Clinical Characteristics of Systemic Lupus Erythematosus in Caucasians and Latin American Hispanics: Data from a Single Tertiary Center.

To determine if there are ethnic differences in the prevalence of antiphospholipid syndrome (APS), clinical presentation and autoantibody profile between Roma and Caucasian patients with systemic lupus erythematosus (SLE). A cross-sectional study was conducted including data from Roma and Caucasian SLE patients consecutively attending six hospitals in Spain. Socio-demographic characteristics, prevalence of APS, clinical and analytical features of SLE and APS were compared between ethnic groups. Data from 52 Roma and 98 Caucasian SLE patients were included. Roma SLE patients had a higher risk (odds ratio 2.56, 95% CI 1.02-6.39) and prevalence of APS (28.8% vs. 13.3%, P=0.027). Furthermore, Roma SLE patients had a statistically significant higher prevalence of abortions (23.5% vs. 10.2%, P=0.049). In relation to other APS diagnostic criteria, Roma SLE patients had a non-statistically significant higher prevalence of fetal deaths (14.3% vs. 5.1%, P=0.106) and thrombotic events (21.1% vs. 12.2%, P=0.160). In relation to SLE clinical features, Roma patients had a significantly higher prevalence of arthritis (75% vs. 57.1%, P=0.034) and non-significant higher prevalence of serositis (44.2% vs. 29.6%, P=0.104), discoid lesions (11.5% vs. 5.1%, P=0.191), oral ulcers (46.1% vs. 34.7%, P=0.218) and livedo reticularis (21.1% vs. 15.3%, P=0.374). No statistically significant differences were found in the Systemic Lupus International Collaborating Clinics Damage Index or the autoimmune serological profile. Prevalence and risk of APS were significantly higher in Roma SLE patients. Furthermore, Roma patients had a significantly higher prevalence of abortions and a non-significant higher prevalence of fetal deaths and thrombotic events.

Impact of Race on Outcomes in Intermediate Risk Acute Myeloid Leukemia

Hispanic Ethnicity as a Predictor of Voice Therapy Adherence

Basal cell carcinoma (BCC) is the most common malignancy worldwide. While most BCCs are treated surgically, advanced BCCs are often treated with gene-targeted therapies. While there has been a lot of research in BCC from Caucasian patients, research is lacking in patients with skin of color. To identify potential variations in BCC gene mutations between Asian, Hispanic, and Caucasian patients. A cohort study was performed from 2015 to 2017 with 23 patients treated for BCC at an urban academic hospital. Gene mutations were assessed using a targeted mutation panel for 76 cancer-associated genes from formalin-fixed paraffin-embedded (FFPE) samples. Groups studied comprised Asian (n=5), Hispanic (n=10), and Caucasian (n=8) patients. The Hispanic cohort had the highest number of mutations per patient on average (3.4 versus 2.8 for both Caucasian and Asian cohorts). GATA3 mutations were more prevalent in Hispanic patients (P=0.02, single factor ANOVA). ARID1A and PTEN mutations co-occurred in the Hispanic cohort (P<0.05). The most common mutation in the Asian cohort was TP53 (2/5). The Caucasian cohort had the highest percent of UVB mutations (68.4%). This study shows potential differences in the prevalence of somatic gene mutations for BCC patients of different races and ethnicities, which could inform the underlying pathogenesis, impact the efficacy of therapies in specific populations, and may also help identify novel therapeutic targets. J Drugs Dermatol. 20(5): doi:10.36849/JDD.5884.

Despite a high prevalence of hypertension in the population with CAD, there are limited data describing the clinical characteristics and treatments, as well as their interrelations in these patients. This is particularly true for black and Hispanic patients who have been underrepresented in randomized CAD trials. There exist racial and ethnic differences that define the characteristics of patients with both coronary artery disease (CAD) and hypertension. This report describes the characteristics of Caucasian, Hispanic, and black patients enrolled in the International Verapamil SR/trandolapril Study (INVEST), a prospective trial undertaken exclusively in patients with CAD and hypertension. In all, 10,925 Caucasian, 8,045 Hispanic, and 3,029 black patients are described. An abnormal angiogram or documented myocardial infarction was observed more frequently in Caucasian patients (73%), while angina pectoris was more prevalent in Hispanic patients (87%). Diabetes and left ventricular hypertrophy were most common in black patients (33 and 29%, respectively), while hypercholesterolemia and prior revascularization (coronary artery bypass graft or angioplasty) were most common in Caucasian patients (64 and 41%, respectively). More than 60% of Hispanic and black patients were women--a unique characteristic for randomized CAD trials. Comparing race/ethnic cohorts, there were significant differences for all characteristics. More than 80% of patients in all race/ethnic groups were receiving antihypertensive therapy; however, only fewer than 25% had controlled blood pressure according to guidelines from the sixth report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. This high-risk population of hypertensive patients with CAD has been undertreated and does not have well-controlled BP. Race/ethnic differences were observed for clinical characteristics and medication use.

