Most chilblains observed during the COVID-19 outbreak occur in patients who are negative for COVID-19 on polymerase chain reaction and serology testing.

BACKGROUND: Acral lesions, mainly chilblains, are the most frequently reported cutaneous lesions associated with COVID-19. In more than 80% of patients tested, nasopharyngeal swabs were negative on reverse transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2 when performed, and serology was generally not performed. METHODS: A national survey was launched on 30 March 2020 by the French Society of Dermatology asking physicians to report cases of skin manifestations in patients with suspected or confirmed COVID-19 by using a standardized questionnaire. We report the results for acral manifestations. RESULTS: We collected 311 cases of acral manifestations [58.5% women, median age 25.7 years (range 18-39)]. The most frequent clinical presentation (65%) was typical chilblains. In total, 93 cases (30%) showed clinical suspicion of COVID-19, 67 (22%) had only less specific infectious symptoms and 151 (49%) had no clinical signs preceding or during the course of acral lesions. Histology of skin biopsies was consistent with chilblains. Overall, 12 patients showed significant immunological abnormalities. Of the 150 (48%) patients who were tested, 10 patients were positive. Seven of 121 (6%) RT-PCR-tested patients were positive for SARS-CoV-2, and five of 75 (7%) serology-tested patients had IgG anti-SARS-CoV-2. Tested/untested patients or those with/without confirmed COVID-19 did not differ in age, sex, history or acral lesion clinical characteristics. CONCLUSIONS: The results of this survey do not rule out that SARS-CoV-2 could be directly responsible for some cases of chilblains, but we found no evidence of SARS-CoV-2 infection in the large majority of patients with acral lesions during the COVID-19 lockdown period in France. What is already known about this topic? About 1000 cases of acral lesions, mainly chilblains, were reported during the COVID-19 outbreak. Chilblains were reported to occur in young people within 2 weeks of infectious signs, which were mild when present. Most cases did not have COVID-19 confirmed by reverse transcription polymerase chain reaction (RT-PCR), and few serology results were available. What does this study add? Among 311 patients with acral lesions, mainly chilblains, during the COVID-19 lockdown period in France, the majority of patients tested had no evidence of SARS-CoV-2 infection. Overall, 70 of 75 patients were seronegative for SARS-Cov-2 serology and 114 of 121 patients were negative for SARS-CoV-2 RT-PCR.

How do mobile health applications support behaviour changes? A scoping review of mobile health applications relating to physical activity and eating behaviours.

OBJECTIVE: The objective of this review was to analyse how researchers conducting studies about mobile health applications (MHApps) effectiveness assess the conditions of this effectiveness. STUDY DESIGN: A scoping review according to PRIMSA-ScR checklist. METHODS: We conducted a scoping review of efficacy/effectiveness conditions in high internal validity studies assessing the efficacy of MHApps in changing physical activity behaviours and eating habits. We used the PubMed, Web of Science, SPORTDiscus and PsycINFO databases and processed the review according to the O'Malley and PRISMA-ScR recommendations. We selected studies with high internal validity methodologies (randomised controlled trials, quasi-experimental studies, systematic reviews and meta-analyses), dealing with dietary and/or physical activity behaviours; covering primary, secondary or tertiary prevention and dealing with behaviour change (uptake, maintenance). We excluded articles on MHApps relating to high-level sport and telemedicine. The process for selecting studies followed a set protocol with two authors who independently appraised the studies. RESULTS: Twenty-two articles were finally selected and analysed. We noted that the mechanisms and techniques to support behaviour changes were poorly reported and studied. There was no explanation of how these MHApps work and how they could be transferred or not. Indeed, the main efficacy conditions reported by authors refer to practical aspects of the tools. Moreover, the issue of social inequalities was essentially reduced to access to the technology (the shrinking access divide), and literacy was poorly studied, even though it is an important consideration in digital prevention. All in all, even when they dealt with behaviours, the evaluations were tool-focused rather than intervention-focused and did not allow a comprehensive assessment of MHApps. CONCLUSION: To understand the added value of MHApps in supporting behaviour changes, it seems important to draw on the paradigms relating to health technology assessment considering the characteristics of the technologies and on the evaluation of complex interventions considering the characteristics of prevention. This combined approach may help to clarify how these patient-focused MHApps work and is a condition for improved assessment of MHApps in terms of effectiveness, transferability and scalability.

[Primary and secondary prevention of cancer in women: How can awareness be improved? A literature review]. / Prévention primaire et secondaire des cancers féminins : comment améliorer la sensibilisation des femmes ? Une revue de la littérature.

