Chronic mucocutaneous candidiasis: a case with exuberant cutaneous horns in nipples

Chronic mucocutaneous candidiasis is a rare disorder characterized by persistentand recurrent infections by Candida due to changes in cellular immunity and maybe associated with autoimmune endocrine disorders. It is refractory to the usualantifungal treatments, which merely control it with imidazole derivatives. Thisreports the case of a 50-year-old female patient who referred vaginal dischargeassociated with vulvar ulcerated lesions and whitish plaques on oral and genitalmucous membranes of onset in adolescence besides cutaneous horns in nipples. Theclinical picture, family history, culture and anatomopathological studies wereconsistent with chronic infection by candida. Treatment with systemicantifungals obtained partial response of lesions characterizing a clinicalpicture of Chronic Mucocutaneous Candidiasis.     

Prediction of neonatal metabolic acidosis in women with a singleton term pregnancy in cephalic presentation

We sought to predict neonatal metabolic acidosis at birth using antepartum obstetric characteristics (model 1) and additional characteristics available during labor (model 2). In 5667 laboring women from a multicenter randomized trial that had a high-risk singleton pregnancy in cephalic presentation beyond 36 weeks of gestation, we predicted neonatal metabolic acidosis. Based on literature and clinical reasoning, we selected both antepartum characteristics and characteristics that became available during labor. After univariable analyses, the predictors of the multivariable models were identified by backward stepwise selection in a logistic regression analysis. Model performance was assessed by discrimination and calibration. To correct for potential overfitting, we (internally) validated the models with bootstrapping techniques. Of 5667 neonates born alive, 107 (1.9%) had metabolic acidosis. Antepartum predictors of metabolic acidosis were gestational age, nulliparity, previous cesarean delivery, and maternal diabetes. Additional intrapartum predictors were spontaneous onset of labor and meconium-stained amniotic fluid. Calibration and discrimination were acceptable for both models (c-statistic 0.64 and 0.66, respectively). In women with a high-risk singleton term pregnancy in cephalic presentation, we identified antepartum and intrapartum factors that predict neonatal metabolic acidosis at birth.     

Perils of scaling up: Effects of expanding a nutrition programme in Madagascar

Scaling up integrated nutrition programmes from small, targeted interventions or pilot studies to large‐scale government‐run programmes can be challenging, with risks of changing the nature and quality of the interventions such that effectiveness is not sustained. In 1999, the Government of Madagascar introduced a nationwide, community‐based, growth‐monitoring and nutrition education programme, which was gradually scaled up throughout the country until 2011. Data from three nationally representative surveys, administered pre‐ and post‐programme implementation, in participating and non‐participating communities, were used to evaluate the effectiveness of the programme to reduce malnutrition in children under 5 after two phases of expansion (1999–2004 and 2004–2011). In our analyses, we compared “original” communities, who had initiated the programme during the first phase, and “new” communities, who initiated the programme during the second phase. “Original” communities demonstrated a significant effect on mean weight‐for‐age and on the prevalence of underweight by 2004; this effect was sustained at a reduced level through 2011. In contrast, “new” communities showed no benefits for any childhood nutritional outcomes. An explanation for these findings may be that community health workers in the “new” communities reported lower motivation and less use of key messages and materials than those in the “original” communities. Frontline workers reported increased workload and irregular pay across the board during the second phase of programme expansion. Our findings underscore the risk of losing effectiveness if programme quality is not maintained during scale‐up. Key factors, such as training and motivation of frontline workers, are important to address when bringing a programme to scale.     

Evaluation of a social network intervention on child feeding practices and caregiver knowledge

Food insecurity and poor infant and young child feeding (IYCF) practices contribute to undernutrition. The Kanyakla Nutrition Program was developed in rural Kenya to provide knowledge alongside social support for recommended IYCF practices. Utilizing a social network approach, the Kanyakla Nutrition Program trained community health workers (CHWs) to engage mothers, fathers, and grandparents in nutrition education and discussions about strategies to provide instrumental, emotional, and information support within their community. The 12‐week programme included six sessions and was implemented on Mfangano Island, Kenya, in 2014–2015. We analysed intervention effects on (a) nutrition knowledge among community members or CHWs and (2) IYCF practices among children 1–3 years. Nutrition knowledge was assessed using a postintervention comparison among intervention (community, n = 43; CHW, n = 22) and comparison groups (community, n = 149; CHW, n = 64). We used a quasi‐experimental design and difference‐in‐difference to assess IYCF indicators using dietary recall data from an ongoing cohort study among intervention participants (n = 48) with individuals living on Mfangano Island where the intervention was not implemented (n = 178) before the intervention, within 1 month postintervention, and 6 months postintervention. Findings showed no effect of the intervention on IYCF indicators (e.g., dietary diversity and meal frequency), and less than 15% of children met minimum acceptable diet criteria at any time point. However, knowledge and confidence among community members and CHWs were significantly higher 2 years postintervention. Thus, a social network approach had an enduring effect on nutrition knowledge, but no effects on improved IYCF practices.     

Biological significance of the antibody response to HIV antigens expressed on the cell surface

Summary Human antibodies to HIV antigens expressed on the surface of infected cells may inhibit cell fusion with uninfected CD 4-positive cells and mediate killing of the infected cells by effector cells bearing the Fc receptor.Sequential sera from ten HIV-antibody seroconverted men, of which five progressed to ARC or AIDS (CDC stage IV) during the follow-up period of two years, were tested for the ability to inhibit CD 4-dependent cell fusion, (CFI) and to mediate antibody-dependent cellular cytotoxicity (ADCC).Nine patients developed HIV-specific ADCC and seven CFI-antibodies using the HIV strain HTLV-IIIB as target antigen. These antibodies appeared approximately at the same time 2–12 months after primary infection, defined as antibody seroconversion or antigenaemia. ADCC antibodies were detectable at higher titers as compared to CFI-antibodies. All sera of asymptomatic individuals (CDC stage II and III) were CFI antibody positive and had a higher mean ADCC titer as compared to sera from patients progressing to AIDS or ARC.ADCC and CFI antibodies coincided in some cases in the complete absence of core antibodies. Because the relationship between ADCC and CFI was not exclusive it is concluded that distinct domains of the HIV envelope induce natural antibodies mediating ADCC and CFI.     

Sleep in post-menopausal women: Differences between early and late post-menopause

Objective

The aim of this study was to evaluate the differences in sleep between women of early and late post-menopause.

Study design

Thirty post-menopausal women who came to the climacteric service of their own volition were selected. Fourteen were in early post-menopause (less than 5 years after menopause), and sixteen were in late post-menopause (more than 5 years since menopause). None of the women were suffering from any other clinical diseases. Participants had no previous history of hormone therapy or hypnotic drug use. These patients were not previously selected with regard to any sleep complaints. All participants answered a sleep questionnaire and underwent a polysomnography recording.

Results

Subjective complaints included body pain, bruxism, anxiety, depression, lack of concentration, and sleepiness (measured by the Epworth Sleepiness Scale). These complaints were more frequent in the late post-menopause group. In contrast, complaints of memory impairment were more frequent in the early post-menopause group (p ≤ 0.05). Polysomnographic findings revealed no differences between the early and late post-menopause groups.

Conclusions

Although early menopause is associated with several symptoms, complaints related to sleep were higher in the late post-menopausal group.