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Clin Microbiol Infect 2012; 18: 514-520 Abstract It is now well established that simian immunodeficiency viruses (SIVs) from chimpanzees (SIVcpz) and gorillas (SIVgor) from west Central Africa are at the origin of HIV-1/AIDS. Apes are also infected with other retroviruses, notably simian T-cell lymphotropic viruses (STLVs) and simian foamy viruses (SFVs), that can be transmitted to humans. We discuss the actual knowledge on SIV, STLV and SFV infections in chimpanzees, gorillas, and bonobos. We especially elaborate on how the recent development of non-invasive methods has allowed us to identify the reservoirs of the HIV-1 ancestors in chimpanzees and gorillas, and increased our knowledge of the natural history of SIV infections in chimpanzees. Multiple cross-species events with retroviruses from apes to humans have occurred, but only one transmission of SIVcpz from chimpanzees in south-eastern Cameroon spread worldwide, and is responsible for the actual HIV pandemic. Frequent SFV transmissions have been recently reported, but no human-to-human transmission has been documented yet. Because humans are still in contact with apes, identification of pathogens in wild ape populations can signal which pathogens may be cause risk for humans, and allow the development of serological and molecular assays with which to detect transmissions to humans. Finally, non-invasive sampling also allows the study of the impact of retroviruses and other pathogens on the health and survival of endangered species such as chimpanzees, gorillas, and bonobos. [ABSTRACT FROM AUTHOR]

Abstract: Private practice physicians play a central role in the detection and control of outbreaks. In Geneva, a local alert and response network completes the federal surveillance system, based on the mandatory reporting of infectious diseases. The common objective of these two mechanisms is to help health authorities in detecting, assessing, and controlling infectious diseases treats. Private practice physicians are one of the most effective and timely sources of information. As network members, they receive brief reports and information and are involved in the implementation of control and prevention measures. Their key-role was confirmed during a measles epidemic which occurred in Geneva in the spring of 2003. [Copyright &y& Elsevier]

Rothmund Thomson syndrome is a rare autosomal recessive skin disorder. The main clinical feature is poikiloderma appearing in early childhood associated with skeletal abnormalities. Early occurrence of malignancies is another relevant feature. Here we describe the clinical features of 2 patients with Rothmund Thomson syndrome who were investigated for the in vitro DNA repair capacities of blood cells following UVC radiation exposure. DNA excision repair, assessed with unscheduled DNA synthesis following UVC exposure, was decreased in both patients. Such a defect might explain the patients'sensitivity to sunlight and the relatively high risk of cancer associated with this syndrome. [ABSTRACT FROM AUTHOR]

La détection des auto-anticorps anti-centromères, anti-topo-isomérase-1 (ATA) et anti-ARN-polymérase III est utile pour déterminer le pronostic dans la sclérodermie systémique (ScS). Chez les patients positifs aux ATA, nous avons évalué si les taux d'ATA étaient associés à la gravité de la maladie au diagnostic et avec la progression au cours du suivi. Notre étude observationnelle rétrospective française monocentrique a été menée entre 2014 et 2021 chez les patients positifs pour les ATA, remplissant les critères de classification ACR/EULAR 2013 de la ScS, avec un suivi minimal d'un an et au moins 2 dosages d'ATA. Les patients ayant des ATA d'isotype IgG élevés à l'inclusion (> 240 UI/mL) ont été comparés aux patients présentant des taux faibles (≤ 240 UI/mL), à l'inclusion, à 1 et 3 ans. Une variation d'au moins 30 % des taux était considérée significative. Parmi les 59 patients inclus, ceux avec des taux élevés d'ATA présentaient une sclérose cutanée plus importante, évaluée par le score cutané de Rodnan modifié (p = 0,0480). Ils avaient un coefficient de transfert du monoxyde de carbone plus faible (p = 0,0457), une capacité vitale forcée plus faible (p = 0,0427). Des niveaux initiaux élevés d'ATA étaient associés à une progression vasculaire à un an (p = 0,0495). Les niveaux d'ATA semblent associés à la sclérose cutanée et la progression vasculaire dans la ScS. En plus de la simple détection des ATA, leur quantification pourrait être intéressante pour prédire la gravité et le pronostic de la ScS. Anti-centromere antibodies, anti-topoisomerase-1 antibodies (ATA), and anti-RNA-polymerase III antibodies are three Systemic Sclerosis (SSc)-specific autoantibodies. Their detection is helpful in determining the prognosis. We aimed to evaluate whether ATA levels were associated with disease severity at diagnosis or disease progression during follow-up in ATA positive patients. We conducted a single-centre French retrospective observational study, between 2014 and 2021. ATA positive patients fulfilling the ACR/EULAR 2013 classification criteria for SSc with a minimal follow-up of 1 year and 2 ATA dosages were included. SSc patients with high IgG ATA levels at baseline (> 240 IU/mL) were compared with SSc patients with low levels (≤ 240 IU/mL), at inclusion and at 1 and 3 years. A variation of at least 30 % of ATA levels was considered significant. Fifty-nine SSc patients were included and analysed. There was a predominance of women and of patients with diffuse interstitial lung disease. Patients with high ATA levels exhibited a higher skin sclerosis assessed by the modified Rodnan skin score (P = 0.0480). They had a lower carbon monoxide transfer coefficient (P = 0.0457), a lower forced vital capacity (FVC) (P = 0.0427) and more frequently had a FVC under 80 %, when compared to patients with low ATA levels (P = 0.0423). Initial high ATA levels were associated with vascular progression at one year (21.95 % vs. 0 %; P = 0.0495). ATA levels are associated with skin sclerosis and vascular progression in SSc. Beyond the detection of ATA, quantifying this autoantibody might be of interest in predicting disease severity and prognosis in SSc. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 70-year-old woman with a history of systemic lupus erythematosus (SLE) and presented with subcutaneous nodules. She was on treatment with corticosteroids and methrotrexate for 15 years for her skin and joint disease. The laboratory tests revealed the presence of diffuse calcinosis cutis associated with SLE. The article discusses calcinosis cutis as a disorder defined by skin and subcutaneous calcifications.

