Abstract A 27 year old female with acquired immunodeficiency syndrome (AIDS) developed tender erythematous nodules on her thighs. A skin biopsy of the lesions showed septal panniculitis and venulitis and Pseudomonas species was cultured from both the urine and the skin biopsy tissue. The lesions resolved on antibiotic therapy. Panniculitic nodules may represent an early stage of ecthyma gangrenosum which is a well recognised cutaneous complication of pseudomonas septicaemia.
The aim of this study was to estimate the heritability of and environmental contributions to skeletal muscle phenotypes (appendicular lean mass and calf muscle cross-sectional area) in subjects of African descent and to determine whether heritability estimates are impacted by sex or age. Body composition was measured by dual-energy X-ray absorptiometry and computed tomography in 444 men and women aged 18 yr and older (mean: 43 yr) from eight large, multigenerational Afro-Caribbean families (family size range: 21-112). Using quantitative genetic methods, we estimated heritability and the association of anthropometric, lifestyle, and medical variables with skeletal muscle phenotypes. In the overall group, we estimated the heritability of lean mass and calf muscle cross-sectional area (h(2) = 0.18-0.23, P < 0.01) and contribution of environmental factors to these phenotypes (r(2) = 0.27-0.55, P < 0.05). In our age-specific analysis, the heritability of leg lean mass was lower in older vs. younger individuals (h(2) = 0.05 vs. 0.23, respectively, P = 0.1). Sex was a significant covariate in our models (P < 0.001), although sex-specific differences in heritability varied depending on the lean mass phenotype analyzed. High genetic correlations (rho(G) = 0.69-0.81; P < 0.01) between different lean mass measures suggest these traits share a large proportion of genetic components. Our results demonstrate the heritability of skeletal muscle traits in individuals of African heritage and that heritability may differ as a function of sex and age. As the loss of skeletal muscle mass is related to metabolic abnormalities, disability, and mortality in older individuals, further research is warranted to identify specific genetic loci that contribute to these traits in general and in a sex- and age-specific manner.
A59 Between 1990 and 2010, the International Agency for Research on Cancer (IARC) predicts a 60% increase in the number of cancer deaths in developing countries, versus a 30% increase in developed countries. Cancer is among the top five leading causes of death in the Caribbean islands and Africa. In the United States (US), cancer mortality rates are highest among African Americans. For several years, ongoing collaborations on prostate, breast and cervical cancer have been conducted by faculty at the University of Pittsburgh in collaboration with investigators from University and Centers located in the Caribbean islands and Africa. In an effort to narrow the disparities in these populations, the African-Caribbean Cancer Consortium (AC3) was constituted in May 2007 as part of the Caribbean Health Research Council, 52nd Annual Council and Scientific Meeting. Currently, ongoing studies conducted by the AC3 members include prostate cancer studies in Grenada, Trinidad and Tobago, Jamaica and Nigeria; cervical cancer studies in Jamaica, Tobago and Nigeria; a breast cancer study in Nigeria; the Barbados National Cancer Study (of prostate and breast cancers) in Barbados; studies of cancer risk among immigrant Caribbean populations in New York; investigations of the perception of the HPV vaccine (in the Caribbean and US); and assessments of current screening programs for common cancers in St. Kitts and Nevis. The overall purpose of the AC3 is to provide a forum for the development and coordination of collaborations between the investigators from the US, Caribbean and Africa to study viral, genetic and environmental cancer risk factors across these minority populations. The Consortium will hold a conference in the Spring of 2008, aimed at bringing together faculty members from US institutions as well as those from Universities and Centers in the Caribbean islands and Africa. The primary goal of this conference is to develop new collaborative studies between the consortium members. The conference will serve as a medium for the participating investigators to 1) present their data 2) describe the health resources, screening and other preventive activities present in their country and 3) to formally discuss the coordination of future collaborations in order to conduct studies of cancer risk across these minority populations. The data that will be presented at this meeting would support initial proposals for studies focusing on viruses and cancer, particularly cervical and prostate cancer. However, the goal is to develop into a broad-based resource for studies related to all aspects of the etiology, prevention and treatment of cancer in these populations. The AC3 will address a significant need for studies related to cancer in individuals of African descent. Such a forum will lead to the development of pooled and/or multi-centered studies for the investigation of cancer in minority populations where cancer research is limited. The opportunities for expanding collaborative studies involving populations of African descent will advance scientific knowledge of the roles that viral and other environmental risk factors, along with genetic risk factors play in cancer etiology among minority populations. The AC3 conference is funded by the NIH/R13 CA130596A and also in part by the NIH/NCRR 1KL2 RR024154-02 awards.
