Patients Of Other Ethnicities Research Articles

Microsatellite Instability assessment in Black South African Colorectal Cancer patients reveal an increased incidence of suspected Lynch syndrome

Microsatellite Instability (MSI) is a hallmark of colorectal cancer (CRC) and occurs in 15–16% of CRC. Molecular biological information of CRC in South Africa (SA) is largely unrecorded. This study was undertaken to determine the frequency of MSI, with particular reference to Lynch syndrome (LS) with a view to improve surveillance and prevention strategies. This was a retrospective study on CRC samples diagnosed between 2011–2015 at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Samples diagnosed between 2011–2012 were screened for MSI by PCR and mismatch repair (MMR) immunohistochemistry (IHC), and additional BRAFV600E mutational analysis performed. T-tests, Fischer’s exact and Chi square statistical tests were applied. Twelve percent of patients displayed MSI, with increased frequency in black (15%) versus other ethnic group (OEG) (8%) patients. MSI patients were significantly younger than microsatellite stable (MSS) patients, however when stratified by ethnicity, black patients were predominantly younger (median age: 47), with increased MSH2/6 loss, and no BRAF mutations. These findings suggest a large proportion of young black SA CRC patients develop via the LS pathway due to earlier age onset and predominant MSH2/6 protein loss. SA patients of other ethnicities appear to follow the more well established sporadic MSI pathway.

1250 Gastric Intestinal Metaplasia Is a Common Finding Among Veterans Undergoing Endoscopy in South Texas

INTRODUCTION: Gastric intestinal metaplasia (GIM) is a premalignant change of the mucosa of the stomach. Risk factors for intestinal metaplasia previously identified include chronic infection with Helicobacter pylori (HP), dietary factors, smoking, alcohol consumption, and chronic bile reflux. We aim to study the prevalence of GIM and its risk factors in a Texan Veteran population. METHODS: A retrospective chart review was performed among adults undergoing outpatient esophagogastroduodenoscopy (EGD) in 2013 and 2017 at a large Veterans Administration facility in Texas. Patient records were reviewed for demographic information, medication use, smoking and alcohol use, indication for EGD, presence of HP or GIM on gastric biopsies. Studies performed specifically to survey for known GIM were excluded. For patients with presence of GIM, data for type and location on biopsy were recorded. Student's t test was used for quantitative comparisons while the chi-square test or Fisher's exact test was used for qualitative comparisons using R. RESULTS: A total of 860 EGDs were reviewed, of which 340 (39.5%) underwent gastric biopsy. Of those undergoing gastric biopsy, 298 (87.7%) were male with a mean age of 58.0 years (±12.5) and 155 (45.6) were Non-Hispanic Caucasian, 92 (27.1) were Hispanic, and 39 (11.5%) were African-American. A total of 38 (11.2%) patients were found to have GIM. Among patients with GIM, 6 (15.8%) were found to have incomplete GIM. There was no significant difference in mean age among patients with GIM, 61.1 (±13.1) versus those without GIM, 57.6 (±12.4), P = 0.11. The rate of GIM among the non-Hispanic Caucasian population was significantly lower than patients of other ethnicities (7.7% vs. 16.9%, P = 0.02). We did not identify a statistically significant difference between GIM rates among those with HP and those without HP (18.4% vs. 10.3%, P = 0.17). PPI use was associated with lower rates of GIM (8.4% vs. 16.0%, P = 0.03). CONCLUSION: GIM was identified in 1 out of 9 patients in this Veterans cohort in Texas. As previously reported, GIM rates were higher in the Hispanic, African American and Asian patients. Patients taking PPIs were less like to have GIM. HP infection was not associated with GIM in this cohort. Longitudinal data is needed to better understand the risks of gastric cancer and how to risk stratify patients for ongoing surveillance in this diverse population.

Characteristics of Perifoveal Exudative Vascular Anomalous Complex in Korean Patients

ABSTRACTPurpose: To investigate the clinical characteristics of perifoveal exudative vascular anomalous complex (PEVAC) in Korean patients.Methods: This retrospective study included 8 eyes (8 patients) diagnosed with PEVAC. Demographic characteristics of the patients, fundus photography, optical coherence tomography (OCT), fluorescein angiography, and indocyanine-green angiography (ICGA) findings were analyzed. Available follow-up data were also reviewed.Results: The mean ± standard deviation age was 61.0 ± 11.0 years and mean logarithm of minimal angle of resolution (logMAR) best-corrected visual acuity was 0.15 ± 0.14. PEVAC was noted in 2 eyes with coincident age-related macular degeneration (AMD) and in the fellow eye of 1 eye with unilateral type 3 neovascularization. On fundus photography, PEVAC presented as a perifoveal isolated aneurysm associated with retinal exudation and hemorrhage. Well-defined hyperfluorescent lesions with leakage were noted on fluorescein angiography, but no leakage was observed on ICGA. Anti-vascular endothelial growth factor (VEGF) therapy was performed for 2 patients. However, there was no notable improvement after treatment.Conclusions: The clinical characteristics of PEVAC in Korean patients were similar to those reported in patients of other ethnicities. Further studies are needed to better understand the nature of this newly described clinical entity.