Examines a case of vesicular eczema and systemic contact dermatitis due to sorbic acid intake. Description of symptoms; Use of sorbic acid as food preservatives; Food products containing sorbic acid.

The article presents an association between erythema elevatum diutinum and chronic lymphocytic leukaemia. Erythema elevatum diutinum is characterized histologically by a leucocytoctastic vasculitis and the presence of a marked polymorphonuclear leucocyte infiltrate has made some authors classify it with the neutrophilic dermatoses. Haematological abnormalities and inflammatory bowel disease have been described in association with neutrophilic dermatoses as well as with erythema elevatum diutinum and leucocytoclastic vasculius can be associated with malignant blood diseases.

This article discusses a case of lentigines, or small hyperpigmented macules, that appeared on the wrists, hands, and knees of an 8-year-old girl with a history of atopic dermatitis. The lentigines developed after the patient started treatment with dupilumab, a medication used to treat atopic dermatitis. The article suggests that the inhibition of the IL-4 and IL-13 pathway by dupilumab may lead to an unregulated upregulation of melanogenesis, resulting in the formation of lentigines. The article emphasizes that lentigines are a rare and benign adverse event and reassures patients that they are not associated with an increased risk of skin cancer. [Extracted from the article]

Background Psoriasis is frequently associated with overweight and obesity. Anti-TNF-α therapies are effective in the treatment of psoriasis. TNF-α is highly involved in body weight regulation. Objective Our objective was to evaluate the increase in weight throughout the treatment with infliximab and the association of weight gain with the body mass index (BMI). Methods Thirty-five patients affected with severe plaque psoriasis receiving infliximab were included. A control group consisted of 16 patients affected with severe plaque psoriasis and treated with cyclosporine, methotrexate, or acitretin. Assessment of PASI score, body weight and BMI were performed at a 1 and 3-year follow-up. Results We observed a body weight increment of 2.5 ± 4.4 kg (mean ± SD) (i.e. + 3.6% of baseline) and 0.1 ± 5 kg (i.e. + 1.2%) in patients treated with infliximab and the control group, respectively ( P = 0.046), after 1 year of treatment. After 3 years of infliximab administration, weight gain was 4.8 ± 5 kg ( n = 16) (i.e. + 6%) ( P = 0.005). Moreover, as classified by BMI, normal weight patients experienced a 4 ± 3.7 kg weight gain (i.e. + 6%) whereas overweight and obese patients had gained 1.3 ± 4.8 kg (i.e. + 1.2%) ( P = 0.039) after 1 year of anti-TNF-α therapy. Percentual changes in body weight were larger in normal weight patients at baseline than in overweight/obese counterparts ( P = 0.0149). Conclusion All patients, including normal weight patients, should receive a dietary intervention. [ABSTRACT FROM AUTHOR]

Clin Microbiol Infect 2010; 16: 1525-1531 Abstract The tremendous diversity of human immunodeficiency virus (HIV)-1 strains circulating worldwide has an important impact on almost all aspects of the management of this infection, from the identification of infected persons, through treatment efficacy and monitoring, and prevention strategies such as vaccine design. The areas where HIV-1 genetic diversity is highest are those where the majority of patients in need of treatment and biological monitoring live. With increased access to treatment in these areas, it is expected that the demand for monitoring tools such as viral load assays and resistance tests will also increase, and their reliability will be critical. Regular updates of these assays during the last two decades have aimed at improving their performances in different ways that include their reliability with different HIV-1 strains. We here review to what extent HIV-1 genetic diversity still limits or not the use of currently available viral load and resistance tests. [ABSTRACT FROM AUTHOR]

Purpose. – Urticaria is a muco-cutaneous illness which is characterized by a dermal or hypodermal oedema due to a vasodilatation attributed to the release of histamine by mast cells and basophils. Urticaria is a very common complaint, since among 20% of the population will experience at least one episode of urticaria during their life. Chronic urticaria by definition is daily and has persisted for at least six weeks. By contrast with acute urticaria, its etiological and therapeutic approaches can present a significant challenge, leadind to repeated examinations.Current knowledge and key points. – Questioning and clinical examination are essential for the etiological diagnosis of chronic urticaria, because they are able to lead rapidly to the suspicion of several causes which can be eradicated to treat the symptoms. If no cause is found, further investigations may be required. Recent studies have shown the lack of profitability of exhaustive laboratory investigations. Thus, many authors at present time advise minimal and non expensive investigations which are determinated by anamnestic data. But most often, the etiology of urticaria remains unknown and this situation leads to the diagnosis of chronic idiopathic urticaria. The treatment of chronic urticaria is above all based on the elimination of the symptoms, either on a specific fashion if the etiological diagnosis is already known, or in a non specific way. The anti-H1 agents are the medications of choice for first line treatment.Future prospects and projects. – Pathophysiology of chronic urticaria is to date well established. As the mechanisms responsible for chronic urticaria are better defined, more therapeutic agents, which are effective on other targets than histamine, should become available. Moreover, recent advances have supported the notion that an underlying autoimmune process could account for many cases of chronic “idiopathic” urticaria. In such severe and refractory urticaria, immunomodulation therapy may bring about clinical improvement. [Copyright &y& Elsevier]

Actinic keratoses (AKs) are pre-neoplastic lesions that can develop into squamous cell carcinomas (SCCs) of the skin. Often AK and SCC have commonly altered p53. A status of another tumor suppressor, the p16INK4a, was reported for SCC but not for AK. A comparative study of SCC and AK human samples by loss of heterozygosity (LOH) analysis determined that the p16INK4a/ARF locus is less frequently altered in AKs than in SCCs. These LOH data highly correlated with immunohistochemical findings demonstrating the presence of p16INK4a in the AK skin samples but its absence in SCC lesions. Our results imply that progression of AK into SCC may involve inactivation of p16INK4a. [Copyright &y& Elsevier]

