Afro-Caribbean Patients Research Articles

Stroke Recurrence in First-Ever Symptomatic Carotid Web: A Cohort Study

A multicenter, observational cohort study was performed from January 2008 to March 2019. A total of 92 consecutive Afro-Caribbean patients (57% women; mean age, 50 years) had first-ever ipsilateral cerebral ischemic events (79 ischemic strokes; 13 transient ischemic attacks) associated with an ipsilateral carotid artery web diagnosed by computed tomography angiography. The mean symptomatic bulb stenosis was only 36%. During a mean follow-up of 4 years, 21% (19 of 92) of patients experienced recurrent ipsilateral cerebral ischemic events (16 strokes; 3 transient ischemic attacks). Of 21 patients who underwent carotid endarterectomy and two who underwent carotid artery stenting (CAS), no recurrence occurred during a median follow-up of 3 years. Using medical treatment alone, the cumulative recurrent cerebral ischemic event rate was 20% at 2 years and 27% at 5 years. Using medical treatment alone, symptomatic carotid artery webs were associated with a high rate of recurrence that reached 27% at 5 years. Surgery or stenting seems to be efficient.

Long-Term Outcomes of Selective Laser Trabeculoplasty for Open-Angle Glaucoma in the Caribbean

To characterize long-term clinical outcomes of monotherapy selective laser trabeculoplasty (SLT) in Afro-Caribbean patients with open-angle glaucoma (OAG). This was a post hoc analysis of nearly 8 years (median, 3.2; interquartile range, 2.1-7.1) of pooled data from the West Indies Glaucoma Laser Study and its preliminary study. Setting: Three eye care practices in Saint Lucia and Dominica. Afro-Caribbean adults with mild-moderate OAG treated with ≤2 medications (61 in preliminary study, 72 in West Indies Glaucoma Laser Study). Participants underwent medication washout, baseline intraocular pressure (IOP) determination, and bilateral 360-degree SLT. Participants were followed for up to 94 months. Repeat SLT was performed according to prespecified criteria. The primary outcome was mean IOP reduction from baseline. The secondary outcome was medication-free survival with SLT repeated as needed. The pooled data set included 265 eyes of 133 Afro-Caribbean participants. The mean (standard deviation) baseline IOP was 21.2 (3.4) and 21.2 (3.9) mmHg in right and left eyes, respectively. Over 8 years, the mean IOP ranged from 12.8 to 15.7 mm Hg and from 13.1 to 15.8 mm Hg, respectively (P < .0001 for every comparison with baseline). The median medication-free survival time for initial SLT was 85.4 months in both eyes. The 94-month medication-free survival of SLT repeated as needed was 71.2% and 71.7%, respectively. Monotherapy SLT, repeated as needed, safely provides significant IOP reductions in most Afro-Caribbean adults with primary OAG through nearly 8 years of follow-up and has significant potential to delay or prevent glaucoma-related vision loss in black patients in low-resource regions.

Visual field defects due to optic nerve drusen in Afro-Caribbean patients: A case series of 16 eyes

Optic Nerve Head Drusen (ONHD) are very rare among black patients but may cause more severe visual defects in these patients. The goal of our study was to describe the frequency of visual field defects secondary to OND in Afro-Caribbean patients and study the characteristics of their physical examination, color vision and contrast sensitivity. We carried out a prospective study at the Martinique university medical center on patients of African descent with ONHD diagnosed on fundus examination and B-scan ultrasonography. All patients received a complete neuro-ophthalmological examination. The primary study endpoint was the frequency of visual field defects. Secondary study endpoints were the results of ETDRS visual acuity, Pelli-Robson contrast sensitivity chart, and 15hue color vision test. Sixteen eyes of 10 patients from 11 to 68 years of age were included. Forteen eyes (87%) had exposed ONHD. Eleven eyes (69%) showed a visual field defect: 9 eyes (69%) had an enlarged blind spot, and 9 eyes (69%) had an arcuate scotoma. 3 eyes (19%) had loss of ETDRS visual acuity, and 12 eyes (75%) showed loss of Pelli-Robson contrast sensitivity. Five eyes (31%) had an abnormal color vision test. This is one of the largest case series of ONHD in Black patients. The frequency of visual field defects was high but comparable to that of studies in other ethnic groups. Larger comparative studies are necessary to confirm these results.

