Failure of a Mexican antivenom on recovery from snakebite-related coagulopathy in French Guiana.

INTRODUCTION: In French Guiana, most snakebites are caused by crotalids, with the main signs being tissue damage and bleeding due to venom-induced coagulopathy. Since December 2014 the Western Guiana Hospital (WGH) has used Antivipmyn Tri TM, a Mexican polyvalent antivenom. The aim of the study was to assess its benefit on the correction of snakebite-related coagulopathy. METHODS: This retrospective study included patients hospitalized at the WGH with snakebite and a coagulopathy defined by: a prothrombin rate (PR) lower than 45%, an activated partial thromboplastin time ratio (aPTTr) greater than 2 or a fibrinogen lower than 100 mg.dL-1. The antivenom group included patients receiving Antivipmyn Tri TM from December 2014 to September 2017. The control group included patients admitted between January 2013 and November 2014 (when antivenom was unavailable) or admitted between December 2014 and September 2017 during times of antivenom shortage. We graphically compared the time courses of PR, aPTTr and fibrinogen between groups. Other endpoints were the length of hospital stay and the need for surgery or dialysis. RESULTS: 84 patients were included: 42 in the antivenom group, 42 in the control group. Both groups were similar for age, sex-ratio, proportion of bleedings, necrosis, and severity. Most patients in the antivenom group received 3 vials. There were no significant differences in recovery of PR, aPTTr and fibrinogen through the first 24 h. Fibrinogen declined again in the control group at 30 h and showed a slower rise to normal concentration. There were no significant differences in any secondary endpoint. CONCLUSION: Antivipmyn Tri TM as currently used did not show any benefit in recovery from coagulopathy.

[The public health department of the Western French Guiana Hospital: a 5-year return of experience] / Le département de santé publique du centre hospitalier de l'ouest guyanais : un retour d'expérience à cinq ans.

INTRODUCTION: The western French Guiana hospital (Chog) is atypical. The creation of a public health department (PSP) is the result of a willingness of the institution to respond to public health issues on its territory. The main objective of this article is to identify the levers and impediments for the development of public health activities within this hospital, after five years of implementation. METHOD: This article was based on the analysis of documents produced within the PSP, the institution and at the regional level (2013-2018), and on interviews conducted in 2017 with PSP professionals, and chiefs of other departments of the Chog (N = 16). RESULTS: The added value of the PSP is based on the pooling of human resources and technical skills, the coexistence of clinical activities, prevention, research, teaching and international cooperation with Suriname, and the development of multidisciplinary and evaluative approaches. The lack of a set of public health objectives in the establishment project, the lack of place for these activities in its new hospital, and the difficult mobilization of financial resources, however, limit the prospects. CONCLUSION: This analysis has shown difficulties in developing public health activities within this hospital, in an overseas territory with nonetheless multiple and complex needs. The authors invite politics and health authorities to value, and develop these activities, conditions necessary for the positioning of the hospital as an actor of the “turn in prevention”.

[The public health department of the Western French Guiana Hospital: a 5-year return of experience]. / Le département de santé publique du centre hospitalier de l'ouest guyanais : un retour d'expérience à cinq ans.

INTRODUCTION: The western French Guiana hospital (Chog) is atypical. The creation of a public health department (PSP) is the result of a willingness of the institution to respond to public health issues on its territory. The main objective of this article is to identify the levers and impediments for the development of public health activities within this hospital, after five years of implementation. METHOD: This article was based on the analysis of documents produced within the PSP, the institution and at the regional level (2013-2018), and on interviews conducted in 2017 with PSP professionals, and chiefs of other departments of the Chog (N = 16). RESULTS: The added value of the PSP is based on the pooling of human resources and technical skills, the coexistence of clinical activities, prevention, research, teaching and international cooperation with Suriname, and the development of multidisciplinary and evaluative approaches. The lack of a set of public health objectives in the establishment project, the lack of place for these activities in its new hospital, and the difficult mobilization of financial resources, however, limit the prospects. CONCLUSION: This analysis has shown difficulties in developing public health activities within this hospital, in an overseas territory with nonetheless multiple and complex needs. The authors invite politics and health authorities to value, and develop these activities, conditions necessary for the positioning of the hospital as an actor of the “turn in prevention”.

