Clinical Characteristics in Early Childhood Associated with a Nevus-Prone Phenotype in Adults from Tropical Australia: Two Decades of Follow-Up of the Townsville Preschool Cohort Study

Having numerous melanocytic nevi increases melanoma risk. Few studies have enumerated nevi in children and re-examined them as adults. We aimed to determine if childhood nevus-counts predict nevus-prone adults, and further explore the relevance of host-factors and sun-exposure. Fifty-one Caucasian residents of Townsville (19.16° S, Queensland, Australia) had full-body nevus-counts aged 1–6 and 21–31 years-old. Sun-exposure was determined from questionnaires. Children in the upper-quartile of nevus-counts acquired nevi more rapidly than those in the bottom-quartile (13.3 versus 4.7 nevi/year; p < 0.0005). Children sunburnt before 7 years-old acquired more incident nevi by adulthood (238 versus 126, p = 0.003) particularly if sunburn was severe (321 versus 157.5, p = 0.003) or erythema occurred annually (380 versus 132, p = 0.008). Fair-skinned, freckled children with some nevi ≥ 3 mm, solar lentigines, or a family history of melanoma acquired more incident nevi than children without these attributes. Nevus-prone adults exhibit distinguishing features earlier in life (<7 years-old in Queensland) than has been shown previously. In addition to intervening with sun-protection counselling early enough to reduce risk, being able to reliably triage children into high- and low melanoma-risk groups may inform more efficacious and cost-effective targeted-screening in melanoma-prone populations. Further longitudinal research is needed to confirm that these attributes can reliably separate risk-groups.

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Survey and Diagnostic Challenges after Transmission-Stop: Confirming Elimination of Schistosomiasis haematobium in Morocco

Journal of Parasitology Research ◽

10.1155/2020/9705358 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Amarir Fatima ◽

Balahbib Abdelaali ◽

Paul L. A. M. Corstjens ◽

Sadak Abderrahim ◽

Adlaoui El Bachir ◽

...

Keyword(s):

Past History ◽

National Laboratory ◽

National Level ◽

Cost Effective ◽

Risk Groups ◽

Diagnostic Tools ◽

Pooling Strategies ◽

History Of ◽

Sensitivity Specificity

Clinical cases of Moroccan residents have been recorded since 2004, indicating successful interruption of transmission of S. haematobium infection at national level. The first national survey initiated in 2009 for Schistosomiasis haematobium among children born after 2004, applied diagnostic test was the HAMA-EITB, based on the Western blot technology, and molecular malacological diagnostic tools clearly confirm transmission stop. In 2015, a recent, small survey utilizing an HAI, ELISA tests and an ultrasensitive antigen test, FTCUP CAA, in a group of individual with a past history of infection. However, obviously follow-up surveys to prevent reemergency and for certification of the schistosomiasis elimination require vigilant diagnosis strategies. Here we discuss diagnosis story line in the national laboratory and challenges based on the available tools in relation to their clinical parameters (sensitivity/specificity; Sn/Sp), practicability and associated costs. When transmission stop has been achieved, survey cost and speed are likely to benefit from cost effective pooling strategies and ultrasensitive assays indicating active infection in all potential risk groups. Similarly molecular pooling strategies to monitor infections in the snail vectors.

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Coronary risk of patients with valvular heart disease: prospective validation of CT-Valve Score

Open Heart ◽

10.1136/openhrt-2020-001380 ◽

2020 ◽

Vol 7 (2) ◽

pp. e001380

Author(s):

Rasmus Bo Hasselbalch ◽

Mia Marie Pries-Heje ◽

Sarah Louise Kjølhede Holle ◽

Thomas Engstrøm ◽

Merete Heitmann ◽

...

