Bothrops lanceolatus Bites: Guidelines for Severity Assessment and Emergent Management

Approximately 20-30 declared snakebite cases occurin Martinique each year. Bothrops lanceolatus, a member of the Crotalidae family, is considered to be the only involved snake. B. lanceolatus, commonly named “Fer-de-Lance”, is endemic and only found on this Caribbean island. Envenomation local features include the presence of fang marks, swelling, pain, bleeding from punctures, and ecchymosis. Severe envenomation is associated with multiple systemic thromboses appearing within 48 h of the bite and resulting in cerebral, myocardial or pulmonary infarctions. Diagnosis requires first of all identification of the snake. Coagulation tests are helpful to identify thrombocytopenia or disseminated intravascular coagulation. A clinical score based on 4 grades is helpful to assess envonimation severity. A specific monovalent equine anti-venom (Bothrofav®, Sanofi-Pasteur, France) to neutralize B. lanceolatus venom is available. Its early administration within 6h from the biting in case of progressive local injures, general signs or coagulation disturbances is effective to prevent severe thrombosis and coagulopathy. Its tolerance is considered to be good. Despite an increasing incidence of bites, no deaths have been recently attributed to B. lanceolatus in Martinique, probably due to the currently recommended strategy of early antivenom administration when required

Genetic mechanisms of critical illness in COVID-19.

Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, P = 1.65 × 10-8) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, P = 2.3 × 10-8) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, P = 3.98 ×  10-12) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, P = 4.99 × 10-8) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice

Intérêt du dosage plasmatique du " brain natriuretic peptide " dans l'atteinte cardiaque au cours du sepsis sévère et du choc septique

L'altération de la performance myocardique au cours du sepsis sévère étant la conséquence d'une atteinte structurale du cardiomyocyte, des marqueurs biologiques témoins de ces anomalies pourraient permettre de diagnostiquer la dysfonction myocardique secondaire au sepsis. Le BNP (brain natriuretic peptide), produit chez l'homme principalement au niveau des myocytes ventriculaires, augmente de façon rapide et puissante en réponse à l'étirement des myocytes, lequel est secondaire à une augmentation de volume ou de pression transmurale du ventricule. Dans ce travail prospectif, en comparant les taux plasmatiques de BNP chez 15 patients en sepsis sévère et chez 10 patients en sepsis sans signe de sévérité, nous démontrons que : - 1/ Les taux sanguins de BNP sont plus élevés chez les patients en sepsis sévère que chez les patients en sepsis : 102 : 11,2-997 vs 15,6 : 5-112 pg/ml, p < 0,01. - 2/ Les taux de BNP demeurent élevés en dehors de toute atteinte systolique ou diastolique visible à l'échographie. Au total, dans notre travail, nous n'avons pas pu corréler l'augmentation du BNP au cours du sepsis sévère à une dysfonction myocardique recherchée par échocardiographieFORT-DE-FRANCE-CHRU-BU (972332102) / SudocBESANCON-BU Médecine pharmacie (250562102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Utilisation d'un système informatique de recueil et de stockage de données physiologiques en réanimation (évaluation des pratiques professionnelles dans la prise en charge de l'hypertension intracrânienne post-traumatique)

DIJON-BU Médecine Pharmacie (212312103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Bothrops lanceolatus envenomation in a patient with arteriovenous fistula for hemodialysis access

International audienc

Influence of intra-abdominal pressure on the specificity of pulse pressure variations to predict fluid responsiveness

The positive predictive value of pulse pressure variations (ΔPP) to discriminate patients who should respond to volume expansion (VE) may be altered in mechanically ventilated patients. Our goal was to determine whether intra-abdominal pressure (IAP) measurements could discriminate patients with true-positive ΔPP values versus patients with false-positive ΔPP values

Severe manifestations of chikungunya virus in critically ill patients during the 2013–2014 Caribbean outbreak

Objectives: A chikungunya epidemic occurred in 2013–2014 in the Caribbean and Americas. Although the disease is usually benign, some patients required admission to the intensive care unit (ICU). The characteristics and outcomes of patients with chikungunya virus (CHIKV) infection admitted to an ICU during this epidemic are reported. Methods: An observational study of consecutive patients with confirmed CHIKV infection admitted to ICUs in Martinique and Guadeloupe, French West Indies, between January and November 2014, was performed. In addition, patients with CHIKV-related manifestations were compared with those whose manifestations were not specifically related to CHIKV infection. Results: Sixty-five patients were admitted to the ICU with CHIKV infection. Fifty-four (83%) had a pre-existing underlying disease and 27 (41.5%) were admitted due to exacerbation of a comorbidity. Thirty-seven (57%) patients were mechanically ventilated. ICU and hospital mortality rates were 26% and 27%, respectively. CHIKV-related manifestations were observed in 28 (18%) patients and were mainly encephalitis, Guillain–Barré syndrome, and severe sepsis. These patients less frequently had chronic arterial hypertension and diabetes and more frequently had autoimmune diseases compared with patients without CHIKV-related manifestations. Conclusions: Most patients admitted to the ICU with CHIKV infection had a pre-existing comorbidity. However, severe manifestations such as Guillain–Barré syndrome, encephalitis, and severe sepsis could be specifically related to CHIKV

Sargassum seaweed on Caribbean islands: an international public health concern

International audienc

Sargassum seaweed health menace in the Caribbean: clinical characteristics of a population exposed to hydrogen sulfide during the 2018 massive stranding

International audienc