Le département de santé publique du centre hospitalier de l'ouest guyanais : un retour d'expérience à cinq ans.

INTRODUCTION: The western French Guiana hospital (Chog) is atypical. The creation of a public health department (PSP) is the result of a willingness of the institution to respond to public health issues on its territory. The main objective of this article is to identify the levers and impediments for the development of public health activities within this hospital, after five years of implementation. METHOD: This article was based on the analysis of documents produced within the PSP, the institution and at the regional level (2013-2018), and on interviews conducted in 2017 with PSP professionals, and chiefs of other departments of the Chog (N = 16). RESULTS: The added value of the PSP is based on the pooling of human resources and technical skills, the coexistence of clinical activities, prevention, research, teaching and international cooperation with Suriname, and the development of multidisciplinary and evaluative approaches. The lack of a set of public health objectives in the establishment project, the lack of place for these activities in its new hospital, and the difficult mobilization of financial resources, however, limit the prospects. CONCLUSION: This analysis has shown difficulties in developing public health activities within this hospital, in an overseas territory with nonetheless multiple and complex needs. The authors invite politics and health authorities to value, and develop these activities, conditions necessary for the positioning of the hospital as an actor of the "turn in prevention".

Prevalence of Plasmodium spp. in illegal gold miners in French Guiana in 2015: a hidden but critical malaria reservoir.

BACKGROUND: Malaria is endemic in French Guiana, an overseas territory of France on the Guiana Shield. Since 2005, notified malaria cases are decreasing. However, new data show that malaria affects many Brazilian gold miners working illegally in French Guiana, the majority of whom are not counted in official data. In addition, one major concern is the usual practice of improper self-treatment in this mining population, raising fear of the development of anti-malarial resistance. This prospective study, conducted in 2015, aimed to estimate the prevalence of Plasmodium spp. in illegal gold miners working in French Guiana. METHODS: The recruitment of gold miners was carried out in resting sites along the French Guiana-Suriname border, where they go for supplies, medical care or leisure. After recording agreement, three malaria diagnostic methods were performed: rapid diagnostic test, microscopy and PCR. RESULTS: Among 421 persons recruited in the study, malaria prevalence, detected by nested-PCR, was 22.3 % (CI [18.3-26.3], n = 94/421) of which 84 % were asymptomatic. CONCLUSIONS: This significant malaria reservoir in a mobile and illegal population with difficult access to a health care system raises the threat of artemisinin resistance and puts the population of the Guiana Shield at risk of new transmission foci while countries of the region aim at malaria elimination. Even though French legislation may hamper dealing with this population, France must face the reality of malaria in illegal gold miners in order to meet its commitment to malaria elimination.

Nosocomial Infections with Aeromonas hydrophila from Leeches.

The manner in which leeches are maintained before they are used for therapy has not been studied as a factor contributing to nosocomial infections. A 5-year retrospective survey of Aeromonas hydrophila nosocomial infections at a hospital in Marseille, France, revealed infections in 5 (4.1%) of an estimated 122 patients treated with leeches in the Hand Surgery Unit and 2 (2.4%) of an estimated 85 patients treated with leeches in other hospital units. The retrospective survey showed that the Hand Surgery Unit was the only unit that had its own aquarium for maintaining leeches; this aquarium was filled with tap water contaminated with Aeromonas species and was not regularly disinfected or cleaned. Leeches used in other units were maintained in noncarbonated water in a transport device. Use of leeches kept in aquariums that are filled with tap water and not disinfected or cleaned regularly may be linked to A. hydrophila infections.