[Characteristics and health care pathways of HIV-infected patients in Mayotte (1990-2010)]. / Caractéristiques et trajectoires de soins des patients infectés par le VIH suivis à Mayotte (1990-2010).

OBJECTIVES: To evaluate the characteristics of HIV-infected patients treated in Mayotte, focusing on health care pathways. METHODS: Observational study, with retrospective collection of data from medical charts according to a standardized questionnaire. All HIV-infected patients who consulted at the Centre Hospitalier de Mayotte from 1990 through 2010 were included. Patients were classified as lost to follow-up if they had not consulted for at least 6 months and if no information about their outcome was available. Variables associated with loss to follow-up were analyzed by bivariate analysis (Chi(2)), and then multivariate analysis (logistic regression). RESULTS: Overall, 236 patients were enrolled (134 females, 102 males), with a mean age of 30.7 ± 12 years, and a median CD4 cell count of 390/mm(3) at diagnosis. HIV testing was most often ordered because of: i) HIV-related symptoms (n = 70); ii) risk factors (n = 67); iii) pregnancy (n = 51). The 52 patients (22%) lost to follow-up were less likely to have medical insurance (52% versus 67%, p = 0.05) or antiretroviral treatment (56% versus 71%, p = 0.04), and were more frequently aged younger than 15 years (15% versus 2%, p<0.001). On multivariate analysis, initial management at the Centre Hospitalier de Mayotte (OR 2.62 [1.09-6.29], p = 0.03, and the absence of antiretroviral treatment (OR 1.97 [1.00-3.89], p = 0.05) were significantly associated with loss to follow-up. CONCLUSION: The HIV epidemic in Mayotte follows an African pattern in terms of main transmission pathways, age and circumstances of diagnosis, but the median CD4 cell count at diagnosis is closer to the pattern in metropolitan France. The rate of patients lost to follow-up is high (22%), mostly linked to problems with access to care.

Prevalence of type 2 diabetes and other cardiovascular risk factors in Mayotte in 2008: the MAYDIA study.

AIM: Mayotte, a French overseas territory located in the Indian Ocean, has never had a previous estimate of diabetes prevalence, but has recently undergone socioeconomic changes leading to lifestyle modifications. For this reason, a survey was carried out in 2008 to estimate the prevalence of diabetes and cardiovascular risk factors in the island's population. METHODS: A three-step, randomized sample of 1268 individuals, aged 30-69 years, was home-screened, using capillary blood glucose and capillary HbA(1c), weight, height, waist circumference and two blood-pressure measurements. Those with a history of diabetes, glucose ≥1 g/L (fasting) or ≥1.40 g/L (non-fasting), or HbA(1c)≥6%, and a subgroup of those with normal results were examined at a healthcare centre to measure venous HbA(1c) and glucose, and to diagnose diabetes, using an oral glucose tolerance test. RESULTS: The weighted prevalence of diabetes (venous plasma glucose ≥1.26 g/L at fasting and/or ≥2 g/L at 2 h, or treatment with oral hypoglycaemic agents or insulin) was 10.5% (95% CI: 8.2-13.4%). This increased with age from 3% at age 30-39 years to 26% at age 60-69 years, with no gender differences. Also, more than 50% of those with diabetes were unaware of it, while half of those treated for diabetes still had HbA(1c) levels >7%. The prevalence of overweight (BMI: 25-29 kg/m(2)) was estimated to be 35% in men and 32% in women, while obesity (≥30 kg/m(2)) was estimated to be 17% in men and 47% in women. CONCLUSION: The high prevalence of obesity combined with a high prevalence of diabetes indicates a potential for further increases in the prevalence of diabetes and cardiovascular disease in Mayotte. Preventative action against obesity, diabetes and hypertension is required now, as well as plans for appropriate healthcare delivery in the island.

[Malaria in Mayotte: epidemiology, diagnostic, prevention and treatment]. / Bilan du paludisme à Mayotte. Epidémiologie, diagnostic, prevention et traitement.

Mayotte is a little French island, located in the Indian ocean, between Madagascar and Mozambic. Officially there is a population of 150000 inhabitants, but in fact, there are probably about 200000 people, largely due to numerous illegal immigrants, especially coming from Anjouan the nearest Comorian island. There is only one hospital, with 252 beds. The malaria incidence reaches about 3000 cases per year; and treatments until august 2001 were generally haphazard. This is changing with the use of the Optimal rapid diagnostic test (DiaMed, Cressier Switzerland). More precise statistics should be available in the coming years. In 2000, 252 patients were hospitalised with malaria fever. Preventive measures were scarce. These have been reenforced this year, with the arrival of an entomologist, the use of reenforced pesticide pulverisation in high-risk areas, the distribution of impregnated bednets to pregnant women, and media based information campaigns. Common drugs resistance is becoming a real concern in Mayotte. First-line treatment was: chloroquine; second-line: sulfadoxine-pyrimethamine, and third-line: quinine. In vitro studies have shown high levels of resistance, therefore another antimalarial drug therapy will be introduced at the end of the year: first-line: artemether-lumefantrine, second-line: mefloquine or halofantrine, third-line: quinine. To conclude, solutions exist but a real policy from the decision makers is necessary to implement them. The eradication of malaria remains a dream, but we can expect "zero death" in Mayotte, considering that the fight against this disease may help to start a regional health program.

[Gunshot injuries of the face. Clinical observations in 21 cases]. / La balistique lésionnelle appliquée aux traumatismes faciaux. Déductions cliniques. A propos de 21 cas.

The authors report their experience of facial ballistic trauma based on a series of twenty one homogeneous cases. After a review of the aetiopathogenesis, the characteristics of facial shocks by missiles of fire arms are described, with particular emphasis on specific wounds encountered in the head and neck. Two classifications are suggested: on based on the main clinical features and the other based on the various types of bullets organized according to wound profiles and modern ballistics. This new ballistic classification is related to the clinical features. Although a better approach to ballistics and wound profiles helps to guide the clinical assessment, the medical and surgical treatments are based on same principles and approaches in war surgery and in civilian practice.