Médecine tropicale : revue du Corps de santé colonial
-
Envenomation by Elapidae snakes is less frequent than by Viperidae snakes but represents a true medical emergency due to rapid progression of cobra syndrome. Elapidae venom contains neurotoxins that paralyze striated muscles especially in the thoracic cavity. ⋯ When cobra envenomation is suspected, antivenom administration by the direct venous route must be undertaken as quickly as possible to stop the envenomation process. Artificial ventilation is necessary in case of dyspnea.
-
Venomous animals that are able to innoculate or inject venom and poisonous animals that cannot inject venom but are toxic when ingested belong to all zoological groups. They can be encountered worldwide in any ecosystem on land and at sea but they are more common and more dangerous in tropical areas. This first article of a series to appear in the next issues of Medecine Tropicale presents an overview of species involved in envenomations and poisonings. In addition to a brief reviewing geographic risks and circumstances in which bites, stings or ingestion occur, some information is provided about antivenim therapy, the only etiological treatment.
-
Malaria requiring intensive care is characterized by failure of one or more organ systems and/or development of several metabolic disorders secondary to the presence of Plasmodium faliciparum in the blood. Severe imported malaria in non-immunized adults causes multiple organ failure with variable degrees of altered mental status. Acute pulmonary edema is frequent, jaundice associated with mild disturbance of liver function is consistent, arterial hypertension due to hypovolemia is usual, and acute renal insufficiency is uncommon. ⋯ Supportive symptomatic treatment, e.g. mechanically assisted ventilation and kidney dialysis, is required. In endemic zones over 90% of deaths involve children without access to intensive care facilities. Mortality rates associated with management of severe imported malaria in intensive care range from 10 to 30%.
-
French Guiana is a French Overseas Department in South America. Ninety-five percent of the territory is a tropical rainforest. Its rich fauna includes seven families of snakes but only 3 are potentially venomous. ⋯ Crotalus durissus, a rattlesnake living in coastal savannah, or Micrurus sp cause neuromuscular poisoning. Coral snakes are encountered throughout French Guiana, but envenomation is very rare. Antivenom therapy must be administered by the intravenous route in association with symptomatic treatment and, if necessary, resuscitation in a specialized care unit.
-
In this article, the author describes, in layman's terms, the legal framework for international humanitarian operations. He explains a number of complex and intricate principles used in these situations. He acknowledges the burden that legal considerations place on humanitarian organizations but also demonstrates that legal expertise is an indispensable tool in the provision of humanitarian services.