Keyword(s):

Heart Disease ◽

Valvular Heart Disease ◽

Primary Outcome ◽

Multislice Ct ◽

Cost Effective ◽

University Hospital ◽

Before And After ◽

History Of ◽

Artery Disease

ObjectiveTo prospectively validate the CT-Valve score, a new risk score designed to identify patients with valvular heart disease at a low risk of coronary artery disease (CAD) who could benefit from multislice CT (MSCT) first instead of coronary angiography (CAG).MethodsThis was a prospective cohort study of patients referred for valve surgery in the Capital Region of Denmark and Odense University Hospital from the 1 February 2015 to the 1 February 2017. MSCT was implemented for patients with a CT-Valve score ≤7 at the referring physician’s discretion. Patients with a history of CAD or chronic kidney disease were excluded. The primary outcome was the proportion of patients needing reevaluation with CAG after MSCT and risk of CAD among the patients determined to be low to intermediate risk.ResultsIn total, 1149 patients were included. The median score was 9 (IQR 3) and 339 (30%) had a score ≤7. MSCT was used for 117 patients. Of these 29 (25%) were reevaluated and 9 (7.7%) had CAD. Of the 222 patients with a score ≤7 that did not receive an MSCT, 14 (6%) had significant CAD. The estimated total cost of evaluation among patients with a score ≤7 before implementation was €132 093 compared with €79 073 after, a 40% reduction. Similarly, estimated total radiation before and after was 608 mSv and 362 mSv, a 41% reduction. Follow-up at a median of 32 months (18–48) showed no ischaemic events for patients receiving only MSCT.ConclusionThe CT-Valve score is a valid method for determining risk of CAD among patients with valvular heart disease. Using a score ≤7 as a cut-off for the use of MSCT is safe and cost-effective.

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Nonfamilial Cutaneous Melanoma Incidence in Women Associated With Sun Exposure Before 20 Years of Age

PEDIATRICS ◽

10.1542/peds.84.2.199 ◽

1989 ◽

Vol 84 (2) ◽

pp. 199-204

Author(s):

Martin A. Weinstock ◽

Graham A. Colditz ◽

Walter C. Willett ◽

Meir J. Stampfer ◽

Ben A. Bronstein ◽

...

Keyword(s):

Cutaneous Melanoma ◽

White Women ◽

Conditional Logistic Regression ◽

Sun Exposure ◽

Study Cohort ◽

Control Analysis ◽

Melanoma Risk ◽

Equatorial Latitude ◽

First Degree Relatives ◽

History Of

Despite strong evidence that sun exposure causes malignant melanoma, the details of this relation remain unclear. A nested case-control analysis was conducted within the Nurses' Health Study cohort to examine the relation between timing of severe sun exposure and incidence of melanoma. The subjects were 130 white women aged 38 to 65 years with confirmed cutaneous melanoma (other than acral lentigenous) who reported no history of melanoma in first-degree relatives. The control subjects were 300 women matched by race, date of birth, and cycle of questionnaire who also reported no history of melanoma in first-degree relatives. We used conditional logistic regression to evaluate the relation of sun damage after 30 years of age and sun damage from 15 to 20 years of age to the incidence of melanoma. Blistering sunburns between 15 to 20 years of age were associated with risk of melanoma (relative risk = 2.2 for five or more burns vs none, 95% confidence interval 1.2 to 3.8). This association persisted when a history of burns after 30 years of age was controlled in the analysis. No material association was found between blistering sunburns after 30 years of age and melanoma. Similarly, a more equatorial latitude of residence between 15 and 20 years of age was positively associated with melanoma; latitude after 30 years of age was less strongly and not significantly related to melanoma risk. Sun exposure prior to 20 years of age is more closely associated with melanoma risk than sun exposure after 30 years of age.