BACKGROUND: Cancer in women is a major public health concern especially since primary and secondary prevention can reduce mortality. Institutional interventions could play an important role by working directly with healthcare providers. Thus, the objective of this literature review is to draw up an inventory of the interventions proposed to promote the prevention of breast and cervical cancer and to analyze their feasibility or applicability in the French institutional context. METHODS: The literature review was conducted on Cairn, Cochrane, PubMed and ScienceDirect databases with relevant keywords. RESULTS: Forty articles were selected. Interventions focusing on breast and cervical cancer have been quite similar. The format is usually a written document presenting a personalized letter inviting the recipient to participate in a screening program. Paper or call reminders are pivotal tools. Educational groups involving a few sessions, as well as individual education, are particularly important to increase women's knowledge about lesser known prevention behaviors (ex. breast self-examination). CONCLUSION: This work points out concrete ways to establish relevant actions for secondary prevention of cancer in women. A personalized approach (ex., sending personalized letters) appears to be a relevant lever to incite women to participate.

Study protocol for a pragmatic randomised controlled trial evaluating efficacy of a smoking cessation e-'Tabac Info Service': ee-TIS trial.

INTRODUCTION: A French national smoking cessation service, Tabac Info Service, has been developed to provide an adapted quitline and a web and mobile application involving personalised contacts (eg, questionnaires, advice, activities, messages) to support smoking cessation. This paper presents the study protocol of the evaluation of the application (e-intervention Tabac Info Service (e-TIS)). The primary objective is to assess the efficacy of e-TIS. The secondary objectives are to (1) describe efficacy variations with regard to users' characteristics, (2) analyse mechanisms and contextual conditions of e-TIS efficacy. METHODS AND ANALYSES: The study design is a two-arm pragmatic randomised controlled trial including a process evaluation with at least 3000 participants randomised to the intervention or to the control arm (current practices). Inclusion criteria are: aged 18 years or over, current smoker, having completed the online consent forms, possessing a mobile phone with android or apple systems and using mobile applications, wanting to stop smoking sooner or later. The primary outcome is the point prevalence abstinence of 7 days at 6 months later. Data will be analysed in intention to treat (primary) and per protocol analyses. A logistic regression will be carried out to estimate an OR (95% CI) for efficacy. A multivariate multilevel analysis will explore the influence on results of patients' characteristics (sex, age, education and socioprofessional levels, dependency, motivation, quit experiences) and contextual factors, conditions of use, behaviour change techniques. ETHICS AND DISSEMINATION: The study protocol was reviewed by the ethical and deontological institutional review board of the French Institute for Public Health Surveillance on 18 April 2016. The findings of this study will allow us to characterise the efficacy of e-TIS and conditions of its efficacy. These findings will be disseminated through peer-reviewed articles. TRIAL REGISTRATION NUMBER: NCT02841683; Pre-results.

[Eruptive pseudoangiomatosis in an adult renal transplant recipient]. / Pseudo-angiomatose éruptive chez un adulte transplanté rénal.

BACKGROUND: In 1969, Cherry et al. described four children with acute onset angioma-like papules with spontaneous regression during an acute viral infection. Similar cases, called eruptive pseudoangiomatosis, have been reported since and considered to be a viral exanthema. We observed a similar eruption in a 48-year-old male kidney transplant recipient. CASE REPORT: One month after kidney transplantation, the patient rapidly developed macules and papules on the trunk. He had unexplained fever 15 days before the eruption. A biopsy specimen revealed dermal blood vessels surrounded by lymphoid infiltrate. Serology tests were unable to identify any virus. The lesions resolved spontaneously within 15 days. DISCUSSION: In our patient, eruptive pseudoangiomatosis was diagnosed on the basis of the clinical and histological features and the disease course. This case demonstrates that the entity is not limited to children. Further cases should be studied to determine the precise pathogenics of this uncommon entity.

[Mucinous carcinoma of the prostate: critical review of Elbadawi's criteria]. / Carcinoma mucinoso de la próstata: revisión crítica de los criterios de Elbadawi.

OBJECTIVES: We present our experience on prostatic mucinous adenocarcinoma and at once we practice an actualization and a critical review of Elbadawi's criteria. METHODS: After reviewing 206 prostatic carcinomas diagnosed in our hospital, we describe one case that fulfill criteria for being considered a prostatic mucinous adenocarcinoma. We also carry out a wide literature review trying to define anew the including criteria of this tumour by the light of modern knowledge and technology. CONCLUSIONS: We think that for accepting a tumour as a prostatic mucinous adenocarcinoma, this have to fulfill the following criteria: 1. "More than 25% of a significative tumoral sample is mucinous pattern and present, single or clustered, tumour cells floating in immunohistochemically probed, acidic and neutral, mucin lakes". 2. "Tumour is Gleason 3-4 cribiform pattern with direct transition to colloid areas and usually coexist with classic adenocarcinoma but papillary growth patterns should be excluded. Tumour may contain a moderate proportion of signet-ring cells". 3. "Immunohistochemical staining for PSA have to be strongly positive in both, cribiform and mucinous, areas". 4. "Those PSA nonreactive, or only focally positive, mucinous adenocarcinomas, could be labeled as prostatic only when local or distant mucinous carcinomas are ruled out".

A case of dyskeratosis congenita associated with impaired DNA repair as shown by the comet assay.