Objectives: Evidence comparing the economic and patient values of the World Health Organization's preferred (dolutegravir 50 mg [DTG]-based) and alternative (low-dose [400 mg] efavirenz [EFV400]-based) first-line antiretroviral regimens is limited. We compared patient-reported outcomes (PROs), costs, and the cost-utility of DTG- versus EFV400-based regimens in treatment-naive HIV-1 adults in the randomised NAMSAL ANRS 12313 trial in Yaoundé, Cameroon. Methods: We used clinical data, PROs, and health resource use data collected in the trial's first 96 weeks (2016–2019). Quality-adjusted life-years (QALYs) were computed using utility scores obtained from the 12-item Short Form (SF-12) generic health scale. Other PROs included perceived symptoms, depression, anxiety, and stress. In the 96-week base-case analysis, we estimated the unadjusted and multivariate-adjusted (1) mean costs (in US$, 2016 values) and QALYs/patient, (2) incremental costs and QALYs/patient, and (3) net health benefit (NHB). Outcomes were extrapolated over 5 and 10 years. Uncertainty was assessed using the cost-effectiveness acceptability curve and scenario and cost-effective price threshold analyses. Results: In the base-case analysis, the NHB (95% confidence interval) for the DTG-based regimen relative to the EFV400-based regimen was 0.056 (− 0.037 to 0.153), corresponding to an 88% probability of DTG being cost-effective. A 10% decrease in this regimen's price (from $5.2 to $4.7/month) would increase its cost-effectiveness probability to 95%. When extrapolating outcomes over 5 and 10 years, the DTG-based regimen had a 100% probability of being cost-effective for a large range of cost-effectiveness thresholds. Conclusions: At 2020 antiretroviral drug prices, a DTG-based first-line regimen should be preferred over an EFV400-based regimen in sub-Saharan Africa. Trial Registration: ClinicalTrials.gov Identifier: NCT02777229. [ABSTRACT FROM AUTHOR]

Summary: Background: Specific trichoscopic signs of tinea capitis (TC) were first described in 2008. The accuracy of this diagnostic tool has not been evaluated. Objectives: To assess the diagnostic accuracy of trichoscopy. Methods: A prospective, multicentre study was done between March 2015 and March 2017 at the dermatology departments of four French university medical centres. Patients with a presumed diagnosis of TC were included. Trichoscopy was considered to be positive if at least one specific trichoscopic sign was observed. Trichoscopy results were compared with the gold standard for diagnosis of TC (mycological culture). Results: One hundred patients were included. Culture was positive for 53 patients and negative for 47. The sensitivity of trichoscopy was 94% [95% confidence interval (CI) 88–100], specificity was 83% (95% CI 72–94), positive predictive value was 92% and negative predictive value was 86%. Comma hairs, corkscrew hairs, zigzag hairs, Morse‐code‐like hairs and whitish sheath were significantly more frequent in patients with a positive mycological culture (P < 0·001). Comma hairs were more frequent in patients with Trichophyton TC (P = 0·026), and zigzag hairs were more frequent in patients with Microsporum TC (P < 0·001). Morse‐code‐like hair was not observed in any patients with Trichophyton TC and therefore appears to be highly specific for Microsporum TC. Conclusions: The presence of a single trichoscopic finding is predictive of TC. Trichoscopy is a useful, rapid, painless, highly sensitive tool for the diagnosis of TC – even for dermoscopists with little experience of trichoscopy. It enhances physicians' ability to make treatment decisions. What's already known about this topic? Tinea capitis (TC) must be confirmed by a mycological culture that may take up to 6 weeks, delaying treatment.Specific trichoscopic signs of TC were first described in 2008, but the accuracy of trichoscopy for diagnosing TC has not previously been evaluated. What does this study add? The present series is the largest yet on the use of trichoscopy in the diagnosis of TC.Our results demonstrated that the presence of a single feature (comma hair, corkscrew hair, zigzag hair, Morse‐code‐like hair or whitish sheath) is predictive of TC.Trichoscopy is painless and highly sensitive.Morse‐code‐like hair appears to be highly specific for Microsporum TC. Linked Comment: Brasileiro. Br J Dermatol 2019; 181:893–894. Plain language summary available online Respond to this article [ABSTRACT FROM AUTHOR]

Objectives: In terms of HIV infection, western and central Africa is the second most affected region world‐wide, and the gap between the regional figures for the testing and treatment cascade and the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90–90–90 targets is particularly worrying. We assessed the prevalence of virological suppression in patients routinely treated in 19 hospitals in Cameroon. Methods: A cross‐sectional survey was performed in adult patients receiving antiretroviral therapy (ART) in the Centre and Littoral regions. The prevalences of virological suppression (<1000 HIV‐1 RNA copies/mL) were compared among all 19 hospitals using the χ2 test. Potential individual and health care‐related determinants of virological suppression were assessed using multivariate logistic regression models. Results: A total of 1700 patients (74% women; median age 41 years; median time on ART 3.7 years) were included in the study. The prevalence of virological suppression was 82.4% overall (95% confidence interval 80.5–84.2%). It ranged from 57.1 to 97.4% according to the individual hospital (P < 0.001). After adjustment, virological suppression was associated with age, CD4 cell count at ART initiation, disclosure of HIV status to family members, interruption of ART for more than two consecutive days, and location of patient's residence and hospital (rural/urban). These factors did not explain the heterogeneity of virological suppression between the study hospitals (P < 0.001). Conclusions: The overall prevalence of virological suppression was reassuring. Nevertheless, the heterogeneity of virological suppression among hospitals highlights that, in addition to programme‐level data, health facility‐level data are crucial in order to tailor the national AIDS programme's interventions with a view to achieving the third UNAIDS 90 target. [ABSTRACT FROM AUTHOR]

