Search Results (36)

Background/Objectives: The establishment of the first tertiary Neurointerventional Center at the University Hospital of Martinique in 2021, with full coverage of the populations of the French Antilles and Guyana, represents a paradigm shift in the treatment of intracranial aneurysms in the eastern Caribbean. We sought to evaluate the outcomes of the first cohort of patients treated for intracranial aneurysms from 2021 to 2024. Methods: We analyzed demographic, clinical, and angiographic data from a prospectively maintained database of patients treated from 1 January 2021 to 31 March 2024. The primary endpoint was the clinical outcome (mRS at discharge and at 4–6 months), and the secondary endpoint was the angiographic outcomes. Results: One hundred patients (mean age 56.7 ± 12.2 years old) with a total of 125 aneurysms (60.8% ruptured; 39.2% unruptured) were included from the following regions: 60% from Martinique, 21% from Guadeloupe, 13% from French Guyana, 1% from mainland France, 2% from St Martin, and 3% from abroad. The mean initial GCS value was 11.6 (median: 13; min: 4; max: 15); the mean mRS was 1.8 ± 1.7 before intervention, 1.8 ± 2 at discharge, and 1.7 ± 2 at 4–6 months. A total of 75% of the aneurysms were treated with coiling or remodeling, 23% received stents (20% FDs), and 0.8% were treated surgically. The procedure-related morbidity rate was 5.6% (7/125), and the mortality rate was 10.4%; both these percentages concerned only the ruptured cases. In the ruptured aneurysm subgroup, 32.8% (25/76) of complications were SAH-related, 9.2% (7/76) were hydrocephalus incidences, and 23.6% (18/76) were vasospasm cases. Satisfactory occlusion was obtained for 95.2% of the aneurysms post-procedure and for 96.7% at the last angiographic control. At the six-month control, 68% of the patients were independent in their everyday lives (mRS ≤ 2). Conclusions: The population was distinct in terms of the hyperexpression of risk factors, the multiplicity of IAs, and the severity of SAH. Female predominance was higher than usual in the population (81%). The organizational schema seemed effective; the treatments were safe and effective in terms of the clinical and angiographic outcomes. Full article

Background: Dengue virus type 2 (DENV2) is endemic to hyperendemic in the French territories of the Americas (FTAs), including French Guiana, Guadeloupe, Martinique, Saint-Barthelemy, and Saint-Martin. In 2023–2024, French Guiana, Martinique, and Guadeloupe experienced unprecedented dengue epidemics partly associated with this serotype. In response, we conducted a retrospective study of the diversity of DENV2 strains circulating in the FTAs from 2000 to 2024. Methods: To this end, we selected DENV2 samples from the collection at the National Research Center for Arboviruses in French Guiana (NRCA-FG) and sequenced them using Oxford Nanopore Technologies (ONT)-based next-generation sequencing (NGS). Results: Phylogenetic analysis revealed that (i) the 77 DENV2 sequences from the FTAs belong to two distinct genotypes—Asian American and Cosmopolitan; (ii) from the 2000s up to the 2019 epidemic in French Guiana, all sequenced strains belonged to the Asian American genotype; (iii) and from 2019 to 2020, strains circulating in Martinique and Guadeloupe belonged to the Cosmopolitan genotype, specifically the Indian subcontinent sublineage, while (iv) strains from the 2023–2024 outbreak in Martinique, Guadeloupe, and French Guiana fall within a distinct sublineage of the same genotype—Other Cosmopolitan. Additionally, we analyzed amino acid (AA) changes in FTA sequences compared to the Dengvaxia^® and Qdenga^® vaccines. The analysis of amino acid changes in FTA sequences compared to the vaccines (Dengvaxia^® and Qdenga^®) identified 42 amino acid changes in the prM/E regions (15 in the prM region and 27 in the E region) relative to CYD-2 Dengvaxia^® and 46 amino acid changes in the prM/E regions relative to Qdenga^®, including 16 in the prM region and 30 in the E region. Some of these AA changes are shared across multiple genotypes and sublineages, with 8 substitutions in the prM region and 18 in the E region appearing in both analyses. This raises questions about the potential impact of these changes on vaccine efficacy. Conclusion: Overall, these findings provide a current overview of the genomic evolution of DENV2 in the FTA, which is crucial for developing more effective prevention and control strategies and for selecting future vaccines tailored to circulating strains. Full article