Description of the molecular and phenotypic spectrum of Wiedemann-Steiner syndrome in Chinese patients

BackgroundWiedemann–Steiner syndrome (WDSTS) is a rare genetic disorder characterized by facial gestalt, neurodevelopmental delay, skeletal anomalies and growth retardation, which is caused by variation of KMT2A gene. To date, only 2 Chinese WDSTS patients have been reported. Here, we report the phenotypes and KMT2A gene variations in 14 unrelated Chinese WDSTS patients and investigate the phenotypic differences between the Chinese and French cohorts. MethodsNext generation sequencing was performed for each patient, and the variants in the KMT2A gene were validated by Sanger sequencing. The phenotypes of 16 Chinese WDSTS patients were summarized and compared to 33 French patients.ResultsGenetic sequencing identified 13 deleterious de novo KMT2A variants in 14 patients, including 10 truncating, 2 missenses and 1 splicing variants. Of the 13 variants, 11 are novel and two have been reported previously. One of the patients is mosaic in the KMT2A gene. The variation spectra and phenotypic profiles of the Chinese WDSTS patients showed no difference with patients of other ethnicities; however, differ in the frequencies of several clinical features. We demonstrated that variations in the KMT2A gene can lead to both advanced and delayed bone age. We identified 6 novel phenotypes, which include microcephaly, deep palmar crease, external ear deformity, carpal epiphyseal growth retardation, dyslipidemia, and glossoptosis. In addition, patients harbored missense variants in the CXXC zinc finger domain of KMT2A showed more severe neurophenotypes.ConclusionOur study consists of the largest cohort of Chinese WDSTS patients that continues to expand the WDSTS phenotypic and variation spectrum. Our results support the notion that the CXXC zinc finger domain of KMT2A gene is a hotspot for missense variants associated with more severe neurophenotypes.

Treatment retention on fingolimod compared with injectable multiple sclerosis therapies in African-American patients: A subgroup analysis of a randomized phase 4 study

BackgroundSuboptimal persistence with injectable disease-modifying therapies (iDMTs; interferon beta-1a/b, glatiramer acetate) is common in patients with relapsing forms of multiple sclerosis (MS), reducing the effectiveness of these agents. Adherence to, and persistence with, an effective therapy is important for patient populations at increased risk of rapid disease progression. African-American individuals with multiple sclerosis may experience a more aggressive disease course than Caucasian patients, with a greater risk of developing ambulatory difficulties and other disabilities, and may also have a diminished response to some disease-modifying therapies compared with patients of other ethnicities. Retention on oral fingolimod and on iDMTs was evaluated in a post hoc analysis of data from African-American patients in the parallel-group, 48-week ‘Prospective, Randomized, active-controlled, open-label study to Evaluate patient retention on Fingolimod versus approved first-line disease modifying thErapies in adults with Relapsing–remitting Multiple Sclerosis’ (PREFERMS). MethodsIn PREFERMS, patients with relapsing-remitting MS aged 18–65 years with an Expanded Disability Status Scale score ≤6 enrolled at 117 US study sites were treatment-naïve or had received only one iDMT class. Patients were randomized 1:1 (fingolimod 0.5 mg/day:preselected iDMT) using an interactive voice-and-web-response system without blinding, followed up quarterly, and allowed one study-approved treatment switch after 12 weeks, or earlier, for efficacy or safety reasons only. The primary outcome was patient retention on randomized treatment over 48 weeks. In this post hoc analysis of African-American patients in PREFERMS, outcome variables included rate of patient retention on randomized treatment, reasons for discontinuing randomized treatment, patient-reported treatment satisfaction, and safety. Clinical and radiographic outcomes such as annualized relapse rate, brain volume loss, and lesion count changes were also investigated. ResultsIn PREFERMS, 141 of 875 patients (16.1%) randomized to a study drug were African-American. Analysis of data for the full analysis set of 67 patients receiving fingolimod and 69 receiving iDMTs showed that the retention rate over 48 weeks was significantly higher with fingolimod than with iDMTs (80.6% [n = 54] vs 30.4% [n = 21]; between-group difference: 50.2%; 95% confidence interval 35.8–64.6%; p < 0.0001). The most common treatment switch was from an iDMT to fingolimod for injection-related reasons, and patient satisfaction was greater with fingolimod than with iDMTs. Adverse events were consistent with the respective prescribing information for each treatment. ConclusionIn PREFERMS, fingolimod was associated with better treatment retention than iDMTs in African-American patients. Optimal outcomes in the management of multiple sclerosis depend on good persistence with treatment, and this is particularly important in patient populations at increased risk of a rapidly progressing disease course.