Le syndrome de Wells (SW) est une dermatose éosinophilique rare avec environ 200 cas rapportés dans la littérature. Nous rapportons le cas d'une patiente de 43 ans présentant un SW bulleux mimant une vascularite éosinophilique avec polyangéite (EGPA). Une femme de 43 ans est hospitalisée suite à un déficit sensitivomoteur du nerf sciatique poplité externe gauche avec douleurs neuropathiques, associé à un tableau cutané polymorphe évoluant depuis deux mois sans altération de l'état général. Les antécédents sont une polypose nasale, une pansinusite chronique et un asthme apparu à l'âge adulte sous corticothérapie inhalée au long cours. La patiente présente une allergie à l'acide acétylsalicylique dans le cadre d'un syndrome de Widal. L'examen retrouve des nodules dermohypodermiques migrateurs et résolutifs au repos associés à des lésions de purpura vasculaire punctiforme de la malléole interne droite. Après un effort physique, apparaissent des lésions purpuriques infiltrées sur la face interne de la cuisse accompagnées d'un œdème de la cheville. Le lendemain, des bulles à contenu clair puis sérohématique apparaissent sur les chevilles et l'avant-pied accompagnées de douleurs intenses distales des deux jambes. La biologie retrouve une hyperéosinophilie à 2,1 giga/l, la CRP est inférieure à 5 mg/l, le reste de l'hémogramme et le sédiment urinaire sont normaux. L'électrophorèse des protéines et le dosage pondéral des immunoglobulines sont normaux. Les IgE totales sont élevées à 799 KU/L, l'alpha-1-antitrypsine est normale, les antinucléaires et les ANCA sont négatifs. L'ENMG montre une compression du nerf fibulaire gauche au niveau du col du péroné avec démyélinisation et atteinte neurogène d'origine mécanique. Le scanner thoracique retrouve quelques plages de verre dépoli de topographie postérieure, sans lésion nodulaire ou micronodulaire, sans réticulation ou épaississement des septa. La biopsie d'une lésion purpurique de la jambe montre un infiltrat périvasculaire riche en polynucléaires éosinophiles, avec minimes phénomènes d'activité vascularitique, sans granulome ni altération du collagène, ce qui est en défaveur d'une EGPA. La biopsie d'une bulle de la cheville retrouve un clivage jonctionnel associée à un infiltrat péri capillaire fait de nombreux polynucléaires éosinophiles et de lymphocytes. L'immunofluorescence est négative. Le diagnostic d'EGPA est initialement évoqué devant l'atteinte pulmonaire et neurologique périphérique avec l'hyperéosinophilie, mais l'absence d'histologie compatible et la négativité des ANCA, l'aspect atypique des lésions cutanées et pulmonaires ont conduit à l'élimination du diagnostic. Le tableau clinico-histologique avec le très fort infiltrat éosinophilique permet de conclure à un SW. La patiente est traitée par corticothérapie orale (1 mg/kg/J) pendant 10 jours avec décroissance rapide et sevrage en 3 semaines permettant une régression totale des lésions cutanées, des myalgies et de l'hyperéosinophilie. À ce jour (3 mois après), il n'y a pas eu de récidive. Le SW se caractérise par la survenue brutale d'un ou plusieurs placards très inflammatoires et œdématiés, parfois recouverts de vésicules ou de bulles et siégeant préférentiellement sur le tronc et les extrémités. L'éruption dure entre 4 à 6 semaines et la récidive est la règle. Une hyperéosinophilie sanguine est présente dans 50 % des cas. Sur la base des caractéristiques cliniques et histologiques, le diagnostic retenu ici est un SW bulleux. La littérature rapporte une dizaine de cas de SW associé à une EGPA, parfois sans ANCA [1] et trois patients avec une évolution du SW vers une EGPA [2]. Seul le suivi à plus long terme de la patiente confirmera le caractère isolé ou non du SW. [ABSTRACT FROM AUTHOR]

Background Decision-making is a complex process. The aim of our study was to assess factors associated with the choice of the first biological treatment in patients with moderate-to-severe psoriasis. Methods Data on all patients included in the French prospective, observational, cohort, Psobioteq and initiating a first biologic prescription between July 2012 and July 2016 were analysed. Demographic information and clinical features were collected during routine clinical assessments by the dermatology team at the recruiting centres using a standardized case report form. The primary outcome was the nature of the first biologic treatment. Four groups were identified as follows: adalimumab, etanercept, ustekinumab and infliximab groups. Factors associated with the choice of the first biological agent were determined by a multinomial logistic regression model adjusted on year of inclusion. Results The study population included the 830 biological-naïve patients who initiated a first biological agent. The mean age was 46.6 years (± SD 13.9), and 318 patients (38.3%) were female. The most commonly prescribed biologic was adalimumab: 355 (42.8%) patients, then etanercept ( n = 247, 29.8%), ustekinumab ( n = 194, 23.4%) and infliximab ( n = 34, 4.0%). In the multinomial logistic regression analysis, patients were significantly more likely to receive adalimumab if they had a severe psoriasis as defined by baseline PASI or if they had psoriatic arthritis compared to etanercept ( aOR, 0.42; 95% CI, 0.16-1.07) and ustekinumab ( aOR, 0.15; 95% CI, 0.04-0.52). Patients were significantly more likely to receive ustekinumab ( aOR, 2.39; 95% CI, 1.04-5.50) if they had a positive screening for latent tuberculosis compared to adalimumab. Younger patients were also more likely to receive ustekinumab. Patients with chronic obstructive pulmonary disease were more likely to be prescribed ustekinumab or etanercept compared to adalimumab. There was a trend in favour of etanercept prescription in patients with cardiovascular comorbidities, metabolic syndrome and in patients with a history of cancer. Conclusion We identified patient- and disease-related factors that have important influence on the choice of the first biological agent in clinical practice. Clinicians appear to have a holistic approach to patient characteristics when choosing a biological agent in psoriasis. [ABSTRACT FROM AUTHOR]