Background: Osteoarticular deformities or contractures in institutionalized elderly individuals, described as acquired deforming hypertonia (ADH), have a multifactorial origin. The reported prevalence of ADH in French Caucasian patients in long-term care units (LTCUs) is 25.6%. To date, ADH in the Caribbean population has never been studied. We aimed to assess the prevalence and characteristics of ADH in such a population. Materials and Methods: This was a cross-sectional observational study of a French Caribbean population in Martinique in which patients aged 75 years or older were institutionalized in LTCUs during the study period. Data extraction from the medical files of eligible LTCU patients was conducted to assess the prevalence, clinical characteristics, and impact of ADH on patients’ daily care. The assessments were performed collaboratively between the patients’ geriatric team and a PM&R physician. Results: In total, 81 patients were included, with an ADH prevalence of 77.8%. Reported ADH was bilateral (86%) or multiple (66% of patients had ≥5 ADH) and was responsible for major alterations in terms of hygiene, dressing, pain, and skin damage. ADH patients had a high level of dependence (GMP = 924), and this level of dependence was significantly associated with the presence of at least one ADH (p < 0.001) regardless of prior disease. Conclusions: The incidence of ADH in our Caribbean population seems twice as high as that in Caucasian patients, underlining the necessity for this nosological framework to be better recognized, particularly in an insular context. Local campaigns for the prevention and recognition of ADH must be considered, and targeted multidisciplinary protocols need to be established for adapted care in all institutions receiving elderly people. Full article

Anesthesiology, the medical specialty that deals with the management of vital functions in patients undergoing surgery, has played an important role in the successful development of cardiac interventions worldwide. Tracing the historical roots of cardiac anesthesia and critical care from its inception in the late 1950s, a paradigm shift in perioperative care has been driven by a better understanding of the mechanisms of organ dysfunction in stressful conditions and technological advances regarding surgical approach, patient monitoring, and organ protection. Although progress in cardiac anesthesia and critical care lagged a little behind in Caribbean territories, successful achievements have been accomplished over the last forty years. Compared with Western countries, the greater prevalence of obesity, diabetes mellitus, and hypertension as well as specific diseases such as cardiac amyloidosis, sickle cell anemia, rheumatic heart disease, and tropical infections may reduce a patient’s physiologic reserve and increase the operative risk among the multi-ethnic population living in the French West Indies and Guiana. So far, cardiac anesthesiologists at the University Hospital of Martinique have demonstrated their abilities in implementing evidence-based clinical care processes and adaptating to efficiently working in a complex environment interacting with multiple partners. Attracting specialized physicians in dedicated cardiac surgical centers and the creation of a regional health network supported by governmental authorities, insurance companies, and charitable organizations are necessary to solve the unmet needs for invasive cardiac treatments in the Caribbean region. Full article

Since 2011, Caribbean territories have experienced massive and repeated sargassum seaweed inundations. Once on shore, sargassum degradation through anaerobic metabolism elicits the release of many noxious molecules, including hydrogen sulfide (H₂S) and ammonia (NH₃). H₂S has been long recognized as a malodorous and highly toxic gas, while chronic exposure has not been extensively explored. Our objective was to assess whether pregnant women exposed to sargassum emissions would be more prone to developing hypertensive disorders compared to unexposed women. We conducted a retrospective study including 3020 pregnant women at the Obstetrics Department of the University Hospital of Martinique between 25 January 2016 and 31 July 2020. Exposure was defined as a distance of less than 2 km between the residence/workplace of the women and the sargassum strandings. Multivariate regression retained age, body mass index, sickle cell disease, primipaternity, gestational diabetes and sargassum emissions exposure as independent predictors of hypertensive events in pregnant women. Jointly with previous studies from our group, this study highlights the deleterious effects of sargassum emissions on human health in individuals chronically exposed to low to moderate H₂S concentrations. Full article

