Médecine tropicale : revue du Corps de santé colonial, 2012
After a brief overview of the history of arbovirus epidemics in the Indian Ocean in XIXth and XXt... more After a brief overview of the history of arbovirus epidemics in the Indian Ocean in XIXth and XXth centuries, a full evaluation of the chikungunya epidemic that occurred in 2005-2006 is provided including both lessons learned and future perspectives. On the positive side, the epidemic has allowed improvement of clinical and pathophysiological knowledge, epidemiological surveillance, vector control, awareness of entomology, avenues for research, and understanding of economic and societal repercussions. On the negative side, the epidemic revealed the limitations of a health care system in an island setting, need for an effective sanitary policy, low public-spiritedness, poor diffusion and understanding of public health announcements, endemization of chikungunya virus in the Indian Ocean, absence of vaccine, and global spread of tropical disease. Discussion of perspectives for future arbovirus disease outbreaks in the Indian Ocean is set against the background of climatic change, unequ...
Introduction: Activation of the liver X receptors (LXRs) has been shown to modulate cholesterol a... more Introduction: Activation of the liver X receptors (LXRs) has been shown to modulate cholesterol absorption in the small intestine, although the individual effects of LXRa and LXRb have not been fully understood. Our study aimed to investigate how cholesterol absorption is modulated by the two isoforms in the small intestine. Methods: Wild type (WT), LXRa−/− or LXRb−/− mice were subjected either to standard diet or 0.2% cholesterol-enriched diet. Results: No differences of cholesterol absorption were observed in all genotypes of mice under normal diet. However, LXRb−/− mice showed a significant lower cholesterol absorption rate than WT mice when fed 0.2% cholesterol diet. This profile was altered when GW3965 was added to the 0.2% cholesterol diet, while the absorption rate increased significantly only in LXRa−/− mice. Analysis of gallbladder bile demonstrated that 0.2% cholesterol diet significantly lower the ratios of CA/b-muricholic acid (b-MCA) in LXRb−/− and WT mice compared to LXRa−/−, even when GW3965 was added. Additionly, hepatic Cyp8b1 mRNA was reduced in WT fed with 0.2% cholesterol ± GW3965, which agreed with the CA% in the bile. Similar patterns were seen in LXRb−/− mice, but not in LXRa−/−. The Cyp7a1 mRNA in LXRa−/−was repressed by the 0.2% cholesterol treatment, and remained low when adding GW3965. Fecal analysis showed a strong reduction of bile acid excretion in LXRa−/− mice subjected to 0.2% cholesterol ± GW3965. Conclusion: Our data indicate that LXRa and LXRb affect the synthesis of individual bile acids in different ways upon activation, leading to alterations in the intestinal cholesterol absorption.
Arteriosclerosis, Thrombosis, and Vascular Biology, 2010
Objective-Earlier in vitro studies suggested a putative role for the plasma phospholipid transfer... more Objective-Earlier in vitro studies suggested a putative role for the plasma phospholipid transfer protein (PLTP) in the modulation of blood coagulation. The effect of PLTP expression on blood coagulation under both basal and oxidative stress conditions was compared here in wild-type and PLTP-deficient (PLTPϪ/Ϫ) mice. Methods and Results-Under basal conditions, PLTP deficiency was associated with an extended tail bleeding time despite a significant depletion of vascular ␣-tocopherol content and an impairment of endothelial function. When acute oxidative stress was generated in vivo in the brain vasculature, the steady state levels of oxidized lipid derivatives, the extent of blood vessel occlusion, and the volume of ischemic lesions were more severe in wild-type than in PLTPϪ/Ϫ mice. Conclusion-In addition to its recognized hyperlipidemic, proinflammatory, and proatherogenic properties, PLTP increases blood coagulation and worsens the extent of ischemic lesions in response to acute oxidative stress. Thus, PLTP arises here as a cardiovascular risk factor for the late thrombotic events occurring in the acute phase of atherosclerosis. (Arterioscler Thromb Vasc Biol. 2010;30:00-00.)