Background Limited information is available regarding factors associated with long-term drug survival of infliximab for psoriasis in real life. Objectives The main aim pf this study was to identify predictors of long-term (>12 months) drug survival among patients treated with infliximab for psoriasis in a real-world clinical setting. Methods Retrospectively collected data, relating to disease, patient characteristics and treatment procedures, in a multicentre observational cohort of patients with moderate-to-severe plaque psoriasis treated with infliximab at eight university hospitals, 120 of whom maintained a response to infliximab for more than 12 months, were compared with prospectively collected data in the same centres from 54 patients who experienced secondary loss of response within a 12-month period. Results Mean duration of drug survival of infliximab in patients with long-term drug survival was 41.12 months ± 20.64 SD vs. 8.5 months ± 2.43 SD in patients with a secondary loss of response. Multivariate analysis identified greater disease severity at treatment onset ( PASI score >12) ( OR = 5.18, 95% CI: 1.60-16.77, P = 0.006), high levels of initial psoriasis clearance ( PASI-90 reduction or equivalent) ( OR = 18.50, 95% CI: 4.56-74.45, P = 0.0001) and combination with methotrexate ( OR = 13.15, 95% CI: 1.46-118.79, P = 0.022) as independent predictors of long-term drug survival and sustained efficacy of infliximab. Conclusion Positive predictors for long-term drug survival of infliximab in real life were identified. Their impact on treatment management should be addressed in further prospective trials. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Pyoderma gangrenosum (PG) is an unusual dermatitis witch is associated at least in half of the cases with a systemic illness. Case record: A 54 year-old woman suffering from Churg and Strauss syndrome has been monitored for many years. She was hospitalized in dermatology unit for a PG without showing any activity signs of her angeitis. After a well conducted localized treatment, the cutaneous lesions rapidly improved. Discussion: PG physiopathology is still not well known, but its interest lies in the fact of the high number of associated internal pathologies and is probably linked to granulomatosis such as Churg and Strauss angeitis. [Copyright &y& Elsevier]

Résumé La calciphylaxie ou artériolopathie calcique est une pathologie rare obstructive des artères de petit calibre du tissu cutané et sous-cutané au pronostic très sombre. Principalement décrite chez les insuffisants rénaux en phase terminale, on retrouve dans la littérature quelques cas chez des patients non insuffisants rénaux. Les principaux facteurs de risque identifiés en dehors de l’insuffisance rénale et des troubles du métabolisme phosphocalciques sont le sexe féminin, l’obésité, le terrain vasculaire, le diabète, la prise d’anti-vitamine K au long cours (AVK). Nous avons été confrontés à un cas exceptionnel de calciphylaxie de l’abdomen, de la face inférieure des seins et du haut des cuisses chez une patiente avec fonction rénale et métabolisme phosphocalcique normaux. Elle avait pour principaux facteurs de risque une maladie thromboembolique veineuse avec traitement par AVK au long cours et une obésité avec perte de poids majeure récente. La patiente a bénéficié d’une approche multidisciplinaire dermatologique, chirurgicale et réanimatoire permettant une régression et une stabilisation de la pathologie en quatorze semaines. La prise en charge multidisciplinaire est une nécessité bien que la place de la chirurgie ne soit pas clairement définie. Nous rapportons une observation dans laquelle l’exérèse chirurgicale large et précoce des lésions de calciphylaxie a permis d’obtenir une évolution favorable. Nous proposons ensuite une stratégie thérapeutique, après revue de la littérature. Summary Calciphylaxis or calcific arteriolopathy is a rare, life-threatening obstructive pathology of the small cutaneous and subcutaneous vessels. It mainly affects patients with chronic renal failure but it also has been described in patients with normal renal function. The principal risks factors apart from renal failure and phosphocalcic metabolism imbalance are: the female sex, obesity, peripheral vascular disease, diabetes and oral anti-coagulation. We present a very rare case of abdominal, mammarian and upper thighs calciphylaxis in a patient with normal renal function. She presented a severe obesity with a recent important loss of weight and had been treated by oral anticoagulants for a long time. She benefited of a multidisciplinary approach with dermatologists, plastic surgeons and anesthesists permitting a recovery in fourteen weeks. Multidisciplinary approach is necessary but the place of the surgery is not well defined. We report a case in which early and wide surgical approach permitted to obtain a favourable evolution of the pathology. Then, we propose a therapeutic strategy after review of the literature. [ABSTRACT FROM AUTHOR]

Background Patients with inflammatory bowel diseases ( IBD) may present with lesions in their oral cavity. Lesions may be associated with the disease itself representing an extraintestinal manifestation, with nutritional deficiencies or with complications from therapy. Aim To review and describe the spectrum of oral nonmalignant manifestations in patients with inflammatory bowel diseases [ulcerative colitis ( UC), Crohn's disease ( CD)] and to critically review all relevant data. Methods A literature search using the terms and variants of all nonmalignant oral manifestations of inflammatory bowel diseases ( UC, CD) was performed in November 2014 within Pubmed, Embase and Scopus and restricted to human studies. Results Oral lesions in IBD can be divided into three categories: (i) lesions highly specific for IBD, (ii) lesions highly suspicious of IBD and (iii) nonspecific lesions. Oral lesions are more common in CD compared to UC, and more prevalent in children. In adult CD patients, the prevalence rate of oral lesions is higher in CD patients with proximal gastrointestinal tract and/or perianal involvement, and estimated to range between 20% and 50%. Oral lesions can also occur in UC, with aphthous ulcers being the most frequent type. Oral manifestations in paediatric UC may be present in up to one-third of patients and are usually nonspecific. Conclusions Oral manifestations in IBD can be a diagnostic challenge. Treatment generally involves managing the underlying intestinal disease. In cases presenting with local disabling symptoms and impaired quality of life, local and systemic medical therapy must be considered and/or oral surgery may be required. [ABSTRACT FROM AUTHOR]