Acne keloidalis nuchae in Asian: A single institutional experience

Acne keloidalis nuchae, a type of folliculitis involving the back of the neck, is common in black men, although rare cases have been reported in patients of other ethnicities. We analyzed the clinicopathological features of acne keloidalis nuchae in 17 Asians. Patients’ age at the time of presentation ranged from 20 to 69 years. Most patients experienced the disease over 2 years (range, 3 months–20 years); follow-up data were available for 11 (65%) patients (range, 2–95 months). Nine (53%) patients had comorbidities, but none had a history of other skin disease or a family history of acne keloidalis nuchae. Macroscopically, seven (41%) patients had multiple erythematous pustulopapular lesions, and 10 (59%) had a single large plaque. Histopathologically, deep scarring folliculitis containing naked hair shafts was identified. In all cases, inflammation was most severe in the upper two-thirds of the dermis, and the differences in pustulopapular and plaque lesions were more prominent in the peri-inflammation area. Of the seven patients with plaque lesions treated with steroids alone or steroids and cryotherapy, three experienced plaque reduction. Acne keloidalis nuchae occurring in Asian patients frequently present with typical clinicopathological features, and therefore in spite of very low incidence the diagnosis of this disease entity should be considered in idiopathic scarring folliculitis of the posterior neck.

T372R Mutation Status in Yin Yang 1 Gene in Insulinoma Patients.

Insulinomas are rare pancreatic neuroendocrine tumors. The genetic causes underlying insulinoma are still being investigated. Recently, 3 independent studies reported a recurrent somatic mutation in YY1 gene (C>G; Thr372Arg) among insulinoma patients belonging to Chinese and Western Caucasian populations, which was found to increase insulin secretion by β-cells. However, the status of this key gene variation remains unknown in patients of other ethnicities. We, therefore, screened Indian sporadic insulinoma patients for YY1 T372R mutation in the present study. Seventeen patients diagnosed with insulinoma were recruited retrospectively and their records of family history and clinical parameters were collected. Formalin-fixed paraffin-embedded tumor tissues were used to extract genomic DNA, which was subjected to PCR amplification of YY1 exon 5, followed by Sanger sequencing. Nucleotide sequences thus obtained were aligned against the documented sequence of YY1 exon 5. We found absence of C to G mutation at YY1 codon 372 in all 17 (100%) insulinoma tissues analyzed. On comparison with the mutation frequency observed in the Chinese patients, our results point to genetic heterogeneity in the pathogenesis of insulinoma. This is the first report on the status of YY1 T372R in insulinoma cases of Indian origin. This also warrants analysis of other documented as well as novel mutations in genes in insulinoma tumorigenesis.

Role of FDG-PET/CT for Detection of Occult Bone Marrow Involvement in Patients from the Middle East and North Africa Region with Hodgkin Lymphoma