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Buschke-Löwenstein Tumour: Successful Treatment with Minimally Invasive Techniques

Case Reports in Dermatological Medicine ◽

10.1155/2015/651703 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4

Author(s):

Estefânia Correia ◽

António Santos

Keyword(s):

Minimally Invasive ◽

Cost Effective ◽

Functional Results ◽

Moderate Degree ◽

Minimally Invasive Techniques ◽

Secondary Intention ◽

History Of ◽

Full Thickness Excision ◽

Invasive Techniques

We report a case of an 80-year-old female who presented with a four-year history of a growing mass in the perianal area with pain and bleeding during defaecation. Clinical examination revealed a locally destructive, cauliflower-like, verrucous mass measuring 10×12 cm in diameter. Histologic findings revealed a moderate degree of dysplasia of the epithelium with koilocytosis atypia, acanthosis, and parakeratosis, features that are consistent with Buschke-Löwenstein tumour. Polymerase-chain-reaction assay for human papillomavirus (HPV) showed an infection with HPV type 11. Full-thickness excision of involved skin was undertaken by cryotherapy and electrocautery over five months. The entire wound was left open to heal by secondary intention. After 3 years of follow-up, the patient has not experienced a recurrence, with excellent functional results, but the cosmetic results were satisfactory. These minimally invasive techniques can be safer and more cost-effective than surgery and the General Practitioner can play a key role in diagnosis.

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Development and external validation of a clinical prediction model for MRSA carriage at hospital admission in Southeast Lower Saxony, Germany

Scientific Reports ◽

10.1038/s41598-020-75094-6 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Gabriele Raschpichler ◽

Heike Raupach-Rosin ◽

Manas K. Akmatov ◽

Stefanie Castell ◽

Nicole Rübsamen ◽

...

Keyword(s):

Hospital Admission ◽

External Validation ◽

Model Development ◽

Cost Effective ◽

Risk Groups ◽

Validation Dataset ◽

Lower Saxony ◽

Screening Programs ◽

Lower Specificity ◽

History Of

Abstract In countries with low endemic Methicillin-resistant Staphylococcus aureus (MRSA) prevalence, identification of risk groups at hospital admission is considered more cost-effective than universal MRSA screening. Predictive statistical models support the selection of suitable stratification factors for effective screening programs. Currently, there are no universal guidelines in Germany for MRSA screening. Instead, a list of criteria is available from the Commission for Hospital Hygiene and Infection Prevention (KRINKO) based on which local strategies should be adopted. We developed and externally validated a model for individual prediction of MRSA carriage at hospital admission in the region of Southeast Lower Saxony based on two prospective studies with universal screening in Braunschweig (n = 2065) and Wolfsburg (n = 461). Logistic regression was used for model development. The final model (simplified to an unweighted score) included history of MRSA carriage, care dependency and cancer treatment. In the external validation dataset, the score showed a sensitivity of 78.4% (95% CI: 64.7–88.7%), and a specificity of 70.3% (95% CI: 65.0–75.2%). Of all admitted patients, 25.4% had to be screened if the score was applied. A model based on KRINKO criteria showed similar sensitivity but lower specificity, leading to a considerably higher proportion of patients to be screened (49.5%).

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Skin Cancers Among Chronic Lymphocytic Leukemia (CLL) Patients - the Effect of UV Radiation and CLL Clinical Characteristics

Blood ◽

10.1182/blood.v128.22.4772.4772 ◽

2016 ◽

Vol 128 (22) ◽

pp. 4772-4772 ◽

Cited By ~ 4

Author(s):

Geffen Kleinstern ◽

Abdul Rishi ◽

Sara J Achenbach ◽

Kari Rabe Chaffee ◽

Neil E. Kay ◽

...

