Epidemiology and medical management of body-packers in French Guiana between 2010 and 2015.

Background: French Guiana is used as a drug trafficking pipeline of cocaine to Europe. The number of arrests for transporting cocaine in corpore has increased exponentially in recent years. Since 2010, Cayenne Hospital's emergency care unit has applied a medical management protocol system for body-packers. Our objective was to describe the epidemiology of body-packers and to evaluate medical management. Method: A retrospective descriptive study was performed among patients hospitalized in Cayenne Hospital for transporting cocaine in corpore between January 2010 and November 2015. In addition, a qualitative study including interviews of body-packers imprisoned in Rémire-Montjoly prison was conducted in April 2016. Result: A total of 282 patients were included in the study. The median age was 24 years and the sex ratio M/W was to 4/1. Among them, 3.5% showed signs of severity (9 with pre-existing condition and 1 with severe form). No surgery or deaths were reported. Ten endoscopies were performed because of the delay in evacuation without complications. Approximately 28% of patients had urinary screening, of which 60.7% were positive. The median length of stay was 1.8 days. Prolonged length of stay was significantly associated with the presence of gastrointestinal symptoms, hypoglycemia, or having swallowed a minimum of 10 pellets. Conclusion: This study led to a change in the management of body-packers in the hospital setting in Guiana. A computed tomography scan at discharge became more prevalent. Endoscopy has emerged as an effective and safe alternative to surgery. Despite the increase in the number of patients treated, it should be noted that there were few complications and no deaths in our cohort.

Is botulism type C transmissible to human by consumption of contaminated poultry meat? Analysis of a suspect outbreak in French Guyana.

Botulism type C was suspected in a 46-year old man after consumption of sick poultry from a flock where botulism type C was confirmed. The patient developed characteristic signs of botulism, but investigation of biological samples did not confirm the presence of Clostridium botulinum or botulinum toxin. Despite having classical botulism symptoms, the man recovered very quickly. This raises the question of botulism transmission to humans by ingestion of contaminated poultry.

Clinical features and prognosis of paraquat poisoning in French Guiana: A review of 62 cases.

Paraquat is a nonselective contact herbicide of great toxicological importance, being associated with high mortality rates. Because of its high toxicity, the European Union withdrew it from its market in 2007. The aim of this study is to analyze all cases of paraquat poisoning hospitalized in French Guiana in order to assess their incidence and main characteristics.Medical records of all paraquat intoxicated patients hospitalized from 2008 until 2015 were reviewed in this retrospective study.Demographics, clinical presentation, and laboratory data were evaluated.A total of 62 cases were reviewed. The incidence of paraquat poisoning was 3.8/100,000 inhabitants/year. There were 44 adults and 18 children younger than 16 years of age. The median ages were 31 years [18.08-75.25] in adults and 13.4 years [0.75-15.08] in children, respectively. The median duration of hospitalization was longer in children [15.5 days (1-24)] than in adults [2 days (1-30)], P < .01. The majority of cases was due to self-poisoning (84%).Children had ingested a lower quantity of paraquat [48.8 mg/kg (10-571.1)] than adults [595.8 mg/kg (6-3636.4), P = .03]. There were more deaths among adults (65%) than in children (22%), P = .004. The severity and outcome was determined primarily by the amount of paraquat ingested.In conclusion, French Guiana has the largest cohort of paraquat poisonings in the European Union. The major factor affecting the prognosis of patients was the ingested amount of paraquat. The administration of activated charcoal or Pemba, in situ, within the first hour after ingestion of paraquat is essential.

Prehospital Emergencies in Illegal Gold Mining Sites in French Guiana.

