SARS-CoV-2 in the Amazon region

A medida que la pandemia del Síndrome Respiratorio Agudo Severo Coronavirus 2 (SARS-CoV-2) continúa expandiéndose, los recursos de atención médica a nivel mundial se han reducido. Ahora, la enfermedad es extendiéndose rápidamente por América del Sur, con consecuencias mortales en áreas con ya sistemas de salud pública debilitados. La región amazónica es particularmente susceptible a la devastación generalizada de la enfermedad por coronavirus 2019 (COVID-19) debido a sus habitantes amerindios nativos inmunológicamente frágiles y vulnerabilidades epidemiológicas. Aquí, nosotros discutir la situación actual y el impacto potencial de COVID-19 en la región amazónica y cómo una mayor propagación de la ola epidémica podría resultar devastadora para muchas personas amerindias que viven en la selva amazónicaAs the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic continues to expand, healthcare resources globally have been spread thin. Now, the disease is rapidly spreading across South America, with deadly consequences in areas with already weakened public health systems. The Amazon region is particularly susceptible to the widespread devastation from Coronavirus disease 2019 (COVID-19) because of its immunologically fragile native Amerindian inhabitants and epidemiologic vulnerabilities. Herein, we discuss the current situation and potential impact of COVID-19 in the Amazon region and how further spread of the epidemic wave could prove devastating for many Amerindian people living in the Amazon rainfores

Adult sinonasal soft tissue sarcoma: Analysis of 48 cases from the French Sarcoma Group database

International audienceOBJECTIVE:The aim of this study was to determine the frequency of primary sinonasal adult sarcoma, identify histological subtypes, and analyze prognostic factors.STUDY DESIGN:Retrospective review.METHOD:Forty-eight adult sinonasal sarcomas included in the French Sarcoma Group database (Conticabase) were reviewed.RESULTS:The most frequent tumor types were alveolar rhabdomyosarcoma (33.3%), embryonal rhabdomyosarcoma (14,6%), unclassified sarcoma (14.6%), and leiomyosarcoma (12.5%). All round cell tumors were rhabdomyosarcomas. The 5-year overall survival (OS), metastasis-free survival (MFS), and local recurrence-free survival (LRFS) rates were 62.3%, 73%, and 88.8%, respectively. Histotype was a prognostic factor for OS, MFS, and LRFS, with the worst prognosis associated with rhabdomyosarcomas, regardless of the subtype. The tumor grade influenced the OS and MFS. Surgery was a predictive factor for a complete response.CONCLUSIONS:These results suggest that sinonasal tract should be considered as an unfavorable site for rhabdomyosarcoma. Moreover, surgery should always be considered in treatment

PADS 2-07 - La leptospirose en Guyane française : 1re étude transversale multicentrique 2007-2014.

National audienceIntroduction La leptospirose est une zoonose de répartition mondiale avec une incidence en augmentation. Elle représente un problème de santé publique en zone tropicale. L’objectif de notre étude était de faire un état des lieux de la leptospirose en Guyane Française afin d’en améliorer la prise en charge

High prevalence of hepatitis B and syphilis in illegal gold miners in French Guiana

International audienceViral hepatitis and syphilis remain important public health issues because of chronic forms and clinical complications. The omission of hard-to-reach and disadvantaged populations from public health and medical research is one of the current barriers to achieve the WHO target of reducing the burden of viral hepatitis and syphilis by 2030 [ 1 ]. Illegal gold miners in French Guiana, a French overseas territory in South America, are a perfect example of this type of population: they comprise about 10 000 people from Brazil living in a remote mining camp in the rainforest. We have previously shown that gold miners are a vulnerable population, notably with a human immunodeficiency virus (HIV) prevalence of 1.4% (95% CI 0.29–2.56) in a context where prostitution is frequent and condom access is difficult [ 2 ]. This study, nested in the Orpal study conducted in 2015 (NCT02903706) [ 3 ], aimed to estimate the prevalence of hepatitis B (HBV), D (HDV) and C (HCV) viruses, and syphilis in the specific population of illegal gold miners in French Guiana. The data collection method was previously reported [ 3 ]. Subjects provided informed consent. This ancillary study was approved by the Cayenne General Hospital Ethics committee

