Essential Oil of Deverra tortuosa Aerial Parts: Detailed Chemical Profile, Allelopathic, Antimicrobial, and Antioxidant Activities.

Essential oils (EOs) are a promising group of natural products of the aromatic plants due to their various biological effects such as allelopathic, antioxidant, antimicrobial activities. The present study aimed to construct the detailed chemical profile of the EO derived from Deverra tortuosa aerial parts along with assessing its allelopathic, antimicrobial, and antioxidant potentialities. The EO was extracted by hydrodistillation and analyzed via gas chromatography-mass spectrometry (GC/MS). The allelopathic activity of the EO was assessed against the germination and seedling growth of the weed Chenopodium murale. Also, the EO was tested against five microbes. The antioxidant activity was determined using the free radical 2,2-diphenyl-1-picrylhydrazyl (DPPH) and 2,2'-azinobis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS). The GC/MS analysis of EO revealed the presence of 86 compounds with a preponderance of oxygenated sesquiterpenes and monoterpene hydrocarbons. Widdrol, ß-phellandrene, piperitol, cubedol, α-terpinene, (E)-10-heptadecen-8-ynoic acid methyl ester, citronellyl tiglate, and m-cymene were the major compounds. A comparative profile was established between the EOs constituents of our study with the documented EOs of D. tortuosa and the other Deverra species around the world via agglomerative hierarchical clustering (AHC) and principal components analysis (PCA). The EO showed a substantial allelopathic activity against C. murale, as well as it showed considerable antimicrobial and antioxidant activities. Thereby, the EO of D. tortuosa could be considered as a promising environmental-friendly bioherbicide against weeds. Also, it could be integrated into food preservation due to its potent antimicrobial and antioxidant activities. However, further study is recommended for more characterization of the major compounds and evaluation of their activities, either singular or synergistic, and assess their efficiency and biosafety.

Clinical and microbiological features associated with group B Streptococcus bone and joint infections, France 2004-2014.

This study describes the clinical and microbiological features associated with group B Streptococcus (GBS) bone and joint infections (BJIs). It was a retrospective analysis of adult cases of GBS BJIs reported to the French National Reference Center for Streptococci from January 2004 to December 2014. Clinical data and GBS molecular characteristics are reported. Strains were collected from 163 patients. The most frequent comorbidities were: solid organ cancer (n = 21, 21%) and diabetes mellitus (n = 20, 20%). The main infection sites were knee (47/155 = 30%) and hip (43/155 = 27%), and occurred on orthopedic devices in 71/148 cases (48%). CPS III (n = 47, 29%), Ia (n = 26, 16%) and V (n = 40, 25%) were predominant. Resistance to erythromycin, clindamycin and tetracycline was detected in 55/163 (34%), 35/163 (21%) and 132/163 (81%) strains, respectively. The most frequent sequence types were ST-1 (n = 21, 25%), ST-17 (n = 17, 20%) and ST-23 (n = 11, 13%). The rate of resistance to erythromycin was 0% for ST-17 strains, 52% (n = 11) for ST-1 and 44% (n = 7) for ST-23 (p < 0.001). GBS bone and joint infections predominantly occur in patients aged >50 years and/or with comorbidities such as cancer and diabetes mellitus. CPS type distribution and MLST are very similar to that of other adult GBS invasive infections.

Hip Joint Infections Caused by Multidrug-Resistant Enterobacterales Among Patients With Spinal Cord Injury: Experience of a Reference Center in the Greater Paris Area.

