Différencier la COVID-19 et la dengue des autres maladies fébriles dans un contexte de co-épidémie : développement et validation internes des scores COVIDENGUE

Introduction

Matériels et méthodes

Résultats

Conclusion

[Prevalence and Risk Factors of Chlamydia Trachomatis Infection Among Women Consulting at the Sexually Transmitted Infection Centre in la Reunion: A Cross-Sectional Study]

Introduction

Chlamydia trachomatis (CT) infection is the commonest bacterial sexually transmitted infection (STI) in the world. Often asymptomatic, it can lead to significant complications in women. In France, since 2003, systematic screening for CT in STI center has been recommended for women aged less than 25 year. The main objective of this study was to determine CT prevalence in patients attending STI centers in Reunion Island. The second objective was to explore the determinants of this infection.

Method

A cross-sectional survey using an anonymous questionnaire was conducted among women attending STI center in two hospitals in western and southern Reunion Island during one year. All women who had performed a CT PCR, based on vaginal self-swabs, were included.

Results

Among the 620 patients tested, the prevalence of infection was 6.6% (95% CI [4.7-8.6]). By age group, the highest prevalence was between 12 and 17 years with 14.3% positive tests compared to 7.5% and 3.9% respectively in 18-24 and 25-67 year age group (p = 0.003). The risk factors for CT were a young age (p = 0.02), a first sexual intercourse between 11 and 14 years old (p = 0.01), lack of previous STI screening history (p = 0.02), and the following motives for seeking screening: "partner unfaithfulness" (p = 0.01) and "infected partner" (p = 0.02).

Conclusion

This study highlights the high prevalence of CT among Reunionese minors. A more systematic screening and a reinforcement of STI awareness among young people in Reunion Island seem to be essential.

Identifying factors associated with treatment delay in leptospirosis: A retrospective study of patients admitted to hospital in Reunion (Indian Ocean) between 2014 and 2015

BACKGROUND

Leptospirosis is a life-threatening zoonotic disease for which delayed treatment onset has been associated to poor prognosis. The purpose of the study was to identify the determinants of therapeutic delay in hospitalized leptospirosis cases.

PATIENTS AND METHODS

We carried out a retrospective multicenter study in the 4 public hospitals of Reunion Island, South Western Indian Ocean. Medical records of confirmed leptospirosis cases occurring in 2014-2015 were reviewed for socio-economic, demographic, geographic and medical data. The primary outcome measure was the therapeutic delay, defined as the time elapsed between the onset of symptoms and initiation of antibiotics.

RESULTS

Of the 117 patients included, 107 were men, with an average age of 44.9±15years. The median therapeutic delay was 4 days (interquartile: 2-5 days) and this delay was not found to be associated with severity. The following were found to be at increased risk of having a longer therapeutic delay: cases occurring outside the epidemic period, or rainy season (OR 2.8 [1.08-7.3], P=0.04) and cases with first medical evaluation in primary health care (OR 4.63 [1.43-14.93]; P=0.01) instead of emergency unit. No socio-economic or geographic characteristics were found to be linked to a longer therapeutic delay.

CONCLUSION

Although delayed treatment was not associated to disease severity, our results indicate that leptospirosis awareness is needed all year in the subtropical area of Reunion Island and particularly in primary care.

[Evaluation of the smoking cessation at the patients of Saint-Denis (Reunion island), over the year 2014]

INTRODUCTION

The fight against smoking is a major challenge for public health in Reunion Island. This French overseas department knows considerable social inequalities and so there is a possibility of free access to nicotine substitution among disadvantaged patients. The objective was to describe the social characteristics, the level of addiction to smoking and the actual level of smoking cessation at 18 months of tobacco-smoking patients from Reunion who consulted in 2014.

METHODS

It was an observational, retrospective, monocentric study carried out in the addictology service in the teaching hospital in Saint-Denis, Reunion Island. Inclusion of patients over the year 2014 who were mono-dependent on tobacco and who were consulting for the first time in order to give up smoking.

RESULTS

122 patients were included, 51 % of women, of an average age of 47.5 years. The rate of smoking cessation at a year and a half was 23 %. There was no significant difference concerning smoking cessation according to the patient's level of addiction, the educational level, the profession or the level of confidence when stopping.