Background: Routine bone marrow biopsy (BMB) for the initial staging of Hodgkin Lymphoma (HL) is not recommended in the era of FDG-PET/CT staging (J Clin Oncol. 2014;32(27):3059). However, patients from the Middle East and North Africa (MENA) region have epidemiologic and clinical features of lymphoma that are different from patients of other ethnicities (J Natl Compr Canc Net2010;8:S-29-S-35). Therefore, it is unknown whetherFDG-PET/CT can substitute for staging BMB in this population.At our center, we perform routine BMB for all newly diagnosed lymphoma cases.Aim: To investigate whether routine BMB is essential in detecting bone marrow disease where FDG-PET/CT is used in initial staging for HL in patients from the MENA region.Methods: Patients with HL at our institution between 2010 - 2015 were identified. Inclusion criteria included newly diagnosed patients who had BMB and FDG-PET/CT as part of initial staging. All baseline and laboratory features were retrospectively extracted. Pathology reports of bone marrow aspirate and trephine biopsies were reviewed by two independent Hematologists. All written FDG-PET/CT reports were retrieved and carefully reviewed and cases with positive skeletal uptake were re-interpreted by an experienced radiologist. Pattern of skeletal FDG-PET/CT uptake was determined and classified as unifocal or multifocal. Sensitivity and specificity was computed while defining bone marrow disease by positive BMB and / or focal skeletal uptake on FDG-PET/CT. Categorical and continuous variables were analyzed using Pearson's chi-squared and Student's t-test, respectively.Results:A. Baseline characteristics:A total of92 patients met the inclusion criteria and were considered for this analysis. All patients were from the MENA region and > 90% were from the Arabian peninsula. From this cohort, bone marrow disease was detected in 7 (7.6%) patients using BMB while 20 (21.7%) patients had unifocal or multifocal bone marrow uptake on FDG-PET/CT. An additional 21 patients (23%) had diffuse homogenous FDG uptake and was not considered to represent HL. The cohort was characterized by a male to female ratio of 1.4 and a median age at diagnosis of 27 years (6-83). About two thirds of the cases were classical HL of the nodular sclerosis subtype (Table 1). Almost 60% of cases were stage III - IV with corresponding median IPS of 2 (0-6). Incidence of bulky disease and B-symptoms among the entire cohort was 32% and 50%, respectively.B. Comparison of FDG-PET/CT and BMBNo patient with involved BMB (iBMB) had early stage disease on FDG-PET/CT and BMB identified only one patient with positive BM involvement yet negative skeletal uptake on FED-PET/CT. Involvement by BMB upstaged 3 patients previously assessed by CT scan as having stage III, however, none of the patients were allocated to a different treatment plan based on the BMB result. On the other hand, FDG-PET/CT upstaged 24 patients (26%); 9 patients from stage III to IV and 14 patients from early to advanced stage resulting in change of therapeutic plan in the latter group. Focal skeletal FDG-PET/CT lesions identified positive marrow disease with a sensitivity and specificity of 95.2% and 70.4%, respectively. On the other hand, sensitivity and specificity of BMB was 35% and 100%, respectively (Table 2).Abnormal skeletal FDG uptake was seen in a total of 20 patients (21.7%); 11 (55%) had unifocal / bifocal while 9 (45%) had multifocal disease of the axial skeleton. Patients with iBMB compared to those with negative BMB but positive unifocal / multifocal skeletal FDG-PET/CT lesions were more likely to be male (p = 0.002), have B-symptoms (p = 0.028), extranodal disease (p = 0.017) and more likely to have multifocal uptake on FDG-PET/CT (0.017) (Table 3).Conclusion:To our knowledge, this is the first analysis to examine the role of FDG-PET/CT for detection of bone marrow involvement in HL in a patient cohort from the MENA region. We observed that FDG-PET/CT had a higher sensitivity and negative predictive value compared to BMB leading to a treatment change in a significant proportion of patients. This analysis highlightsthat FDG-PET/CT can substitute for BMB in routine staging for newly diagnosed patients with HL from the MENA region. [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Aesthetic Plastic Surgery in Asians: Principles & Techniques.

As a service to our readers, Plastic and Reconstructive Surgery® reviews books, DVDs, practice management software, and electronic media items of educational interest to reconstructive and aesthetic surgeons. All items are copyrighted and available commercially. The Journal actively solicits information in digital format for review. Reviewers are selected on the basis of relevant interest. Reviews are solely the opinion of the reviewer; they are usually published as submitted, with only copy editing. Plastic and Reconstructive Surgery® does not endorse or recommend any review so published. Send books, DVDs, and any other material for consideration to: Arun K. Gosain, M.D., Review Editor, Plastic and Reconstructive Surgery, Brookriver Executive Center, 8150 Brookriver Drive, Suite S-415, Dallas, Texas 75247. Arun K. Gosain, M.D. Review Editor As the demand for aesthetic procedures among Asian patients continues to rise, there is an increasing need for a comprehensive textbook that focuses primarily on this ethnic group. Aesthetic Plastic Surgery in Asians: Principles & Techniques covers the spectrum of this vast topic, and condenses the knowledge and expertise of the many contributing authors. This textbook is packed from cover to cover with the personal advice, pearls, tips, and tricks of the premier authorities in the fields of face and body aesthetic surgery, throughout Asia and beyond.This two-volume series is divided into 10 parts consisting of 74 chapters. In addition to the text, there are more than 2500 high-quality illustrations, complementary electronic-book access, and three accompanying video DVDs illustrating key procedures. Each part highlights the fundamental anatomical differences in this patient group and cultural and societal influences on the perceptions of beauty within the ethnic group. Some chapters focus entirely on the surgical procedures, and others are focused on the evaluation of the Asian cosmetic patient, equipping the reader with the knowledge to effectively strategize, and implement treatment plans. In Volume I, Parts 1 and 2 of this series focus on patient evaluation and innovations in nonsurgical and minimally invasive procedures. Part 3 emphasizes key considerations for facial aesthetic operations, including face, neck, and brow lifting, and Part 4 is dedicated to the Asian eyelid, with detailed procedural descriptions and a plethora of illustrative photographs. Part 5 explores primary and secondary rhinoplasty, and Part 6 details Asian cosmetic surgery of the ear. In Volume II, Part 7 details considerations for aesthetic correction of facial skeleton abnormalities, with procedures subdivided into the upper, middle, and lower thirds of the face. Part 8 is dedicated to aesthetic and reconstructive breast procedures, and Part 9 focuses primarily on aesthetic procedures of the trunk and extremity. Hair transplant, labiaplasty, and penile enhancement are described in Part 10. This comprehensive two-volume series is the consummate guide to the management of the Asian patient seeking aesthetic intervention. It gives terrific insight into recognizing the key anatomical, cultural, and structural differences between Asians and patients of other ethnicities. It highlights how Asians can age differently, and guides surgeons to enhance overall facial and body attractiveness while retaining aesthetic characteristics of Asian ethnicity. This two-volume series will prove an invaluable asset for plastic surgeons, otolaryngologists, and oculoplastic surgeons alike.