Few studies have focused on the infectious complications in kidney transplant recipients in tropical regions, particularly in the Caribbean. The primary objective of this study was to determine the incidence of bacterial, fungal, and parasitic infections in kidney transplant recipients in the French Caribbean and French Guiana. We included all patients who received a kidney transplant at the University Hospital of Guadeloupe between January 2014 and October 2016, with post-transplant follow-up in the French Caribbean. A total of 91 patients were included, of whom 57 developed an infectious event during follow-up. When infections were documented (94/111), bacterial infections were the most frequent (79/94), followed by fungal (11/94) and parasitic infections (4/94). Four cases of nocardiosis were identified (4/79). Phaeohyphomycosis was the most common fungal infection (7/11). In a multivariate analysis, the female gender and diabetes mellitus at the time of transplant were significantly associated with a higher risk of infection. This study is the first to describe the epidemiology of infections in kidney transplant recipients in the Caribbean and to analyze the potential risk factors. We reported a similar profile of bacterial infections to that which were observed in the European and American studies. However, we found a higher incidence of tropical infections, such as nocardiosis and phaeohyphomycosis, which highlights the need for heightened awareness among healthcare teams to ensure earlier and more appropriate treatment. Further studies focusing on these rare tropical infections are necessary to better understand their risk factors Full article

Thelyphonida Blanchard, 1852, also known as vinegaroons or whip-scorpions, is a small arachnid order with 140 described species contained in a single family, Thelyphonidae Lucas, 1835. Despite being conspicuous and widely distributed across the tropics and subtropics on four continents, knowledge of the order has been slow to advance. Hypoctoninae Pocock, 1899, one of four subfamilies currently recognized and one of two represented in the New World, comprises five genera. Since its inception, Thelyphonellus Pocock, 1894 has remained the only hypoctonine genus occurring in South America, with only four species described prior to the present contribution. The first detailed morphological study and phylogenetic analysis of Thelyphonellus is presented herein. The morphological phylogenetic analysis—the first for Thelyphonida—includes all except one of the previously described species of Thelyphonellus in addition to two new species described herein; the species of Ravilops Víquez and Armas, 2005 (from the Caribbean island of Hispaniola); and the monotypic Old World genus Etienneus Heurtault, 1984 (from West Africa) scored for 45 morphological characters. A single, most parsimonious phylogenetic hypothesis revealed that Thelyphonellus is paraphyletic with respect to Ravilops. The New World Hypoctoninae comprises four clades with disjunct distributions and well supported by a combination of morphological characteristics, on the basis of which four genera, two of which are new, are recognized: Ravilops, with two species, endemic to Hispaniola; Thelyphonellus, herein restricted to Thelyphonellus amazonicus (Butler, 1872) and Thelyphonellus ruschii Weygoldt, 1979, occurring in Guyana, Suriname, French Guiana, and northern Brazil; Wounaan, gen. n., containing Wounaan vanegasae (Giupponi and Vasconcelos, 2008), comb. n. and Wounaan yarigui, sp. n. from Colombia; and Yekuana, gen. n., containing Yekuana venezolensis (Haupt, 2009), comb. n. and Yekuana wanadi, sp. n. from Venezuela. The two new species are described and illustrated. A key to the identification of the Neotropical genera of Hypoctoninae and a map plotting the known distribution of its species are also presented. Full article

French Guiana experienced an unprecedented dengue epidemic during 2023–2024. Prior to the 2023–2024 outbreak in French Guiana, DENV-3 had not circulated in an epidemic manner since 2005. We therefore studied retrospectively the strains circulating in the French Territories of the Americas (FTA)—French Guiana, Guadeloupe, and Martinique—from the 2000s to the current epidemic. To this end, DENV-3 samples from the collection of the National Reference Center for Arboviruses in French Guiana (NRCA-FG) were selected and sequenced using next-generation sequencing (NGS) based on Oxford Nanopore Technologies, ONT. Phylogenetic analysis showed that (i) the 97 FTA sequences obtained all belonged to genotype III (GIII); (ii) between the 2000s and 2013, the regional circulation of the GIII American-I lineage was the source of the FTA cases through local extinctions and re-introductions; (iii) multiple introductions of lineages of Asian origin appear to be the source of the 2019–2021 epidemic in Martinique and the 2023–2024 epidemic in French Guiana. Genomic surveillance is a key factor in identifying circulating DENV genotypes, monitoring strain evolution, and identifying import events. Full article

