Emergence and evolution of the Omicron SARS-CoV-2 variant in the island of Martinique.

INTRODUCTION: We aimed to describe the epidemiological situation during the Omicron variant circulation in light of genomic surveillance data in Martinique, a territory with low vaccination rates. PATIENTS AND METHODS: We exploited COVID-19 national databases of virological tests, for the collection of hospital data and for the sequencing data from December 13, 2021 to July 11, 2022. RESULTS: Three prevailing sub-lineages of Omicron have been identified in Martinique (BA.1, BA.2, BA.5) during this period causing three distinct waves characterized by an increase in virological indicators compared to previous waves, with moderate severity in the first and last waves, caused by BA.1 and BA.5, respectively. CONCLUSION: The SARS-CoV-2 outbreak is still progressing in Martinique. Genomic surveillance system in this overseas territory must be continued for rapid detection of emerging variants/sub-lineages.

Lessons raised by the major 2010 dengue epidemics in the French West Indies.

Dengue fever has been endemo-epidemic in the whole Region of America. In 2010, Guadeloupe and Martinique experienced historical epidemics, with an estimated attack rate of 10% in two islands. When considering the temporal evolution of epidemiological indicators, an unusual increase in the number of dengue cases could be detected very early. Two main factors might have facilitated the settlement of a viral transmission despite the dry season: a low immunity of the population against the circulating serotype and particular climatic conditions, notably very high temperatures which could have improved both virus and vector efficiency. This unusual situation was considered as a warning sign, and indeed led to major outbreaks in both islands a few weeks later. This event underlines that follow-up of epidemiological indicators is necessary to detect the unusual situations as soon as possible. Furthermore, development of biological and modelling tools should be promoted, as well as integrated management strategies for dengue prevention and control.

Outbreak of leptospirosis among canyoning participants, Martinique, 2011.

Two gendarmes who participated in canyoning activities on 27 June 2011 on the Caribbean island of Martinique were diagnosed with leptospirosis using quantitative real-time polymerase chain reaction (qPCR), 9 and 12 days after the event. Among the 45 participants who were contacted, 41 returned a completed questionnaire, of whom eight met the outbreak case definition. The eight cases sought medical attention and were given antibiotics within the first week after fever onset. No severe manifestations of leptospirosis were reported. In seven of the eight cases, the infection was confirmed by qPCR. Three pathogenic Leptospira species, including L. kmetyi, were identified in four of the cases. None of the evaluated risk factors were statistically associated with having developed leptospirosis. Rapid diagnostic assays, such as qPCR, are particularly appropriate in this setting ­ sporting events with prolonged fresh-water exposure ­ for early diagnosis and to help formulate public health recommendations. Participants in such events should be made specifically aware of the risk of leptospirosis, particularly during periods of heavy rainfall and flooding.

[Epidemic of influenza A(H1N1) 2009 in the French overseas territories of the Americas: epidemiological surveillance set up and main results, April 2009-January 2010]. / L'épidémie de grippe A(H1N1) 2009 dans les territoires français des Amériques: dispositif de surveillance mis en place et principaux résultats, avril 2009-janvier 2010.

Guadeloupe, French Guiana, Martinique, St. Martin and St. Barthelemy were the French territories most exposed to the new influenza A(H1N1)v, and adequate epidemiological surveillance tools were promptly developed in order to detect its emergence. The first stage, "containment phase", consisted in detection and management of individual cases. Then, when an autochthonous A(H1N1)v circulation was confirmed, its evolution has been monitored within the whole population, mainly through data collected from sentinel doctors' networks and virological surveillance. This allowed to detect very early the occurrence of epidemics, and to follow their evolution until they were over. Like all the other Caribbean countries, the five French overseas territories were hit by an outbreak of influenza A(H1N1)v. Although they had globally similar characteristics, each epidemic had its specificity in terms of scale and severity. They started between August and September 2009 in four of the five territories, while the last one, St. Barthelemy, was not affected until the end of the year. Attack rate estimates varied from 28 to 70 per 1000 inhabitants according to the territory, and hospitalisation rate varied from 4.3 to 10.3 per 1000 cases. Severity rate didn't reach 1 per 1000 cases in any of the territories. Compared to metropolitan France, the surveillance system presented several strengths, including the pre-existence of both an active sentinel network and an expert committee on emerging diseases in each territory. On the other hand, specific difficulties appeared, notably linked with logistical aspects of virological surveillance and the co-circulation of dengue virus in Guadeloupe and St. Barthelemy. Despite these difficulties, the different tools allowed early detection of the epidemics and follow-up of their evolution. All of them lead to very concordant results, suggesting that they are completely appropriate to monitor a potential new epidemic wave.

Prospective and descriptive study of adult dengue cases in an emergency department, in Martinique.

