Kerbaul F.,Service dAnesthesie Reanimation Adultes |
Kerbaul F.,Aix - Marseille University |
Kerbaul F.,Groupe Hospitalier Of La Timone |
Rondelet B.,Free University of Brussels |
And 6 more authors.
Anesthesiology | Year: 2011
Background: Normovolemic hemodilution is known to inhibit hypoxic pulmonary vasoconstriction. How the coupling between the pulmonary arterial (PA) circulation and the right ventricle (RV) is affected by normovolemic hemodilution and by the composition of replacement solutions remains unknown. Therefore, the effects of isotonic and hypertonic saline hydroxyethylstarch solutions on the pulmonary circulation and RV, in control and hypoxic conditions, were compared. Methods: Anesthetized piglets (n = 14) were equipped with manometer-tipped catheters in the RV and main PA and an ultrasonic flow probe around the main PA. The pulmonary circulation was assessed by pressure-flow relations and vascular impedance, RV afterload by effective arterial elastance (Ea), RV contractility by end-systolic elastance (Ees), and RV-PA coupling by the Ees/Ea ratio. Measurements were done in control (Fio2 0.40) and hypoxic (Fio2 0.12) conditions before and after acute normovolemic hemodilution with either 20 ml/kg isotonic saline hydroxyethylstarch (hydroxyethylstarch 130/0.4 6% in NaCl 0.9%, Voluven, Fresenius-Kabi, Sevres, France) or 5 ml/kg hypertonic saline hydroxyethylstarch (hydroxyethylstarch 200/0.5 6% in NaCl 7.2%, HyperHES, Fresenius-Kabi) solutions. Results: Hypoxic pulmonary vasoconstriction was associated with proportional increases in Ea and Ees and did not affect RV-PA coupling. Hemodilution attenuated the hypoxic response. Hemodilution with isotonic saline hydroxyethylstarch did not affect the RV-PA coupling, whereas hemodilution with hypertonic saline hydroxyethylstarch increased Ees and the Ees/Ea ratio. Conclusion: In experimental normovolemic hemodilution, both in control and in hypoxic conditions, RV-PA coupling is unaffected by isotonic saline hydroxyethylstarch but improved by hypertonic saline hydroxyethylstarch, mainly because of an increase in RV contractility. Copyright © 2011, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins.
Texier G.,Institute Of Medecine Tropicale |
Buisson Y.,Institute Of La Francophonie Pour La Medecine Tropicale
Revue d'Epidemiologie et de Sante Publique | Year: 2010
Background: Bioterrorist threats and the emergence of new infectious pathogens force structures and means dedicated to outbreaks detection to evolve. Obtaining early information is becoming a major stake. Development of early warning system and new epidemiological tools open new perspectives in real time management of outbreaks. Methods: Through several examples, this overview presents a synthesis and reports the recent multidisciplinary evolutions, which occurred in the field of outbreak detection and information useful for outbreaks anticipation. Conclusion: Outbreak detection is a multidisciplinary activity which relies on many protean epidemiologic sensors. Detection should not be perceived as a finality, but as a crucial step of a broader process in outbreak management (detection, alarm, alert, acceptability, implementation of countermeasures or not). That is why the evaluation of a monitoring system should not be limited to only its ability to detect an aberration. Today, progress in biology, modeling, remote sensing and environmental detection allow model development with anticipation aiming © 2010 Elsevier Masson SAS.
Michel R.,Institute Of Medecine Tropicale |
Bardot S.,British Petroleum |
Queyriaux B.,Institute Of Medecine Tropicale |
Boutin J.-P.,Institute Of Medecine Tropicale |
Touze J.-E.,Direction Centrale du Service de Sante des Armees
Transactions of the Royal Society of Tropical Medicine and Hygiene | Year: 2010
Failures of malaria chemoprophylaxis have been related to a lack of compliance with doxycycline due to its short elimination half-life. Adding a molecule with a long half-life to doxycycline could be useful to take over from this drug in case of occasional missed doses. A double-blind, placebo-controlled randomized field trial was designed to compare the tolerability of a doxycycline-chloroquine combination vs. doxycycline as malaria prophylaxis among French soldiers deployed in Africa. Data from 936 volunteers were analyzed. In both groups, the proportion of volunteers who reported at least one adverse effect was about 57%. Tolerability was similar in the groups except for a higher proportion of nausea or vomiting in the doxycycline-chloroquine group. The reported compliance rate was 86.6% and was similar in the two groups. Eight Plasmodium falciparum malaria cases were diagnosed in the doxycycline group and seven in the doxycycline-chloroquine group. The efficacy of the two chemoprophylaxis regimens was similar. Our study was the first randomized field trial to assess a doxycycline-chloroquine combination as malaria prophylaxis and showed no significant decrease of overall tolerability of the combination compared with doxycycline alone. Our results showed that a doxycycline-chloroquine combination could be a safe combination for malaria chemoprophylaxis. © 2010 Royal Society of Tropical Medicine and Hygiene.