INTRODUCTION: Illegal gold mining is flourishing in French Guiana, existing outside the law due to both the high cost of gold mining permits and the challenges of law enforcement within the Amazon forest. We report the characteristics of, and the medical responses to, medical emergencies in illegal gold mining sites. METHODS: We performed a retrospective study of all medical emergencies reported from illegal gold mining sites to the centralized call office of SAMU 973 from 1998 through 2000 and from 2008 through 2010. According to the national health care system, any medical emergency within the territory is handled by the prehospital emergency medical service (SAMU 973), irrespective of the patients' legal status. Data were extracted from the SAMU 973 notebook registry (1998-2000) or the SAMU 973 computerized database (2008-2010) and werre collected using a standardized questionnaire. RESULTS: Of 71,932 calls for medical emergencies in French Guiana during the study periods, 340 (0.5%) originated from illegal gold mining sites. Of these, 196 (58%) led to medical evacuation by helicopter, whereas the overall rate of evacuation by helicopter after placing a call to SAMU 973 was only 4% (3020/71,932; P<0.0001 for comparison with illegal gold mining sites). Medical emergencies were classified as illness (48%, mostly infectious), trauma (44%, mostly weapon wounds), and miscellaneous (8%). CONCLUSIONS: Medical emergencies at illegal gold mining sites in the Amazon forest mostly include infectious diseases, followed by trauma, and often require medical evacuation by helicopter. Our study suggests that implementation of preventive medicine within gold mining sites, irrespective of their legal status, could be cost-effective and reduce morbidity.

Fatal case of chikungunya and concomitant thrombotic thrombocytopenic purpura in French Guiana during air flight medical evacuation.

Thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy associated to severe ADAMTS13 deficiency. It has been linked to various viral infections. Among arboviruses, only Crimean-Congo haemorrhagic fever and dengue fever have been linked to this severe disease. We report the first documented case of TTP concomitant to Chikungunya virus infection.

Diabetes education of patients and their entourage: out-of-hospital national study (EDUCATED 2).

AIMS: To determine the contributing factors in the successful diabetes education of patients and their entourage. METHODS: Prospective observational study conducted in a pre-hospital setting by 17 emergency services across France (September 2009-January 2011) included all insulin-treated patients (≥18 years) provided that at least one family member was present on scene. Data were collected from patients and their entourage: (1) personal details including language proficiency and educational attainment, (2) treatments, (3) diabetes-related data (log sheets, glucose meter, glucagon, glycated hemoglobin, prior hypoglycemic episodes); (4) care by diabetologist, general practitioner and/or visiting nurse. The main end points were ability to measure capillary blood sugar (patient) and awareness of hypoglycemia symptoms and ability to administer glucagon (entourage). RESULTS: Overall, 561 patients and 736 family members were included; 343 patients (61%) were experiencing a hypoglycemic episode (<2.5 mmol/L). A total of 141 (75%) patients and 343 (50%) family members could measure capillary blood sugar. They could name a median of 2 [0-3‰] hypoglycemia symptoms although 217 (39%) patients and 262 (39%) family members could name no symptom. Few patients (33%) had glucagon available. In multivariate analyses, the main factor associated with better patient education was care by a diabetologist. Lack of an educational qualification and visits by a nurse were associated with poor patient education, and French mother tongue and care by a diabetologist with better education of the entourage. CONCLUSIONS: In France, diabetic patients and their entourage are inadequately educated. Their education benefits most from care by a diabetologist.

Incidence and Predictive Factors of Central Nervous System Dysfunction in Patients Consulting for Dengue Fever in Cayenne Hospital, French Guiana.