Stroke Recurrence in First-Ever Symptomatic Carotid Web: A Cohort Study.

Background and Purpose Carotid web (CaW) is an intimal variant of fibromuscular dysplasia responsible for ipsilateral cerebral ischemic events (CIE). Symptomatic CaW likely has a high risk of recurrent CIE, but no salient prospective data are available. We aimed to assess recurrence rate and its predictors after a first-ever CIE. Methods Consecutive Afro-Caribbean patients who had cryptogenic first-ever CIEs (ischemic stroke [IS] or transient ischemic attack [TIA]) associated with ipsilateral CaW were included in this multicenter observational cohort study. The follow-up (January 2008 to March 2019) focused on CIE recurrences. Kaplan-Meier method assessed rates of recurrences and Cox proportional hazards regression analyzed risk factors. Results Ninety-two patients (79 first-ever ISs and 13 TIAs; mean age±standard deviation, 49.8±9.9 years; 52 [56.5%] women) were included. During a mean follow-up of 50.5±29.6 months, 19 (20.7%) patients experienced recurrent ipsilateral CIEs (16 ISs and three TIAs). Of 23 patients receiving surgery/stenting treatment, no recurrence occurred after the intervention (median follow-up, 39.8 months [interquartile range, 27.6 to 72.4]). Under medical treatment alone, the annual recurrent CIE rate was 6.9%, and the cumulative rate was 4.4% at 30-day, 10.8% at 1-year, 19.8% at 2-year, 23.2% at 3-year, and 27.3% at 5-year. Presence of silent cerebral infarctions was the only independent risk factor of CIE recurrences (hazard ratio, 6.99; 95% confidence interval, 2.4 to 20.4; P=0.004). Conclusions Under medical treatment alone, symptomatic CaW was associated with a high rate of recurrence that reached 27.3% at 5-year. Surgery/stenting seems to be efficient, and randomized control trials are required to confirm the benefit of these interventions.

Multiple sclerosis-like NMOSD patients suffer severe worsening of status after fingolimod initiation

BackgroundInitial clinical manifestations of NMOSD may rarely overlap with MS. Fingolimod may trigger severe attacks in patients with NMOSD previously misdiagnosed as MS. These cases are rare and their pathophysiology remains elusive. MethodsWe recruited all NMOSD patients treated by fingolimod in a single-center cohort of Afro-Caribbean neuro-inflammatory patients in Fort-de-France (French West Indies). Six patients were collected from the literature. ResultsAmong 622 patients followed locally for MS, 101 received fingolimod and two suffered severe attacks revealing a typical NMOSD presentation. These two patients were found to have AQP4-IgG. The risk of misdiagnosed NMOSD in MS in our high-risk Afro-Caribbean patients was estimated to be 1.9% (0 to 4.7%). Among the whole cohort, relapses occurred within a month after fingolimod initiation in five patients. All attacks were severe and contrasted with previously benign attacks, suggesting a shift to a more severe disorder. An unusual finding in these patients was large brain lesions. ConclusionAQP4-IgG should be obtained before initiation of fingolimod in high-risk patients, especially in those from areas of high NMOSD prevalence.

Clinical outcomes following selective laser trabeculoplasty in Afro-Caribbean patients with glaucoma at high risk for progression

AimTo characterise clinical outcomes following selective laser trabeculoplasty (SLT) in eyes of Afro-Caribbean patients with open-angle glaucoma (OAG) at high risk for progression.MethodsIn a prospective interventional case series, patients meeting...

Systemic inflammation and protease profile of Afro-Caribbean patients with sepsis.