Objectives The World Health Organization ( WHO) recommends task-shifting HIV care to nurses in low-resource settings with limited numbers of physicians. However, the effect of such task-shifting on the health-related quality of life ( HRQL) of people living with HIV ( PLHIV) has seldom been evaluated. We aimed to investigate the effect of task-shifting HIV care to nurses on HRQL outcomes in PLHIV initiating antiretroviral therapy ( ART) in rural district hospitals in Cameroon. Methods Outcomes in PLHIV were longitudinally collected in the 2006−2010 Stratall trial. PLHIV were followed up for 24 months by nurses and/or physicians. Six HRQL dimensions were assessed during face-to-face interviews using the WHO Quality of Life ( WHOQOL)- HIV BREF scale: physical health; psychological health; independence level; social relationships; environment; and spirituality/religion/personal beliefs. The degree of task-shifting was estimated using a consultant ratio (i.e. the ratio of nurse-led to physician-led visits). The effect of task-shifting and other potential correlates on HRQL dimensions was explored using a Heckman two-stage approach based on linear mixed models to adjust for the potential bias caused by missing data in the outcomes. Results Of 1424 visits in 440 PLHIV (70.5% female; median age 36 years; median CD4 count 188 cells/μL at enrolment), 423 (29.7%) were task-shifted to nurses. After multiple adjustment, task-shifting was associated with higher HRQL level for four dimensions: physical health [coefficient 0.7; 95% confidence interval ( CI) 0.1-1.2; P = 0.01], psychological health (coefficient 0.5; 95% CI 0.0-1.0; P = 0.05), independence level (coefficient 0.6; 95% CI 0.1-1.1; P = 0.01) and environment (coefficient 0.6; 95% CI 0.1-1.0; P = 0.02). Conclusions Task-shifting HIV care to nurses benefits the HRQL of PLHIV. Together with the previously demonstrated comparable clinical effectiveness of physician-based and nurse-based models of HIV care, our results support the WHO recommendation for task-shifting. [ABSTRACT FROM AUTHOR]

Levamisole (an increasingly frequent contaminant of cocaine) can cause antineutrophil cytoplasmic antibody-associated vasculitis. Dermatologists should consider a diagnosis of cocaine/levamisole-associated cutaneous vasculopathy syndrome in cases of purpura of the ears and/or extensive retiform purpura in drug users. We report a case of particularly severe levamisole-induced necrotic purpura and immunological abnormalities in a 40-year-old woman. [ABSTRACT FROM AUTHOR]

Objectives The emergence of HIV drug resistance is a crucial issue in Africa, where second-line antiretroviral therapy ( ART) is limited, expensive and complex. We assessed the association between adherence patterns and resistance emergence over time, using an adherence measure that distinguishes low adherence from treatment interruptions, in rural Cameroon. Methods We performed a cohort study among patients receiving nonnucleoside reverse transcriptase inhibitor ( NNRTI)-based ART in nine district hospitals, using data from the Stratall trial (2006−2010). Genotypic mutations associated with antiretroviral drug resistance were assessed when 6-monthly HIV viral loads were > 5000 HIV-1 RNA copies/mL. ART adherence data were collected using face-to-face questionnaires. Combined indicators of early (1−3 months) and late (6 months to t − 1; t is the time point when the resistance had been detected) adherence were constructed. Multivariate logistic regression and Cox models were used to assess the association between adherence patterns and early (at 6 months) and late (after 6 months) resistance emergence, respectively. Results Among 456 participants (71% women; median age 37 years), 45 developed HIV drug resistance (18 early and 27 late). Early low adherence (< 80%) and treatment interruptions (> 2 days) were associated with early resistance [adjusted odds ratio (95% confidence interval) 8.51 (1.30-55.61) and 5.25 (1.45-18.95), respectively]. Early treatment interruptions were also associated with late resistance [adjusted hazard ratio (95% confidence interval) 3.72 (1.27-10.92)]. Conclusions The emergence of HIV drug resistance on first-line NNRTI-based regimens was associated with different patterns of adherence over time. Ensuring optimal early adherence through specific interventions, adequate management of drug stocks, and viral load monitoring is a clinical and public health priority in Africa. [ABSTRACT FROM AUTHOR]

Highlights: [•] We evaluated if RNAlater® could preserve parasites in wild-living chimpanzees stools. [•] RNAlater® is suited for samples collections in logistically challenging areas. [•] Parasites were identifiable in samples preserved at −80°C for as many as 7years. [•] RNAlater® may facilitate combined studies (molecular analyses and coprology together). [ABSTRACT FROM AUTHOR]

Background Even though efficacy of biologics has been extensively studied in psoriasis vulgaris, studies in erythrodermic psoriasis, the most severe form of the disease, have been scarcely reported. Objectives To address the efficacy and safety of biologics in patients with erythrodermic psoriasis. Methods A multicentre national retrospective study was performed using the French Psoriasis Group network. Patients showing psoriasis involving at least 90% of body surface area (BSA), and in whom severity of the disease had been evaluated before and after 3 and/or 6 months of treatment with biologics, were enrolled in the study. Results were expressed using intention-to-treat analysis. Results We included 28 patients, representing 42 flares of erythrodermic psoriasis treated with infliximab ( n = 24), adalimumab ( n = 7), etanercept ( n = 6), ustekinumab ( n = 3) or efalizumab ( n = 2). A 75% improvement of BSA or Psoriais Area and Severity Index 12-14 weeks after treatment onset was reached in 48% of flares treated with infliximab, in 50% of those treated with adalimumab and in 40% of those treated with etanercept. Twelve serious adverse events, consisting of bacterial infection in seven of them, were observed. Biological treatment was discontinued for safety concern in 19% of cases. A given biologic was administered for up to 48 weeks in 34% of flares. Conclusions Biologics show overall good short-term efficacy, but treatment switch due to lack of efficacy or side-effects is frequently observed on a longer term, with only one-third of patients still receiving the same drug after 1 year. The most significant safety concern consists of severe infections. [ABSTRACT FROM AUTHOR]