An 18-year old boy with dyskeratosis congenita is presented. To examine the DNA metabolism of our patient, we applied the comet assay, a simple, quick and sensitive method that so far has not been used in this disease. After exposure to UVB, cells originating from the patient present abnormal DNA repair localized in the late step. We consider that such repair deficiency could be related to susceptibility to cancer. The comet assay seems to be a good procedure to investigate dyskeratosis congenita or other genodermatoses.

[Pilar dysplasia: an early marker of giant axonal neuropathy]. / Dysplasie pilaire: un marqueur précoce de la neuropathie à axones géants.

BACKGROUND: Giant axonal neuropathy is an autosomal recessive condition characterized by progressive degeneration of the central and peripheral nervous system. Sensoromotor neuropathy develops around 3 years of age. Children have particular faces with curly hair. Characteristic pilar anomalies occur early and have diagnostic value. CARE REPORT: An Algerian boy born to consanguineous parents (first cousins) had language retardation and gait disorders developed around 3 years of age. At 9 years, the child was in a cachetic state with valgus feet, amyotrophy and diminished muscle force predominating distally, ataxia, areflexia, sensoromotor neuropathy and nystagmus. Skin tropism was altered with pale, thin and dry skin, cold, cyanotic limbs and thick curly hair. Electrophysiology explorations showed signs of chronic sensoromotor polyneuropathy with axonal predominance. Brain and spinal MRI revealed cerebellar atropy and signs of leukodystrophy. The spinal tap was normal. A neuromuscular biopsy confirmed the diagnosis of giant axonal neuropathy. At examination the hair was thick with reduced refrangibility and a pseudo-pili torti aspect. DISCUSSION: Giant axonal neurpathy is characterized by anomalous organization of the cytoskeleton of intermediary filaments in different types of cells. Hair anomalies occur early, before onset of neurological signs. At gross examination the hair is thick and curly, sometimes crimped and pale. Examination of the pilar shaft shows trichorrhexis nodosa, scalloped fringes and lack of internal structure. On the molecular level, there is a reduction in the number of bisulfur bridges which could be the cause of defective keratin filament alignement. Pathogenicaly, the pilar anomalies are considered as a direct manifestation of defective keratin organization characteristic of the disease.

[Use of the urologic resectoscope in the treatment of rectal pathology. Analysis of our experience and review of the literature]. / Utilización del resector urológico en el tratamiento de patología rectal. Análisis de nuestra experiencia y revisión de la literatura.

Treatment of rectal polypoid disease, particularly villous adenoma, by electrocoagulation has proven its efficacy in a large number of cases. However, it does not permit adequate control or analysis of the specimen because the morbid excrescence is destroyed. Transsphincteric or transanal surgery, anterior resection or abdominoperineal amputation are generally too aggressive for a recurrent but benign condition. The enhanced efficacy of other therapeutic modalities such as chemo-, immuno- or radiotherapy will undoubtedly be beneficial to conservative surgical management of a malignant rectal pathology. Our initial experience in 15 patients with different rectal tumors is reported. These patients were treated by endoscopic transanal resection (ETAR) utilizing the urologic resectoscope. Local control of the disease process was achieved in 66.6% of the cases with scant morbidity and a mortality rate of 7.3% (1 case). The foregoing results and those reported in the literature indicate that ETAR is a valid alternative surgical procedure for definitive treatment of sessile, villous, or mixed adenomatous polyps and certain cases of rectal adenocarcinoma. Moreover, this procedure has proved effective as palliative treatment in advanced rectal adenocarcinoma and obviates the need for stomas.

[Symptomatic simple cyst of the kidney. Treatment using puncture-aspiration and sclerosis with 95% ethanol]. / Quistes renales simples sintomáticos. Tratamiento mediante punción-aspiración y esclerosis con etanol 95 por 100.

Puncture of cystic renal masses is useful in diagnosing a small number of cases when commonly used imaging techniques cannot determine the benign nature of the liquid mass with total accuracy. It can also be used as a therapeutic procedure in those cases with symptomatology arising from the presence of a renal cyst or functional alterations. In the present study, we report our experience using puncture-aspiration and sclerosis with 95% ethanol instillation in 12 renal cysts causing different symptoms. The procedure achieved good overall results with practically no complications. In 10 of the 12 cases the procedure was performed on an outpatient basis.

[Adrenal gland myelolipoma: apropos of a case]. / Mielolipoma suprarrenal: a propósito de un caso.

The myelolipoma is an uncommon benign tumour of the suprarrenal gland, composed of fat and hematopoietic tissue. We submit a case diagnosed preoperatively by means of echography and T.A.C. and treated surgically with tumoural excision. The gland was preserved to a large extent. We comment on etiopathogenic and diagnostic aspects.

[Incomplete bladder partition. Comments. A clinical case]. / Tabique vesical incompleto. Comentarios. A un caso clínico.

The authors present a rare case of incomplete vesical partition wall in a 59 years old woman, with mictional troubles and repeated cystitis which was surgically resolved by the abdominal way with excellent results. They finally review the different possibilities of vesical partition.