The Lancet
Apr 11, 2015 Volume 385 Number 9976 p1365-1476
http://www.thelancet.com/journals/lancet/issue/current

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Editorial
Achieving respectful care for women and babies
The Lancet
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60701-2
Summary
April 11 is the International Day for Maternal Health and Rights, which aims to encourage rights-based, respectful care of women during pregnancy and childbirth. The day was launched last year by the Center for Health and Gender Equity, and co-sponsored by a consortium of maternal health organisations, including Women Deliver and the International Planned Parenthood Federation. These organisations are calling on governments, international institutions, and the global community to officially recognise the day and promote and support this issue.

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Comment
Making sense of health estimates
Irene Agyepong, Tumani Corrah, Yan Guo, Bruce Hollingsworth, Michael Klag, Kim Longfield, Maria de Fatima Marinho de Souza, Peter Piot, JVR Prasada Rao, John-Arne Røttingen, Peter Smith, Marc Sprenger, Trevor Sutton, Sarah Curran, Edmond SW Ng, on behalf of the Independent Advisory Committee to the Global Burden of Disease
Published Online: 18 March 2015
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60024-1
Summary
Epidemiological data provide the metrics from which burdens attributable to different diseases and conditions causing ill health can be estimated. Comprehensive, consistent, and coherent health estimates, together with information about any associated uncertainties, are indispensable for decision making by governments, non-governmental organisations, practitioners, and national and international funders in helping to gauge and track the changing demands and challenges presented by poor health. Estimates of disease burden are an essential platform for public health policy and priority setting, and for evaluating intervention programmes.

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Articles
Severe Ebola virus disease with vascular leakage and multiorgan failure: treatment of a patient in intensive care
Timo Wolf, MD, Gerrit Kann, Prof Stephan Becker, MD, Christoph Stephan, MD, Hans-Reinhardt Brodt, MD, Philipp de Leuw, MD, Thomas Grünewald, MD, Thomas Vogl, MD, Prof Volkhard A J Kempf, MD, Prof Oliver T Keppler, MD, Prof Kai Zacharowski, MD
Published Online: 18 December 2014
DOI: http://dx.doi.org/10.1016/S0140-6736(14)62384-9
Supplementary video
Zacharovsky and colleagues demonstrate infection control procedures for Ebola. Audio/Video – Download File (43.75 MB)
Summary
Background
In the current epidemic of Ebola virus disease in western Africa, many aid workers have become infected. Some of these aid workers have been transferred to specialised hospitals in Europe and the USA for intensified treatment, providing the potential for unique insight into the clinical course of Ebola virus disease under optimised supportive measures in isolation units.
Methods
A 38-year-old male doctor who had contracted an Ebola virus infection in Sierra Leone was airlifted to University Hospital Frankfurt, Germany, on day 5 after disease onset. Within 72 h of admission to the hospital’s high-level isolation unit, the patient developed signs of severe multiorgan failure, including lungs, kidneys, and gastrointestinal tract. In addition to clinical parameters, the diagnostic work-up included radiography, ultrasound, pulse contour cardiac output technology, and microbiological and clinical chemistry analyses. Respiratory failure with pulmonary oedema and biophysical evidence of vascular leak syndrome needed mechanical ventilation. The patient received a 3 day treatment course with FX06 (MChE-F4Pharma, Vienna, Austria), a fibrin-derived peptide under clinical development for vascular leak syndrome. After FX06 administration and concurrent detection of Ebola-virus-specific antibodies and a fall in viral load, vascular leak syndrome and respiratory parameters substantially improved. We gave broad-spectrum empiric antimicrobial therapy and the patient needed intermittent renal replacement therapy. The patient fully recovered.
Findings
This case report shows the feasibility of delivery of successful intensive care therapy to patients with Ebola virus disease under biosafety level 4 conditions.
Interpretation
The effective treatment of vascular leakage and multiorgan failure by combination of ventilatory support, antibiotic treatment, and renal replacement therapy can sustain a patient with severe Ebola virus disease until virological remission. FX06 could potentially be a valuable agent in contribution to supportive therapy.
Funding
University Hospital of Frankfurt.