Prurigo pigmentosa: a clinical and histopathological study of nine Chinese cases.

Prurigo pigmentosa (PP) is a chronic and recurrent inflammatory skin disease with the distinctive and prominent feature of reticulate hyperpigmentation. Most known cases have been reported in Japan; here we report nine Chinese cases. To determine the clinical manifestation of PP and its effects in Chinese individuals compared with patients of other ethnicities. We retrospectively analysed nine cases of PP. For all cases, clinical information was collected and reviewed, and skin biopsies were performed. Furthermore, we followed all nine patients to determine the recurrence rate. All nine patients fulfilled the diagnostic criteria of PP. The mean age of the patients at diagnosis was 27.4 years, and the patients were predominantly female. Skin lesions at different stages commonly co-occurred in the same patient. The most commonly affected part of the body was the back, but the armpit was also often involved. Patients responded well to minocycline treatment for the short duration of 8.62 days, and a lower recurrence rate (28.3%) was recorded after treatment. Biopsy revealed classic neutrophil and (or) lymphocyte infiltration, spongiosis, and necrotic keratocytes. Abscesses occasionally occurred in the follicular orifice. The abnormal presentation of hair follicles was also discovered. All characteristics were found to coexist in different stages. We conclude that PP is easy to misdiagnose. Histopathological characteristics can coexist at different stages, consistent with the clinical finding that different stages of skin lesions presented concurrently, contributing to misdiagnosis. Oral administration of minocycline not only yields an excellent response but also effectively reduces the recurrence rate.

Abstract C68: Decreased antitumor cytotoxic immunity in African American colon cancer

