In vitro evaluation of a new viscoelastometry-based point-of-care analyzer.

INTRODUCTION: The VCM is a point-of-care analyzer using a new viscoelastometry technique for rapid assessment of hemostasis on fresh whole blood. Its characteristics would make it suitable for use in austere environments. The purpose of this study was to evaluate the VCM in terms of repeatability, reproducibility and interanalyzer correlation, reference values in our population, correlation with standard coagulation assays and platelet count, correlation with the TEG5000 analyzer and resistance to stress conditions mimicking an austere environment. METHODS: Repeatability, reproducibility, and interanalyzer correlation were performed on quality control samples (n = 10). Reference values were determined from blood donor samples (n = 60). Correlations with standard biological assays were assessed from ICU patients (n = 30) and blood donors (n = 60) samples. Correlation with the TEG5000 was assessed from blood donor samples. Evaluation of vibration resistance was performed on blood donor (n = 5) and quality control (n = 5) samples. RESULTS: The CVs for repeatability and reproducibility ranged from 0% to 11%. Interanalyzer correlation found correlation coefficients (r2) ranging from 0.927 to 0.997. Our reference values were consistent with those provided by the manufacturer. No robust correlation was found with conventional coagulation tests. The correlation with the TEG5000 was excellent with r2 ranging from 0.75 to 0.92. Resistance to stress conditions was excellent. CONCLUSION: The VCM analyzer is a reliable, easy-to-use instrument that correlates well with the TEG5000. Despite some logistical constraints, the results suggest that it can be used in austere environments. Further studies are required before its implementation.

Flight safety risk assessment of self-medication among fighter pilots: a cross-sectional study.

BACKGROUND: Fighter pilots are a specific population in which any adverse drug reaction can unpredictably interact with aeronautical constraints and thus compromise flight safety. This issue has not been evaluated in risk assessments. AIM: To provide a semi-quantitative assessment of the risk to flight safety of self-medication in fighter pilots. METHOD: A cross-sectional survey that aimed at identifying the determinants of self-medication in fighter pilots was conducted. All medications consumed within 8 h preceding a flight were listed. A modified Failure Mode and Effects Analysis was performed, and any adverse drug reaction reported in the French marketing authorization document of a drug was considered a failure mode. The frequency of occurrence and severity were evaluated using specific scales to assign each to three risk criticality categories: acceptable, tolerable, and unacceptable. RESULTS: Between March and November 2020, the responses of 170 fighter pilots were analyzed, for an overall return rate of approximately 34%. Among them, 78 reported 140 self-medication events within 8 h preceding a flight. Thirty-nine drug trade names (48 different international nonproprietary names) were listed, from which 694 potential adverse drug reactions were identified. The risk criticality was considered unacceptable, tolerable and acceptable for 37, 325 and 332 adverse drug reactions, respectively. Thus, the risk criticality was considered unacceptable, tolerable and acceptable for 17, 17, and 5 drugs, respectively. CONCLUSION: This analysis suggests that the overall risk to flight safety of the current practice of self-medication in fighter pilots may be considered at least tolerable, or even unacceptable.

Profile of injuries in recent warfare.

BACKGROUND: The epidemiology of French military severe trauma patients injured during recent military operations remains poorly described, even if French operations, casualties sustained, and care rendered in a different trauma system are distinct from others. This study aimed at describing the characteristics of these patients upon arrival at hospital in France and during hospital stay. METHODS: This 5-year retrospective cohort study included all French military servicemen injured during military operations and admitted to the intensive care unit. Data on the characteristics upon arrival at the Percy hospital in France and during hospital stay were obtained from a national civilian trauma registry. RESULTS: Of 1,990 military trauma patients injured in military operations, 39 were finally admitted to the intensive care unit of the Percy hospital and included in the analysis. Traumas were related to battle injuries and nonbattle injuries in 27 and 12 patients, respectively. Ninety-eight wounds were described: torso (n = 32), limbs (n = 32), head and neck (n = 25), and spine (n = 9). The mechanism of injury was explosion in 19 patients, gunshot wound in 8 patients, motor vehicular crash in 7 patients, or other mechanisms in 5 patients. The median Injury Severity Score was 25.5 (interquartile range, 14-34). CONCLUSION: This study highlights the small number of military severe trauma patients injured in recent warfare and their characteristics. The use of dedicated systemic military trauma registries could improve the specific epidemiological knowledge on recent warfare and help better prepare for future conflicts that may include major engagements and large-scale combat operations. LEVEL OF EVIDENCE: Prognostic and Epidemiological; Level V.

Self-Medication Among Military Fighter Aircrews.

BACKGROUND: The practice of self-medication among military fighter aircrew could compromise flight safety because of the adverse effects that can occur in flight. However, data on this subject is scarce. The aim of this study was to identify the determinants of the practice in this population.METHODS: A cross-sectional study was carried out among the French Air Force fighter aircrew based on an anonymous questionnaire distributed electronically. The questions included personal characteristics, opinions, and relations with the healthcare domain as well as the use of self-medication in general and before a flight.RESULTS: Between March and November 2020, 170 questionnaires were reviewed for an overall return rate of approximately 34%. Our data showed an absolute self-medication rate of 97.6%, but the frequency of its use was rare or nonexistent in 53.5% of cases. Factors associated with a more frequent use of self-medication were the function of pilot, age under 35, having a regular prescription, lacking intentionality toward getting enough sleep, having confidence in the medical profession, and some specific clinical situations. The consumption of 97 medications was recorded and 49 before a flight.DISCUSSION: Despite the limitations due to the design of this survey, results suggest that the use of self-medication in fighter aircrews is a reality, but that the frequency of its use is less common. This practice is probably the result of a complex interaction between many personal factors. However, its impact on flight safety remains uncertain.du Baret de Limé M, Monin J, Leschiera J, Duquet J, Manen O, Chiniard T. Self-medication among military fighter aircrews. Aerosp Med Hum Perform. 2022; 93(7):571-580.

Role of Anopheles stephensi Mosquitoes in Malaria Outbreak, Djibouti, 2019.

Anopheles stephensi mosquitoes share urban breeding sites with Aedes aegypti and Culex quinquefasciatus mosquitoes in the Republic of Djibouti. We present evidence that A. stephensi mosquitoes might be responsible for an increase in malaria incidence in this country. We also document resistance of Plasmodium falciparum to dihydroartemisinin/piperaquine.