropriees et discute leurs mecanismes. Methodes : neuf patients atteints d’Ebola ont ete hospitalises au cours du mois de mars 2015. Les donnees cliniques ont ete relevees a l’admission puis deux fois par jour, et des analyses biologiques (avec dosage de troponine) systematiquement realisees. Resultats : a l’admission, les patients n’etaient pas (ou peu) tachycardes (FC = 82 ± 27/mn). Parmi eux, une sage-femme de 32 ans presentait une bradycardie marquee a 43/mn. L’electrocardiogramme (ECG) enregistrait une bradycardie sinusale, sans trouble conductif, tout comme pour les trois autres malades bradycardes

BACKGROUND The pathogenesis of Ebola virus disease (EVD) remains unclear. The sporadic nature of Ebola outbreaks and their occurrence in resource-limited settings have precluded the acquisition of extensive clinical and laboratory data. Rhabdomyolysis during EVD has been suggested to occur in previous studies showing increased aspartate aminotransferase-alanine aminotransferase ratios, but, to date, has not been confirmed with creatine kinase (CK) assays. METHODS We performed an observational study of 38 patients admitted to an Ebola treatment center from January to April 2015. CK values from patients with confirmed EVD were compared with those in patients without confirmed EVD. A panel of other analyses were also performed. In patients with EVD, characteristics were compared between survivors and nonsurvivors. RESULTS High levels of CK were more frequent in patients with EVD than in those without (P = .002), and rhabdomyolysis was more frequent (59% vs 19%, respectively; P = .03). CK levels >5000 U/L were observed in 36% of patients with EVD. Also in patients with EVD, fatal outcome was significantly associated with higher creatinine and bilirubin levels, international normalized ratio, and viral load. CONCLUSIONS Rhabdomyolysis is a frequent disorder in EVD and seems to be more common than in other viral infections. It may contribute to the renal failure observed in nonsurviving patients. More studies are needed to determine the impact of rhabdomyolysis on EVD outcome.

Ebola patients frequently exhibit behavioral modifications with ideation slowing and aggressiveness, sometimes contrasting with mild severity of Ebola disease. We performed lumbar punctures in 3 patients with this presentation and found Ebola virus in all cerebrospinal fluid samples. This discovery helps to discuss the concept of a specific Ebola virus encephalitis.

We report 77 cases of occupational exposures for 57 healthcare workers at the Ebola Treatment Center in Conakry, Guinea, during the Ebola virus disease outbreak in 2014-2015. Despite the high incidence of 3.5 occupational exposures/healthcare worker/year, only 18% of workers were at high risk for transmission, and no infections occurred.

BackgroundWest African outbreak of Ebola virus disease (EVD) currently affects urban areas in Guinea. Although some cases of bradycardia have been reported since the first Ebola outbreak in 1976, they have never been documented to our knowledge.Methodswe analyse heart rate (HR) for our cohort of nine consecutive patients (5 males, mean age: 38.7 years [range: 27-62]) testing positive for EVD and admitted to the EVD Treatment Centre (EVDTC) in Conakry, Guinea. Treatment and care were standardized, all healthcare workers by wearing personal protective equipment. ECG was recorded if HR was

Purpose Transthoracic echocardiography (TTE) for Ebola virus disease (EVD) might contribute to evaluate gravity, guide treatment, and finally improve prognosis and has not previously been described. This report delineates the safety, feasibility and clinical implications of systematic TEE for patients with EVD, in the setting of a deployed French military Ebola virus disease Treatment Center in Guinea. Methods In first 48 hours after admission for EVD, a TTE was performed. All patients were monitored by continue video survey and radio call. Data were collected prospectively on all cases to include TTE hemodynamic parameters, and evaluate EVD cardiac complications. Data were collected by in-live oral transmission to medical center, and correlated to blood test variables including I-Troponin and Brain Natriuretic Peptide. Result Eight consecutive patients, hospitalized in March 29th underwent TTE evaluation performed by a cardiologist during the first 48 hours of admission. Mean time in Personal Protective Equipment (PPE) was 82 min. No virus accidental exposition during procedure was deplored. TTE were feasible for all patients and all parameters could be studied. All TTE showed signs of hypovolemia with low LV pressure filled despite 2 patients with dyspnea; 1 patient had pericarditis effusion (with inappropriate sinus bradycardia and elevated troponin), and 1 had previous aspect of ischemic cardiomyopathy with conserved left ventricular ejection fraction (LVEF). Conclusion Early use of TTE in Ebola virus disease is safe, effective and facilitates patient care. It should be considered a feasible additional exam, where physician expertise and resources allow. In our study, contrary to the hypotheses previously made, dyspnea had a non-hemodynamic origin (figure next page). Download : Download high-res image (127KB) Download : Download full-size image Abstract 0563 - Figure: Echography characteristics