Keyword(s):

Skin Cancer ◽

Uv Radiation ◽

Mayo Clinic ◽

Research Funding ◽

Sun Exposure ◽

Prior History ◽

Skin Cancers ◽

History Of ◽

Very High

Abstract Background: It is well established that the incidence of skin cancers in patients with CLL are significantly elevated compared to age- and sex- matched controls. However, little is known about the characteristics of CLL patients who develop skin cancer. Herein, we evaluate the associations of CLL clinical and prognostic characteristics, along with UV radiation exposure, with risk of first skin cancer following CLL diagnosis. Methods: Newly diagnosed CLL patients from Minnesota, Iowa, and Wisconsin were enrolled in the Mayo Clinic case-control study from 2002-2015 and systematically followed in the Iowa/Mayo Lymphoma SPORE. Clinical and prognostic CLL data were obtained from the Mayo Clinic CLL database, and skin cancer clinical data were abstracted from medical records using a standard protocol. The CLL international prognostic index (CLL-IPI) was computed using a weighted average of five independent CLL prognostic factors (IGHV mutational status, serum b2-microglobulin, Rai stage, age, and FISH 17p deletion/TP53 status). Self-reported history of midday sun exposure at various ages (birth to age 12; 13 to 21 years; 22 to 40 years, and 41+ years) was obtained from a risk factor questionnaire. For each age, we asked the extent of mid-day sun as: practically no exposure (under 3 hours per week), little exposure (4-7 hours per week), moderate exposure (8 to 14 hours per week) and extensive exposure (15+ hours per week). Midday sun exposure was modeled as an ordinal covariate. To evaluate associations with risk of skin cancer following CLL diagnosis, we calculated time from date of CLL diagnosis to date of first skin cancer, death, or last known follow-up. We used Cox regression analysis to estimate hazard ratios (HRs) and 95% CIs. CLL treatment was considered a time-dependent covariate. Results: Among 846 CLL patients enrolled, the median age at diagnosis was 63 years (range 28-91), 68% were male, 7% had Rai stage III-IV at diagnosis. Based on the CLL-IPI, 42% were categorized as low risk, 33% as intermediate risk, and 25% as high or very-high risk. 109 CLL cases (13%) had one or more reported skin cancers at or prior to CLL diagnosis. Melanoma was observed in 19 (2%) cases and non-melanoma was in 90 (11%) cases. At a median follow-up of 7 years from CLL diagnosis, 165 patients (20%) had one or more skin cancers after CLL diagnosis. Among these patients, 49 had skin cancer before CLL diagnosis. The most frequent skin cancer was squamous cell carcinoma (59%), followed by basal cell (31%), melanoma (5%), and Merkel cell (1%). 552 (65%) of the 846 patients returned a questionnaire. Significant associations of clinical and prognostic characteristics with risk of first skin cancer were observed for age (HR=1.35 per 10 year increase, 95% CI=1.17-1.56, P<0.001), male sex (HR=1.38, 95% CI 0.98-1.96, p=0.07), prior history of skin cancer (HR=4.19, 95% CI=2.98-5.88, P<0.001), and CLL-IPI (HR=1.26, 95% CI= 1.03-1.54, P=0.026, after adjusting for age, sex, and prior skin cancer). Of note, the risk of first skin cancer in those CLL patients categorized as very high via CLL-IPI had 2.28 fold risk (95% CI 1.02-5.11). Midday sun exposures for each of the ages considered showed no evidence of association with risk of first skin cancer (all P>0.05). 50 CLL patients were treated prior to first skin cancer following CLL diagnosis; we observed no evidence of association between treatment and risk of first skin cancer (HR=1.44, 95% CI= 0.93-1.92, P=0.12). Conclusion: CLL patients who are at an increased risk of skin cancer following CLL diagnosis are those who either have had a prior history of skin cancer or a more aggressive CLL disease at diagnosis, according to CLL IPI. Routine skin cancer screening is currently recommended for CLL patients. Our data suggest that more frequent screening would be particularly important among patients with aggressive CLL and who have a prior history of skin cancer. Unexpectedly, we found no evidence of association of skin cancer risk with UV radiation following CLL diagnosis or with CLL treatment. Further investigation is needed to determine whether other factors increase the risk of skin cancer following CLL diagnosis. Disclosures Shanafelt: Genentech: Research Funding; GlaxoSmithkKine: Research Funding; Janssen: Research Funding; Celgene: Research Funding; Cephalon: Research Funding; Pharmacyclics: Research Funding; Hospira: Research Funding.