Abstract Background: African Americans (AA) have a higher incidence of colorectal cancer (CRC) and more aggressive disease than patients of other ethnicities. Several studies have suggested that biological/genetic factors contribute to this health disparity. Recent work has shown the importance of the immune system to cancer patient prognosis, for CRC in particular. Anti-tumor T helper 1 (TH1) cell activation of cytotoxic T lymphocytes (CTL) increases CRC patient disease-free survival while deficiencies in these responses correlate with a worse prognosis. We hypothesize that differences in anti-tumor immunity by race contribute to the disparity and lead to more aggressive CRC in AA patients. Methods: Over 250 human colon tumors samples were stained using immunohistochemistry to evaluate in situ immune cell infiltration (CD8 and CD57), CTL activity [granzyme B (GzmB)], and IL-17 production. Also, using GzmB immunostaining, we analyzed the histological location of CTL/Natural Killer (NK) cell activity at intratumoral vs. invasive border sites of the CRC samples. In addition, a colon cancer mouse model is being used to identify mechanisms that may alter TH1 and CTL activity in developing tumors. The mouse model is the TS4Cre x APCfl-468 conditional Adenomatous Polyposis Coli (APC) knockout. Exons 11 and 12 are deleted from one APC gene in the colon and distal ileum due to the expression of CRE under a Fatty acid binding protein promoter leading to polyposis. These colonic tumors are being evaluated using qPCR on immune and inflammatory gene products. Results: Our studies on human microsatellite stable colon cancer samples showed that the number of CD8+ and CD57+ tumor-infiltrating cells doesn't differ by race (p=0.83 and 0.32, respectively). The level of GzmB+ cells, i.e. CTLs and activated NK cells, however, does vary significantly by race (p=0.01), particularly at the invasive border (p=0.0006). The numbers of IL-17A producing cells do not vary (p=0.63) but IL-17 may modulate GzmB correlation with CD8 and CD57 by race. For example, in AA, the correlation between GzmB and CD8 drops from 0.80 in IL-17Ahigh samples to 0.53 in IL-17Alow samples. For GzmB and CD57, the correlation level drops from 0.51 to 0.28 between IL-17A-high and -low samples, respectively. No such drop in correlation is observed in Caucasian American samples. In our mouse model, our preliminary studies show the TS4CRExAPCfl-468 mice initiate colonic polyposis at ~18 weeks of age and invasive cancer is observed in 20-25% of mice older than 31 weeks. The mean number of colonic polyps significantly increases between 18 and 24 weeks (from 2.3±0.9 to 8.0±1.9 tumors/mouse). Interestingly, the number declines by 36 weeks of age (5.5±0.5 tumors/mouse). However, the mean size of the colonic polyps significantly increases from 18 weeks to 36 weeks of age (from 1.54mm±0.55 to 4.23mm±0.56). To determine what mechanisms might result in lower anti-tumor CTL/NK activity, mouse tumors at different stages of development are currently being evaluated for IL-27, GzmA, IL-23, ƔIFN, CD8, Perforin, CX3CL1, IL-17a, H2DMB2, and Tbet gene expression using qPCR. Primers sets are also being developed to include IL-4, IL-6, IL-10, IL-12p40, and FoxP3 in our analyses. Conclusion: Our data to date indicate that the number of AA patients with high numbers of GzmB expressing cells infiltrating their tumors is significantly lower than Caucasians. In addition, IL-17 may have a modulatory effect on anti-tumor cytotoxicity by race. These observations support our hypothesis that immune processes contribute to the racial disparities observed in CRC. Current studies in our mouse model of CRC should identify mechanisms decreasing anti-tumor CTL/NK cell activity that will be tested in our Caucasian and AA colon cancer patient tumor samples in future studies. Note: This abstract was not presented at the conference. Citation Format: Mohammad W. Khan, MengXi Tian, John M. Carethers, Kathleen L. McGuire. Decreased antitumor cytotoxic immunity in African American colon cancer. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C68.

Asian Rhinoplasty: Preoperative Simulation and Planning Using Adobe Photoshop

A rhinoplasty in Asians differs from a rhinoplasty performed in patients of other ethnicities. Surgeons should understand the concept of Asian beauty, the nasal anatomy of Asians, and common problems encountered while operating on the Asian nose. With this understanding, surgeons can set appropriate goals, choose proper operative procedures, and provide an outcome that satisfies patients. In this article the authors define the concept of an Asian rhinoplasty-a paradigm shift from the traditional on-top augmentation rhinoplasty to a structurally integrated augmentation rhinoplasty-and provide a step-by-step procedure for the use of Adobe Photoshop as a preoperative program to simulate the expected surgical outcome for patients and to develop a preoperative plan for surgeons.

Determinants of Topical 5-Aminosalicylic Acid Use in Veterans with Ulcerative Colitis

Aims: The aim of our study was to identify the determinants of topical 5-ASA therapy in a large ulcerative colitis cohort. Methods: We performed a cross sectional study of patients receiving care through the Veterans Administration (VA) from 2003 to 2009. Patients with UC were identified using ICD-9 codes. Patient demographic and prescription data were obtained from national VA datasets. Univariate and multivariate logistic regression were used to identify the effect of age, gender and race on topical 5-ASA therapy use. Results: We identified 20,259 UC patients for inclusion in the analysis. The prevalence of topical 5-ASA therapy use was 27%. With univariate logistic regression, female gender and non-Caucasian race were associated with a higher odds of topical 5-ASA therapy use. Increasing age was associated with lower odds of topical 5-ASA therapy use. On multivariate logistic regression, Blacks and Hispanics remained more likely to use topical 5-ASA therapies compared to Caucasians and increasing age remained associated with a lower odds of topical 5-ASA therapy; however, other demographic features lost significance. Conclusions: In a large, national cohort of patients with UC, Blacks and Hispanics were more likely to use topical 5-ASA therapies compared to patients of other ethnicities.

The effects of HIV-1 subtype and ethnicity on the rate of CD4 cell count decline in patients naive to antiretroviral therapy: a Canadian-European collaborative retrospective cohort study.

