Impact of Maternal Nutrition and Perinatal Factors on Breast Milk Composition after Premature Delivery.

(1) Background: Premature infants require mothers' milk fortification to meet nutrition needs, but breast milk composition may be variable, leading to the risk of inadequate nutrition. We aimed at determining the factors influencing mothers' milk macronutrients. (2) Methods: Milk samples were analyzed for the first five weeks after premature delivery by infrared spectroscopy. Mothers' nutritional intake data were obtained during standardized interviews with dieticians, and then analyzed with reference software. (3) Results: The composition of 367 milk samples from 81 mothers was (median (range) g/100 mL): carbohydrates 6.8 (4.4⁻7.3), lipids 3.4 (1.3⁻6.4), proteins 1.3 (0.1⁻3.1). There was a relationship between milk composition and mothers' carbohydrates intake only (r = 0.164; p < 0.01). Postnatal age was correlated with milk proteins (r = -0.505; p < 0.001) and carbohydrates (r = +0.202, p < 0.001). Multiple linear regression analyses showed (coefficient) a relationship between milk proteins r = 0.547 and postnatal age (-0.028), carbohydrate intake (+0.449), and the absence of maturation (-0.066); associations were also found among milk lipids r = 0.295, carbohydrate intake (+1.279), and smoking (-0.557). Finally, there was a relationship among the concentration of milk carbohydrates r = 0.266, postnatal age (+0.012), and smoking (-0.167). (4) Conclusions: The variability of mothers' milk composition is differentially associated for each macronutrient with maternal carbohydrate intake, antenatal steroids, smoking, and postnatal age. Improvement in milk composition could be achieved by the modification of these related factors.

["Living with chronic pain means fighting to remain positive"]. / « Vivre avec une douleur chronique, c'est se battre pour garder l'espoir ¼.

Chronic pain has a significant impact on a patient's personal, professional and social life. Effective short- or medium-term resources exist, but patients nevertheless face a daily struggle to resist, to gain a little autonomy, to get out of bed, to suffer less. Support from family and friends, as well as trusting relationships forged with health professionals, are an essential resource. Testimony.

Continuous increase of Trichophyton tonsurans as a cause of tinea capitis in the urban area of Paris, France: a 5-year-long study.

Tinea capitis (TC) is a highly contagious fungal infection of the scalp due to dermatophytes in children. To obtain information on the epidemiology of TC in the urban area of Paris, we analysed the microbiological results of 3090 patients seen with suspected TC from October 2010 to September 2015 at Saint Louis hospital, Paris, France. A peak of TC was observed in 3-6 year-old children, followed by a progressive decrease until 16 years of age. Of the 1311 positive cultures, 95% (1246) yielded one of the three anthropophilic species [Trichophyton tonsurans (33.5%), Trichophyton soudanense (38.3%), or Microsporum audouinii (28.2%)]. When considering one TC case per family, we observed a significant increase of T. tonsurans (P = .018) during these 5 years. The increase was more pronounced (P = .0047) in patients of West-African descent (n = 666), and was at the expense of M. audouinii and T. soudanense. On the other hand, the Caribbean patients (n = 85) remained predominantly (72.9%) infected by T. tonsurans. Our results show a better virulence of T. tonsurans over other species as already reported. Since T. tonsurans has not been reported in Africa, the infection of patients of West-African descent probably took place in the Paris area by exchanges with Caribbean patients. This increase of TC due to T. tonsurans was observed in the context of griseofulvin being the only licensed paediatric treatment for TC in France, which should deserve reappraisal because terbinafine may be more efficacious.

Invasive pulmonary infection due to Trichoderma longibrachiatum mimicking invasive Aspergillosis in a neutropenic patient successfully treated with voriconazole combined with caspofungin.

Trichoderma longibrachiatum, a filamentous fungus, was recently described as an emerging pathogen in immunocompromised patients. Here, we report the first case, to our knowledge, of isolated invasive lung infection by T. longibrachiatum in a patient with hematologic malignancy. The infection mimicked invasive pulmonary aspergillosis and was successfully treated with a combination of voriconazole and caspofungin.

In vitro activity of amphotericin B, itraconazole, voriconazole, posaconazole, caspofungin and terbinafine against Scytalidium dimidiatum and Scytalidium hyalinum clinical isolates.

OBJECTIVES: The objective of this work was to evaluate the in vitro activity of amphotericin B, itraconazole, voriconazole, posaconazole, caspofungin and terbinafine against clinical isolates of Scytalidium dimidiatum and Scytalidium hyalinum. METHODS: Microdilution testing was performed in accordance with the CLSI M38-A method on 17 S. dimidiatum and 15 S. hyalinum clinical isolates. RESULTS: The MIC ranges of voriconazole, posaconazole, itraconazole, terbinafine, caspofungin and amphotericin B were <0.03 to 0.5 mg/L, 0.06-2 mg/L, <0.03 to >16 mg/L, 0.06-2 mg/L, 0.06-8 mg/L and 0.06-1 mg/L, respectively. CONCLUSIONS: Amphotericin B and voriconazole exhibit the lowest MICs for Scytalidium spp. Voriconazole could be a promising agent for the treatment of these refractory infections.

