Evaluation of a school-based sun safety education program in Reunion Island, 2016-2017.

BACKGROUND: Sun exposure, especially during childhood, is the main environmental risk factor for skin cancers. This study evaluated the impact of the school-based sun safety education program "Living with the Sun" on the knowledge and behavior of primary school children regarding sun safety in Reunion Island. METHODS: This multicenter, comparative intervention study was conducted in selected primary schools of Reunion during the 2016-2017 school year. The intervention consisted of an in-class slide-show presentation on sun safety, a teaching guide, and school trips during which children were offered sunscreen and were requested to wear sunglasses, a T-shirt, and a cap. The children completed a questionnaire before and after the intervention. The percentage of children wearing a cap in school playgrounds at the end of the school year was compared between paired intervention and control schools. RESULTS: Seven hundred children from 7 Reunionese schools completed the questionnaire before and after the intervention. There was a statistically significant improvement in children's knowledge of sun safety, with differences between schools, teachers, school levels, and questionnaire responses. The percentage of children wearing a cap at the end of the school year was significantly higher in intervention schools compared to control schools. CONCLUSIONS: Children's knowledge and behavior regarding sun safety improved significantly as a result of the intervention.

[American histoplasmosis: clinicopathological features in immunocompetent and immunocompromised patients. A report of two cases of infection by Histoplasma capsulatum on Reunion Island]. / Histoplasmose : aspects clinicopathologiques chez l'immunocompétent et l'immunodéprimé. À propos de deux cas d'infection à Histoplasma capsulatum sur l'Île de la Réunion.

INTRODUCTION: Histoplasmosis is a fungal infection caused by Histoplasma capsulatum var. capsulatum. It shows pulmonary or multivisceral involvement. Infective spores are inhaled from soils that contain bat or bird guano. The clinical picture depends on the intensity of the exposure and the immune status of the host. CASE REPORTS: We report two cases of histoplasmosis that reflect its variability in clinical and histopathological expression: a pseudo-tumoral nodular form or histoplasmoma in a pauci-symptomatic immunocompetent patient and a disseminated form with severe respiratory and mucocutaneous involvement in an immunocompromised patient. The histoplasmoma presented as a spiculated, hypermetabolic, solitary pulmonary nodule. Histopathological examination showed well-formed epithelioid granulomas with caseous central necrosis containing numerous histoplasma yeasts. In the patient with disseminated infection, the diagnosis was confirmed by seeing yeast forms in bronchoalveolar lavage fluid and skin biopsy. CONCLUSIONS: These patients are the second and third cases of histoplasmosis reported on Reunion Island. Both had traveled in endemic areas several years previously. The most likely pathophysiological mechanism is the reactivation of an old latent infection. There is, therefore, no argument at present in favor of the presence of contaminated soils on Reunion Island.

[Membranous glomerulonephritis as a paraneoplastic manifestation of melanoma]. / Glomérulonéphrite extramembraneuse paranéoplasique au cours d'un mélanome.

BACKGROUND: Membranous glomerulonephritis (MG) is generally idiopathic. Causes of secondary MG (15 % of cases), namely solid or haematological cancers, are common, with parallel development between the two diseases suggesting paraneoplastic syndrome. However, paraneoplastic syndrome is rare in melanoma. We report a case of a patient with stage III melanoma presenting MG developing in parallel to the melanoma. PATIENTS AND METHODS: A 61-year-old man was referred for melanoma on the right side with a Breslow index of 3mm, and without ulceration. While the patient had no adenopathy, he was presenting severe hypertension diagnosed two months earlier as well as diffuse pitting oedema, with weight gain of 15kg in one month. Additional treatment of the patient's melanoma included extended excision, examination of the two right axillary sentinel nodes (positive), and axillary lymph node dissection revealing four more metastatic nodes. A thoracic-abdominal-pelvic CAT scan showed no further metastasis. Investigation of the oedema revealed nephrotic syndrome with hypoalbuminaemia of 14g/L and proteinuria of 5g/24h. Renal biopsy resulted in the diagnosis of MG. Histological and immunohistochemical examination (HMB-45, Melan A, S100 protein) showed no tumour cells in the kidney, and urinary cytology was negative. Non-tumoral causes of MG were thus ruled out. The oedema regressed rapidly following surgical treatment of the melanoma, with no specific renal or oncological treatment being given. Two years after axillary lymph node dissection, the patient was in complete remission of his melanoma and renal tests showed spontaneous regression of nephrotic syndrome, with disappearance of the oedema, normalisation of blood pressure and gradual correction of serum albumin (40g/L) and proteinuria (1g/24h). DISCUSSION: Paraneoplastic MG has been described particularly in patients with gastrointestinal and pulmonary cancer. To our knowledge, this is only the second case associated with melanoma. Our report suggests the need for routine cutaneous examination as part of the initial investigations for MG.