Ethnic differences have the potential to confound associations between HIV-1 subtype and immunologic progression. We compared declines in CD4 cell counts during untreated infection for the most prevalent HIV-1 subtypes, focusing on distinguishing between the effects of viral subtype and ethnicity. We combined data from 4 European and 6 Canadian cohorts, selecting adults in the stable chronic phase of untreated HIV infection. We estimated the change in square root CD4 cell count over time for subtypes and ethnicities using mixed models, adjusting for covariates selected for their potential effect on initial CD4 cell count or its decline. Data from 9772 patients were analyzed, contributing 79175 measurements of CD4 cell count and 24157 person-years of follow-up. Overall, there were no appreciable differences in CD4 cell count decline for viral subtypes A, CRF01_AE, CRF02_AG, C and G compared with viral subtype B; whereas the decline in CD4 cell count in patients of African ancestry was considerably slower than in patients of other ethnicity. When ethnic groups were studied separately, there was evidence for slower declines in CD4 cell count in viral subtypes C, and possibly A and G, compared with viral subtype B in patients of African ancestry but not among patients of other ethnicities, suggesting an interaction between subtype and ethnicity. Ethnicity is a major determinant of CD4 cell count decline; viral subtype differences may have existed but were small compared with the effect of ethnicity and were most apparent in patients of African ancestry. In developing countries, slower CD4 cell count declines among individuals of African descent may translate to a longer asymptomatic phase and increase the opportunity for HIV transmission.

Palliative Care Intervention in the Intensive Care Unit: Comparing Outcomes among Seriously Ill Asian Patients and those of Other Ethnicities

The literature describing the attitude of Asians toward palliative care in the intensive care unit (ICU) is scarce. The purpose of this study was to compare outcomes of Asians and people of other ethnicities after palliative care intervention in the ICU. A retrospective chart review was conducted of all ICU patients evaluated by palliative care; the outcomes measured were incidence of life-sustaining treatments, institution of advance care directives, and preferences for end-of-life care. The palliative care team evaluated 119 patients (46.2 percent Caucasian, 27.2 percent Asian, and 26.1 percent other ethnicities). There were no differences in demographics or clinical variables. Thirty-six percent of the Asians, 49 percent of the Caucasians, and 28.6 percent of the patients of other ethnicities (p = 0.19) had healthcare proxies. The palliative care team increased advance care directives by more than 40 percent in all groups (p < 0.001). There were no differences in the use of life-sustaining treatments or preferences for comfort measures among ethnic groups. Asians are as likely as people of other ethnicities to decide on advance care directives, life-sustaining treatments, and comfort measures after palliative care evaluation in the ICU.

Characteristic of Patients with Inflammatory Bowel Disease Who Reside in the Department of Corrections in Connecticut

Purpose: Inflammatory bowel diseases are significant problems in the United States and developed countries. It has become more recognized in patients of other ethnicities, such as African American, Hispanic and Asian although it may be under-recognized and under-reported. In this retrospective descriptive study, we tried to assess the characteristics of incarcerated patients who present to the state hospital with a known diagnosis or symptoms of inflammatory bowel disease. We also tried to determine how these patients are being treated and if the recommended health maintenance is followed. Methods: Retrospective study of department of correction patients who were seen in a GI clinic at University of Connecticut from 10/01/2001 to 10/01/2011. All patients with IBD aged 18 and above were included, while pregnant, breastfeeding patients and patients younger than 18 were excluded. Demographic data were collected and analyzed. Categorical variables were expressed in percentages, and continuous variables were expressed as means. Results: 93 incarcerated patients with IBD were seen in the GI clinic during the defined period, but only 65 charts were included due to incomplete data on the others. 64 patients were male with only one female, 26 had Crohn's disease (40%), 35 had ulcerative colitis (40%), and four had indeterminate colitis (6%). More than two thirds of patients (72%) were initially diagnosed after incarceration. More than half were Caucasian (54%), while the rest were African Americans (28%), Hispanics (18%) and others. A significant number have co-existing hepatitis C (15%). Low levels of 25 hydroxyvitamin D were seen in eight patients, but an overwhelming number of patients (80%) were not tested for vitamin D levels. Majority of patients were recommended to have DEXA scans done, but only one patient had the test performed. A vast majority of patients (94%) were managed with 5-ASA. In addition to 5-ASA, patients were given steroids (78%), 6-MP (37%), infliximab (15%), azathioprine (8%), and only 1.5% were given cyclosporine, methotrexate, natalizumab, adalimumab, certulizumab. Conclusion: The majority of individuals who enter the department of corrections with symptoms of IBD are diagnosed after incarceration. This can be explained in part by the lack of access to health providers prior to the incarceration. Their entry into the system allows them access to healthcare via the state hospital, and ensures close follow up. The composition of patients shows a disproportionately large group of non-Caucasians (46%), although the total number of prisoners are unknown to us. Many of these patients were treated with immunomodulators, which may indicate more severe disease in the population. Routine health maintenance also needs to be addressed in more patients.