Summary: Hibernomas are uncommon tumors composed of brown fat. Their consistency is multiple but usually harder than a regular lipoma. It is a mobile, slow-growing mass. Clinical symptoms are exceptional (pain or massive weight loss). The case of a 26 years old patient who suffered of a cervical hibernoma is reported to discuss the clinical and paraclinical aspect of the diagnosis. [Copyright &y& Elsevier]

Abstract: To document the prevalence of gastrointestinal parasites in Cameroonian monkeys and to assess the risk of transmission to humans, we sampled 125 primates belonging to 15 species, of which 78 had been captured for bushmeat in the wild, and 47 were pets kept in urban areas. Seven nematode species, one trematode, one cestode and three protozoa were detected. Eight different parasite species were found in Cercopithecus nictitans and six in C. neglectus, C. pogonias and Cercocebus agilis. Helminths were found in 77% of monkeys, and protozoa in 36%. Trichuris sp. and Entamoeba coli were the most frequent parasites, being found in 54% and 36% of animals, respectively. Helminths were more frequent in adults than in juveniles, while the prevalence of protozoa was not age-related. No significant gender difference was found. Bushmeat monkeys had a significantly higher prevalence of helminth infection than pets (92% versus 51%), whereas there was no significant difference in the prevalence of protozoa (32% versus 43%). Among helminth species, Strongyloides fulleborni was more prevalent in bushmeat monkeys than in pets (55% versus 15%), as were Ancylostoma spp. (62% versus 9%). As these parasites are transmitted transcutaneously by infectious larva, they have a high potential for transmission to humans, during butchering. One pet monkey kept in an urban household in Yaoundé was infected by Schistosoma mansoni. The potential public health implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

Objectives To investigate the presence of hepatitis B virus (HBV) DNA and hepatitis C virus (HCV) RNA in HIV-infected patients initiating antiretroviral therapy in Cameroon. Methods Baseline blood samples from 169 patients were tested retrospectively for hepatitis B surface antigens (HBsAg), anti-hepatitis B core (anti-HBc), anti-HCV and – if HBsAg or anti-HCV result was positive or indeterminate – for HBV DNA or HCV RNA, respectively, using the Cobas Ampliprep/Cobas TaqMan quantitative assay (Roche Diagnostics GmbH, Mannheim, Germany). Results HBV DNA was detected in 14 of the 18 patients with positive or indeterminate HBsAg results [8.3% of the total study population, 95% confidence interval (CI) 4.6–13.5]. The median HBV viral load was 2.47 × 107 IU/mL [interquartile range (IQR) 3680–1.59 × 108; range 270 to >2.2 × 108]. Twenty-one patients (12.4%, 95% CI 7.9–18.4) were found with HCV RNA (all with positive HCV serology). The median HCV viral load was 928 000 IU/mL (IQR 178 400–2.06 × 106; range 640–5.5 × 106). No patient was co-infected with HBV and HCV. In multivariate analysis, HCV co-infection was associated with greater age [≥45 years vs. <45 years, odds ratio (OR) 11.89, 95% CI 3.49–40.55, P<0.001] and abnormal serum alanine aminotransferase level [≥1.25 × upper limit of normal (ULN) vs. <1.25 × ULN, OR 7.81, 95% CI 1.54–39.66, P=0.01]; HBV co-infection was associated with abnormal serum aspartate aminotransferase level (OR 4.33, 95% CI 1.32–14.17, P=0.02). Conclusions These high rates of active HBV and HCV co-infections in HIV-positive Cameroonian patients requiring antiretroviral therapy underline the need to promote: (i) screening for HBV and HCV before treatment initiation; (ii) accessibility to tenofovir (especially in HBV-endemic African countries); and (iii) accessibility to treatment for HBV and HCV infections. [ABSTRACT FROM AUTHOR]

Summary: Introduction: Launois–Bensaude''s disease (LBD) is a rare condition affecting patients aged between 30 and 60, and being considered as more frequent in males. It is characterized by symmetric fat deposits mainly on the neck and upper trunk that can lead to major functional and aesthetic damage. The cause of LBD is unknown but alcoholism is often associated. Patients and methods: The objectives were to study the epidemiological, clinical, and biological particularities, the therapeutic modalities and the evolution of 17 patients (nine males, eight females) seen between 2003 and 2005 at a medical and surgical consultation, and to compare them to the literature data. Seven patients were seen again in our out-patient department and the nine others (one was lost for follow-up) agreed to answer our questionnaire on the phone. Results and comments: The high proportion of female in our study is due to the high prevalence of female alcoholism in Northern France. Indeed, all patients were alcoholic but eight were deprived at the time of the first consultation. Mean age for the beginning of the disease was 48. Mean delay between the first signs and our medical and surgical consultation was eight years. Tumoral masses mainly involved the neck, the trunk, and the deltoid areas. Surgical treatment was performed in nine deprived patients for at least 12 months with a satisfactory functional and aesthetic result and a mean decrease of 50% was noted for the dermatology life quality index (DLQI). We observed no immediate complications but two cases with hypertrophic scar and one case with persistent dysesthesia. Four out of them presented recurrence corresponding with resumption of alcohol abuse, confessed in two cases and suspected in the two others. In the absence of surgical management, the disease was stable in three cases but evolved in four cases. No spontaneous regression was observed. [Copyright &y& Elsevier]

