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Delacour H.,Federation de Biologie Clinique | Dorandeu F.,Institute Of Recherche Biomedicale Des Armees
Reanimation | Year: 2014

Chemical warfare agents represent an ever-lasting threat, not only for military forces but also for civilian populations as illustrated by the recent events in Syria. Nerve agents such as those used by Iraq during the Iran/Iraq war or by the Aum Shinri Kyo sect in Japan are among the deadliest of those non-conventional weapons. Their effects are mainly due to their ability to inhibit cholinesterases throughout the body. After a short review of the main characteristics of nerve agents and of the pathophysiology and clinical presentation of acute nerve agent poisoning, the general principles of clinical management will be reviewed. © 2014 Société de réanimation de langue française (SRLF) and Springer-Verlag France.


Martinaud C.,Federation de Biologie Clinique | Verdonk C.,Service des Maladies Respiratoires | Bousquet A.,Federation de Biologie Clinique | MacNab C.,Federation de Biologie Clinique | And 4 more authors.
Journal of Clinical Microbiology | Year: 2011

A strain of Nocardia was isolated from a pulmonary abscess of a human immunodeficiency virus-infected patient in France. Comparative 16S rRNA gene sequence analysis revealed that the isolate represented a strain of Nocardia beijingensis. Antimicrobial susceptibility testing was essential to guide the clinicians to successfully treat this infection. Copyright © 2011, American Society for Microbiology. All Rights Reserved.


Martinaud C.,Federation de Biologie Clinique | Civadier C.,Sanguine | Ausset S.,Departement dAnesthesie et de Reanimation | Verret C.,Center Depidemiologie Et Of Sante | And 2 more authors.
Anesthesiology | Year: 2012

BACKGROUND: French lyophilized plasma (FLyP) is used routinely by the French Armed Forces in war settings. The authors compared concentrations of coagulation proteins and global in vitro hemostatic properties in FLyP and in the same plasma before lyophilization to assess the impact of lyophilization on coagulation properties. METHODS: Twenty-four batches of plasma before and after lyophilization were tested for coagulation proteins. Thrombin generation time, thrombin antithrombin concentration, prothrombin fragment 1 + 2, and thromboelastography were assessed. Finally, the efficiencies of FLyP and plasma before lyophilization were compared on a hemorrhagic shock hemodilution model and tested on TEG(Haemoscope Corporation, Glenview, IL). RESULTS: Prothrombin time ratio (1.1 ± 0.1 vs. 1.2 ± 0.1) and activated partial thromboplastin time (35 ± 1.3 vs. 39 ± 2.4 s) were significantly increased in FLyP (8 ± 3%, P < 0.05 and 11 ± 5%, P < 0.001, respectively). Activity of factors V (85 ± 18 vs. 51 ± 16 UI/ml) and VIII (0.77 ± 0.11 vs. 0.62 ± 0.10 UI/ml) was also diminished (25 ± 12% and 20 ± 7%, respectively); however, activity of other factors was preserved. The authors observed no alteration in the thromboelastographic parameters. Thrombin generation was preserved when induced with 5 pM tissue factor in vitro but significantly reduced when using 1 pM tissue factor. The thrombin-antithrombin complex and prothrombin fragment 1 + 2 attested for the absence of coagulation activation. This hemodilution model showed no significant difference before and after lyophilization. CONCLUSIONS: The study results account for a significant decrease of factors V and VIII in FLyP. However, the global capacity to induce clot formation in vitro seems to be preserved. The clinical relevance of these decreased factors is not known. Copyright © 2012, the American Society of Anesthesiologists, Inc. Lippincott.