Euro surveillance : bulletin Européen sur les maladies transmissibles = European communicable disease bulletin, 2012
In Réunion, a French overseas territory located in the southern hemisphere, increase in influenza... more In Réunion, a French overseas territory located in the southern hemisphere, increase in influenza activity is generally observed several months earlier than in Europe. Influenza activity is monitored in Réunion through a multi-source surveillance system including sentinel practitioners network, hospital emergency department, laboratory and mortality. Since 2009, three successive influenza epidemics occurred on the island. The largest was observed in 2009 while epidemics in 2010 and 2011 were much weaker. In terms of circulating strains, B viruses were predominant at the beginning of the 2009 epidemic but they were completely evicted once A(H1N1)pdm09 circulation started. In 2010, A(H1N1)pdm09 virus was predominant again, but a constant co-circulation of B viruses was observed. In 2011, A(H3N2) virus circulated. The same viruses were identified a few months later in mainland France in the respective seasons. Since 2009, virus circulation, epidemiological trends and health impact of i...
The ristocetin cofactor activity assay (VWF:RCo) is the reference method for assessing von Willeb... more The ristocetin cofactor activity assay (VWF:RCo) is the reference method for assessing von Willebrand factor (VWF) activity but remains difficult to perform, and the coefficient of variation of the method is high (about 20-30%). This study evaluated and compared the performance for measuring the VWF activity of two newly commercialised assays [VWF:Ac Innovance (VWF:Ac) and VWF:RCo Acustar (VWF:RCo Acu)] with the reference VWF:RCo aggregation in 123 pathological plasma samples. The correlation and concordance between both new tests (VWF:RCo-Acu and VWF:Ac) and the reference VWF:RCo were good. The results of the VWF activity to VWF antigen ratio were also comparable whatever the method for the classification of VWF deficiency in all patients. Our results showed that both new tests could replace the "gold standard" VWF:RCo in aggregometry with several benefits: they are fully automated, easier and faster to perform, better adapted to emergency situations if necessary.
Bulletin de la Société de pathologie exotique (1990), 2011
A 19-year-old patient admitted in an oncology unit for an autograft (Hodgkin disease), developed ... more A 19-year-old patient admitted in an oncology unit for an autograft (Hodgkin disease), developed on day 20 a fatal acute respiratory failure and multiple organ failure due to an infection of the A(H1N1)v2009 virus, which was acquired in the hospital, despite partial preventive measures. At that time, the specific vaccine was not available in Réunion. We discuss the nosocomial origin of the infection. Following the epidemic wave, the vaccination rate of the general population and the hospital employees remains very low.
[Analgesic effect of continuous intravenous nefopam after urological surgery]
Annales françaises d'anesthèsie et de rèanimation, 2005
To evaluate the efficacy of continuous infusion of nefopam. Indeed this analgesic is commonly use... more To evaluate the efficacy of continuous infusion of nefopam. Indeed this analgesic is commonly used by continuous infusion by many anaesthetists to reduce its adverse effects. However whether the analgesic effect of an intermittent administration of nefopam has been proven, the efficacy of continuous infusion has not been established. Double-blind placebo controlled prospective randomised study. Sixty patients ASA 1 to 3 undergoing planned urological surgery with laparotomy were included. At the end of surgery, bolus doses of placebo (Group 3) or nefopam 20 mg (Group 1 and 2) were administered to all the patients. Placebo (Group 3), nefopam 80 mg (Group 1) or 120 mg (Group 2) was thereafter continuously infused over 24 hours. All patients received additional analgesia with PCA morphine. We measured pain at rest and on cough with VAS. Adverse side effects such as nausea and vomiting, sedation and respiratory depression were evaluated. Mental performance was measured with mini mental s...