OBJECTIVE: Knowing about the clinical aspects of dengue in endemic zones is essential to implementation of appropriate case management protocols and public health interventions. PATIENTS AND METHODS: The authors made a 4-year prospective, observational study of dengue-infected patients admitted to the emergency department of the Fort-de-France University Hospital. RESULTS: Two hundred and sixty-three male and 297 female patients were included. The median age was 37 years (range: 14-91). The diagnosis was based on a positive RT-PCR (463 patients) or on the presence of specific IgM (97 patients). Two hundred and seventy-seven patients (49.5%) presented with dengue fever without complications. According to WHO criteria, 95 patients (17%) developed plasma leakage, including 39 patients (7%) diagnosed with DHF, and 10 (1.8%) diagnosed with DSS. Among the other patients without plasma leakage, 84 (15%) had isolated thrombocytopenia, 14 (2.5%) had internal bleeding, and 90 (16%) had unusual manifestations. Seven patients died (1.3%): fulminant hepatitis (two), myocarditis (one), encephalitis (one), acute respiratory failure (one), gangrenous cholecystitis (one), and post-traumatic intracranial hemorrhage (one). The other patients recovered. Seven patients were pregnant (1.3%) from 6 to 27 weeks of amenorrhea and carried their pregnancy to term without complications. CONCLUSION: With this experience, we were able to develop appropriate case management protocols for patients during dengue epidemics.

Murdered father; dead father: revisiting the Oedipus complex.

This paper recovers the notion of the sacrifice of sexuality as the central, tragic, element of the oedipal structure. This notion has been largely abandoned in the psychoanalytic literature that has tended to reduce the oedipal structure to processes of exclusion. The paper traces the development of the theoretical and clinical transformations of Freud 's ideas on the role of the father and suggests that they allow us to more fully comprehend the Oedipus complex proposed by Freud. A paradox is explored: the killing of the father is, in Freud 's view, the requirement for the creation of the social order which, from then on, prohibits all killings. The father, however, has to be killed metaphorically only, as the actual exclusion of the father lies at the origin of so many psychopathologies from violence to the psychoses and perversions. The paper analyses the fundamental asymmetry that is present in the Oedipal structure and suggests that the three elements of the oedipal triangle constitute the law (of the dead father, that institutes the sacrifice of sexuality), desire (for the lost object) and identification (with both father and mother). Two clinical examples are discussed. In the first, one can identify a perverse structure in which the father has been murdered; in the second, there is a progressive construction of the dead (symbolic) father in the analytic process.

[Arterial-hypertension prevalence in the general population of Martinique]. / Prévalence de l'hypertension artérielle en population générale à la Martinique.

BACKGROUND: Since 1996, arterial hypertension has been recognized as one of the main health priorities in Martinique. However, its prevalence in the general population has never been measured. Furthermore, obesity is increasing in many countries and studies have shown that hypertension is more frequent in obese people than in people with normal body mass index. The objective of this survey is to measure hypertension prevalence in the general population and to study the link between hypertension, weight status and socioeconomic level. METHODS: Cross-sectional study of randomly selected homes in randomly selected geographical islets. All household members in these homes constituted the eligible population. Arterial hypertension was defined as systolic pressure greater than 140mmHg and/or diastolic pressure greater than 90mmHg and/or antihypertensive treatment. Weight status was estimated using the body mass index. RESULTS: Study concerned 1504 persons aged 16 years or older with a sex-ratio of 0.7 and an average age of 48.3 years for men and 48.5 years for women, p=0.88. The prevalence rate of hypertension is 29% [IC(95%): 25.9-31.8] in the sample and declines to 22.5% [IC(95%): 20.1-25.1] using weighted data. The prevalence rate is 33.1% [IC(95%): 30.2-36.6] for overweight and 20.1% [IC(95%): 17.8-22.6] for obesity. Being overweight is more frequent among persons with hypertension than among ones with normal blood pressure, 73.0 versus 47.4%; p<0.001. In those with hypertension, overweight does not differ significantly between men and women, but the prevalence of obesity is greater among women than among men (35.7 versus 20.6 %, p<0.05). CONCLUSION: The high prevalence of both hypertension and obesity in the general Martinican population has been confirmed by this study. Prevention actions are required to decrease the cardiovascular risk in this population.

Configurações narcísicas: violência e sua ausência no tratamento

Sobre o Narcisismo: uma Introdução constitui uma virada em psicanálise. Apesar de muitos pensadores importantes não terem se referido explicitamente ao conceito de narcisismo durante muitas décadas, pode-se sugerir que desde Freud não há trabalho psicanalítico que não leve implicitamente em consideração modificações no pensar ocasionadas pelo mesmo. Neste artigo a autora contrapõe dois tipos de configurações narcísicas. Na primeira, se lida com a intolerância ao outro através da expulsão e da violência. Na segunda, através do retraimento. A autora contrapõe pacientes que expressam comportamento violento manifesto com pacientes nos quais o comportamento violento encontra-se ausente, mas que, mesmo assim, apresentam histórias com fundo parecido, o que poderia ter levado a uma predição da violência. Também são profundamente diferentes em termos do que provocam na contratransferência. Além disso, o trabalho segue a argumentação de que nos últimos anos o tratamento de personalidades narcísicas contribuiu para a compreensão de uma modalidade de depressão. Seguindo Green, a autora argumenta que em vez de um debate infrutífero a respeito do desenvolvimento do conceito de narcisismo, é preciso distinguir o aspecto narcísico em qualquer relação analítica para identificar a transferência narcísica em diferentes tipos de psicopatologias(AU)