Novel, single-dose, topical treatment of tinea pedis using terbinafine: results of a dose-finding clinical trial.

Tinea pedis is the most common dermatophytosis requiring topical antifungals for at least 1-4 weeks. To determine the effectiveness of a novel topical single dose formulation of terbinafine (film forming solution-FFS) in the treatment of tinea pedis, 344 outpatients from 43 dermatological centres in France and Bulgaria suffering from tinea pedis with possible extension to soles confirmed by mycological examination (direct and culture) were evaluated for efficacy of terbinafine 1%, 5%, 10% FFS in a randomised double blind vehicle controlled parallel group dose finding study. Evaluations were carried out at baseline, 1 and 6 weeks after a single application of FFS. Effective treatment rate based on negative mycology (direct and culture) and minimal signs and symptoms (two or less with only mild recorded) was measured at week 6. Effective treatment rates at week 6 with terbinafine 1%, 5% and 10% FFS were 66%, 70%, 61% compared with 18% with placebo. All three active preparations were shown to be significantly superior to placebo (P < 0.001). Terbinafine 1% and 5% FFS were shown to be non-inferior to terbinafine 10% FFS. Terbinafine 1% FFS is an effective, safe dose for the treatment of tinea pedis. This novel product represents a significant advance with the enhanced compliance and convenience that it offers.

Accuracy of standard dermoscopy for diagnosing scabies.

BACKGROUND: Scabies is a contagious skin infestation caused by the human mite Sarcoptes scabiei. The usual reference method for definitive diagnosis is ex vivo identification of the mite with microscopic examination of skin scrapings. We compared diagnostic accuracy of in vivo dermoscopic (DS) mite identification using a pocket handheld low-magnification DS with the reference method. METHODS: We conducted a prospective, nonrandomized, evaluator-blinded, noninferiority study to compare sensitivities (main outcome) and other diagnostic properties of DS and microscopic examination of skin scrapings. Among 756 patients with a presumptive diagnosis of scabies consulting in one center, 238 were sequentially submitted to the two diagnostic procedures. Three dermoscopists (one expert, two inexperienced) were involved. Diagnostic strategies using clinical skills only, DS results, and a combination of both were compared. RESULTS: Sensitivities were 91% (95% confidence interval: 86-96) for DS and 90% (95% confidence interval: 85-96) for microscopic examination of skin scrapings (P = .005 for noninferiority). Specificities were 86% (95% confidence interval: 80-92) for DS and 100% (by definition) for microscopic examination of skin scrapings. DS sensitivities were similar for the expert and inexperienced dermoscopists, whereas differences were observed in specificities. However, diagnostic accuracy of inexperienced dermoscopists steadily increased during the study. Compared with clinical-based, DS-based treatment decision rule minimized the number of false-positive and false-negative findings, whereas a treatment decision rule based on combination of clinical presumption and DS result drastically reduced the number of patients with scabies left untreated. LIMITATIONS: There is no definitive standard for ruling out the diagnosis of scabies. CONCLUSIONS: Standard DS with a handheld DS is a useful tool for diagnosing scabies, with high sensitivity, even in inexperienced hands. It greatly enhances clinical skills for making treatment decisions.

Scytalidiosis in Paris, France.

BACKGROUND: Scytalidium dimidiatum and S hyalinum are molds responsible for human skin and nail infections in tropical areas. OBJECTIVE: We sought to examine the epidemiology of cutaneous infections caused by Scytalidium species in a temperate country. METHODS: We conducted a retrospective study of patients with Scytalidium spp. infection diagnosed in our laboratory in Paris, France, from 1994 to 1999. RESULTS: Cutaneous Scytalidium infections were diagnosed in 332 patients, all of whom were from the tropics, especially the West Indies and Africa. S hyalinum and S dimidiatum were isolated in 53.6% and 43.9% of cases, respectively, and were associated with dermatophytes in 30 patients. Skin and nail lesions were found in, respectively, 65.3% and 34.7% of cases, and the feet were involved in 90.6% of cases. CONCLUSION: Cutaneous infections caused by Scytalidium species are far from rare in France, a temperate country, and must not be mistaken for dermatophytosis, given the resistance of S hyalinum and S dimidiatum to most antifungal drugs. Mycologic examination is, thus, required to identify Scytalidium spp in patients returning from or residing in tropical areas.

Nucleotide structure of the Scytalidium hyalinum and Scytalidium dimidiatum 18S subunit ribosomal RNA gene: evidence for the insertion of a group IE intron in the rDNA gene of S. dimidiatum.

The molds Scytalidium dimidiatum (Nattrassia mangiferae synanamorph) and Scytalidium hyalinum are responsible for dermatomycosis in humans. We sequenced their 18S subunit ribosomal RNA gene to identify these species with molecular biology-based methods. The coding sequences differed by a single polymorphism (A in S. dimidiatum, G in S. hyalinum). Moreover, we found an insert at position 1199 in the 18S rRNA gene sequence of S. dimidiatum. Its potential secondary structure was characteristic of a group IE intron. Bioinformatic and phylogenic group IE intron analyses generated four main homogeneous clusters. The S. dimidiatum intron is original and not related with other known IE group introns.