Objectives:Sepsis is one of the leading causes of morbidity and mortality within the healthcare system and remains a diagnostic and therapeutic challenge. A major issue in the diagnosis of sepsis is understanding the pathophysiologic mechanism, which revolves around host immune system activation and dysregulated responses. African Americans are more likely to experience severe sepsis with higher mortality rates compared to the general population. This pilot study characterized multiple inflammatory markers and proteases in plasma of primarily African American and Afro-Caribbean patients with mild sepsis.Methods:Plasma was collected from 16 healthy controls and 15 subjects presenting with sepsis, on admission, and again upon resolution of the signs of sepsis, defined as a resolution of sepsis criteria. Plasma samples were analyzed for cytokines, chemokines, and proteases using multiplex bead assays.Results:Elevated levels of granulocyte colony-stimulating factor, interleukin-10, interleukin-15, interleukin-1 receptor antagonist, interleukin-8, interferon gamma-induced protein 10, monocyte chemoattractant protein-1, matrix metallopeptidase 12, and cathepsin S were identified in plasma from sepsis patients on admission compared to control subjects. Interleukin-6, interleukin-8, granulocyte colony-stimulating factor, and cathepsin S were reduced in sepsis patients upon clinical resolution of sepsis.Conclusion:These findings profile the circulating inflammatory cytokines, chemokines, and proteases in African Americans and Afro-Caribbean patients during sepsis. The role of these targets in sepsis needs addressing in this patient population.

Apparent Disparities in Hospital Admission and Biologic Use in the Management of Inflammatory Bowel Disease between 2014–2018 in Some Black and Ethnic Minority (BEM) Populations in England

Discrimination in delivery of care to patients with inflammatory bowel disease has been reported in the UK with regards to the South Asian population. This paper explores whether it is also true for Afro-Caribbean and Eastern European migrant workers. Treatment was investigated in NHS trusts, which served substantial migrant and minority communities, through Freedom of Information requests for data on use of biologics or hospital admissions over a five year period. In Bristol, Nottingham, Derby and Burton, Princess Alexandra Hospital Trust in Harlow, Essex and Kings College Hospital NHS Foundation Trust in South London Afro-Caribbean patients were treated significantly less often than White British patients. Eastern European migrant workers, were admitted significantly less often in Croydon, and the Princess Alexandra Hospital NHS Trust in Essex. However, there was no evidence of barriers to access for these communities in Wye Valley Trust, University Hospitals of Bristol NHS Foundation Trust or Queen Elizabeth Hospital Kings Lynn. In North West Anglia both South Asian and Eastern European patients were significantly less likely to be admitted to hospital than members of the White British community. It is incumbent on all gastroenterologists to consider their own clinical practice and encourage their hospital units to adopt effective policies which remove discriminatory barriers to good quality care.

Infertility and assisted reproductive technology outcomes in Afro-Caribbean women.

To assess the causes of infertility and artificial reproductive technology (ART) outcomes in women of African descent living in the Caribbean and Bermuda. Cross-sectional study composed of a questionnaire administered to providers who care for women undergoing ART in the Caribbean and Bermuda. A questionnaire from the Deerfield Institute was adapted to meet the aims of our study with their permission. Eight infertility clinics in the Caribbean and Bermuda were identified. The primary physician at each site was contacted via email and invited to participate in the study. Questionnaires were completed via interview or electronically. Responses were collected in a REDCap database for statistical analysis. There were five respondents from Barbados, Bermuda (× 2), Puerto Rico, and the Bahamas. The most commonly reported etiologies of infertility among Afro-Caribbean patients were female-male factor and uterine factor. In vitro fertilization (IVF) combined with intracytoplasmic sperm injection (ICSI) is performed more often than conventional IVF. The cumulative live birth rates (LBR) after ART for those ages ≤ 34, 35-37, 38-42, and > 42 were 52%, 40%, 22%, and 12%, respectively. The cumulative live birth rate was 31.5% for total patients. The factors reported to be most important in hindering patients from cycling were coping emotionally with poor ovarian response and cost. The biggest restraints to infertility care were costs and a lack of local IVF centers on all islands. Afro-Caribbean women receiving infertility care in the Caribbean may have better ART outcomes compared to African-American women in the United States (US).