Systemic lupus erythematosus (SLE) is regarded as a prototype autoimmune disease because it can serve as a means for studying differences between ethnic minorities and sex. Traditionally, all Hispanics have been bracketed within the same ethnic group, but there are differences between Hispanics from Spain and those from Latin America, not to mention other Spanish-speaking populations. This study aimed to determine the demographic and clinical characteristics, severity, activity, damage, mortality and co-morbidity of SLE in Hispanics belonging to the two ethnic groups resident in Spain, and to identify any differences. This was an observational, multi-centre, retrospective study. The demographic and clinical variables of patients with SLE from 45 rheumatology units were collected. The study was conducted in accordance with Good Clinical Practice guidelines. Hispanic patients from the registry were divided into two groups: Spaniards or European Caucasians (EC) and Latin American mestizos (LAM). Comparative univariate and multivariate statistical analyses were carried out. A total of 3490 SLE patients were included, 90% of whom were female; 3305 (92%) EC and 185 (5%) LAM. LAM patients experienced their first lupus symptoms four years earlier than EC patients and were diagnosed and included in the registry younger, and their SLE was of a shorter duration. The time in months from the first SLE symptoms to diagnosis was longer in EC patients, as were the follow-up periods. LAM patients exhibited higher prevalence rates of myositis, haemolytic anaemia and nephritis, but there were no differences in histological type or serositis. Anti-Sm, anti-Ro and anti-RNP antibodies were more frequently found in LAM patients. LAM patients also had higher levels of disease activity, severity and hospital admissions. However, there were no differences in damage index, mortality or co-morbidity index. In the multivariate analysis, after adjusting for confounders, in several models the odds ratio (95% confidence interval) for a Katz severity index >3 in LAM patients was 1.45 (1.038-2.026; p = 0.02). This difference did not extend to activity levels (i.e. SLEDAI >3; 0.98 (0.30-1.66)). SLE in Hispanic EC patients showed clinical differences compared to Hispanic LAM patients. The latter more frequently suffered nephritis and higher severity indices. This study shows that where lupus is concerned, not all Hispanics are equal.

Background. Studies of systemic lupus erythematosus (SLE) pathogenesis have identified two major families of mediators: type I interferon (IFN-I) and autoantibodies to nucleic acids and their proteins, as the main factors contributing to the development of the disease. Against a background of genetic predisposition, a trigger stimulus, possibly microbial, induces the production of IFN-I, autoantibodies or, more likely, both, leading to inflammation. The interaction of cells of the innate and adaptive immune system are involved in the autoimmune response with the development of a variety of clinical manifestations of SLE.The aim of our study was to describe clinical and immunological characteristics of systemic lupus erythematosus depending on interferon gene signature (IFNGS).Material and methods This observational retrospective-prospective study included 76 patients (86% women, median aged 33 [25; 43] years (median [interquartile range 25%; 75%]), with a definite diagnosis of SLE (SLICC (Systemic Lupus International Collaborating Clinics), 2012) attending a routine visit at our Clinic between February 2021 and June 2024. Baseline demographics, disease characteristic, organ system involvement/damage were analysed descriptively according to SLE Disease Activity Index 2000 (SLEDAI-2K), SLICC Damage Index (SDI) and IFNGS status (high/low). IFN status was assessed by the expression of IFN-inducible genes (MX1, RSAD2, EPSTI1) using real-time polymerase chain reaction. IFNGS was calculated as the average expression value of three selected genes. In patients, IFNGS was considered high when the average value of gene expression exceeded the average value of gene expression in donors. The control group consisted of 20 healthy donors comparable in sex and age with the SLE patients.Results. The median disease duration was 2.3 [0.2; 11.0] years, SLEDAI-2K – 7 [4; 11], SDI – 0 [0; 2]. IFNGS-high was detected in 72% of SLE patients. IFNGS-high patients were younger at the time of inclusion (31 [25; 41] and 40 [32; 49] years, respectively), had less frequent remission of SLE (SLEDAI-2K=0) (2% and 19%, respectively), and higher concentrations of anti-dsDNA (219.8 [120.3; 729.3] and 131.0 [46.6; 265.9] IU/ml, respectively; normal <100 IU/ml), ANF titer ≥1/1280 (84% and 52%, respectively), lower absolute count of blood leukocytes (4.2 [3.2; 5.6] and 6.6 [4.2; 8.8]×109/L, respectively) and lymphocytes (1.3 [0.8; 1.8] and 2.0 [1.2; 3.2]×109/L, respectively; p<0,05 in all cases). Of the criterion and non-criteria manifestations of SLE the greater proportions of IFNGS-high versus IFNGS-low patients had haematological (56% and 29%, respectively), primarily leukopenia (53% and 24%, respectively) and dermal (31% and 19, respectively %) involvement (p<0,05 in all cases).Conclusions. Elevated type I IFN signalling is a marker of a certain type of SLE patients – young age with predominant skin, haematological and immunological disorders. No association with standard therapy and the expression level of certain IFNGS was found.

