Reply to Colebunders
Notice bibliographique
Résumé
To the Editor–We read with interest the letter by Colebunders [1] regarding our recently published article in Clinical Infectious Diseases [2]. In our study, we found an association between Plasmodium parasitemia and survival of Ebola virus–infected individuals. Patients coinfected with Plasmodium parasites were 20% more likely to survive the Ebola virus infection. This effect was dose dependent as survival in the group with the highest level of parasitemia was 83% compared to 46% in patients infected with Ebola virus alone. All patients in our cohort received antimalarial artemether–lumefantrine (AL) treatment, independent of the outcome of the malaria diagnostic test. In his letter, Colebunders questions whether there really is an association between Plasmodium parasitemia and survival or whether this effect is somehow explained by the AL treatment. He states that Ebola virus–infected patients with an untreated Plasmodium coinfection may have an increased mortality risk compared with patients infected with Ebola virus alone and that antimalarial treatment would thus benefit coinfected patients. Although this is an interesting hypothesis, our cohort only consisted of AL-treated patients either infected with Ebola virus alone or patients coinfected with Ebola virus and Plasmodium parasites. The increased survival in the coinfected patients thus cannot be due to the resolution of the Plasmodium coinfection by the antimalarial treatment, as the other group was not infected with Plasmodium to begin with. Colebunders further argues that AL treatment itself may be detrimental to Ebola virus–infected patients by prolonging the QT interval. Although AL treatment can indeed result in QT interval prolongation, it is not clear how this could have a selective effect only in patients infected with Ebola virus alone. The study by Gignoux et al from Foya, Liberia [3], and referenced by Colebunders, included a group of patients infected with Ebola virus alone who were not treated with antimalarial drugs. When survival in this group was compared to that of patients infected with Ebola virus alone who did receive AL treatment, there was no statistically significant difference in survival, suggesting that AL treatment did not have a negative effect on patient outcome [3]. If there is an indication that AL treatment can have a negative effect on patient outcome in Ebola virus–infected patients, we should consider replacing this treatment scheme with a more appropriate choice of antimalarial drugs, as suggested by Gignoux et al [3] and by Colebunders [1]. However, this does not change our observation of increased survival in patients coinfected with Plasmodium parasites in the patient cohort from Monrovia, Liberia. Potential conflicts of interest. The authors report no conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,017 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,003 | 0,002 |
| Communication savante | 0,003 | 0,003 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,033 | 0,030 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,012 | 0,009 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».