Anticoagulation control in different ethnic groups receiving vitamin K antagonist therapy for stroke prevention in atrial fibrillation

BackgroundEfficacy and safety of vitamin K antagonists (VKAs) is optimised in atrial fibrillation (AF) patients when the International Normalised Ratio (INR) is 2.0–3.0. Anticoagulation control comparing different ethnic groups is limited, although epidemiological studies suggest poorer INR control in non-white cohorts. MethodsVKA control was assessed retrospectively by time-in-the-therapeutic range (TTR) (Rosendaal method) and percentage INR-in-range (PINRR) in 991 White, Afro-Caribbean and South-Asian AF patients [overall mean (SD) age 71.6 (9.4) years; 55% male; mean (SD) CHA2DS2-VASc score 3.4 (1.6)] over a median (IQR) follow-up of 5.2 (3.2–7.0) years. ResultsCompared to Whites, mean (SD) TTR and PINRR were significantly lower in South-Asians [TTR 67.9% vs. 60.5%; PINRR 58.8% vs. 51.6%, respectively] and Afro-Caribbeans [TTR 67.9% vs. 61.3%; PINRR 58.8% vs. 53.1%, respectively], despite similar INR monitoring intensity. Logistic regression revealed non-white ethnicity [OR 2.62; 95% Confidence Interval [CI] (1.67–4.10) and OR 3.47 (1.44–8.34)] and anaemia [OR 1.65 (1.00–2.70) and OR 6.27 (1.89–20.94)] as independent predictors of both TTR and PINRR < 70%, respectively. At follow-up, 329 (33.2%) patients experienced ≥1 major adverse clinical event. Cardiovascular hospitalisation was significantly higher among South-Asians (32.3%) compared to the Whites and Afro-Caribbeans (21.3% vs 25.6% respectively). ConclusionsEthnic disparities in quality of anticoagulation control are evident, with South-Asians and Afro-Caribbeans having poorer control compared to Whites, despite similar intensity INR monitoring. Non-white ethnicity remained the strongest independent predictor of poor TTR and PINRR. Interventions to improve anticoagulation control need to be implemented, particularly targeting ethnic minority patients.

Epidemiologic, Clinical, Ultrasonographic, and Cytological Features of Thyroid Nodules in Predicting Malignancy Risk: A Retrospective Study of 442 French Afro-Caribbean Patients.

Objective To evaluate epidemiologic, clinical, cytological, and ultrasonographic features of thyroid nodules in a sample French Afro-Caribbean population to determine if the standard criteria for predicting malignancy risk are applicable to this specific ethnic population. Methods and Design. This retrospectively designed study consisted of 442 patients who had consulted with the Endocrinology Department in Martinique (French overseas department) between 2007 and 2011. Of the 442 patients, 641 ultrasound-guided fine-needle aspirations (US-FNA) were performed by two experienced endocrinologists, and 212 patients underwent surgery. The geographical situation, age, gender of the patient, clinical and ultrasonographic features, TSH level, and US-FNA results were considered and cross-referenced with their pathology results. Results The overall malignancy rate on final histopathology was 9% (women only), 80% of which were papillary cancer, and 20% were follicular cancer. Occult micropapillary carcinoma represented 35% of the papillary cancer. There was no significant difference in age, nodule localization, number of nodules, or thyroid function test between benign and malignant nodules. Contrary to the literature, we found only 12% incidentaloma in our series, while more than half of the nodules were discovered on palpation or as a clinical symptom. Hypoechogenicity in solid pattern nodules and nodules between 2 and 3 cm in size revealed a high diagnostic value in detecting malignancy. The corresponding rate of malignancy on Bethesda system histopathologic examination was as follows: 0% in undiagnosed (I), 0% benign (II) (micropapillary), 5% (FLUS)/atypia (III), 9% follicular neoplasm (IV), 33% suspected malignancy (V), and no malignant cytology (VI). These results show a different Bethesda system predictive value for this French Afro-Caribbean population. Conclusion Studies evaluating ethnic cancer disparities among patients with thyroid cancer are limited and do not specifically focus on the French Afro-Caribbean population. Despite rare thyroid incidentaloma, 35% of the papillary cancer cases were micropapillary carcinoma, and the incidence and standardized mortality rate in Martinique are lower than in metropolitan France. The malignant risk distribution of thyroid FNA Bethesda classification in this sample population differs from the standard risk, and it is necessary to take that into account in the decision to operate by associating it with echographic malignancy criteria.

