[Fungal colonization in preterm neonates weighing less than 1500g admitted to the neonatal intensive care unit]. / Colonisation à levures chez les prématurés de moins de 1500g hospitalisés en réanimation néonatale.

Fungal colonization is a common occurrence in preterm neonates. Our objective was to describe the profile and characteristics of fungal colonization in preterm infants admitted to the Martinique NICU. From March 2012 to January 2013, an epidemiological prospective cohort study was conducted with 57 very low-birth-weight infants. Cutaneous, rectal, gastric, respiratory, and urinary swabs were collected on admission, then every week for 4 weeks. The prevalence of fungal colonization was 68% (39/57): 46% by Malassezia species, 28% by Candida parapsilosis, 19% by C. albicans, 5% by C. glabrata, and 2% by C. guilliermondii. The colonized patients had a duration of parenteral nutrition and antibiotic therapy longer than the others (P<0.05). Nosocomial colonization (after 2 days of life) occurred in 52% of cases: Malassezia species and C. parapsilosis were the commensal skin yeasts most frequently implicated. Forty-nine percent (28/57) had suspected invasive fungal infections that received probabilistic treatment. Only one case of invasive fungal infection with C. glabrata was diagnosed. This study highlights the important role played by nosocomial transmission in the colonization of preterm newborns. Mycological surveillance cultures in the NICU are very useful for monitoring fungal ecology and can improve the prevention of fungal colonization in preterm infants at risk of invasive fungal infection.

Prophylactic neuroprotection with A91 improves the outcome of spinal cord injured rats.

Iatrogenic injury to the spinal cord (SC) is not an uncommon complication of spinal surgery. In an attempt to establish a preventive therapy for anticipated SC injury, we tested the effect of a single dose (SD) vaccine vs. the addition of a booster dose (BD) of a neural-derived peptide (A91) prior to SC contusion. Immunization with A91 immediately after SC injury has demonstrated to induce significant tissue protection and motor recovery. After injury, only the BD vaccination schedule had a neuroprotective effect. It was capable of improving neurological recovery that was always significantly higher than the one observed in rats with SD immunization or those only treated with PBS. Toward the end of study, animals treated with an A91 BD presented a BBB score of 9.75±0.17 (mean±standard deviation) while rats treated with SD or PBS had a score of 6.6±0.7 and 5.6±0.6 respectively. In the next step we attempted to corroborate the neuroprotective effect induced by A91 immunization. For this purpose, we assessed the survival of rubrospinal neurons (RSNs) and ventral horn neurons (VHNs) sixty days after SC injury. BD vaccination induced a significant survival of both RSNs and VHNs after injury. Finally, the failure or success of this therapy (SD or BD respectively) was associated with a lower (SD) or higher (BD) A91-specific T cell proliferation. Prophylactic neuroprotection with an initial and subsequent booster dose of A91 may improve recovery after SC injury sustained during invasive spinal surgery procedures.

[Practice guidelines of the use of bisphosphonates in solid tumours with bone metastases and in multiple myeloma]. / Guide de recommandations d'utilisation des bisphosphonates dans les lésions osseuses malignes des tumeurs solides et du myélome multiple.

Bisphosphonates are indicated for the treatment of bone lesions in patients with solid tumours or multiple myeloma. Bisphosphonates have proven their effectiveness in reducing the number of bone complications (hypercalcemia, pain, disease-related fractures, spinal cord compression) and delaying their occurrence in patients with bone tumours; they have also been shown to reduce the need for bone surgery and palliative or pain-relieving radiotherapy in these patients. International recommendations for the treatment of bone lesions related to malignant solid tumours and multiple myeloma have been established. We have elaborated clinical practice guidelines on the use of bisphosphonates to assist treatment decision-making in bone oncology. The guide contains decision trees and tables with information to guide pre-treatment evaluation and patient follow-up, as well as indications and conditions of use of bisphosphonates. In 2007, the regional cancer network of Rhône-Alpes, ONCORA, formed a working group (GIP ONCORA) to elaborate the guideline. The final version was then discussed and adopted at a plenary session in July 2009, during a collaborative workshop on supportive care recommendations organized by ONCORA and the regional cancer network of Lorraine.

[Deadly nightshade (Atropa belladonna) intoxication in a 2-year-old child]. / Un cas d'intoxication aiguë par la belladone (Atropa belladona) chez une enfant de 2ans.

Plant intoxications account for 5% of all intoxication cases according to French anti-poison centers. We report an uncommon case of intoxication with deadly nightshade (Atropa belladonna) in a 2-year-old child. The child presented at the ER with an atropinic syndrome, both central and peripheral, after ingestion of wild berries a few hours before. The fruit and leaves brought in by the mother allowed the anti-poison center to identify belladonna, in agreement with clinical findings. The child was kept in the intensive care unit for 48 h and progression was favorable with symptomatic treatment.

Pharmacological neuroprotective therapy for acute spinal cord injury: state of the art.

After spinal cord injury, a number of destructive events developed immediately after the primary insult increase tissue damage. Several therapeutic approaches are directed to neutralize these phenomena. The present manuscript revises diverse pharmacological treatments used to promote neuroprotection, both in clinical and experimental acute spinal cord injuries.

Vaccination with a neural-derived peptide plus administration of glutathione improves the performance of paraplegic rats.

After damage to the central nervous system (CNS) the body is protected by an adaptive immune response which is directed against myelin-associated proteins. Active immunization with nonpathogenic derivatives of CNS-associated peptides (DCAP) reduces the degeneration of neurons and promotes motor recovery after spinal cord injury (SCI) in rats. In order to improve even more the neurological outcome obtained with this therapy, either a combination of DCAP immunization plus glutathione monoethyl ester (GSHE) or a double DCAP immunization were performed. GSHE is a cell-permeant derivative of glutathione, a potent antioxidant agent that significantly inhibits lipid peroxidation after SCI. After a contusive or compressive SCI, the combination of GSHE + DCAP immunization, induced better motor recovery, a higher number of myelinated axons and better rubrospinal neuron survival than immunization alone. On the other hand, double-DCAP immunization counteracted the protective effect of DCAP therapy. Motor recovery and neuronal survival of double-immunized rats were similar to those observed in control animals (PBS-treated). Further studies revealed that double immunization was not encephalitogenic but inhibited the proliferative response of T-cells specific to the DCAP-immunized peptide. This clonal dysfunction was probably secondary to anergy. GSHE improves the protective effect induced by DCAP immunization while double immunization, reverts it.

Connective tissue disease due to intentional inhalation of scouring powder.

There have been reports in the literature of acute and chronic silicosis and connective tissue disease induced by occupational exposure to silica in factories producing scouring powder. Reports of connective tissue diseases induced by intentional inhalation of such a powder are rare and perhaps underestimated. We report the case of a young woman who developed Sharp's syndrome 5 yrs after diagnosis of acute silicosis due to scouring powder inhalation. The frequency of diseases from scouring powder as well as physiopathological and therapeutical issues of the association of pneumoconiosis and connective tissue disease are discussed.