Dear Editor, The actual outbreak of Ebola virus disease (EVD) started in December 2013 in West Africa, and spread from Guinea to Sierra Leone and Liberia. Organ dysfunctions during EVD have only been described through case reports managed in high income countries, and data are still lacking [1]. The Sepsis-related Organ Failure Assessment (SOFA) score has been developed to quantitatively describe the degree of organ dysfunction in intensive care unit septic patients [2]. We aimed to characterize the severity of Ebola patients admitted to our center by calculating the SOFA score on admission. After approval by the local ethics committee, SOFA score was calculated in Ebola-infected patients using the most abnormal values from the first 24 h after admission. Data were collected between January and April 2015. A total of 38 patients were admitted, of whom 22 were infected with Ebola. Results are expressed as mean ± standard deviation. The mean age of confirmed cases was 33 years (±9). Mean viral load expressed as cycle threshold (CT) at admission was 21.6 (±3.9). On the 22 patients, six died (mortality rate of 27.3 %). Mean SOFA score at admission was 2.6 (±1.7). SOFA score at admission was significantly higher in non-survivors than in survivors (4.8 ± 1.7 versus 1.7 ± 1, P = 0.001). Mean viral load was also higher in non-survivors (CT at 17.7 ± 3.8 versus 23 ± 3.1, P = 0.006). Renal dysfunction was the most frequent dysfunction on admission in non-survivors (Fig. 1). Relationships between admission patients’ conditions and outcome have never been explored during EVD, except for age and viral load [3]. A study analyzing the WHO case investigation form data of 3343 infected patients reported a high mortality rate above 70 %, but patients’ organ dysfunctions could not have been scored [4]. In this study, hemorrhage, coma, and ‘‘difficulty breathing’’ were not commonly reported in patients who died, suggesting that massive fluid loss due to gastrointestinal disorders may be the main factor of worse outcome. Another study reported a lower mortality rate of 43 % [3]. Risk of death was associated with an older age, but this study failed in identifying other factors, mainly because biological data on admission were also limited as no routine clinical laboratory testing was available. Presented data showed that patients were hemodynamically stable on admission and had no respiratory dysfunction (3 % of patients with oxygen therapy). Our results highlighted two main points. The first is that cardiovascular, respiratory, and neurological dysfunctions were not common on admission in Ebola patients, even in non-survivors. The second is the frequency of renal dysfunction. Acute kidney injury during EVD may be promoted by several factors: hypovolemia due to gastrointestinal fluid loss, inflammatory response, viral injury as suggested by histopathological examination of tissues from infected animals showing indications of interstitial nephritis [5]. Larger studies are needed to describe objectively organ dysfunction in Ebola patients and evolution during stay. It may also help to optimize the preparation of treatment facilities according to local available resources for the next outbreaks.

This study evaluated the paced QT interval in the days after radiofrequency ablation of the atrioventricular junction in patients with chronic rapid atrial fibrillation. There is an abnormality in the dynamics of the paced QT interval until the second day after ablation, resulting in an increased duration when the paced heart rate is

SummaryBackgroundThe role of implantable loop recorders (ILRs) in the evaluation strategy for recurrent syncope in France is limited by lack of knowledge of the cost.AimTo compare a conventional evaluation strategy for syncope with the early use of an ILR in low-risk patients, in terms of diagnostic yield, cost and impact on quality of life (QoL).MethodsNational prospective randomized open-label multicenter study of patients with a single syncope (if severe and recent) or at least two syncopes in the past year.ResultsSeventy-eight patients (32 men) were randomized to the ILR strategy (ILR group, n=39) or the conventional evaluation strategy (CONV group, n=39): mean age 66.2±14.8 years; 4.3±6.4 previous syncopes. After 14 months of follow-up, a certain cause of syncope was established in 18 (46.2%) patients in the ILR group and two (5%) patients in the CONV group (P