INTRODUCTION: The frequency, the clinical characteristics, and the prognosis of dengue is highly variable. Dengue fever is associated with a range of neurological manifestations. The objective of the present study was to determine the incidence of neurological signs and their predictive factors using data from cases of dengue seen and followed in Cayenne Hospital during the Dengue 2 epidemic in 2013. METHODS: In 2013, a longitudinal study using data from all cases of dengue seen in Cayenne hospital was collected. Medical records used a standardized form to collect demographic information, clinical signs and biological results and the date at which they were present. The analysis used Cox proportional modeling to obtain adjusted Hazard ratios. RESULTS: A total of 1574 patients were included 221 of whom developed central nervous system signs. These signs were spontaneously resolutive. There were 9298person days of follow-up and the overall incidence rate for central nervous system signs was 2.37 per 100 person-days. The variables independently associated with central nervous system anomalies were headache, Adjusted Hazard ratio (AHR) = 1.9(95%CI = 1.4-2.6), bleeding AHR = 2 ((95%CI = 1.3-3.1), P = 0.001, abdominal pain AHR = 1.9 ((95%CI = 1.4-2.6), P<0.001, aches AHR = 2.1 ((95%CI = 1.5-2.9), P<0.001, and fatigue AHR = 1.5 ((95%CI = 1.3-1.7), P<0.001. DISCUSSION: Overall, the present study suggests that neurological signs of dengue are not exceptional even in patients without the most severe features of dengue. These manifestations were spontaneously resolutive. Here it was not possible to distinguish between encephalitis or encephalopathy. Further studies would require more in depth exploration of the patients.

HACEK endocarditis: state-of-the-art.

The HACEK group of bacteria - Haemophilus parainfluenzae, Aggregatibacter spp. (A. actinomycetemcomitans, A. aphrophilus, A. paraphrophilus, and A. segnis), Cardiobacterium spp. (C. hominis, C. valvarum), Eikenella corrodens, and Kingella spp. (K. kingae, K. denitrificans) - are fastidious gram-negative bacteria, part of the normal microbiota of oral and upper respiratory tract in humans. Although their pathogenicity is limited, they are responsible for 1-3% of all infective endocarditis. HACEK endocarditis mostly affect patients with underlying heart disease or prosthetic valves, and are characterized by an insidious course, with a mean diagnosis delay of 1 month (Haemophilus spp.) to 3 months (Aggregatibacter and Cardiobacterium spp.). The advent of continuously monitored blood culture systems with enriched media has erased the need for extended incubation for the diagnosis of HACEK endocarditis. Medical treatment relies on third-generation cephalosporin, with a favorable outcome in 80-90% of cases, with or without cardiac surgery.

Epidemiological and clinical study on scorpionism in French Guiana.

UNLABELLED: Scorpion envenomation is a poorly explored problem in French Guiana. The aim of our study was to describe the epidemiological and clinical features of scorpion stings. METHODS: Our study is retrospective. It was conducted in the emergency department (ED) of Cayenne General Hospital, over an 8-year period (2003-2010). RESULTS: During the study period, 253 patients presented to the emergency department with a history of a scorpion sting. The mean incidence was 32 ± 8 cases per year. The peak of incidence was observed in April and May which are the rainiest months in the year. In most cases, the envenomation occurred between 6:00 and 11:00 am. The site of the sting was on the extremities (hand or foot) in 81% of cases. The scorpion was identified or brought to the hospital in 113 cases. It was described as a slim pincers scorpion in 97 cases. The mean time elapsed between the scorpion sting and admission was 4 ± 5 h. The main clinical symptoms at admission to the ED were local signs in 178 cases (70.4%), digestive disorders in 13 cases, neurologic manifestations in 18 cases, and respiratory manifestations in 7 cases. Adrenergic syndrome was found in 117 cases (46.2%), and cholinergic syndrome in 5 cases (2%). Hypertension was found in 80 patients, 14 of them had already a history of chronic hypertension. Overall, a total of 118 patients (46.6%) had Class I envenoming, 131 patients (51.8%) had Class II envenoming, and 4 patients (1.6%) experienced Class III envenoming. The evolution was favorable in all cases and no death was recorded. However, 42 patients (18.2%) were hospitalized in a medical unit and 4 patients were hospitalized in ICU without needing mechanical ventilation, inotropes or vasoactive drugs. CONCLUSION: Scorpion envenomation is an increasing accident in French Guiana. Symptoms vary from mild to severe and can require ICU admission. Practitioners have to be made aware of severe cases found mainly in children.