DISCUSSION

The proportion of patients who had given up at a year and a half in our study was comparable to the data found in international literature. The impact of free access to nicotine substitution on smoking cessation could not be estimated.

Comparison of streptokinase and urokinase in local thrombolysis of peripheral arterial occlusions for lower limb salvage

PURPOSE

To compare the efficacy and safety of streptokinase (SK) and urokinase (UK) in the treatment of local thrombolysis.

PATIENTS AND METHODS

Over a 24-month period, 40 patients with 45 lower limb arterial occlusions of less than 45 days duration underwent intraarterial fibrinolysis. Twenty occlusions were treated with recombinant UK and tissue culture-derived UK, and 25 occlusions were treated with SK. The study was retrospective, but the two groups were very homogeneous in terms of vascular surgical history, medical risk factors, and occlusion characteristics.

RESULTS

Complete lysis (95% or more) was achieved in 84% of SK infusions and 89% of UK infusions. Endoluminal and surgical interventions as well as clinical outcomes of SK and UK treatment were comparable. However, infusion time was significantly longer for SK treatment: 28.5 hours versus 19.1 hours for UK treatment (P = .035). Complication rates were not statistically significantly different. Average length of stay in the intensive care unit was identical (2.2 days) for both groups, and the difference in hospital stay was not statistically significant (7.7 days for SK vs 8.7 days for UK).

CONCLUSION

At the concentrations and doses used, the efficacy and safety of SK and UK were comparable, despite longer SK infusion time.

Infection with fatal outcome after endovascular metallic stent placement

The authors describe a case in which infection developed in a patient after placement of a metallic endoprosthesis in the iliac artery. The patient died of respiratory failure secondary to sepsis. Imaging studies did not reveal an abscess, aneurysm, or stent occlusion. Stent cultures and hemocultures grew Staphylococcus aureus. As with any foreign body, infectious complications may occur after insertion of metallic stents and should be recognized as soon as possible to initiate appropriate therapy.

[Inflammatory aneurysm of the aorta. Value of x-ray computed tomography and ultrasonography in the diagnosis of a case and review of the literature]

Until recently inflammatory aneurysm of the aorta was discovered only at the time of surgery and confirmed by the pathologist. New imaging modalities, such as ultrasound and CT-scan now enable the radiologist to diagnose this entity before surgery, thus leading to a better surgical planning and reducing the operative morbidity. The authors report a case of inflammatory aneurysm of the aorta and review the literature on this entity.

A case of post-traumatic false aneurysm of the superior gluteal artery with compression of the sciatic nerve

A false aneurysm of the superior gluteal artery with compression of the sciatic nerve is reported in an 18-year-old man who was recovering from multiple injuries sustained in a bicycle accident. Rapidly increasing pain and swelling in the leg, with a rapid fall in the hemoglobin level and weakness of dorsiflexion and inversion of the foot were not compatible with the initial diagnosis of abscess. A selective iliac arteriogram revealed the true diagnosis. The gluteal artery was ligated and the false aneurysm oversewn through a posterior, extrapelvic approach. An abdominal, retroperitoneal approach would have been better but was precluded by injuries to the intrapelvic viscera and left-sided colostomy. False aneurysm of the gluteal artery is a life-threatening condition and must be diagnosed early and treated promptly to ensure a successful outcome.

The cavaportal shunt in interruptions of the suprarenal inferior vena cava

Abrupt interruption of the suprarenal inferior vena cava can have dramatic consequences and can be difficult to repair successfully. In the case reported, an excellent result was obtained by a cavaportal anastomosis, with minimal consequences on renal and hepatic functions.

[Spontaneous rupture of an aneuysm of the abdominal aorta into the inferior vena cava]

Rupture of an aortic aneurysm into the inferior vena cava is a rare complication; it represents 3 p. 100 of all ruptured aneurysms. The authors report a case with a typical clinical history and 3 main symptoms : lumbar pain, a pulsatile expansile mass, a continuous abdominal murmur giving rise to a thrill. The diagnosis was confirmed before operation by angiography which showed a fistula. A technical detail is emphasised: clamping of the inferior vena cava opening the aneurysm to reduce the risk of embolism into the right side of the heart during operation.