BackgroundGenetic contribution to development of chronic damage have been scarcely investigated in systemic lupus erythematosus (SLE). In fact, whereas most studies have looked for an association between genetic variants and...

BACKGROUND: Underutilization of radiotherapy in minorities with glioblastoma (GBM) has been reported. We sought to investigate whether patients of Hispanic descent with GBM had different presentation, treatment, oncologic outcomes compared to Caucasian patients. METHODS: We reviewed all patients with GBM treated with radiotherapy at Columbia University Medical Center from 1998 to 2013. Variables analyzed included age, gender, race, Karnofsky performance status, molecular markers, extent of resection, and radiotherapy scheme. RESULTS: From 1998 to 2013, 444 Caucasian and Hispanic patients with GBM were treated with radiotherapy at our institution. Baseline characteristics (age, gender, KPS) were similar among the two groups (Hispanic vs. Caucasian), as was extent of resection. For example, there were 85 patients of Hispanic descent with a median age of 58 (range 4-91) years, 51 (60%) were men, and median KPS was 80 (range 50-100). In Caucasians cohort (N = 361), the median age was 61 (range 7-87), 208 (58%) were men, and median KPS was 80 (range 30-100). Among the Hispanic patients, 85.5% had gross total or subtotal resection and 14.5% biopsy whereas in Caucasians, 83.2% had gross total or subtotal resection and 16.8% biopsy only. Hispanic and Caucasian patients had similar rates of MGMT methylation (38.5% vs. 42.9%), IDH-1 mutation (5.9% vs. 7.9%), and positive EGFR immunohistochemical staining (78.9% vs. 74.4%). Similar rates of Hispanic and Caucasian patients received intensity-modulated radiotherapy (50.0% vs. 52.4%) and three-dimensional conformal radiotherapy (35.4% vs. 45.4%); whereas more Hispanic patients received two-dimensional radiotherapy (14.5% vs. 2.2%). However, median survival was not statistically different among Hispanics than Caucasians: 287 vs. 388 days (HR: 1.147; 95%CI: 0.863-1.524; p = 0.346). CONCLUSIONS: We found that Hispanic patients with GBM had a trend toward worse but not statistically different overall survival than Caucasian patients having similar baseline characteristics, types of surgery, radiotherapy, and molecular markers.