Restrictive cardiac phenotype as primary cause of impaired aerobic capacity in Afro-Caribbean patients with val122ile variant transthyretin amyloid cardiomyopathy

Background: Impaired aerobic capacity in cardiac amyloidosis patients may be related to limited inotropic myocardial reserve and heart rate (HR) response limiting cardiac output rise. This study sought to investigate whether chronotropic incompetence (CI) and blunted HR recovery would be prevalent in patients with mutant transthyretin (ATTRv) cardiomyopathy.Methods and results: Eighteen ATTRv (Val122Ile) patients (72 ± 8-year) and 15 age-matched controls (73 ± 3-year) were prospectively enrolled. Patients' medical records, pulmonary function and cardiopulmonary exercise testing, including non-invasive cardiac hemodynamics and chronotropic response were studied. Compared with age-matched controls, maximal workload (91 ± 8 vs. 65 ± 20 watts) and peak VO2 (19.5 ± 3.0 vs. 14.4 ± 4.1 mL.kg−1.min−1) were lower in ATTRv patients. Despite reaching similar age-predicted maximal HR, ATTRv patients displayed smaller changes in stroke volume (SV) index relative to change in VO2 (49 ± 26 vs. 67 ± 18%). Adequate chronotropic-metabolic index was prevalent in ATTRv patients. HR recovery, as percent decrease in peak HR at 1 and 3-min, was blunded ATTv patients.Conclusions: In Val122Ile ATTRv patients, chronotropic response was appropriate relative to exercise intensity with only few patients displaying CI. HR response to exercise was further characterised by blunted HR recovery in ATTRv patients suggesting lower parasympathetic activity and greater sympathetic stimulation compared with controls.

Crystalline lens changes after selective laser trabeculoplasty in Afro-Caribbean patients with open-angle glaucoma; report 4 of the West Indies Glaucoma Laser Study (WIGLS)

To characterize changes in nuclear, cortical, and posterior subcapsular lens opacities after selective laser trabeculoplasty (SLT) in Afro-Caribbean eyes with primary open-angle glaucoma (POAG). Three clinical practices, Saint Lucia and Dominica. Prospective case series. Patients with POAG in the West Indies Glaucoma Laser Study (WIGLS) had 360-degree SLT after medication washout. No antiinflammatory therapy was used after SLT. Nuclear, cortical, and posterior subcapsular lens opacities were graded through dilated pupils using the Lens Opacification Classification System III (LOCS III) at baseline and 12, 24, and 36months after SLT, with the grader masked to all previous values after baseline assessment. Changes in opacity scores from baseline were evaluated using paired t tests. Seventy-two patients (142 phakic eyes) were evaluated. The mean (±SD) baseline LOCS III opacity scores in right eyes and left eyes, respectively, were 2.44±1.23 and 2.40±1.16 (nuclear), 0.39±1.08 and 0.30±0.85 (cortical), and 0.22±0.59 and 0.15±0.36 (posterior subcapsular). Other than a small improvement in bilateral nuclear opacity scores at 12months, no statistically or clinically significant changes in any opacity score occurred in either eye up to 36months postoperatively. Three eyes (2.1%) with preexisting lens opacities had cataract surgery for progressive lens changes at 3months, 21months, and 26months, respectively, after SLT. Selective laser trabeculoplasty was not associated with clinically significant changes in nuclear, cortical, or posterior subcapsular lens opacities in glaucomatous Afro-Caribbean eyes. The rate of cataract surgery is consistent with reported rates from longitudinal natural history studies in Caribbean and non-Caribbean populations.

