Guillain-Barré Syndrome after Chikungunya Infection

International audienceno abstrac

Intensive Care Unit Admission for Pandemic (H1N1) 2009, Reunion Island, 2009

International audienceno abstrac

Chikungunya Virus Infection during Pregnancy, Réunion, France, 2006

Except for prenatal hospital admissions for those infected, this virus had no effect on outcomes

L'accès aux soins : indice de l'intégration ou de l'exclusion des minorités : réflexions à propos de la grippe A(H1N1)

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Right ventricular infarction and mitral stenosis: a resuscitation challenge

International audienceWe report the case of a 49-year-old woman who experienced an inferior myocardial infarction with right ventricular extension, poorly tolerated, partly due to a severe rheumatic mitral stenosis discovered during the hospitalization. Following an initial emergent mechanical circulatory support with femoro-femoral extracorporeal life support (ECLS), the patient had the mitral valve replaced, and the arterio-venous ECLS was removed for a right ventricular assistance device. After seven weeks, she was discharged and fully recovered

Specific management of post-chikungunya rheumatic disorders: a retrospective study of 159 cases in Reunion Island from 2006-2012.

BACKGROUND:Since 2003, the tropical arthritogenic chikungunya (CHIK) virus has become an increasingly medical and economic burden in affected areas as it can often result in long-term disabilities. The clinical spectrum of post-CHIK (pCHIK) rheumatic disorders is wide. Evidence-based recommendations are needed to help physicians manage the treatment of afflicted patients. PATIENTS AND METHODS:We conducted a 6-year case series retrospective study in Reunion Island of patients referred to a rheumatologist due to continuous rheumatic or musculoskeletal pains that persisted following CHIK infection. These various disorders were documented in terms of their clinical and therapeutic courses. Post-CHIK de novo chronic inflammatory rheumatisms (CIRs) were identified according to validated criteria. RESULTS:We reviewed 159 patient medical files. Ninety-four patients (59%) who were free of any articular disorder prior to CHIK met the CIR criteria: rheumatoid arthritis (n=40), spondyloarthritis (n=33), undifferentiated polyarthritis (n=21). Bone lesions detectable by radiography occurred in half of the patients (median time: 3.5 years pCHIK). A positive therapeutic response was achieved in 54 out of the 72 patients (75%) who were treated with methotrexate (MTX). Twelve out of the 92 patients (13%) received immunomodulatory biologic agents due to failure of contra-indication of MTX treatment. Other patients mainly presented with mechanical shoulder or knee disorders, bilateral distal polyarthralgia that was frequently associated with oedema at the extremities and tunnel syndromes. These pCHIK musculoskeletal disorders (MSDs) were managed with pain-killers, local and/or general anti-inflammatory drugs, and physiotherapy. CONCLUSION:Rheumatologists in Reunion Island managed CHIK rheumatic disorders in a pragmatic manner following the outbreak in 2006. This retrospective study describes the common mechanical and inflammatory pCHIK disorders. We provide a diagnostic and therapeutic algorithm to help physicians deal with chronic patients, and to limit both functional and economic impacts. The therapeutic indication of MTX in pCHIK CIR could be approved in future efficacy trials

Predicting factors for the need of extracorporeal membrane oxygenation for suicide attempts by cardiac medication: a single-center cohort study

International audienceBACKGROUND: Severe poisoning due to the overdosing of cardiac drugs can lead to cardiovascularfailure. In order to decrease the mortality rate, the most severe patients should be transferred as quicklyas possible to an extracorporeal membrane oxygenation (ECMO) center. However, the predictive factorsshowing the need for venous-arterial ECMO (VA-ECMO) had never been evaluated.METHODS: A retrospective, descriptive, and single-center cohort study. All consecutive patientsadmitted in the largest ICU of Reunion Island (Indian Ocean) between January 2013 and September2018 for beta-blockers (BB), calcium channel blockers (CCB), renin-angiotensin-aldosterone systemblockers, digoxin or anti-arrythmic intentional poisonings were included. ECMO implementation wasthe primary outcome.RESULTS: A total of 49 consecutive admissions were included. Ten patients had ECMO,39 patients did not have ECMO. Three patients in ECMO group died, while no patients in theconventional group died. The most relevant ECMO-associated factors were pulse pressure andheart rate at first medical contact and pulse pressure, heart rate, arterial lactate concentration, liverenzymes and left ventricular ejection fraction (LVEF) at ICU-admission. Only pulse pressure at firstmedical contact and LVEF were significant after logistic regression.CONCLUSION: A transfer to an ECMO center should be considered for a pulse pressure < 35mmHg at first medical contact or LVEF < 20% on admission to ICU