Favorable Bridging Therapy Based on DWI-FLAIR Mismatch in Patients with Unclear-Onset Stroke

International audienceBACKGROUND AND PURPOSE:Standard selection criteria for revascularization therapy usually exclude patients with unclear-onset stroke. Our aim was to evaluate the efficacy and safety of revascularization therapy in patients with unclear-onset stroke in the anterior circulation and to identify the predictive factors for favorable clinical outcome.MATERIALS AND METHODS:We retrospectively analyzed 41 consecutive patients presenting with acute stroke with unknown time of onset treated by intravenous thrombolysis and/or mechanical thrombectomy. Only patients without well-developed fluid-attenuated inversion recovery changes of acute diffusion lesions on MR imaging were enrolled. Twenty-one patients were treated by intravenous thrombolysis; 19 received, simultaneously, intravenous thrombolysis and mechanical thrombectomy (as a bridging therapy); and 1 patient, endovascular therapy alone. Clinical outcome was evaluated at 90 days by using the mRS. Mortality and symptomatic intracranial hemorrhage were also reported.RESULTS:Median patient age was 72 years (range, 17-89 years). Mean initial NIHSS score was 14.5 ± 5.7. Successful recanalization (TICI 2b-3) was assessed in 61% of patients presenting with an arterial occlusion, symptomatic intracranial hemorrhage occurred in 2 patients (4.9%), and 3 (7.3%) patients died. After 90 days, favorable outcome (mRS 0-2) was observed in 25 (61%) patients. Following multivariate analysis, initial NIHSS score (OR, 1.43; 95% CI, 1.13-1.82; P = .003) and bridging therapy (OR, 37.92; 95% CI, 2.43-591.35; P = .009) were independently associated with a favorable outcome at 3 months.CONCLUSIONS:The study demonstrates the safety and good clinical outcome of acute recanalization therapy in patients with acute stroke in the anterior circulation and an unknown time of onset and a DWI/FLAIR mismatch on imaging. Moreover, bridging therapy versus intravenous thrombolysis alone was independently associated with favorable outcome at 3 months

Severe leptospirosis in Morocco: comparative data from the Amazonian area

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Densidad de los armadillos (dasypus spp.) mediante el uso de cámaras la densidad de armadillos trampa y densidad de madrigueras en la Guayana Francesa

Armadillo density estimates are important for species knowledge, but they are unknown in the Guiana Shield. We aimed at estimating Dasypus density through burrow density and camera trapping. We surveyed and trapped burrows in three protected sites in French Guiana, on strip transects covering 4.8 ha in each site, and estimated Dasypus density taking into account burrow measures and occupancy. Population densities ranged between 7.6 and 48.6 animals/km2 for Dasypus sp. nov. and 10.3 and 34.7 animals/km2 for D. kappleri. Dasypus density estimates through burrow survey and exclusive burrow entrance camera trapping is relatively low-cost, non-invasive and reliable.La densidad de armadillos es desconocida en el Escudo guayanés. Nuestro objetivo fue estimar la densidad de Dasypus a través de la densidad de madrigueras y mediante cámaras trampa. Identificamos y monitoreamos madrigueras en tres sitios en Guayana Francesa, en transectos cubriendo 4.8 ha por sitio. Estimamos la densidad poblacional de Dasypus teniendo en cuenta las medidas y la ocupación de las madrigueras. Las densidades poblacionales variaron entre 7.6 y 48.6 animales/km2 para Dasypus sp. nov. y 10.3 y 34.7 animales/km2 para D. kappleri. Estimar la densidad de Dasypus mediante las madrigueras y cámaras trampas es relativamente de bajo costo, no invasivo y confiable.Fil: Schaub, Roxane. Université de Guyane; Guayana Francesa. Centre Hospitalier Andree Rosemon; Guayana FrancesaFil: Leclerc, Léo. Centre Hospitalier Andree Rosemon; Guayana FrancesaFil: Guilloton, Edith. Centre Hospitalier Andree Rosemon; Guayana FrancesaFil: Szpigel, Jean-François. Réserve Naturelle Régionale Trésor; Guayana FrancesaFil: Couppié, Pierre. Université de Guyane; Guayana Francesa. Centre Hospitalier Andree Rosemon; Guayana FrancesaFil: Gozlan, Rodolphe E.. Université de Montpellier; FranciaFil: Ackermann, Luc. Réserve Naturelle Nationale de La Trinite; Guayana FrancesaFil: Superina, Mariella. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto de Medicina y Biología Experimental de Cuyo; ArgentinaFil: Thoisy, Benoit de. Institut Pasteur de la Guyane; Guayana Francesa. Kwata Ngo; Guayana Frances