Background: We aimed to describe the management and treatment of hip joint infections caused by multidrug-resistant Enterobacterales among patients with spinal cord injury (SCI). Methods: We included all hip joint infections associated with grade IV decubitus ulcers caused by extended-spectrum beta-lactamase producing Enterobacterales (ESBL-PE) and carbapenemase-producing Enterobacterales treated in a reference center for bone and joint infections over 9 years in a retrospective study. Results: Seventeen SCI patients with ischial pressure ulcers breaching the hip capsule (mean age 52 ± 15 years) were analyzed. In 16 patients, paraplegia was secondary to trauma and 1 was secondary to multiple sclerosis. Infections were mostly polymicrobial (n = 15; 88.2%), notably caused by Klebsiella pneumoniae (n = 10) and Staphylococcus aureus (n = 10). The carbapenemases identified were exclusively OXA-48-type (n = 3) including 2 isolates coexpressed with ESBL-PE within the same bacterial host. Multidrug-resistant Enterobacterales were commonly resistant to fluoroquinolones (n = 12; 70.6%). Most therapies were based on carbapenems (n = 10) and combination therapies (n = 13). Median duration of treatment was 45 (6-60) days. Of 17 cases of hip joint infections, 94.1% (n = 16) benefited from a femoral head and neck resection. Infection control was initially achieved in 58.8% (n = 10) of cases and up to 88.2% after revision surgeries, after a median follow-up of 3 (1-36) months. Conclusions: Hip infections among SCI patients caused by multidrug-resistant Enterobacterales are often polymicrobial and fluoroquinolones-resistant infections caused by Klebsiella pneumoniae and S aureus, highlighting the need for expert centers with pluridisciplinary meetings associating experienced surgeons, clinical microbiologists, and infectious disease specialists.

Purification of soybean cupins and comparison of IgE binding with peanut allergens in a population of allergic subjects.

Identification, purification and characterization of allergens is crucial to the understanding of IgE-mediated disease. Immunologic and structural studies with purified allergens is essential for understanding relative immunogenicity and cross-reactivity. In this work, the complex soybean 7S vicilins (Gly m 5) with three subunits and 11S legumins (Gly m 6) with five subunits were purified and characterized along with purified peanut allergens (Ara h 1, 2, 3, and 6) by label-free liquid chromatography-tandem mass spectrometry (LC-MS/MS). Individual subjects plasma IgE binding was tested from subjects allergic to soybeans and or peanuts by immunoblotting, ImmunoCAP™ and ISAC™ ImmunoCAP chip, comparing these soybean proteins with those of purified peanut allergens; vicilin (Ara h 1), 2S albumin (Ara h 2 and Ara h 6) and 11S globulin (Ara h 3). Results show differences between methods and subjects demonstrating the complexity of finding answers to questions of cross-reactivity.

Chikungunya associated with cutaneous ulcerations.

Chikungunya is a viral infection commonly causing fever and arthralgias, sometimes accompanied with myalgias and rash. We report a 72-year-old woman presenting with a 3-month history of painful cutaneous ulcerations on both legs, and discuss the cutaneous features associated with chikungunya.

Implementation of a simple innovative system for postprescription antibiotic review based on computerized tools with shared access.

BACKGROUND: Controlling antibiotic use in healthcare establishments limits their consumption and the emergence of bacterial resistance. AIM: To evaluate the efficiency of an innovative antibiotic stewardship strategy implemented over three years in a university hospital. METHODS: An antimicrobial multi-disciplinary team (AMT) [pharmacist, microbiologist and infectious disease specialist (IDS)] conducted a postprescription review. Specific coding of targeted antibiotics (including broad-spectrum ß-lactams, glycopeptides, lipopeptides, fluoroquinolones and carbapenems) in the computerized physician order entry allowed recording of all new prescriptions. The data [patient, antibiotic(s), prescription start date, etc.] were registered on an AMT spreadsheet with shared access, where the microbiologist's opinion on the drug choice, based on available microbiology results, was entered. When the microbiologist and pharmacist did not approve the antibiotic prescribed, a same-day alert was generated and sent to the IDS. That alert led the IDS to re-evaluate the treatment. FINDINGS: From 2012 to 2014, 2106 targeted antibiotic prescriptions were reviewed. Among them, 389 (18.5%) generated an alert and 293 (13.9%) were re-evaluated by the IDS. Recommendations (mostly de-escalation or discontinuation) were necessary for 136 (46.4%) and the prescribers' acceptance rate was 97%. The estimated intervention time was <30 min/day for each AMT member. This system allowed correct use of targeted antibiotics for 91.8% of prescriptions, but had no significant impact on targeted antibiotic consumption. CONCLUSION: This computerized, shared access, antibiotic stewardship strategy seems to be time saving, and effectively limited misuse of broad-spectrum antibiotics.