Background: This study aimed to assess the prevalence of malnutrition and its determinants in older adults living in French Caribbean nursing homes. Methods: This cross-sectional study was taken from the KASEHAD (Karukera Study of Ageing in EHPAD) study. Nutritional status was assessed with the Mini Nutritional Assessment Short-Form (MNA-SF). Clinical characteristics and scores on geriatric scales (Mini-Mental State Examination (MMSE), Activities of Daily Living (ADL), Short Physical Performance Battery (SPPB), Center for Epidemiologic Studies-Depression (CESD) and Questionnaire Quality of Life Alzheimer’s Disease (QoL-AD)) were extracted. Bivariate analysis and logistic models adjusted were performed to test the association between nutritional status and both socio-demographic variables and geriatric scales. Results: A total of 332 older adults from six nursing homes were included in the KASEHPAD study. Among the participants, 319 had an MNA-SF score. The mean age was 81.3 ± 10.6 years, and half of the participants were men. The frequency of malnutrition (MNA-SF ≤ 7) was 27.6% (95% confidence interval (CI): 22.0–32.5) (n = 88). Based on the multivariable analysis, a low MMSE was associated with malnutrition (OR: 0.81 (0.68–0.92); p = 0.015) and there was a borderline significant link between a higher CESD score and malnutrition (OR: 1.05 (1.00–1.12); p = 0.07). Conclusions: Cognitive decline and a tendency toward depression were associated with malnutrition in nursing homes in the French West Indies. Although this study cannot establish causal relationships, the identification of these three geriatric syndromes in nursing homes is crucial for preventing adverse health events. Full article

The drivers of the HIV epidemic, the viruses, the opportunistic infections, the attitudes and the resources allocated to the fight against HIV/AIDS, vary substantially across countries. French Guiana, at the crossroads between Amazonian South America and the Caribbean, constitutes a singular context with poor populations and rich country health funding, which has allowed researchers to gather lots of information on the particulars of our epidemic. We aimed to focus on the little known story of forty years of HIV research in French Guiana and emphasize how local research intertwined with public health action has yielded continuous progress, despite the difficult social conditions of the affected population. We searched Web of Science and associated local experts who worked through much of the epidemic in selecting the most meaningful products of local research for clinical and public health outcomes in French Guiana. Research tools and facilities included, from 1991 onwards, the HIV hospital cohort and the HIV-histoplasmosis cohort. Ad hoc studies funded by the ANRS or the European Regional Development fund shed light on vulnerable groups. The cumulative impact of prospective routine collection and focused efforts has yielded a breadth of knowledge, allowing for informed decisions and the adaptation of prevention, testing and care in French Guiana. After this overview, we emphasize that the close integration of research and public health was crucial in adapting interventions to the singular context of French Guiana. Full article

Climate change mitigation, adaptation to intensifying hurricanes, and decarbonization challenges in developing countries emphasize the urgent need for resilient high-voltage grids to facilitate the expansion of renewables. This research explores the technical feasibility of extending the U.S.–Caribbean Super Grid to include the Virgin Islands, Guadeloupe, Martinique, Trinidad and Tobago, Guyana, Suriname, French Guyana, and the northeastern part of Brazil in South America. This proposed extension aims to capitalize on the recent introduction of a new generation of wind turbines certified for operation under strong hurricane forces. The research utilizes modeling and simulation techniques to evaluate the performance of the proposed extension. A method for modeling and estimating spatiotemporal wind power profiles is applied, and the results demonstrate a reduction in maximum wind power variability within the U.S.–Caribbean Super Grid. Depending on the hurricane trajectory, the variability is reduced from 56.6% to less than 43.2%. This reduction takes effect by distributing peak surplus wind power alongside the proposed U.S.–Caribbean–South America Super Grid (UCASG). The research concludes by acknowledging the merits and limitations of the study and discussing potential directions for future research in this field. Full article

In total, 109 fish species (24,996 individuals) were sampled around Guadeloupe and Martinique Islands from October 2021 to September 2022 to estimate the morphometric relationships between total length and weight (Length Weight Relationship: LWR) of each fish species according to potential spatial, temporal and sex differences. Of these species, this is the first time that the LWR was estimated in the Atlantic Ocean for 16 species. There is a significant relationship between length and weight for all tested species. For 83 tested species, the sex effect on the LWR showed significant sexual dimorphism for 24 species. Additionally, a link between the temporal effect and the reproduction period was tested for 68 species, of which 35 presented significant differences relative to the annual quarter of sampling. Finally, the geographical effect (i.e., the difference between samples from around Guadeloupe Island and those from Martinique Island) was significant for 60 species. This island effect was significant for 25 species. Full article