Pradines B.,Institute Of Medecine Tropicale |
Pistone T.,University of Bordeaux Segalen |
Ezzedine K.,University of Bordeaux Segalen |
Briolant S.,Institute Of Medecine Tropicale |
And 6 more authors.
Emerging Infectious Diseases | Year: 2010
We describe clinical and parasitologic features of in vivo and in vitro Plasmodium falciparum resistance to quinine in a nonimmune traveler who returned to France from Senegal in 2007 with severe imported malaria. Clinical quinine failure was associated with a 50% inhibitory concentration of 829 nmol/L. Increased vigilance is required during treatment follow-up.
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.
PubMed | Institute Of Medecine Tropicale and University of Kinshasa
Type: Journal Article | Journal: Archives de pediatrie : organe officiel de la Societe francaise de pediatrie | Year: 2014
Data on geohelminth infections in children in the Democratic Republic of Congo are sparse. The objective of this study was to document and compare the profile and prevalence in children living in Kinshasa.A prospective cohort study was conducted from May to October 2009 in children in the Biyela health area in Kinshasa, Democratic Republic of Congo. Stool samples were collected from representative members of these two populations and analyzed for geohelminths (GH) using the Kato-Katz technique.In this series, 438 school-age children were included. There were 235 children recruited in schools and 203 in households (77.8%). Overall prevalence of geohelminths was 66.9%. The specific prevalence was 69.4% in children recruited in schools and 64.0% in children recruited in households. The frequency of Ascaris lumbricoides, Trichuris trichiura, and Ancylostoma species were, respectively, 56.2%, 38.7%, and 1.7% in schools and 39.9%, 51.7%, and 1.0% in households. A. lumbricoides was significantly more prevalent in schools (56.2% vs 39.9%; OR=2.0; 95%CI: 1.3-3.0), T. trichiura was significantly less prevalent in schools (38.7% vs 51.7%; OR=0.6; 95% CI: 0.4-0.9). There were no significant differences in the prevalence of Ancylostoma between schools and households.GH is a health problem among Biyela children. Preventive measures and education of the population need to be emphasized in attempts to reduce the prevalence of geohelminths in these children.
Leadership and vision in the improvement of universal health care coverage in low-income countries [leadership et vision exercée pour la couverture universelle des soins dans les pays à faible revenu]
Meda Z.C.,Ministere de la Sante |
Konate L.,Ministere de la Sante |
Ouedraogo H.,Ministere de la Sante |
Sanou M.,Ministere de la Sante |
And 2 more authors.
Cahiers Sante | Year: 2011
In Burkina Faso,asinmost developing countries, the operational levelofthe health system is made up of Health Districts (HDs), the activities of which are typically coordinated by the District Team (DT). Assessing the the core functions of DTs, as described by WHO, shows two important weaknesses. Firstly, instructions from "above" are often implemented rather passively: DTs tend not to display much leadership. Secondly, the current organisation, based on input financing and centralised planning, does not sufficiently promote either the vision or research functions of DTs. In this article, we report our experience in the Orodora HD in Burkina Faso, where the DT's leadership and vision provedto be essential ingredients for effective health action in the district. Our description of six interventions implemented between 2004 and 2008 shows how DT leadership and vision have improved outputs at the HD level. Until 2004, the district applied static health planning. The health system was insufficientlyfinanced and performed poorly. Faced with this situation, theDTdecidedtoset up several priority interventions based on health care access criteria and patient concerns, while respecting and contextualizing national norms and objectives. Six interventions were then implemented. The first was ensure that quality blood (meeting transfusion security norms) was available at the District Hospital (DH), by picking blood up from the regional blood transfusion center weekly. This speeded up care at the DH, reduced the number of cases referred to the regional hospital for transfusion, and reduced neonatal and maternal mortality. The second intervention sought to improve the skills of health workers in managing emergency cases and to improve relationships with the referral hospital through the reintroduction of counter-referral procedures. This led to a decrease in unnecessary referrals and also reduced the mortality rates of serious cases. The third intervention, by implementing a decentralized approach to tuberculosis detection, succeeded in improving access tocare and enabledus to quantify the rateoftuberculosis-HIV co-infectionin the HD. The fourth intervention improved financial access to emergency obstetric care by providing essential drugs and consumables for emergency obstetric surgery free of charge. The fifth intervention boosted the motivation of health workers by an annual 'competition of excellence', organised for workers and teams in the HD. Finally, our sixth intervention was the introduction of a "culture" of evaluation and transparency, by means of a local health journal, usedtointeract with stakeholders bothatthe local level andinthe healthsectormore broadly. Wealso present our experiences regularly during national health science symposia. Although the DT operates with limited resources, it has over time managed to improve care and services in the HD, through its dynamic management and strategic planning. It has reduced inpatient mortality and improved access to care, particularly for vulnerable groups, in line with the Primary Health Care and Bamako Initiative principles. This case study would have benefited from a stronger methodology. However, it shows that in a context of limited resources it is still possible to strengthen the local health system by improving management practices. To progress towards universal health coverage, all core functions of a DT are worth implementing, including leadership and vision. National and international health strategies should thus include a plan to provide for and train local health system managers who can provide both leadership and strategic vision.