e12661 Background: The addition of pembrolizumab to neoadjuvant chemotherapy on the Keynote522 (KN522) clinical trial, changed the standard of care for early stage triple negative breast cancer (TNBC). This regimen demonstrated longer event free survival and higher percentage of patients with pathologic complete responses (pCR). However, limited data exist on the comparative outcomes between Hispanic and non-Hispanic patients in real-world settings as this patient population was likely underrepresented on the original trial. Methods: We conducted a retrospective analysis of patients with early stage TNBC treated on KN522 regimen and undergoing surgery at a single tertiary center from July 2021 to present. Patients were stratified into Hispanic and non-Hispanic ethnicity cohorts. The primary endpoint was pCR rate, and secondary endpoints was incidence of adverse effects (AEs). Results: Among a cohort of 41 patients identified, 26 (63%) were of Hispanic and 15 (37%) were non-Hispanic. The pCR rate was 50% among Hispanic and 53% among non-Hispanic patients (p=0.83). Hispanic patients experienced higher rates of anemia (88% vs. 67%, p=0.06), fatigue (85% vs. 60%, p=0.07), skin rash (46% vs. 27%, p=0.21), and endocrine toxicities (23% vs. 13%, p=0.21). However, Hispanic patient also had fewer hospitalizations (35% vs. 47%, p=0.44), dose-modifications (12% vs. 40%, p=0.53), dose omissions (19% vs. 33%, p=0.31), and showed higher KN522 completion rates (81% vs. 53%, p=0.06). Conclusions: Our findings indicate a comparable pCR rate between Hispanic and non-Hispanic patients with early-stage TNBC receiving KN522 therapy. While Hispanic patients exhibited higher incidences of certain adverse effects, they demonstrated lower rates of hospitalizations, dose modifications, and omissions, alongside a notably higher completion rate of the KN522 regimen. These trends may be attributed to various factors such as genetic predispositions, and potentially differential physiological responses to therapy within this ethnic group. These findings underscore the importance of including minorities, such as Hispanic patients, in clinical trial populations to ensure that treatment outcomes are representative of diverse patient demographics. [Table: see text]

Introduction: Inflammatory bowel disease (IBD) is increasing among Hispanic patients; however few studies have examined differences in epidemiology, disease severity, and treatment course between Hispanic and non-Hispanic patients. Our aim was to evaluate ethnicity as a clinically significant variable influencing disease severity, need for anti-TNF ±immunomodulator therapy, rates of surgery, and hospitalizations. Methods: A cohort of adult IBD patients followed in a large urban safety-net hospital between January 2007 and December 2012 was identified. The following variables were extracted from the electronic medical record: age, gender, race/ethnicity, disease type and severity, treatment regimens, steroid-free remission at 26 weeks, receipt of IBD-related surgery, and hospitalizations. Fisher exact and Mann-Whitney rank sum tests were used to compare categorical and continuous variables between Hispanic and non-Hispanic patients respectively. Results: We identified a total of 291 adult IBD patients, including 148 with Crohn’s Disease (CD), and 143 with ulcerative colitis (UC). Our cohort was 54% male and median age was 44 years. Our cohort was racially diverse with 32% white, 37% black, 28% Hispanic, and 2% Asian. Hispanic patients appeared to have a more benign disease course, with significantly less IBD-related surgeries (mean 0.4 vs. 1.1; p=0.001) and total hospitalizations (mean 2.1 vs. 2.9; p=0.04). Treatment regimens were significantly different between Hispanics and non-Hispanics (p=0.04), as Hispanic patients were less likely to require anti-TNF ± immunomodulator therapy (27% vs. 39%). On subgroup analysis, these differences were primarily noted among those with CD but not those with UC. Hispanic UC patients had a similar number of IBD-related surgeries (p=0.17) and hospitalizations (p=0.62), whereas Hispanic CD had lower rates of both IBD-related surgeries (mean 0.8 vs. 1.8; p=0.01) and total hospitalizations (mean 2.4 vs. 3.8; p=0.04). Hispanic patients with CD also were significantly less likely to require anti-TNF ± immunomodulator therapy (38% vs. 57%; p=0.05). Conclusion: Hispanic CD patients appear to have less severe disease than non-Hispanic patients, with lower rates of IBD-related surgery, hospitalization, and need for anti-TNF therapy. In contrast, Hispanic ethnicity does not appear to be associated with disease course severity in UC patients.