Boyer-Cazajous G.,Service de Medecine | Martinaud C.,Federation de biologie clinique | Dehan C.,Laboratoire Of Biologie Medicale | Hassan M.O.,Center National Of Traitement Of La Tuberculose | And 3 more authors.
Journal of Infection in Developing Countries | Year: 2014

Introduction: The Republic of Djibouti is an African country that exhibits one of the highest incidence rate of tuberculosis in the world. The aim of this study was to evaluate the prevalence of multidrug-resistant tuberculosis among new cases. Methodology: We studied retrospectively every tuberculosis case diagnosed over a 12-month period in patients hospitalized at the French Military Hospital of Bouffard. During this period, 1,274 samples from 675 patients were tested. Results: We isolated 266 mycobacteria corresponding to 180 cases of tuberculosis. Thirty-three were fully susceptible and 57% met the tuberculosis criteria, with 46% primary resistance. No extensively-drug-resistant tuberculosis was found. Conclusion: Our results highlight a major concern about the situation in this part of the world. © 2014 Golkar et al.


Martinaud C.,Federation de Biologie Clinique | Ausset S.,Hopital DInstruction des Armees Percy | Deshayes A.V.,Sanguine | Cauet A.,Hopital DInstruction des Armees Percy | And 2 more authors.
Journal of Trauma - Injury, Infection and Critical Care | Year: 2011

Background: Modern warfare causes severe injuries, and despite rapid transportation to theater regional trauma centers, casualties frequently arrive coagulopathic and in shock. Massive hemorrhage management includes transfusion of red blood cells and plasma in a 1:1 ratio. Fresh frozen plasma requires thawing and badly fits the emergency criteria. Since 1994, the French Military Blood Bank has been producing freeze-dried plasma (FDP) and providing it for overseas operation. The aim of our study was to evaluate the use of FDP in war settings and to assess its clinical efficiency and safety. PATIENTS: We performed a prospective study of the FDP delivered at the International Security Assistance Force Role 3 Military Medical Treatment Facility in the Kabul Afghanistan International Airport between February 2010 and February 2011. We included every patient who received at least one unit of FDP. Basic clinical data were recorded at admission. Transfusion requirements were monitored. Biological testing were performed before and after administration of FDP including hemoglobin concentration, platelets count, fibrinogen level, prothrombin time (PT), and thromboelastography. Result: Eighty-seven casualties received FDP during 93 episodes of transfusion. On average, 3.5 FDP units were transfused per episodes of transfusion. Of the 87 patients studied, 7 died because of nonsurvivable injuries and outcomes were unavailable for 11. The other 59 patients survived. PT significantly declined by an average of 3.3 seconds after FDP transfusion. This moderate decrease in PT reflects continued bleeding and resuscitation. It nevertheless suggests improvement in hemostasis before surgical control of bleeding. All FDP users reported ease of use, clinically observed efficacy equivalent to fresh frozen plasma and the absence of adverse effects associated with FDP. CONCLUSION: Our results provide evidence of the effectiveness of FDP for the prevention or correction of coagulopathy and hemorrhage in combat casualties.Copyright © 2011 by Lippincott Williams & Wilkins.


Mayet A.,Center Depidemiologie Et Of Sante Publique Des Armees | Haus-Cheymol R.,Center Depidemiologie Et Of Sante Publique Des Armees | Bouaiti E.A.,Center Depidemiologie Et Of Sante Publique Des Armees | Decam C.,Institute Of Medecine Tropicale | And 6 more authors.
Eurosurveillance | Year: 2012

French military personnel are subject to a compulsory vaccination schedule. The aim of this study was to describe vaccine adverse events (VAE) reported from 2002 to 2010 in armed forces. VAE are routinely surveyed by the military Centre for epidemiology and public health. For each case, military practitioners fill a notification form, providing patient characteristics, clinical information and vaccines administered. For this study, VAE following influenza A(H1N1)pdm09 vaccination were excluded. Among the 473 cases retained, 442 (93%) corresponded to non-severe VAE, including local, regional and systemic events, while 31 corresponded to severe VAE, with two leading to significant disability. The global VAE reporting rate (RR) was 14.0 per 100,000 injections. While stationary from 2002 to 2008, the RR increased from 2009. The most important observations were a marked increase of VAE attributed to Bacillus Calmette-Guérin (BCG) vaccine from 2005 to 2008, a high RR observed with the inactivated diphtheria-tetanus (toxoids)-poliovirus vaccine combined with acellular pertussis vaccine (dTap-IPV) from 2008 and an increase in RR for seasonal influenza vaccine VAE in 2009. Our RR for severe VAE (1.1 VAE per 100,000) appears comparable with rates observed among United States civilians and military personnel. The increase observed from 2009 could be partly explained by the influenza A(H1N1)pdm09 pandemic which increased practitioner awareness towards VAE. In conclusion, the tolerance of the vaccines used in French armed forces appears acceptable.