Stress (Tako-tsubo) cardiomyopathy in critically-ill patients
European Heart Journal: Acute Cardiovascular Care, 2014
Stress cardiomyopathy (SC) is a transient ventricular dysfunction rarely described in the critica... more Stress cardiomyopathy (SC) is a transient ventricular dysfunction rarely described in the critical care setting. To evaluate the mechanisms, incidence, treatment and prognosis of SC. This is a retrospective observational study of every critically-ill patient admitted to the ICU over a period of two years. Among 1314 patients admitted in the ICU, 20 patients (1.5%) were diagnosed with SC. A total of 249 patients experienced cardiogenic shock, whereas 8% were suffering from SC. SC was suspected because of hemodynamic impairment (80% of cases), ECG modifications (15%) and/or dyspnea (15%). SC was apical (typical Tako-tsubo) in 90% and atypical in 10% of cases. Several mechanisms or conditions may explain the occurrence of SC and are may be combined: catecholamine toxicity (45%), psychological stress, seizures or neurological impairment (35%), non-epicardial coronary ischemia (20%) and left ventricular outflow track (LVOT) obstruction (10%). SC could have indirectly caused death by worsening heart failure in three patients and arrhythmias were seen in 40% of patients. SAPS2, renal impairment, malnutrition, norepinephrine infusion and thrombocytopenia were associated with death in the univariate analysis. Catecholamines were required in 85% and intra-aortic balloon pump in 20% of patients. SC is a rare reversible cardiac impairment in the critically-ill patient that can induce arrhythmias and cardiogenic shock. The likely mechanisms are combined: catecholamine toxicity, stress or neurological involvement and less frequently ischemia or LVOT obstruction.
Bulletin de la Société de pathologie exotique, 2014
Pufferfish poisoning has rarely been reported in the southwestern Indian Ocean and in the French ... more Pufferfish poisoning has rarely been reported in the southwestern Indian Ocean and in the French overseas territories. In Reunion Island, the last notified documented case occurred in 1989 and people are no longer aware of the potential toxicity of pufferfish. We report a family hospitalized for a tetrodotoxin poisoning following the consumption of Lagocephalus sceleratus caught on the coast of Reunion Island in September 2013. Two patients presenting acute vital functions failures were admitted in an ICU. Ten people were admitted simultaneously to the emergency department after consuming L. sceleratus with signs of toxicity appearing within 2 hours. Treatment was supportive, but included the need for mechanical ventilation for two patients. All those affected had complete and uneventful recoveries within a few days. The fish consumed was identified as L. sceleratus, a species known to contain tetrodotoxin. The diagnosis of tetrodotoxin poisoning was suggested by typi-
Formes graves d’infection par le virus A(H1N1)v2009 à La Réunion en 2009 et en 2010
Bulletin de la Société de pathologie exotique, 2011
In the Southern hemisphere, Réunion Island acts as a sentinel for infections preferentially occur... more In the Southern hemisphere, Réunion Island acts as a sentinel for infections preferentially occurring during the austral winter that are likely to reach the Northern hemisphere a few months later. We relate the main features concerning patients that were admitted during years 2009 and 2010 in our intensive care unit with an A(H1N1)v2009 infection, mainly for acute respiratory distress. Demographic, clinical, and biological data as well as given medications and outcome were prospectively collected among all PCR-confirmed influenza-infected patients. In 2009 and 2010, 25 patients met the criteria. Patients' median age was 40.4 (±17.4) years. Most of them (22/25) had comorbidities such as: chronic diseases, overweight, obesity, pregnancy, and Down syndrome. Maximum bed-occupation rate was 10 days per million inhabitants. Main diagnosis for ICU admission was virus-related pneumonia. Twenty-two out of 25 patients needed mechanical ventilation, some required rescue therapies such as extracorporeal membranous oxygenation (ECMO) or hi-frequency oscillation ventilation (HFOV), both only available in few French hospitals. Within the study period, 12 patients died (48%) mainly of multi-organ failure. Through 2009 and 2010 autumn and winter periods, for several weeks, the A(H1N1)v2009 virus infection resulted in a significant increase of workload in Réunion Island ICUs. In 2010, the failure of the mass immunization campaign, particularly among the at-risk groups, led to severe cases of A(H1N1)v2009 infections, particularly among patients with comorbidities. Our data may contribute toward better management of influenza virus pandemics in the future.