While the presentation of Short Root Anomaly (SRA) in Hispanic patients has been described previously, it is not known if this population is predisposed to increased orthodontic root resorption. This study evaluates the response of pre-existing short roots in Hispanic SRA patients to orthodontic treatment. Selected maxillary and mandibular teeth of 40 Hispanic SRA patients (19 male, 21 female) and 40 age and gender matched Caucasian patients (19 male, 21 female) with normal root length were evaluated for root resorption following comprehensive orthodontic treatment. The age range of the subjects was between 10 and 19 years. Relative root length was calculated before and after orthodontic treatment from digital panoramic radiographs. Overall, statistically significant root resorption occurred in the control group, but orthodontic root resorption was not significant in the Hispanic group (p > 0.05). When genders were separated, Hispanic females did experience a mild degree of root resorption in the upper incisors while resorption in Hispanic males was not significant. Caucasian females experienced greater root resorption than Caucasian males. Hispanic SRA patients may be safely treated with comprehensive orthodontics and could be at no more risk of root resorption than Caucasian patients with normal initial root length.

BackgroundLupus Nephritis (LN) is one of the most severe complications that can occur in patients with Systemic Lupus Erythematosus (SLE) as it increases the risk of renal failure, comorbidity and...

Purpose: Inflammatory bowel disease is becoming increasingly recognized in ethnic and racial minorities. IPAA has become the treatment of choice for patients with UC requiring surgery. Few studies have characterized UC and pouch outcomes in the Hispanic American population. The aim of the study was to characterize natural history and outcome of IPAA in a Hispanic population. Methods: Hispanic ethnicity was designated by self-report and the Hispanic patients with UC and IPAA were identified from the prospectively maintained pouch database. Demographics, clinical characteristics and pouch outcomes in Hispanic population were compared to those in a random sample of Caucasian patients (1:2 ratio). Exclusion criteria were patients with a preoperative diagnosis of Crohn's disease, indeterminate colitis, or familial adenomatous polyposis, and patients of other ethnic groups. Results: 33 Hispanic patients with IPAA were identified. Gender distribution, family history of IBD, smoking history, preoperative immunomodulator use, extent of UC, toxic megacolon or fulminant colitis, pouch configuration, stage of pouch, presence of extraintestinal manifestation, autoimmune disorders, primary sclerosing cholangitis, or significant comorbidities were similar between the two groups. Current pouch conditions including normal pouch, irritable pouch syndrome, acute pouchitis, chronic pouchitis, cuffitis, surgical complications, and anismus were also similar. However, when compared with Caucasian controls (n=66), Hispanic patients were younger at UC diagnosis and at colectomy, and they were more likely to have colectomy for dysplasia. The interval between diagnosis and colectomy was comparable. No Hispanic patients received biologic agents for UC before colectomy or pouch disease while 10.3% and 11.8% of Caucasian patients had biologics for underlying UC or for pouch diseases, respectively (Table). Conclusion: The natural history of UC differed between the two ethnic groups before colectomy, but similar after colectomy and IPAA. Biosocioeconomical factors may lead to these differences, which warrants further investigation.Table 1: Comparison of clinical characteristics between Hispanic and caucasian populations

To characterize disease manifestations in Hispanic American patients with systemic sclerosis (SSc) in comparison with non-Hispanic White and Black patients. Longitudinal clinical characteristics were collected prospectively in the Genetics versus Environment in Scleroderma Outcome Study cohort. All patients fulfilled the classification criteria for SSc and had a disease duration less than five years at enrollment. A cohort of 427 patients, consisting of 124 Hispanic, 220 non-Hispanic White, and 83 non-Hispanic Black participants were examined. At enrollment, Hispanic patients were significantly younger but had longer disease duration, higher frequency of U1-RNP positivity as well as concurrent systemic lupus erythematosus (SLE) diagnosis, and lower income and educational levels in comparison to non-Hispanic White patients. Compared with non-Hispanic Black patients, Hispanic patients had more frequently limited cutaneous involvement and anticentromere antibodies. In the longitudinal analysis, Hispanic patients had significantly lower forced vital capacity percents predicted (point estimate, -9.3%; P < 0.001) than non-Hispanic White but not Black patients. Hispanic patients had similar longitudinal modified Rodnan Skin Scores like non-Hispanic White patients but lower measurements than non-Hispanic Black patients (point estimate, -3.2; P = 0.029). Hispanic patients had significantly higher serially obtained perceived functional disability scores than White patients (point estimate, 0.29; P < 0.001). Hispanic patients also had higher mortality rates than White Americans even after adjustment for age, gender, and socioeconomic statuses. Hispanic patients have higher likelihood of having U1-RNP positivity and SLE overlap, more severe restrictive lung disease, as well as higher rate of mortality than non-Hispanic White patients.