Biopsy Grade Group as a reliable prognostic factor for BCR in Afro-Caribbean men with intermediate- and high-risk prostate cancer

The Grade Group (GG) classification is recommended by guidelines as a reliable prognostic factor of prostate cancer. However, most studies have been performed on the Caucasian population. Our objective was to validate GG classification as a safe way to classify intermediate- and high-risk patients with African ancestry. This was a retrospective study in an Afro-Caribbean population. A total of 1236 patients were included between 2000 and 2015. Patients were stratified according to (GG). Survival analysis was performed using the Kaplan-Meier method, univariate and multivariate analyses using the Cox model. There was no significant difference at 5 and 10-year BCR-free survival between the intermediate- and high-risk groups, based on the D'Amico classification. There was a highly significant difference in BCR-free survival at 5 (p < 0.0001) and 10 years (p < 0.0001) for patients of GG 1 and 2 vs 3, 4, and 5, respectively. There was no significant difference in 5-year BCR-free survival of patients of GG grades 1 and 2, whether lymph-node dissection was performed or not. There was a significant difference between GG 2 and 3 patients in 5 (p = 0.008) and 10-year BCR-free survival (p = 0.01). High PSA (p < 0.0001), pathological GG ≥ 3 (p < 0.0001), pathological stage pT3 (p < 0.0001) and positive margins (p < 0.0001) were factors for BCR in multivariate analysis. The GG 2015 classification appears to be a better prognostic factor than D'Amico classification for intermediate- and high-risk Afro-Caribbean patients.

Fingolimod for the treatment of multiple sclerosis in French West Indies, a real-world study in patients from African ancestry

Affecting 2.5 million people worldwide, multiple sclerosis (MS) is one of the main causes of acquired disability among young adults. In French West Indies (FWI), where MS has arisen from the end of the 80's, a low therapeutic response to interferons beta1 (IFN beta1) in patients of African descent, restrains the therapeutic options. Fingolimod is a Sphingosine-1-Phosphate receptor modulator whose efficacy in the treatment of MS has recently been shown in three phase III studies. Nevertheless, data are currently lacking concerning the use of Fingolimod among populations of African descent, particularly in a real-world setting.Efficacy and safety information collected during the first two years of follow-up have been analysed retrospectively for all patients in whom Fingolimod treatment was introduced in FWI between its marketing date and December 2015.Fifty-two consecutive patients with a relapsing remitting MS started Fingolimod therapy in the FWI, according to the European guidelines. After 24 months, 40 patients were still receiving the treatment. The average Annualized Relapse Rate (ARR) dropped by 81%, and 72.5% of patients remained free from disability progression during the 24 months on Fingolimod. MS remained controlled (according NEDA 3 criteria) for 41% of patients who were still on therapy at 24 months. Nine participants presented with a moderate or major side effect.Unlike IFN beta1 therapy, Fingolimod appears to be effective in Afro-Caribbean patients in a real-world setting with a similar benefit to what has been observed in phase III studies in more selected populations.

Predictive value of conventional MRI parameters in first spinal attacks of neuromyelitis optica spectrum disorder

Background: While spinal cord (SC) attacks of neuromyelitis optica spectrum disorder (NMOSD) are often devastating, signs predictive of their poor clinical outcome have been elusive until now, except for the delay in initiating plasma exchange (PE). Objective: We studied the correlation between conventional non-standardized magnetic resonance imaging (MRI) parameters, PE treatment, and clinical data obtained at nadir and recovery. Methods: Retrospective study of first SC attacks of NMOSD. Results: Sixty-nine Afro-Caribbean NMOSD patients were included (aquaporin-4 (AQP4) antibodies positive in 65%). Median nadir and residual expanded disability status score (EDSS) were, respectively, 7.5 and 4.0. In bivariate analysis, all conventional MRI parameters were correlated with nadir and residual EDSS. In multivariate analysis, nadir EDSS correlated with lesion length (p = 0.022) and edema (p = 0.019), whereas residual EDSS correlated with T1w (T1-weighted) hypointense signal (p = 0.003). Gadolinium enhancement was not associated with outcome. Conclusion: A specific pattern of lesions in conventional MRI data is differentially associated with nadir and residual EDSS. Lesions associated with poor prognosis should prompt highly efficient treatment.

