Critical care medicine in the French Territories in the Americas: Current situation and prospects / La medicina intensiva en los territorios franceses de la Región de las Américas: situación actual y perspectivas / Medicina intensiva nos territórios ultramarinos franceses nas Américas: situação atual e perspectivas

ABSTRACT Hospitals in the French Territories in the Americas (FTA) work according to international and French standards. This paper aims to describe different aspects of critical care in the FTA. For this, we reviewed official information about population size and intensive care unit (ICU) bed capacity in the FTA and literature on FTA ICU specificities. Persons living in or visiting the FTA are exposed to specific risks, mainly severe road traffic injuries, envenoming, stab or ballistic wounds, and emergent tropical infectious diseases. These diseases may require specific knowledge and critical care management. However, there are not enough ICU beds in the FTA. Indeed, there are 7.2 ICU beds/100 000 population in Guadeloupe, 7.2 in Martinique, and 4.5 in French Guiana. In addition, seriously ill patients in remote areas regularly have to be transferred, most often by helicopter, resulting in a delay in admission to intensive care. The COVID-19 crisis has shown that the health care system in the FTA is unready to face such an epidemic and that intensive care bed capacity must be increased. In conclusion, the critical care sector in the FTA requires upgrading of infrastructure, human resources, and equipment as well as enhancement of multidisciplinary care. Also needed are promotion of training, research, and regional and international medical and scientific cooperation.

RESUMEN Los hospitales en los territorios franceses de la Región de las Américas funcionan según las normas francesas e internacionales. El objetivo de este artículo es describir distintos aspectos de los cuidados intensivos en los territorios franceses. Para ello, hemos revisado los datos oficiales sobre el tamaño de la población y el número de camas de las unidades de cuidados intensivos (UCI), así como la bibliografía sobre algunos aspectos específicos de las UCI, en los territorios franceses. Las personas que viven en los territorios franceses, o que están de visita en ellos, están expuestas a riesgos específicos: principalmente traumatismos graves causados por el tránsito, envenenamiento por mordeduras, heridas de bala o por apuñalamiento, y enfermedades infecciosas tropicales emergentes. La atención de estos traumatismos y enfermedades puede requerir conocimientos específicos y cuidados intensivos. Sin embargo, no hay suficientes camas de UCI en los territorios franceses. De hecho, hay 7,2 camas de UCI por 100 000 habitantes en Guadalupe, 7,2 en Martinica y 4,5 en Guayana Francesa. Además, los pacientes gravemente enfermos que viven en zonas remotas a menudo tienen que ser trasladados, normalmente por helicóptero, lo que retrasa su ingreso en la unidad de cuidados intensivos. La crisis de la COVID-19 ha puesto de manifiesto que el sistema de atención de salud en los territorios franceses no está preparado para enfrentarse a una epidemia de estas dimensiones y que debe aumentarse la capacidad hospitalaria de las unidades de cuidados intensivos. En conclusión, el sector de los cuidados intensivos en los territorios franceses tiene que mejorar su infraestructura, recursos humanos y equipamiento, así como perfeccionar la atención multidisciplinaria. También es necesario promover la capacitación, la investigación y la cooperación médica y científica, tanto regional como internacional.

RESUMO Os hospitais nos territórios ultramarinos franceses nas Américas funcionam segundo os padrões franceses e internacionais. O objetivo deste artigo é descrever os diversos aspectos da atenção intensiva nesta região. Analisamos os dados oficiais relativos ao tamanho da população e ao número de leitos de unidade de terapia intensiva (UTI) nestes territórios junto com uma revisão da literatura científica sobre as características particulares destes centros de terapia intensiva. Os residentes locais ou visitantes dos territórios ultramarinos franceses nas Américas são expostos a riscos específicos, sobretudo acidentes de trânsito graves, envenenamentos por animais peçonhentos, ferimentos por armas brancas ou armas de fogo e doenças infecciosas tropicais emergentes que requerem conhecimento especializado e atenção intensiva. Porém, não há leitos suficientes de UTI nos territórios ultramarinos franceses nas Américas: são 7,2 leitos de UTI por 100.000 habitantes em Guadalupe, 7,2 na Martinica e 4,5 na Guiana Francesa. Ademais, em áreas remotas, os pacientes em estado crítico frequentemente precisam ser transferidos por helicóptero, o que causa demora na internação em UTI. A crise da COVID-19 demonstra o despreparo do sistema de saúde para enfrentar a pandemia e a necessidade de aumentar o número de leitos de UTI nestes territórios. Em conclusão, é imprescindível modernizar a infraestrutura e os equipamentos, capacitar melhor os recursos humanos e melhorar a atenção multidisciplinar. Incentivar a formação profissional, pesquisa e cooperação médico-científica regional e mundial é também fundamental.

Pediatric scorpionism in northern Amazonia: a 16-year study on epidemiological, environmental and clinical aspects

The Amazon basin is one of the seven major geographical areas where scorpionism is recorded. In French Guiana, 90 stings per 100,000 inhabitants are registered per year. As the severity of cases is higher in children, descriptive studies are needed to have a better understanding of this pathology. The aim of the present study is to describe pediatric scorpionism in French Guiana. Methods: We conducted a monocentric descriptive retrospective study on scorpion stings in all pediatric patients admitted to Cayenne General Hospital from January 1, 2002 to December 31, 2018. Results: In this survey, 132 patients were included. Of them, 63% were male. Patients with general signs of envenomation were younger and lighter (p = 0.04). The picture was "one sting" (95.3%) by a "big" (47.6%), "black" (60%) and "small pincer" (58%) scorpion on the extremity of the body (84%). Stings occurred mainly during the day, while patients changed clothes. There was no envenomation during night. The monthly evaluation highlights that the number of stings and percentage of general signs of envenomation were closely connected to a composite variable including the variation of the level of rivers (p = 0.005). Cardiac symptoms were recorded in 82% of cases with general signs of envenomation. The presence of pulmonary; ear, nose, and throat (ENT); or gastrointestinal symptoms are related to major envenomation (p = 0.001, p = 0.01, and p = 0.02 respectively). Leukocytosis and glycemia increased according to the envenomation grade whereas serum potassium and alkaline reserve decreased. Forty-six patients needed hospitalization and seven of them required intensive care. No patient died nor presented sequelae at discharge from the hospital. Conclusion: Pediatric scorpionism in French Guiana is closely associated with child activities and climatic conditions. Severe envenomation presented most of the time with cardiac, pulmonary, and gastrointestinal symptoms.(AU)

Antibiotic therapy for snakebite envenoming

There are numerous conflicting recommendations available on the use of antibiotics following snakebite. The present letter to the editor presents some recommendations based on recent studies, and aims to stimulate debate on this topic.(AU)