OBJECTIVE: To investigate the nature of polyarthritis in patients with moderate to severe psoriasis undergoing treatment with efalizumab, a humanized anti-CD11a monoclonal antibody. METHODS: In a multicenter study, we retrospectively analyzed patients who developed arthritis during treatment with efalizumab. The relationship between joint manifestations and psoriatic disease was addressed by using different classification criteria for psoriatic arthritis (PsA). The course of arthritis and its response to treatment were also investigated. RESULTS: Sixteen patients developed de novo inflammatory rheumatic disease, with a mean delay of 15 weeks following the start of treatment, and with exclusive asymmetric peripheral monarthritis or oligoarthritis (8 patients), inflammatory spinal disease (1 patient), or both (7 patients), associated in some cases with enthesitis and dactylitis. All patients fulfilled at least 2 different sets of classification criteria for PsA. In most of them, an improvement in skin lesions was observed at the onset of PsA, as measured using the Psoriasis Area and Severity Index (mean score 24.88 before efalizumab versus 18.78 at the time of arthritis). Efalizumab treatment was stopped in 11 patients and was followed by the elimination of rheumatologic symptoms in 1 patient, while 8 patients required treatment with nonsteroidal antiinflammatory drugs with or without methotrexate, with 2 later being switched to tumor necrosis factor alpha inhibitors. Reintroduction of efalizumab (2 patients) was followed by a relapse of PsA. CONCLUSION: This study questions the role of efalizumab in the induction of PsA. It also emphasizes the discrepancy between the courses of psoriatic skin and joint manifestations under treatment. Prospective case-control studies are needed to accurately investigate the impact of efalizumab on PsA. [ABSTRACT FROM AUTHOR]

Background Efavirenz has been associated with neuropsychiatric disorders, but little is known about depression and quality of life in sub-Saharan Africa, where nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens are still the first-line treatment recommended by the World Heath Organization (WHO) and are widely prescribed. Methods In a cross-sectional study, we evaluated quality of life and depression among Senegalese patients receiving efavirenz- or protease inhibitor (PI)-based regimens. Two hundred consecutive patients who had been taking highly active antiretroviral therapy (HAART) for more than 6 months were asked to complete a questionnaire. Results According to the Center for Epidemiologic Studies Depression Scale (CES-D), 18% had depression (19% for patients on a PI-based regimen and 17% for patients on efavirenz-based treatment). Fifty-nine per cent of the patients reported no health problems in the past 4 weeks. A quarter of patients had sleep disorders. Moderate or slight adverse events were reported by 28.5% of patients. Conclusions Quality of life and depression scores remained good in both study groups. However, quality of life and depression should be monitored in follow-up of HIV-infected patients in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

A 70-year-old man was admitted with a 20-year history of multiple cutaneous vascular malformations that had progressively appeared over the face and the trunk (Fig.). Full-body computed tomography (CT) scan showed three cerebral nodules, measuring 7, 4 and 3 mm, respectively, in the frontal lobe, several hepatic lesions in liver segments IV, V and VII, and a para-aortic malformation measuring 25 mm in size. The diagnosis of FCC should be considered in patients with multiple vascular malformations, neurological and/or ophthalmological symptoms, and a positive family history of cerebral cavernomas. [Extracted from the article]

Abstract: Purpose. – Calcic arteriolopathy (CA), also known as " Calciphylaxis " describes a phenomenon of necrosis, mainly cutaneous and sometimes systemic, due to the obliteration of the arteriole''s lumen. Initially there are under-intimal calcic deposits, and then the thrombosis occurs leading to the necrosis. CA affects mainly the renal insufficient hemodialysed patient, but not exclusively. We present 4 cases which illustrate well the etiologic spectrum of CA: terminal renal insufficiency, neoplasia, primary hyperparathyroidism, proteinuria, vitamine K inhibitors. We describe the AC''s epidemiology, its cutaneous and systemic clinical presentations, its treatment. We make the hypothesis that CA is a strong risk marker in matter of cardiac mortality and we discuss this point. Current knowledge and key points. – In this article we describe the numerous breakthroughs that have been made in matter of research about calcification over the past few years: inhibitors of calcium phosphate deposition, vitamin D and PTH1R, nucleational complexes, cell death, induction of bone formation. These data are analysed from a clinical point of view with practical purposes. We present CA not only as a cutaneous disease but as a systemic pathology. Future prospects and projects. – The CA epidemiology is an incentive to more diagnosis suspicion in front of organ infarct involving a patient likely to be concerned by CA. The scientific and therapeutic breakthroughs in matter of calcification enable a better prevention of the disease. Nevertheless it remains very difficult to cure when installed. [Copyright &y& Elsevier]

The frequency and the gravity of allergic reactions to insulin have decreased substantially with the availability of recombinant DNA-human insulins. Today, the frequency of immediate reactions is estimated to be on the order of 10%. Most of these allergic reactions are related to components of these preparations other than insulin. The manifestations are usually benign and localized to the injection site. True insulin allergies are very rare. We report three cases of patients who presented generalized immediate allergic manifestations after insulin injections. Intradermal skin tests with a panel of recombinant DNA-human insulins were negative in nonallergic diabetic controls and non-diabetic controls but positive in our three patients, suggesting the occurrence of IgE-dependant systemic allergy to recombinant DNA-human insulin. [Copyright &y& Elsevier]

Reports on two cases of contact allergy to octocrylene. Case of a 55-year-old man with an erythemato-vesicular eruption; Case of a 31-year-old man with acute photodistributed eczema after application of two sunscreens; Performance of photobiological testing.

Leukemia cutis (LC) are not rare in acute myeloid leukaemia (AML) in children but exceptionally reveal it. Most authors think that they have poor prognosis.Case report. – We report the case of an infant with isolated cutaneous involvement at the time of diagnosis of leukaemia. Bone marrow aspiration showed AML M5. The child was treated by LAME 91 protocol, arm “infant under one year of age”. Complete remission, both in bone marrow and skin, was obtained after induction course. Then the patient received consolidation course and megatherapy followed by autologous bone marrow transplantation. Skin relapse occurred early. The complete remission n° 2 was not obtained by second line treatment: new LC appeared when PMN count increased more than 109/l. Then, the child was treated with oral VP16 but disease progressed with more and more LC, followed by bone marrow relapse. Child’s death occurred about one year after diagnosis. [Copyright &y& Elsevier]

Discusses the epistasis between DSG1 and HLA class II genes in pemphigus foliaceus (PF). Determination of the occurrence of pemphigus foliaceus as a consequence of complex genetic interactions; Contribution of major histocompatibility complex class II and DSG1 polymorphisms to PF susceptibility.