PT048 - Follow up of mostly Afro-Caribbean patients with prostate cancer under active surveillance

PT048 - Follow up of mostly Afro-Caribbean patients with prostate cancer under active surveillance

Severity and Outcomes in Relationship to Known Exposures and Susceptibilities among Afro-Caribbean Patients with Hospital-acquired Acute Kidney Injury

Severity and Outcomes in Relationship to Known Exposures and Susceptibilities among Afro-Caribbean Patients with Hospital-acquired Acute Kidney Injury

Mesures pelvimétriques prédictives de marges chirurgicales au décours d’une prostatectomie totale robot-assitée pour cancer prostatique

Anthropometric data report that pelvic bone of African subjects are narrower and the pelvic cavity is deeper. The aim of the study was to evaluate the influence of pelvic dimensions (PD) on Positive surgical margins (PSM) rate in Afro-Caribbean population after robot-assisted laparoscopic prostatectomy (RALP). Preoperative pelvic MRI of all patients who have had RALP at the University Hospital Center of Guadeloupe between January 2013 and December 2015 was retrospectively analyzed. PD, including the Height of the upper edge of the prostate (HP), the Apical Depth (AD) and Ischial Spines Distance (ISD), and indexes (prostate volumetric index [ISD/VP], apical depth index [ISD/AD] and prostate depth index [ISD/(AD/HP)]) were compared according to the presence or absence of PSM with uni and multivariate analysis. One hundred and seventy-eight patients were included in the study, of whom 60 (33.7%) presented PSM. In univariate analysis, significant differences between the presence or absence of PSM were observed on the AD (30.3±8.7mm versus 24.8±8.0mm, P<0.001), the HP (9.5±8.5mm versus 16.8±11.9mm, P<0.001) and the ISD (89.6±8.8mm versus 96.1±8.4mm) as well as the indexes of apical depth and prostatic depth. In multivariate logistic regression, the ISD (P<0.001) and HP (P=0.02) were associated with increased likelihood of PSM, but not AD or indexes. This study suggests that interspinous distance is the best predictor of PSM during RALP in Afro-Caribbean patients. This measure may be useful to define the therapeutic pattern of patients with prostate cancer. A prospective study with a larger population, comparing RALP in Afro-Caribbean and in caucasians patients, would be needed.

Outcome of spinal attacks in NMO are better predicted by early plasma exchange than by MRI parameters

Introduction Spinal cord (SC) attacks in neuromyelitis optica (NMO) are often associated with incomplete improvement, even after plasma exchange (PLEX). MRI parameters may correlate with nadir and recovery EDSS. Objectifs We studied the correlation of easily available MRI parameters with nadir and recovery EDSS. Study was focused on index attack in a large monocentric cohort. Methodes This retrospective study was based on West French Indies and included all Afro-Caribbean NMO-SD patients in their index SC attack. Exclusion criteria were: unavailable MRI or clinical data; SC relapse in the next 6 months. Since the study was dedicated to SC, optical system was excluded from EDSS calculation. MRI scans were performed on ≥ 1 T magnet, included sagittal T1, T2 and post-contrast T1 images. Lesion length was approximated to number of adjacent vertebral bodies. Resultats In bivariate analysis, nadir and residual EDSS correlated with lesion length, oedema and hypo-T1 lesion. No correlation was found with gadolinium uptake or PLEX treatment. In multivariate analysis, nadir EDSS correlated only with lesion length (P = 0.02) and œdema (P = 0.01). Residual EDSS correlated strongly with nadir EDSS (P Discussion Expectedly, nadir EDSS was the main predictor of residual EDSS. Simple MRI parameters correlated with nadir and recovery EDSS, but in multivariate models, hypo-T1 lesion was associated to poor residual outcome only after exclusion of PLEX. Early PLEX were still associated with an improved outcome although most PLEX were started late (median 17 days). Conclusion MRI features for severe SC lesion are associated with clinical severity, but residual impairment is mainly predicted by nadir EDSS and could be lowered by early PLEX.