THU0405 Prevalence of and Factors Associated with Vitamin D Deficiency in 4,793 Japanese Patients with Rheumatoid Arthritis

BackgroundVitamin D (25[OH]D) deficiency is reported to be common in patients with rheumatoid arthritis (RA). Low vitamin D (25[OH]D) levels are also reported to be associated with disease activity, physical...

Impact of Medication Therapy Management on Underserved, Primarily Hispanic Patients with Diabetes

Diabetes-related complications are more pronounced in Hispanic patients versus patients of other ethnicities. It is documented that medication therapy management (MTM) can improve diabetes outcomes; however, data regarding Hispanic patients are limited. To evaluate the impact of MTM on hemoglobin A1c (A1C), blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) in underserved, primarily Hispanic patients who use a safety-net clinic as their medical home. A retrospective, observational study of uninsured, primarily Hispanic patients with diabetes who received MTM from October 2009 through March 2011. Patients were stratified into 2 cohorts: A1C less than 9% and A1C greater than or equal to 9%. Patients were also stratified by frequency of MTM visits and insulin use, regardless of A1C. A chart review was conducted to evaluate diabetes-related outcomes pre- and postimplementation of MTM. The primary study outcome was reduction of A1C. Secondary outcomes included reduction of BP and LDL-C and reduction of A1C based on MTM visit frequency or insulin use. Sixty-four patients with at least 1 MTM visit and pre- and postimplementation A1C data were included. In the cohort with A1C greater than or equal to 9%, mean (SD) A1C values decreased from 10.9% (1.4%) to 8.8% (1.5%) versus the cohort with A1C less than 9%, whose A1C changed minimally, from 7.2% (0.9%) to 7.4% (1.4%). Regardless of their A1C, patients who were using insulin at baseline had a change in A1C of -0.8% (1.5%) versus -0.1% (1.6%) in those who were not using insulin at baseline (p = 0.04); patients who participated in multiple MTM visits had a significant reduction in A1C, from 9% to 8.3% (95% CI -1.26 to -0.03; p = 0.02) compared with patients participating in only 1 MTM visit. Pharmacist-provided MTM can significantly improve diabetes control in uninsured, primarily Hispanic patients with poorly controlled diabetes and in those who are using insulin. Multiple MTM visits also yielded significant A1C reductions.

Prevalence of and factors associated with vitamin D deficiency in 4,793 Japanese patients with rheumatoid arthritis

To determine the prevalence of vitamin D deficiency and associations with clinical characteristics in Japanese patients with rheumatoid arthritis (RA), serum 25(OH)D levels, laboratory data, and clinical data were obtained from 4,793 patients with RA (4,075 women, 718 men, mean age 59.7 years) who participated in the Institute of Rheumatology Rheumatoid Arthritis observational cohort study in April and May of 2011. Serum vitamin D levels were evaluated using a radioimmunoassay. We defined vitamin D deficiency as <20 ng/mL and severe deficiency as <10 ng/mL. Associations of vitamin D deficiency with patient characteristics were examined using multivariate logistic regression. Among all patients, the mean (SD) serum 25(OH)D level was 16.9 ng/mL (6.1), and the prevalence of vitamin D deficiency and severe deficiency were 71.8 and 11.5%, respectively. In multivariate analysis, female gender, younger age, high Japanese version of health assessment questionnaire (HAQ) disability score, low serum total protein levels, low serum total cholesterol levels, high serum alkaline phosphate (ALP) levels, and non-steroidal anti-inflammatory drug (NSAID) use were significantly associated with vitamin D deficiency (P < 0.01). Vitamin D deficiency appears to be common in Japanese patients with RA, as previously reported for patients of other ethnicities. Female gender, younger age, high HAQ disability score, low serum levels of total protein and total cholesterol, high serum ALP levels, and NSAID use appear to be associated with vitamin D deficiency in Japanese patients with RA.

Diagnostic challenges in Salla disease

Sialic acid storage disease (Salla disease) is an autosomal recessive disorder caused by mutations in a lysosomal sialic acid export protein, SLC17A5 (OMIM #604369). This disorder was initially described in Northern Finland but more recently has been reported in patients of other ethnicities. We describe the clinical presentation and the neuroimaging findings of two non-Finnish children where a diagnosis of Salla disease was suspected on the basis of brain magnetic resonance imaging. The biochemical confirmation of this diagnosis posed a challenge as both patients had elevated percent free urine sialic acid but biochemical analyses in fibroblasts were not conclusive; therefore, molecular testing was necessary for confirmation of the diagnosis. The described encounters demonstrate the importance of pursuing confirmatory molecular diagnostic testing when a sialic acid storage disorder is suspected.