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Detection of a new melanoma in a patient treated with fingolimod

BMJ Case Reports ◽

10.1136/bcr-2018-227951 ◽

2019 ◽

Vol 12 (4) ◽

pp. e227951 ◽

Cited By ~ 3

Author(s):

Yves Michiels ◽

Olivier Bugnon ◽

Jean-François Michiels ◽

Sophie Mazellier

Keyword(s):

Multiple Sclerosis ◽

Sun Exposure ◽

Superficial Spreading ◽

Brown Hair ◽

Skin Cancers ◽

Relapsing Remitting ◽

History Of ◽

Blue Eyes ◽

Relapsing Remitting Multiple Sclerosis

In addition to the TRANSFORMS, FREEDOMS, INFORMS studies, very few publications have identified new cases of skin cancer in patients treated with fingolimod. Here, we present the case of a 52-year-old Caucasian patient with relapsing remitting multiple sclerosis for 19 years, with a phototype II with blue eyes, light brown hair, no personal or family history of melanoma and a low number of naevi (<10). She did not experience intense sun exposure in childhood as well as severe sunburn and did not practise sessions in ultraviolet cabins. This case is distinguished from other published cases, usually superficial spreading malignant melanoma by its unclassifiable histological character. The occurrence of skin cancers in patients with multiple sclerosis remains exceptional, but new cases have recently emerged requiring the strengthening of dermatological follow-up of such patients.

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A Single Surgeon, 10 Year Experience with the Oxford Partial Knee System: What a Difference Experience, Instruments, Implants, and Technique Can Make

Reconstructive Review ◽

10.15438/rr.7.2.180 ◽

2017 ◽

Vol 7 (2) ◽

Author(s):

David Mauerhan ◽

Nigel L Rozario

Keyword(s):

Mobile Bearing ◽

Cost Effective ◽

History Of ◽

Total Knee ◽

One Year ◽

High Degree ◽

The Impact ◽

Partial Knee Replacement ◽

Lower Morbidity

Partial knee (unicompartmental) arthroplasty (PKA) for medial compartment disease of the knee has a long and well documented history of successful results over long periods of follow up. The Oxford Partial Knee Replacement has been available in the U.S. since 2004. After completing an FDA required instructional course, surgeons may use the device. Both the implant and the instruments have evolved since its introduction in 2004. This paper outlines the authors continuous cohort of 249 patients, 286 knees from 2004 to 2014 with minimum 2 year follow up, and reports the results while discussing the impact of experience, instruments and implants, and technique on the outcome of patients in this series. For the aggregate group of 286 knees, there were 17(5.9%) all-cause revisions to TKA, including 2(0.7%) dislocations, resulting in a (83%) survivorship at ten years. The survivorship at ten years for retained implants was 97% if non-implant related causes are not included. At one year, there were 89% excellent and good results, 5% fair, and 6% poor. At two years, there were 93% excellent and good, 1 % fair, and 5.5% poor. The causes for the poor results at one and two years were tibial sided failure or persistent pain. Three (12%) of patients with a poor result at one year had converted to good and excellent at two years. The use of the Oxford Mobile Bearing™ PKA has been shown to be a useful part of the surgeon’s surgical armamentarium when dealing with anteromedial osteoarthritis or osteonecrosis of the knee. PKA has been shown to have a lower morbidity and mortality and is cost effective when compared to total knee arthroplasty. The author’s experience, as demonstrated in this study, adds validity to the concept that understanding the pathoanatomy of anteromedial osteoarthritis and gaining surgical experience through increased surgical volume, adherence to well documented technique, and the use of a time proven implant, can be accomplished with a high degree of successful outcomes for patients with the appropriate indications.

