ABSTRACT
INTRODUCTION: Since 2013, the French Army Health Service, in agreement with international experts, has recommended the administration of 1 g of tranexamic acid (TXA) in trauma patients in haemorrhagic shock or at risk of bleeding within 3 hours of the trauma. METHODS: The aim of this analysis was to describe the administration of TXA in French military personnel wounded during military operations in the Sahelo-Sahelian band between October 2016 and September 2020. Data were collected from forward health records and hospital data from the French hospital where the casualty was finally evacuated. Underuse of TXA was defined as the lack of administration in casualties who had received a blood transfusion with one or more of red blood cells, low-titre whole blood or French lyophilised plasma within the first 24 hours of injury and overuse as its administration in the non-transfused casualty. RESULTS: Of the 76 patients included, 75 were men with an average age of 28 years. Five patients died during their management. 19 patients received TXA (25%) and 16 patients were transfused (21%). Underuse of TXA occurred in 3 of the 16 patients (18.8%) transfused. Overuse occurred in 6 of 60 (10%) non-transfused patients. CONCLUSION: The analysis found an important underuse of TXA (almost 20%) and highlighted the need for optimising the prehospital clinical practice guidelines to aid prehospital medical practitioners more accurately in administering TXA to casualties that will require blood products.
ABSTRACT
OBJECTIVES: To assess the effectiveness of the adjunction of a one-gram single dose of ciprofloxacin to a symptomatic treatment for the early treatment of uncomplicated diarrhea during military operations of the French service members in Africa. PATIENTS AND METHODS: This phase IV, multicentric, randomized, open-label, controlled trial was conducted in Chad, Mali, and in Central African Republic. A total of 267 French service members having at least one loose stool in the previous 24 hours were enrolled from May 2015 to June 2016. Participants were randomized to receive ciprofloxacin 1 g and a symptomatic treatment (racecadotril 100 mg three times a day and ad libidum oral rehydration solution) or a symptomatic treatment alone. The primary outcome was the duration of the diarrhea. Secondary outcomes were evaluated at the 72-hour endpoint and included recovery status, number of loose stools, frequency and duration of associated symptoms and safety of treatments. RESULTS: Among 267 participants, 242 completed the trial. Participants receiving ciprofloxacin and a symptomatic treatment (n = 124) were significantly more likely to be cured at the endpoint than those who only received a symptomatic treatment (118): 94.4 % versus 74.6 % (OR = 5.7; 95 %CI: [2.4-13.6]; p < 10-3). The antibiotic therapy reduced the average diarrhea duration by 30 % (p = 10-4). Fever at inclusion was associated with a longer episode (HR = 0.61; 95 %CI: [0.41-0.89]; p = 0.012). No adverse event of medications was reported. CONCLUSION: A single dose of ciprofloxacin was effective and safe in treating uncomplicated diarrhea among service members in Africa.
Subject(s)
Ciprofloxacin , Diarrhea , Humans , Ciprofloxacin/therapeutic use , Diarrhea/drug therapy , Anti-Bacterial Agents/therapeutic use , Africa , Fever/drug therapyABSTRACT
Following an original case report of massive regurgitation of maggots and the difficulty of medical management, we return to the fecal contamination problem for troops in the field. The survey of maggots has allowed for the diagnosis of contamination by ingestion of house fly eggs as a major infection vector. The successive ingestion of anti-acid and gastric dressing can induce an important diminution of gastric acidity that can allow for the proliferation of germs. In an operational context or natural catastrophe andin addition to field hygiene rules that are very important, it can also be useful to propose exclusive field rationsfor few daysin order to limit the interhuman contamination.
Subject(s)
Houseflies , Larva , Vomiting/parasitology , Animals , Haiti , Humans , Male , Military Personnel , Young AdultABSTRACT
This case report about a young French soldier hit in the eye by a spitting cobra in the Central African Republic prompts us to review the potential toxicity of this venom to the eyes and the management of this injury. The initial phase is simple to implement, but is often performed badly or not at all because unknown. It is a condition, however, for optimal recovery of the cornea.
Subject(s)
Elapidae , Eye Injuries/etiology , Snake Venoms/adverse effects , Animals , Humans , Male , Young AdultABSTRACT
This case report describes a 4-year-old girl in Chad with noma, also called cancrum oris. This acute gangrenous stomatitis has a combined morbidity-mortality rate that can reach 70%. It occurs worldwide but is most common in sub-Saharan Africa in children aged 2 to 16 years. Its pathogenesis is uncertain, but several bacteria including Fusobacterium necrophorum, Prevotella intermedia and Pseudomonas aeruginosa may be responsible for the development of noma, which develops over the oral lesions these bacteria cause. Poverty is its most important risk factor. Due to its rapid course and high lethality, it requires emergency treatment with antibiotics, daily dressing of the lesion, and nutritional rehabilitation. Surgical removal of the remaining necrotic tissue can be followed by reconstructive procedures. Physical and speech therapy should be initiated to prevent functional complications.
Subject(s)
Noma , Chad , Child, Preschool , Female , Humans , Noma/diagnosis , Noma/drug therapyABSTRACT
Although stingray injuries have always been frequent in the Republic of Djibouti, it was not until July 2008 that the Bouffard Hospital developed a standardised management protocol. The purpose of this report is to describe that protocol and evaluate its impact on the outcome of stingray injuries based on a prospective study for the period between July 2008 and July 2009. During the study period, 12 stingray stings were treated. The treatment protocol that is based on a multidisciplinary approach involving the intensivist, anaesthesiologist, and surgeon achieved wound healing within one month. This outcome contrasts with previous publications that have generally described longer healing times with frequent infectious complications.
