Paraquat poisoning in Western French Guyana: a public health problem persisting ten years after its withdrawal from the French market.

OBJECTIVE: Paraquat poisoning has almost disappeared from metropolitan France following its ban from the European market ten years ago. However, due to neighboring countries still authorizing paraquat use, French Guyana seems in a different situation. Here we aimed to report a series of paraquat-poisoned patients admitted to the emergency department of the Western French Guyana Hospital in Saint-Laurent du Maroni, to raise awareness of national health authorities on this persistent major issue. PATIENTS AND METHODS: We conducted a retrospective observational study describing the clinical features, the prognostic factors and the final outcome of paraquat-poisoned patients admitted to the emergency department between January 2008 and August 2014. RESULTS: Twenty-six paraquat-poisoned patients were included in the study. The median estimated paraquat dose intentionally ingested was 105 mg/kg (interquartile range, IQR: 359). Eighteen patients were treated with the cyclophosphamide/dexamethasone combination and seventeen with N-acetylcysteine in addition to the usual supportive care. Six patients survived and twenty died within a median 36h delay after admission (IQR: 130). Death was associated with cardiovascular (65%) and respiratory (35%) failure. Based on a bivariate analysis, predictive factors of death included (p≤0.05): advanced age, higher ingested paraquat dose, altered renal function, hypokalemia, acidosis, and dark blue dithionite test, observed on hospital admission. CONCLUSIONS: Paraquat poisoning still persists in French Guyana despite its withdrawal from the market. It is possible to determine the probability of death on patient admission based on routine clinical and biological parameters. There is an urgent need to request neighboring countries to ban paraquat with the aim of eradicating this dramatically life-threatening poisoning.

[Geophagia: progress toward understanding its causes and consequences]. / La géophagie : avancées dans la compréhension de ses causes et conséquences.

Geophagia is an ancient practice subject to many prejudices. Recent animal experiments have shed light on its causes and consequences. Geophagia, a form of pica, may be induced by various factors. Clay, the material preferentially ingested by geophagic subjects, interacts with the food bolus and the digestive mucosa. Its capacity to form colloids and to adsorb and exchange ions results in both beneficial and harmful effects. In a less civilized age, the ingestion of clay may have reinforced digestive barriers against alkaloids and toxins, conferring a selective advantage on individuals practicing geophagia. However, in the modern Western world, complex interactions of clay with metals and ions are likely to generate low-level poisoning and deficiencies, potentially damaging the health of geophagic individuals and their offspring.