[Keratoderma palmoplantaris striata]. / Kératodermie palmo-plantaire striée.

Keratoderma palmoplantaris striata is a rare disease, with a well-defined clinical presentation which differentiates it from other cutaneous keratoses. Although there is a familial incidence, sporadic cases have been reported. Extracutaneous lesions have also been observed. We report a new case which responded well to retinoid therapy.

[Porphyria cutanea tarda and HIV-1 infection. 2 new cases]. / Porphyrie cutanée tardive et infection à VIH-1. Deux nouveaux cas.

We report two new cases of HIV-1 seropositive subjects who developed porphyria cutanea tarda (PCT). Laboratory examinations revealed a rise of uroporphyrin in the 24-hour urine and a fall of CD4 lymphocytes below 200/mm3 reflecting severe immuno-depression. Treatment with iterative phlebotomy resulted in regression of PCT. In both patients HIV seropositivity was discovered before PCT was diagnosed. Up to now, none of the hypotheses put forward concerning the exact role played by HIV in the genesis of PCT has been confirmed.

[Systemic sensitization to 17-beta estradiol induced by transcutaneous administration]. / Sensibilisation systémique au 17 beta-oestradiol induite par la voie transcutanée.

INTRODUCTION: Transdermal administration of drugs to obtain a systemic effect may lead to allergic sensitization and compromise subsequent use via another administration route. OBSERVATION: A 52-year-old woman presented contact eczema with the transdermal therapeutic system Estraderm TTS50. Generalized eczema developed later after oral administration of an oestrogen derivative. Skin tests demonstrated allergic sensitization to 17 beta-oestradiol. DISCUSSION: Contact eczema due to transdermal therapeutic systems are usually caused by agents other than the active drug. Sensitization to the active drug raises the risk of generalized eczema and subsequent systemic complications. This risk must be taken into account when prescribing substitution hormone therapy for menopause.

[Erythema multiforme caused by saquinavir]. / Erythème polymorphe au saquinavir.

BACKGROUND: Saquinavir is a protease inhibitor used for the treatment of HIV infection. Adverse skin reactions have been rare. We report here the first case of erythema multiforme in a patient given saquinavir. CASE REPORT: A 32-year-old man was seropositive for HIV and consulted due to the development of round maculo-papular lesions centered on a bulla and two erosive lesions of the palate five days after the introduction of saquinavir. Histology was compatible with erythema multiforme. After withdrawal of saquinavir, the skin and mucosal lesions regressed in 15 days, with no recurrence at 3 months. DISCUSSION: Adverse skin reactions to saquinavir are exceptional (eruptions, pruritus). We describe here the first case of erythema multiforme caused by saquinavir (imputability criteria 12 BO). Due to the structural analogy of saquinavir with other protease inhibitors (indiravir, ritonavir, nelfinavir) it would be difficult to prescribe a compound of the same class.

[Syphilitic labial leucokeratosis]. / Leucokératose labiale syphilitique.

BACKGROUND: Several diagnoses, including syphilis, can be entertained in patients with leukokeratosis of the buccal mucosa. We report a case of labial leucokeratosis which revealed latent syphilis. CASE REPORT: A 36-year-old man with a past history of genital syphilis chancre which have been treated 12 years earlier, developed buccal leucokeratosis with no other clinical manifestation. Histology showed dermal infiltration containing plasma cells, polynuclears and lymphocytes. Blood tests were positive for syphilis. Complementary examinations were unable to detect another localization. Leucokeratosis regressed completely after one injection of Extencilline. There has been no recurrence at one year. DISCUSSION: The clinical and histological presentations of syphilis can mimic different skin diseases. Serodiagnosis alone is significant. Isolated buccal lesions are rarely described in syphilis suggesting serodiagnosis should always be ordered. Whatever the clinical stage of the diseases, serological surveillance after treatment for syphilis is essential.