Background: Estimating the prevalence of the double burden of malnutrition (DBM) remains challenging in Latin America and the Caribbean (LAC), where DBM typologies are heterogeneous and estimates are scattered across the literature. We aimed to comprehensively appraise the evidence and estimate the prevalence of any typology of DBM in LAC. Methods: A systematic search was conducted on PubMed, Embase, Scopus and Web of Science to identify studies on the prevalence of DBM published in English, Spanish, French or Portuguese between 1 January 2000 and 23 January 2023. The primary outcome was any typology of DBM derived from combining levels (individual, household, across the life course) and identified DBM typologies. The data extraction and methodological quality assessment were conducted in duplicate. Random effect meta-analyses of proportions were used to estimate the pooled prevalence, stabilized using the Freeman–Tukey transformation. Heterogeneity was assessed using Cochran’s Q and I2-statistics. PROSPERO-CRD42023406755. Results: In total, 754 records were identified, of which 60 (8%) studies were eligible, with a median 4379 individuals, including 314 DBM estimates. Most studies were nationally representative surveys (68%), had a low risk of bias (70%) and came from South America (53%). In total, 40% of DBM estimates corresponded to the individual level, where the most frequent typologies were ‘overweight + stunting’ among <18 years, and ‘overweight + anemia’ among >18 years. The household level represented 59% of estimates, where ‘adults with overweight + child with stunting’ was the most frequent typology. The pooled prevalence of any typology of DBM was 4% (95% prediction interval: 4–5%). For the individual level, the most contributing typology for <18 year was ‘overweight + anemia’, 3% (2–5%), and for >18 year, ‘overweight + short stature’, 22% (14–30%). The typology of ‘adults with overweight + child with stunting, 9% (8–9%), contributed the most at the household level. The pooled prevalence estimates carried large heterogeneity (I2 > 90%). The preliminary source of heterogeneity was the setting, as Mesoamerica and South America had 5% prevalence of DBM and the Caribbean had 2%. The DBM across individuals’ life course could not be estimated due to the scarcity of estimates. Conclusion: The prevalence of multiple forms of malnutrition in LAC varies between 2 and 5%. Adult with overweight are the most common contributor to DBM across levels and typologies. Substantial progress can be made in curbing the burden of DBM in LAC through strategies addressing overweight within the general population. Full article

Synalpheopsis gen. nov. is established for a remarkable new alpheid species, Synalpheopsis laureae sp. nov., presently known only from the male holotype collected at 111–162 m east of La Désirade, Guadeloupe, Lesser Antilles. Synalpheopsis gen. nov. peculiarly combines features of two genera, Alpheopsis Coutière, 1897 and Synalpheus Spence Bate, 1888; however, it is presumably closer to the former genus. The new genus is characterised by the moderately developed orbital hoods, well-developed rostrum and orbital teeth, sixth pleonite without articulated flap, tip of the third maxilliped with crown of spiniform setae, chelipeds with two strong teeth on distolateral margin and lacking snapping mechanism on finger cutting edges, and gill formula without mastigobranchs and setobranchs. Full article

Dengue fever has been a public health problem in the Caribbean region since 1981, when it first reappeared in Cuba. In 1989, it was reported in Martinique and Guadeloupe (two French islands 200 km apart); since then, DENV has caused several epidemics locally. In 2019–2021, DENV-1, DENV-2, and DENV-3 were detected. Serotype distribution was differentiated, with DENV-2 and DENV-3 predominating in Guadeloupe and Martinique, respectively. Complete genome sequencing was carried out on 32 specimens, and phylogenic analysis identified the circulation of genotype V for DENV-1, cosmopolitan genotype for DENV-2, and genotype III for DENV-3. However, two distinct circulating groups were identified for DENV-1 and DENV-3, suggesting independent introductions. Overall, despite the context of the COVID-19 pandemic and the associated travel restrictions, these results confirm the active circulation of DENV and specific epidemiological features on each of the two islands. Such differences may be linked to the founder effect of the various introduction events, and to local factors such as the population immunity and the transmission capacity of the vectors. Further genomic and epidemiological characterization of DENV strains remains essential to understand how dengue spreads in each specific geographical context and to prevent future epidemics. Full article