Médecine tropicale : revue du Corps de santé colonial, 2012
After a brief overview of the history of arbovirus epidemics in the Indian Ocean in XIXth and XXt... more After a brief overview of the history of arbovirus epidemics in the Indian Ocean in XIXth and XXth centuries, a full evaluation of the chikungunya epidemic that occurred in 2005-2006 is provided including both lessons learned and future perspectives. On the positive side, the epidemic has allowed improvement of clinical and pathophysiological knowledge, epidemiological surveillance, vector control, awareness of entomology, avenues for research, and understanding of economic and societal repercussions. On the negative side, the epidemic revealed the limitations of a health care system in an island setting, need for an effective sanitary policy, low public-spiritedness, poor diffusion and understanding of public health announcements, endemization of chikungunya virus in the Indian Ocean, absence of vaccine, and global spread of tropical disease. Discussion of perspectives for future arbovirus disease outbreaks in the Indian Ocean is set against the background of climatic change, unequ...
Introduction: Activation of the liver X receptors (LXRs) has been shown to modulate cholesterol a... more Introduction: Activation of the liver X receptors (LXRs) has been shown to modulate cholesterol absorption in the small intestine, although the individual effects of LXRa and LXRb have not been fully understood. Our study aimed to investigate how cholesterol absorption is modulated by the two isoforms in the small intestine. Methods: Wild type (WT), LXRa−/− or LXRb−/− mice were subjected either to standard diet or 0.2% cholesterol-enriched diet. Results: No differences of cholesterol absorption were observed in all genotypes of mice under normal diet. However, LXRb−/− mice showed a significant lower cholesterol absorption rate than WT mice when fed 0.2% cholesterol diet. This profile was altered when GW3965 was added to the 0.2% cholesterol diet, while the absorption rate increased significantly only in LXRa−/− mice. Analysis of gallbladder bile demonstrated that 0.2% cholesterol diet significantly lower the ratios of CA/b-muricholic acid (b-MCA) in LXRb−/− and WT mice compared to LXRa−/−, even when GW3965 was added. Additionly, hepatic Cyp8b1 mRNA was reduced in WT fed with 0.2% cholesterol ± GW3965, which agreed with the CA% in the bile. Similar patterns were seen in LXRb−/− mice, but not in LXRa−/−. The Cyp7a1 mRNA in LXRa−/−was repressed by the 0.2% cholesterol treatment, and remained low when adding GW3965. Fecal analysis showed a strong reduction of bile acid excretion in LXRa−/− mice subjected to 0.2% cholesterol ± GW3965. Conclusion: Our data indicate that LXRa and LXRb affect the synthesis of individual bile acids in different ways upon activation, leading to alterations in the intestinal cholesterol absorption.
Arteriosclerosis, Thrombosis, and Vascular Biology, 2010
Objective-Earlier in vitro studies suggested a putative role for the plasma phospholipid transfer... more Objective-Earlier in vitro studies suggested a putative role for the plasma phospholipid transfer protein (PLTP) in the modulation of blood coagulation. The effect of PLTP expression on blood coagulation under both basal and oxidative stress conditions was compared here in wild-type and PLTP-deficient (PLTPϪ/Ϫ) mice. Methods and Results-Under basal conditions, PLTP deficiency was associated with an extended tail bleeding time despite a significant depletion of vascular ␣-tocopherol content and an impairment of endothelial function. When acute oxidative stress was generated in vivo in the brain vasculature, the steady state levels of oxidized lipid derivatives, the extent of blood vessel occlusion, and the volume of ischemic lesions were more severe in wild-type than in PLTPϪ/Ϫ mice. Conclusion-In addition to its recognized hyperlipidemic, proinflammatory, and proatherogenic properties, PLTP increases blood coagulation and worsens the extent of ischemic lesions in response to acute oxidative stress. Thus, PLTP arises here as a cardiovascular risk factor for the late thrombotic events occurring in the acute phase of atherosclerosis. (Arterioscler Thromb Vasc Biol. 2010;30:00-00.)
