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Duron S.,Center Depidemiologie Et Of Sante Publique Des Armees | Mayet A.,Center Depidemiologie Et Of Sante Publique Des Armees | Lienhard F.,Center Depidemiologie Et Of Sante Publique Des Armees | Haus-Cheymol R.,Center Depidemiologie Et Of Sante Publique Des Armees | And 12 more authors.
Swiss Medical Weekly | Year: 2013

QUESTION UNDER STUDY: Influenza is a viral infection caused by a pathogen with considerable ability for genetic mutation, which is responsible for seasonal outbreaks as well as pandemics. This article presents the results of epidemiological and virological monitoring of four successive influenza outbreaks in the French armed forces, for the period 2008 to 2012. METHODS: The main events monitored were acute respiratory infection (ARI). Weekly incidence rates were calculated by relating cases to the number of servicepersons monitored. RESULTS: In continental France, the incidence rates for ARI and for medical consultation attributable to influenza were highest during the pandemic and decreased to reach their lowest values in 2010-2011 and 2011-2012. In terms of virological results, the 2008-2009 outbreak was mainly due to the A(H3N2) virus, while the 2009-2010 pandemic and the following season saw the emergence of the A(H1N1) pdm09 strain. The last season 2011-2012 was characterised by a predominant circulation of A(H3N2) viruses. CONCLUSIONS: Despite some limitations, the MISS represents a good source of information about influenza in young people. Virological results are compatible with those reported by most other influenza surveillance networks, but could be improved by a better knowledge of the other respiratory viruses in circulation in the military community. Source

Massoure P.L.,Service de cardiologie | Roche N.C.,Service de cardiologie | Topin F.,Hopital dInstruction des Armees Laveran | Fourcade L.,Service de cardiologie
Medecine et Sante Tropicales | Year: 2013

Background. The features of heart failure (HF) in Djibouti have not been well described. We sought to document the current patterns of HF here. Methods. We prospectively included Djiboutian adults hospitalized for HF in the French Military Hospital (Djibouti) from August 2008 through December 2010. Results. Of 1688 adults hospitalized in the medical department, 45 (2.7%) had symptomatic HF: 38 (84%) men, mean age 55.8 years (range 27-75). Twenty-five (56%) patients were initially hospitalized for acute pulmonary edema. The underlying diseases included coronary artery disease (CAD) (62%), hypertensive heart disease (18%), rheumatic valvular disease (13%), and primary dilated cardiomyopathy (7%). Their cardiovascular risk factors included tobacco use (53%), hypertension (69%), diabetes (47%), and hypercholesterolemia (51%). Patients in the CAD group were older, and had diabetes more often (p<0.01). All khat chewers (53%) were males and smokers. Mean left ventricular ejection fraction (LVEF) was 39 ± 14%. During follow-up (14.4 ± 9 months), 8 (18%) patients died, 9 (20%) were again hospitalized for HF, and 3 (7%) had ischemic strokes. One month after discharge, the New York Heart Association (NYHA) class was II for 40%, III for 44%, and IV for 16%. Higher NYHA classes and dilated cardiomyopathy were both associated with poorer outcomes (p<0.03). Conclusion. In hospitalized Djiboutians, most HF patterns are similar to those in industrialized countries. CAD is more prevalent than previously reported in African patients with HF. Source

Introduction. The use of the World Health Organization surgical safety checklist, mandatory in operating rooms (OR) in France, significantly reduces morbidity and mortality. Our objective was to evaluate the use of this checklist in the OR of a French military hospital in Djibouti (Horn of Africa). Methods. The study was performed in three stages: a retrospective evaluation of the checklist use over the previous two months, to assess the utilization and completeness rates; provision of information to the OR staff; and thereafter, prospective evaluation for a one-month period of checklist use, the reasons for noncompliance, and the cases in which the checklist identified errors and thus prevented serious adverse events. Results. The initial utilization rate was 49%, with only 24% complete. After staff training and during the study these rates reached 100% and 99%. The staff encountered language difficulties in 53% of cases, and an interpreter was available for 81% of them. The capacity of the surgical safety checklist to detect serious adverse events was highlighted. Conclusion. The utilization and completeness rates were initially worse than those observed in metropolitan French ORs, but a simple staff information program was rapidly effective. Language difficulties are frequent but an interpreter is often available, unlike in developed countries where language problems are uncommon and the availability of interpreters difficult. Moreover, this study illustrates the ability of the checklist to detect and therefore prevent potentially serious adverse events. Source

Viguier M.,University Paris Diderot | Pages C.,University Paris Diderot | Aubin F.,University of Franche Comte | Delaporte E.,Lille 2 University of Health and Law | And 8 more authors.
British Journal of Dermatology | Year: 2012

Background Even though efficacy of biologics has been extensively studied in psoriasis vulgaris, studies in erythrodermic psoriasis, the most severe form of the disease, have been scarcely reported. Objectives To address the efficacy and safety of biologics in patients with erythrodermic psoriasis. Methods A multicentre national retrospective study was performed using the French Psoriasis Group network. Patients showing psoriasis involving at least 90% of body surface area (BSA), and in whom severity of the disease had been evaluated before and after 3 and/or 6 months of treatment with biologics, were enrolled in the study. Results were expressed using intention-to-treat analysis. Results We included 28 patients, representing 42 flares of erythrodermic psoriasis treated with infliximab (n = 24), adalimumab (n = 7), etanercept (n = 6), ustekinumab (n = 3) or efalizumab (n = 2). A 75% improvement of BSA or Psoriais Area and Severity Index 12-14 weeks after treatment onset was reached in 48% of flares treated with infliximab, in 50% of those treated with adalimumab and in 40% of those treated with etanercept. Twelve serious adverse events, consisting of bacterial infection in seven of them, were observed. Biological treatment was discontinued for safety concern in 19% of cases. A given biologic was administered for up to 48 weeks in 34% of flares. Conclusions Biologics show overall good short-term efficacy, but treatment switch due to lack of efficacy or side-effects is frequently observed on a longer term, with only one-third of patients still receiving the same drug after 1 year. The most significant safety concern consists of severe infections. © 2012 The Authors. BJD © 2012 British Association of Dermatologists. Source

Waroux S.,British Petroleum | Peduzzi F.,British Petroleum | Marsaa H.,British Petroleum | Saulnier J.,Hopital dInstruction des Armees Laveran | Carpentier J.P.,EPPA
Journal Europeen des Urgences et de Reanimation | Year: 2013

When they take place in urban areas, earthquakes trigger off many casualties. Emergency doctors may practice intensive care and surgical acts under rubbles. During the Haïti earthquake, French civil protection rescuers were sent to Port-au-Prince. We report the case of a 60-year-old patient, who was found buried under the rubble. Sedation, intubation and amputation of the two legs had to be practiced on the victim. © 2013 Elsevier Masson SAS. Source

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