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Personal melanoma risk awareness versus intrinsic risk.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.9069 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 9069-9069

Author(s):

Caroline Robert ◽

Céleste Lebbé ◽

Sevrine Ricard ◽

Philippe Saiag ◽

Florent Grange ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Family History ◽

Sun Exposure ◽

Risk Level ◽

Control Group ◽

Melanoma Risk ◽

Protection Measures ◽

Frequent Use ◽

History Of

9069 Background: Intrinsic risk factors for melanoma include personal and family history of the condition, a high number of naevi and a light skin phototype (I or II). The objective of this study was to evaluate the correlation between personal awareness of melanoma risk and objective risk factors and to analyze the elements associated with under-or over-evaluation of the actual risk. Methods: EDIFICE melanoma, a nationwide French observational survey, was conducted through phone interviews on a representative sample of 1502 subjects aged ≥ 18 using typical quotas. The survey took place from 28th Sept 2011 to 20th Oct 2011. Results: 393 subjects (26%) had at least one melanoma risk factor: personal: 1%; family history: 11%; high number of naevi: 8% and phototype I-II: 11%. 1109 (74%) had no risk factor. 1029 (73%) had a correct perception of their risk level, 135 (10%) overestimated their risk and 241 (17%) underestimated it. Compared to the control group (correct perception), the population overestimating the melanoma risk is characterised by a higher percentage of individuals living alone (32% vs. 24%, p<0.05), socio-professional category + (38% vs. 28%, p<0.01) and greater alcohol consumption (45% vs. 34%, p<0.02). They are also more likely to expose themselves to the sun (89% vs. 78%, p<0.004) and less likely to use sunscreen protection (58% vs. 44%, p<0.003). A greater proportion of them participates in melanoma screening programmes (21% vs. 14%, p<0.04). The population that underestimates the risk is characterised by lower educational attainment (11% vs. 7%, p<0.05), greater use of high SPF sunscreen (41% vs. 29%, p<0.0004) and a more frequent use of UV sunbeds (9% vs. 6%, p<0.06). Conclusions: Overall, the French have a fair perception of their personal likelihood of developing melanoma. Interestingly, subjects overestimating their intrinsic risk do not behave appropriately with respect to sun protection measures (more sun exposure and less sunscreen protection). On the other hand, subjects underestimating their risk use UV sunbeds more extensively.

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Adult Patient Risk Stratification Using a Risk Score for Periodontitis

Journal of Clinical Medicine ◽

10.3390/jcm8030307 ◽

2019 ◽

Vol 8 (3) ◽

pp. 307 ◽

Cited By ~ 2

Author(s):

Miguel de Araújo Nobre ◽

Ana Ferro ◽

Paulo Maló

Keyword(s):

Risk Score ◽

Risk Model ◽

Risk Groups ◽

First Year ◽

C Statistic ◽

History Of ◽

Study Population ◽

Subgingival Calculus ◽

Analytical Tools

Background: There is a need for analytical tools predicting the risk of periodontitis. The purpose of this study was to estimate and evaluate a risk score for prediction of periodontitis. Materials and methods: This case-cohort study included a random sample of 155 cases (with periodontitis) and 175 controls (randomly sampled from the study population at baseline) that were followed for 3-year. A logistic regression model was used with estimation of the risk ratio (RR) for each potential predictor. Results: The risk model included the predictors “age > 53 years” (RR = 0.53), “smoking” (RR = 2.9), “gingivitis at baseline” (RR = 3.1), “subgingival calculus at baseline” (RR = 1.9), “history of periodontitis” (RR = 2.3), and “less than 2 observations in the first year of follow-up” (RR = 3.7). Patients were distributed into three risk groups based on the preanalysis risk: low risk, moderate risk, and high risk. The risk score discrimination (95% confidence interval (CI)) was 0.75 (0.70; 0.80) (p < 0.001, C-statistic). Conclusions: The risk score estimated in the present study enabled to identify patients at higher risk of experiencing periodontitis and may be considered a useful tool for both clinicians and patients.

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