Euro surveillance : bulletin Européen sur les maladies transmissibles = European communicable disease bulletin, 2012
In Réunion, a French overseas territory located in the southern hemisphere, increase in influenza... more In Réunion, a French overseas territory located in the southern hemisphere, increase in influenza activity is generally observed several months earlier than in Europe. Influenza activity is monitored in Réunion through a multi-source surveillance system including sentinel practitioners network, hospital emergency department, laboratory and mortality. Since 2009, three successive influenza epidemics occurred on the island. The largest was observed in 2009 while epidemics in 2010 and 2011 were much weaker. In terms of circulating strains, B viruses were predominant at the beginning of the 2009 epidemic but they were completely evicted once A(H1N1)pdm09 circulation started. In 2010, A(H1N1)pdm09 virus was predominant again, but a constant co-circulation of B viruses was observed. In 2011, A(H3N2) virus circulated. The same viruses were identified a few months later in mainland France in the respective seasons. Since 2009, virus circulation, epidemiological trends and health impact of i...
The ristocetin cofactor activity assay (VWF:RCo) is the reference method for assessing von Willeb... more The ristocetin cofactor activity assay (VWF:RCo) is the reference method for assessing von Willebrand factor (VWF) activity but remains difficult to perform, and the coefficient of variation of the method is high (about 20-30%). This study evaluated and compared the performance for measuring the VWF activity of two newly commercialised assays [VWF:Ac Innovance (VWF:Ac) and VWF:RCo Acustar (VWF:RCo Acu)] with the reference VWF:RCo aggregation in 123 pathological plasma samples. The correlation and concordance between both new tests (VWF:RCo-Acu and VWF:Ac) and the reference VWF:RCo were good. The results of the VWF activity to VWF antigen ratio were also comparable whatever the method for the classification of VWF deficiency in all patients. Our results showed that both new tests could replace the "gold standard" VWF:RCo in aggregometry with several benefits: they are fully automated, easier and faster to perform, better adapted to emergency situations if necessary.
Bulletin de la Société de pathologie exotique (1990), 2011
A 19-year-old patient admitted in an oncology unit for an autograft (Hodgkin disease), developed ... more A 19-year-old patient admitted in an oncology unit for an autograft (Hodgkin disease), developed on day 20 a fatal acute respiratory failure and multiple organ failure due to an infection of the A(H1N1)v2009 virus, which was acquired in the hospital, despite partial preventive measures. At that time, the specific vaccine was not available in Réunion. We discuss the nosocomial origin of the infection. Following the epidemic wave, the vaccination rate of the general population and the hospital employees remains very low.
[Analgesic effect of continuous intravenous nefopam after urological surgery]
Annales françaises d'anesthèsie et de rèanimation, 2005
To evaluate the efficacy of continuous infusion of nefopam. Indeed this analgesic is commonly use... more To evaluate the efficacy of continuous infusion of nefopam. Indeed this analgesic is commonly used by continuous infusion by many anaesthetists to reduce its adverse effects. However whether the analgesic effect of an intermittent administration of nefopam has been proven, the efficacy of continuous infusion has not been established. Double-blind placebo controlled prospective randomised study. Sixty patients ASA 1 to 3 undergoing planned urological surgery with laparotomy were included. At the end of surgery, bolus doses of placebo (Group 3) or nefopam 20 mg (Group 1 and 2) were administered to all the patients. Placebo (Group 3), nefopam 80 mg (Group 1) or 120 mg (Group 2) was thereafter continuously infused over 24 hours. All patients received additional analgesia with PCA morphine. We measured pain at rest and on cough with VAS. Adverse side effects such as nausea and vomiting, sedation and respiratory depression were evaluated. Mental performance was measured with mini mental s...