Abstract Previous literature suggests an association between the use of biologics and the development of keratinocyte carcinoma in psoriasis. Our aim was to evaluate the risks of developing basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (SCC) in patients with moderate-to-severe psoriasis treated with biologic therapy compared with those receiving nonbiologic systemic therapy. We used data from BADBIR, a multicentre register evaluating the long-term safety and effectiveness of systemic therapy for patients with moderate-to-severe psoriasis, between September 2007 and November 2023. Data are linked with additional keratinocyte carcinoma events recorded in NHS Digital. Patients (Fitzpatrick skin types I–IV) with chronic plaque psoriasis, who were biologic naive at registration to BADBIR, with no history of any cancer, and who had completed at least one follow-up visit, were eligible for study inclusion. To balance between the compared groups in their baseline characteristics, we calculated probability-weighted regression adjustment estimators with a propensity score model including age, sex, previous acitretin, previous ciclosporin, and number of courses of psoralen and ultraviolet A or narrowband ultraviolet B. These weights were therefore used in a flexible parametric survival model to estimate hazard ratios (HRs) for developing incident BCC and SCC, using imputed data. In total, there were 9303 patients (67%) registered to the biologic cohort and 4622 patients (33%) in the nonbiologic systemic cohort. The biologic cohort was older (median age 44 years, interquartile range 35–53) vs. median 42 years, interquartile range 32–53), with more men (58% vs. 56%) and comorbidities (68% vs. 61%) compared with those in the nonbiologic systemic cohort. Patients in the biologic cohort contributed 62 141 and 62 433 person-years of follow-up for the BCC and SCC analyses, respectively, while patients in the nonbiologic systemic cohort contributed 19 565 and 19 592 person-years of follow-up. In total, 119 patients (1.3%) developed first BCC and 60 patients (0.6%) developed first SCC in the biologic cohort during follow-up. In the nonbiologic systemic cohort, 28 patients (0.6%) developed first BCC, with 17 patients (0.4%) developing first SCC. These differences in risk of developing first BCC or SCC were not statistically significant between the two cohorts: for BCC, adjusted hazard ratio (aHR) 1.18, 95% confidence interval (CI) 0.71–1.95; and for SCC, aHR 0.91, 95% CI 0.41–1.73. The findings from these real-world data showed no increased risk of BCC or SCC for biologic-treated patients compared with those receiving nonbiologic systemic therapy. However, caution is needed in interpreting the current findings due to the small number of first events. This study is funded by the Psoriasis Association.
The impact of skin disease can be profound. Itch may interfere with sleep. Real or perceived cosmetic disfiguration can cause psychosocial and sexual dysfunction. Activities of daily living or ability to walk can be impaired. Determination of disease impact can influence treatment decisions. Skin symptoms include itch, rash, lump, ulceration, cracking, blistering, redness, scaling, flushing, pain, body-image issues, hair loss and nail changes. Drugs rashes are common; all medications taken must be identified. Some may be volunteered, such as over-the-counter treatments, herbal agents or illicit drugs. Endocrine assessment is needed if there is evidence of polycystic ovarian syndrome or Cushing's syndrome. Use high-dose prednisolone, with adjuvant steroid-sparing agents; cyclophosphamide, rituximab and IVIG are alternatives. Pseudomonas infection can cause otitis externa, folliculitis with systemic symptoms and necrotic ulcers in immunocompromised individuals. Frequently affects groins and feet; flexural involvement manifests with macerated erythema with a scaly edge.
Abstract QCT provides a measure of volumetric BMD (vBMD) and distinguishes trabecular from cortical bone. Few studies have determined the factors related to vBMD in men, especially among men of African heritage. This study evaluated the relationship of anthropometric, medical, and behavioral factors and vBMD in a population-based cohort of men of African ancestry (n = 1901) ≥40 yr of age who had undergone screening for prostate cancer for the first time. Trabecular and cortical vBMD were measured at the radius and tibia by pQCT. Multiple linear regression analysis identified age, height, body weight, cigarette smoking, history of diabetes, fracture, and prostate cancer as the independent correlates of vBMD. However, associations with several variables differed between cortical and trabecular vBMD and between the radius and tibia. Longitudinal studies are needed to gain a better understanding of the mechanisms underlying these differential associations that may show new insight into the etiology of trabecular and cortical bone loss in men.
A 32‐year‐old woman presented with a 2‐year history of recurrent cellulitis of the middle finger of her left hand. She had been seen on four or five occasions in the accident and emergency, general medical, orthopaedic, and plastic surgery departments. At each episode, she had presented with cellulitis and lymphangitis, and painful lymphadenopathy of the left axilla. She had been treated with multiple courses of oral and intravenous antibiotics, requiring seven admissions; each episode resolved after 10–21 days. Wound swabs, blood cultures and fungal cultures were repeatedly negative. Prolonged tissue culture for acid‐fast bacilli had also been negative. X‐rays of the left middle finger showed no bony abnormality. A magnetic resonance imaging scan of her left hand had shown high signal within the soft tissue of the middle finger, consistent with oedema. A nailfold biopsy had shown epithelial hyperplasia and underlying granulation tissue, with no evidence of neoplasia or granulomatous inflammation.
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