Selective free health care in sub-Saharan Africa: An opportunity for strengthening health systems? [Labolition sélective du paiement direct en Afrique subsaharienne: Une opportunité pour le renforcement des systdmes de santé?]
Ridded V.,University of Montréal |
Meessen B.,Institute Of Medecine Tropicale |
Kouanda S.,Institute Of Recherche En Science Of La Sante
Sante Publique | Year: 2011
As the idealistic deadline of the Millennium Development Goals (MDGs), 2015, looms ever closer, some are calling for user fees abolition. In many African countries, this involves targeting groups considered vulnerable. However, operational problems have surfaced in the experiences of some of the pioneering West African countries. We identified various health system bottlenecks. These challenges are also starting points and opportunities to strengthen health care systems in Africa through making changes such as significantly increasing health care funding, improving the reliability of funding, making equity a health policy priority, adopting "New Public Management" types of reforms, ensuring the supply and quality of inputs, making efforts to reinforce the systemic components of the health sector, and improving the quality and quantity of evaluations undertaken in the health sector.
Morillon M.,Institute Of Medecine Tropicale
Médecine tropicale : revue du Corps de santé colonial | Year: 2011
After becoming a military doctor at the behest of his father, Ronald Ross was destined to make a discovery of paramout importance, i.e., malaria transmission through mosquito bites. This landmark discovery that was the fruit of a combination of curiosity, tenacity and luck, earned him the Nobel Prize in Medicine.
Touze J.-E.,Membre de lAcademie Nationale de Medecine |
Laroche R.,Institute Of Medecine Tropicale
Bulletin de l'Academie Nationale de Medecine | Year: 2013
Tropical medicine was a key element of the medical structures provided by France to our former colonies and, later, to countries within the scope of our international cooperation. In recent decades, France has drastically reduced its bilateral commitments to countries in the tropics, and especially in sub-Saharan Africa. At the same time, the teaching of tropical medicine, which was highly regarded even beyond our borders, has lost a good deal of its expertise. Initially available in a few large French centers, and ensured by teachers with extensive field experience, training in tropical medicine is now offered in many universities. However, their programs and educational objectives, focusing mainly on infectious and parasitic diseases, no longer meet the healthcare priorities of southern countries, which are facing an epidemiological transition and the rise of non communicable diseases. Few teachers now have recognized expertise in tropical medicine. These changes have had negative consequences for research programs in tropical medicine and for the image of French assistance to developing countries. In this context, the following perspectives should be considered: 1) training in tropical medicine should be enhanced by the creation of a national diploma recognized by international bodies. 2) The creation of a doctoral course in tropical medicine is a prerequisite for achieving this goal, and the future diploma must include a significant research component. 3) Teaching in tropical medicine must become more practical and be ensured by teachers with extensive field experience. 4) Training in tropical medicine should be part of a bilateral relationship with countries in the tropics, each party contributing its expertise while respecting that of its partners. 5) Training in tropical medicine should be backed up by high-level scientific research based on enhanced synergy of our current networks (Institute for Research and Development, Network of overseas Pasteur Institutes, universities, etc.). 6) Teaching of tropical medicine should be coordinated by a supra-university structure whose mission is to ensure coherence. 7) Success in all these objectives will require strong political commitment. This is the only way to restore the enviable position which France occupied in the recent past.