Grondin C.,Service des Maladies Infectieuses et Tropicales | Imbert P.,Service de Maternite pediatrie | Ficko C.,Service des Maladies Infectieuses et Tropicales | Merens A.,Federation de Biologie Clinique | And 3 more authors.
Journal of Travel Medicine | Year: 2012

Shigella bacteremias are uncommon in immune-competent adults. We report two cases of Shigella flexneri bacteremia that occurred in healthy young travelers, who recovered. Self-medication with loperamide and ibuprofen without antibiotics (case 1) and concomitant falciparum malaria (case 2) were the only co-morbidities found in our two patients. © 2012 International Society of Travel Medicine.


Flateau C.,Service des Maladies Infectieuses et Tropicales | Asfalou I.,Service de Cardiologie | Deman A.-L.,Service de Cardiologie | Ficko C.,Service des Maladies Infectieuses et Tropicales | And 5 more authors.
Infection | Year: 2013

We report the case of a patient who presented with a thrombus of the aortic arch complicated with splenic, renal and peroneal artery embolisms, associated with transient lupus anticoagulant, during a Mycoplasma pneumoniae infection. The outcome was good under antibiotic and anticoagulant treatment. We also review the medical literature on M. pneumoniae-related thromboses. © 2013 Springer-Verlag Berlin Heidelberg.


Delacour H.,Federation de Biologie Clinique | Dubrous P.,Federation de Biologie Clinique | Koeck J.L.,Federation de Biologie Clinique
Medecine Tropicale | Year: 2010

Although norovimses were the first viral agents to be linked to gastrointestinal disease, they were long considered a secondary cause far behind rotaviruses. Development of molecular-based diagnostic techniques has provided clearer insight into the epidemiological impact of norovimses that are now recognized not only as the leading cause of non-bacterial gastroenteritis outbreaks but also as an important cause of sporadic gastroenteritis in both children and adults. Norovirus infection is generally characterized by mild acute vomiting and diarrhea usually lasting for only a few days, but it can lead to more severe and potentially life-threatening symptoms in high-risk groups such as young children, elderly, and immunodeficient persons. It has been demonstrated that they are present in tropical countries. Molecular epidemiological studies have documented the great genetic diversity of norovimses with regular emergence of variants. Since no vaccine is available, prevention on norovims infection depends mainly on strict personal and community hygiene measures.


PubMed | Federation de biologie clinique
Type: Journal Article | Journal: Archives de pediatrie : organe officiel de la Societe francaise de pediatrie | Year: 2016

Succinylcholine is a neuromuscular block whose duration of action depends on rapid hydrolysis by butyrylcholinesterase (BChE). In patients with common BChE activities, succinylcholine duration of action is short (10min). BChE deficiency induces a slower hydrolysis of the drug and consequently prolonged neuromuscular block, leading to apnea. We report a case of prolonged neuromuscular block after administration of succinylcholine in a 14-year-old boy. Biological investigations revealed a marked BChE deficiency (1099U/L) related to the presence of three point mutations in the BCHE gene in a compound heterozygous state: p.Asp70Gly (rs1799807), p.Ala539Tyr (rs1803274), and p.Phe118Valfs*12 (rs398124632). The diagnosis of genetic BChE deficiency (OMIM 177400) was retained. This case is intended to present the pathophysiology of genetic BChE deficiency, its management, and the diagnostic strategy to be implemented.

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