The authors describe three cases of severe accidental poisoning by plants used as part of a traditional treatment in Mayotte. The established, or suspected, toxicity of Thevetia peruviana (Yellow oleander), Cinchona pubescens (Red quinine-tree), Melia azaderach (Persian lilac, also called china berry) and Azadirachta indica (Neem), is discussed. The clinical presentation is cardiac (atrioventricular block) and well known for Thevetia and Cinchona intoxications. Neurological signs and multi-organ failure are found for Azadirachta and Melia. The identification of the plants is never easy, nor is the evidence of their accountability. In the three cases reported, no other cause than the traditional treatment has been found to explain the clinical presentation. The outcome was favorable in all cases. The authors emphasize the difficulties to investigate these accidents, the poor medical knowledge of these practices in tropical areas, and in Mayotte particularly. The need for cooperation with local botanists, familiar with traditional medicine, is also underlined.

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Platelet activation is accompanied by characteristic morphological changes: smooth-disc platelets become more spherical in shape and develop pseudopods. The purpose of this study is to investigate whether platelets change after extracorporeal bypass. Twenty-two patients undergoing cardiopulmonary bypass (CPB) were studied prior to anesthesia and immediately after the operation. Platelets activated by different agonists were monitored simultaneously for morphological changes, ATP release and aggregation. While shape change measured before surgery was large, it was significantly reduced after bypass surgery (p < 0.01); morphological changes were quicker postoperatively. Several other parameters also changed: the time lapse between administration of the agonist and the start of ATP secretion decrease significantly (p < 0.01). After activation with high concentrations of ADP, ATP release was significantly increased (p < 0.01). On the other hand, less ATP was released after platelet activation with collagen and arachidonic acid, suggesting a change in platelet adhesion or a downregulation of endoperoxide synthesis. In our study, the importance of preactivation change in shape, estimated quantitatively by percent loss in ability of changing shape, can be compared using various agonists, with proportional defects in release and aggregation. These data provide evidence for different intrinsic levels in platelet defects after CPB.

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Objectifs : L'acidose lactique à la metformine (ALAM) est une complication grave du traitement par metformine. L'hypothèse des praticiens du centre hospitalier de Mayotte (CHM) serait que l'incidence d'ALAM serait plus élevée sur l'île qu'en métropole. Tous les cas d'ALAM ayant nécessité une hospitalisation en réanimation ont été colligés de manière rétrospective. L'objectif principal de l'étude était d'évaluer l'incidence de survenue d'ALAM à Mayotte. Les objectifs secondaires étaient d'en identifier les causes possibles pour mettre en place une prévention efficace et un protocole d'identification et de prise en charge aux urgences. Matériels et méthodes : Les cas d'ALAM admis en réanima-tion au CHM de janvier 2010 à août 2014 ont été inclus de manière rétrospective. Les critères d'inclusions étaient un pH inférieur à 7,35 et un taux de lactate supérieur à 5 mmol/L chez des patients ayant pris de la metformine. Les données anamnestiques, cliniques, biologiques et évolutives de ces patients ont été étudiées. Résultats : Sur cette période, 17 cas d'ALAM ont été inclus. L'incidence d'ALAM à Mayotte a été estimée à 50/100 000 patients/an. Le facteur déclenchant retrouvé était l'absence d'interruption du traitement par la metformine lors de la survenue d'un événement intercurrent dans 94 % des cas. La posologie de la metformine n'était pas adaptée dans plus de 30 % des cas. Conclusion : L'incidence d'ALAM est plus élevée à Mayotte qu'en métropole. Une éducation thérapeutique insuffisante et une prescription inadaptée de la metformine semblent être en cause. Le taux de lactate et le pH ne devraient pas être, à eux seuls, considérés comme facteurs pronostiques. La mortalité est liée à la gravité des pathologies associées. Mots clés Metformine · Acidose lactique · Diabète · MayotteAbstract Aims: Metformin associated lactic acidosis (MALA) is a serious complication of the treatment by metformin. The hypothesis raised by the practitioners of the Mayotte central hospital (MCH) is that the occurrence of MALA would be higher in Mayotte than in mainland France. All of the MALA cases that required an admission to the intensive care department were retrospectively listed. The main goal of this study was to evaluate the MALA occurrence rate. The secondary goals were to identify causes to allow the implementation of an effective prevention, and to build a protocol of identification and care at the emergencies department. Materials and methods: All of the MALA cases, from January 2010 to August 2014 eligible to MCH intensive care department were retrospectively included in the study. The inclusion criteria were: a pH below 7,35 and a lactate rate higher than 5 mmol/L for patients who have taken Metformin. All of the patient's anamnestic, clinical and biological data were studied. Results: During this time range, seventeen patients have been included. The occurrence of MALA at Mayotte is estimated at 50/100,000 patients per year. The inducing factor found in 94 % of the cases was the non-interruption of metformin treatment during t...