Stress (Tako-tsubo) cardiomyopathy in critically-ill patients
European Heart Journal: Acute Cardiovascular Care, 2014
Stress cardiomyopathy (SC) is a transient ventricular dysfunction rarely described in the critica... more Stress cardiomyopathy (SC) is a transient ventricular dysfunction rarely described in the critical care setting. To evaluate the mechanisms, incidence, treatment and prognosis of SC. This is a retrospective observational study of every critically-ill patient admitted to the ICU over a period of two years. Among 1314 patients admitted in the ICU, 20 patients (1.5%) were diagnosed with SC. A total of 249 patients experienced cardiogenic shock, whereas 8% were suffering from SC. SC was suspected because of hemodynamic impairment (80% of cases), ECG modifications (15%) and/or dyspnea (15%). SC was apical (typical Tako-tsubo) in 90% and atypical in 10% of cases. Several mechanisms or conditions may explain the occurrence of SC and are may be combined: catecholamine toxicity (45%), psychological stress, seizures or neurological impairment (35%), non-epicardial coronary ischemia (20%) and left ventricular outflow track (LVOT) obstruction (10%). SC could have indirectly caused death by worsening heart failure in three patients and arrhythmias were seen in 40% of patients. SAPS2, renal impairment, malnutrition, norepinephrine infusion and thrombocytopenia were associated with death in the univariate analysis. Catecholamines were required in 85% and intra-aortic balloon pump in 20% of patients. SC is a rare reversible cardiac impairment in the critically-ill patient that can induce arrhythmias and cardiogenic shock. The likely mechanisms are combined: catecholamine toxicity, stress or neurological involvement and less frequently ischemia or LVOT obstruction.
Bulletin de la Société de pathologie exotique, 2014
Pufferfish poisoning has rarely been reported in the southwestern Indian Ocean and in the French ... more Pufferfish poisoning has rarely been reported in the southwestern Indian Ocean and in the French overseas territories. In Reunion Island, the last notified documented case occurred in 1989 and people are no longer aware of the potential toxicity of pufferfish. We report a family hospitalized for a tetrodotoxin poisoning following the consumption of Lagocephalus sceleratus caught on the coast of Reunion Island in September 2013. Two patients presenting acute vital functions failures were admitted in an ICU. Ten people were admitted simultaneously to the emergency department after consuming L. sceleratus with signs of toxicity appearing within 2 hours. Treatment was supportive, but included the need for mechanical ventilation for two patients. All those affected had complete and uneventful recoveries within a few days. The fish consumed was identified as L. sceleratus, a species known to contain tetrodotoxin. The diagnosis of tetrodotoxin poisoning was suggested by typi-
Formes graves d’infection par le virus A(H1N1)v2009 à La Réunion en 2009 et en 2010
Bulletin de la Société de pathologie exotique, 2011
In the Southern hemisphere, Réunion Island acts as a sentinel for infections preferentially occur... more In the Southern hemisphere, Réunion Island acts as a sentinel for infections preferentially occurring during the austral winter that are likely to reach the Northern hemisphere a few months later. We relate the main features concerning patients that were admitted during years 2009 and 2010 in our intensive care unit with an A(H1N1)v2009 infection, mainly for acute respiratory distress. Demographic, clinical, and biological data as well as given medications and outcome were prospectively collected among all PCR-confirmed influenza-infected patients. In 2009 and 2010, 25 patients met the criteria. Patients' median age was 40.4 (±17.4) years. Most of them (22/25) had comorbidities such as: chronic diseases, overweight, obesity, pregnancy, and Down syndrome. Maximum bed-occupation rate was 10 days per million inhabitants. Main diagnosis for ICU admission was virus-related pneumonia. Twenty-two out of 25 patients needed mechanical ventilation, some required rescue therapies such as extracorporeal membranous oxygenation (ECMO) or hi-frequency oscillation ventilation (HFOV), both only available in few French hospitals. Within the study period, 12 patients died (48%) mainly of multi-organ failure. Through 2009 and 2010 autumn and winter periods, for several weeks, the A(H1N1)v2009 virus infection resulted in a significant increase of workload in Réunion Island ICUs. In 2010, the failure of the mass immunization campaign, particularly among the at-risk groups, led to severe cases of A(H1N1)v2009 infections, particularly among patients with comorbidities. Our data may contribute toward better management of influenza virus pandemics in the future.
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Papers by D. Vandroux