[Photosensitive prurigo in AIDS]. / Prurigo photodéclenché au cours du SIDA.

INTRODUCTION: A case of photosensitive prurigo during AIDs is reported. This is the second case in the literature. We discuss the relations between HIV infection and photodermatoses. OBSERVATIONS: A woman, known to be HIV seropositive from 1990, developed during the spring 1990 a prurigo on light exposed areas who received the next year. A photobiological investigation was performed, showing a polymorphic light eruption induced by UVB. DISCUSSION: Patients infected with HIV have a high prevalence of UV radiation responsive skin diseases. On the other hand, UVA radiations, UVB and UVC have been shown to induce activation and replication of HIV. PUVA therapy and UVB therapy have shown their efficacity in the treatment of many photodermatoses associated with HIV infection, without any worsening of the illness. Many questions are not yet solved in the relationship between HIV and photosensitivity and the photobiological investigation should be more frequently done.

[Recurrent phototriggered summer light eruption of the axillary and inguinal area: an atypical topographic form of benign summer lucitis]. / Eruption estivale photodeclenchée récidivante des régions axillaires et inguinales: une forme topographique atypique de lucite estivale bénigne.

UNLABELLED: INTRODUCTION This case report of benign summer light eruption emphasizes the importance of phototests in the diagnosis of photosensitive dermatoses. CASE REPORT: A 25-year-old man, phototype II, had experienced a pruriginous papulovesicular erythematous eruption of the axillary and inguinal regions each summer for 12 years. A high-dose UV phototest (40 J/cm2 x 3 days) directed on the right posterior axillary area and a whole body exposure test (4 J/cm2 UVA, 20 mJ/cm2 UVB x 3 days) were positive both clinically and histologically on day 4. DEM B was normal at 26 mJ/cm2. Iterative polychromatic phototest (DEM x 3 days) in the area usually involved (left posterior axillary region) was negative. The simple UVA (13 J/cm2) and iterative phototests performed on the back were negative. The results of the phototests led to the diagnosis of benign light eruption despite the unusual localization. DISCUSSION: The diagnosis of benign light eruption is generally clinical. Phototests are unnecessary in most cases. Benign light eruption can be triggered by high-dose iterative UVA exposure of the susceptible area or whole body phototests (UVA-UVB). These specific phototests are indicated in atypical forms or localizations in order to determine the course of benign light eruption and to uncover simulations.

[Actinic erythema, false innocuousness of UV.A]. / Erythème actinique, fausse innocuité des UV.A.

The number of skin cancers is doubled every ten years. The responsibility of excessive sun exposure is incontestable as much for what concerns spino and baso cellular epitheliomas as for malignant melanomas. Over-exposure to ultraviolet B rays was considered as the determining cause of skin cancer and the entire prevention campaign was limited to the safeguard from these rays only. In reality, ultraviolet B rays are not uniquely responsible. Recent studies show that ultraviolet A rays, previously considered innocuous, are on the contrary aggressive as well and in a very deceiving way: it appears that it is the exposure to these rays in weak but repeated doses which are the most dangerous. It appeared that the visually determined value of MED was unchanged but the minimal dose responsible for color changes detectable with chromameter was decreased in the presence of UV.A for 3 subjects out of 4. This decrease was about 50% of the value obtained with UV.B alone. The strategy of protection needs to be completely reconsidered, particularly because today's lifestyle favors the exposition to ultraviolet A rays. There is an increase in exposure to UV.A rays when protection is limited only against ultraviolet B rays, giving a false sense of security especially to those who frequent tanning salons. It is therefore necessary to limit exposure time, use sunscreens protecting against not only UV.B, but also UV.A rays, and prohibit tanning salons. Public educational measures are inexistant, but should be introduced hastily in all public services.