Migration in French Guiana: Implications in health and infectious diseases

In French Guiana, more than a third of the population, and nearly half of the adults, are of foreign origin. This immigration is explained by the French standard of living, which is attractive to nationals of surrounding countries. Infectious diseases remain in the top 10 causes of premature death, often in the most precarious populations. In this context we aimed to synthesize the state of the knowledge regarding immigration and infectious diseases in French Guiana and the general implications that follow this diagnosis.For HIV, although the majority of patients are of foreign origin, estimates of the presumed date of infection based on CD4 erosion modelling and from molecular analyses suggest that the majority of transmissions in foreign-born individuals occur in French Guiana and that the Guiana shield has been a crossroad between Latin America and the Caribbean. Among key populations bridging these regions illegal gold miners are very mobile and have the greatest proportion B Caribbean HIV viruses. Gold miners have been a key vulnerable population for falciparum malaria and other tropical diseases such as leishmaniasis, leprosy, or leptospirosis. The complex history of migrations in French Guiana and on the Guiana Shield is also reflected in the fingerprinting of mycobacterium tuberculosis and the high incidence of tuberculosis in French Guiana, notably in immigrants, reflects the incidences in the countries of origin of patients. The high burden of infectious diseases in immigrants in French Guiana is first and foremost a reflection of the precarious living conditions within French Guiana and suggests that community-based proactive interventions are crucial to reduce transmission, morbidity, and mortality from infectious diseases

Usefulness of C-Reactive Protein in Differentiating Acute Leptospirosis and Dengue Fever in French Guiana

International audienceObjective: Leptospirosis and dengue fever (DF) are hard-to-differentiate diseases in cocirculating areas, especially during DF epidemics. Misdiagnosis and ensuing lack of antibiotic therapy can be detrimental in leptospirosis. The objective of this study was to identify factors that help differentiate acute leptospirosis from dengue fever on admission.Method: Patients with leptospirosis (positive serology or polymerase chain reaction) were compared with patients with DF (positive nonstructural 1 [NS1] antigen) in a case-control study with age matching. Data on admission were compared using bivariate analysis and multivariate analysis.Results: Seventy-two patients with leptospirosis were compared to 216 patients with DF. In bivariate analysis, the factors associated with leptospirosis were male gender, cough, anemia, and elevated blood levels of C-reactive protein (CRP), leukocytes, creatinine, bilirubin, and creatine phosphokinase. Exanthema, purpura, myalgia, headache, and neutropenia were associated with DF. In multivariate analysis, elevated blood levels of leukocytes, bilirubin, and CRP were associated with leptospirosis. The CRP threshold of 50 mg/L taken alone had elevated sensitivity and specificity.Conclusions: The CRP level, an easy-to-obtain biomarker, was a powerful tool to differentiate on admission leptospirosis and DF. Facing a dengue-like syndrome in cocirculating areas and awaiting new specific rapid diagnostic tests, CRP dosing could help the clinician to promptly consider the diagnosis of leptospirosis and initiate antibiotic therapy early

Human leptospirosis in French Guiana: first multicentric transversal study (2007-2014)

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