Effect of Obesity on Retinal Integrity in African Americans and Caucasian Americans With Relapsing Multiple Sclerosis

Objective: To study the effect of obesity on retinal structures in African Americans (AAs) and Caucasian Americans (CAs) with relapsing-remitting multiple sclerosis (RRMS).Methodology: About 136 patients with RRMS without history of optic neuritis were divided into two groups, based on body mass index (BMI): 67 obese (40 AA, 27 CA, mean BMI ± SD: 36.7 ± 5.8), and 69 non-obese (23 AA, 46 CA, mean BMI ± SD: 24.0 ± 3.1). The peripapillary retinal nerve fiber layer (pRNFL) thickness was quantified by optical coherence tomography (OCT) and was segmented into quadrant thickness: superior (S), inferior (I), temporal (T), and nasal (N). Papillomacular bundle (PMB) thickness, retinal nerve fiber layer (RNFL), ganglion cell + inner plexiform layer (GCIPL), inner nuclear (INL), outer plexiform (OPL), outer nuclear (ONL), and total macular (TMV) volumes were obtained.Results: Obesity was associated with lower T thickness (58.54 ± 15.2 vs. 61.9 12.4, p = 0.044), higher INL (0.98 ± 0.07 vs. 0.96 ± 0.06, p = 0.034), and lower RNFL (0.77 ± 0.14 vs. 0.82 ± 0.12, p = 0.009) volumes. Obese AA had significantly thinner T (58.54 ± 15.19 vs. 61.91 ± 12.39, p = 0.033), N (68.94 ± 2.7 vs. 77.94 ± 3.3, p = 0.044), and TMV (8.15 ± 0.07 vs. 8.52 ± 0.09, p = 0.003), RNFL (0.74 ± 0.02 vs. 0.82 ± 0.02, p = 0.013), OPL (0.76 ± 0.01 vs. 0.79 ± 0.1, p = 0.050), ONL (1.68 ± 0.031 vs. 1.79 ± 0.038, p = 0.026), and GCIPL (1.78 ± 0.04 vs. 1.9 ± 0.05, p = 0.038) compared to obese CA. Among patients with non-obesity, the ONL was significantly lower in AA (1.78 ± 0.04 vs. 1.9 ± 0.05, p < 0.001).Conclusions: Obesity is associated with retinal structure abnormalities in patients with RRMS. Its impact might be more prominent in AA than CA. Large longitudinal studies are needed to validate our findings.

Workplace discrimination allegations and outcomes involving caucasian Americans, African Americans, and Hispanic/Latinx Americans with multiple sclerosis: A causal comparative analysis

BACKGROUND: Although African Americans and Hispanic/Latinx Americans with multiple sclerosis (MS) frequently cite workplace discrimination as a major concern, the specific nature of this discrimination is not yet well understood. OBJECTIVE: The purpose of this study was to investigate racial/ethnic differences in allegations of workplace discrimination by Caucasian, African American, and Hispanic/Latinx American individuals with MS. METHODS: The United States Equal Employment Opportunity Commission (EEOC) Integrated Mission System (IMS) database was used to describe and compare the frequency and characteristics of discrimination allegations filed by people with MS in the three race/ethnicity groups. Quantitative analyses, including a one-way analysis of variance and Chi-square tests, were used to examine 2009–2016 Americans with Disabilities Act Amendments Act (ADAAA) Title I complaints. These complaints were received by the EEOC from people with MS who identified themselves as Caucasian, African American, and Hispanic/Latinx American (N = 3,770). RESULTS: Both African Americans and Hispanic/Latinx Americans tended to encounter discrimination at a younger age than Caucasian Americans. African American and Hispanic/Latinx American charging parties were more likely to be women than were Caucasian charging parties. The size and location of employers against whom allegations were filed varied significantly among the three racial/ethnic groups. The EEOC was more likely to resolve allegations in the charging parties’ favor when the allegations were filed by Caucasians. CONCLUSION: The present study revealed modest but significant differences in the workplace discrimination experiences of the three groups under study. More research is needed to determine why racial/ethnic status bears on the discrimination experiences of Americans with MS.

Prevalence and Morphology of the Coracoclavicular Joint: An Osteological Study of 2,724 Subjects Using Univariable and Multivariable Logistic Regression Analyses

Background: The coracoclavicular joint (CCJ) is an anomalous articulation between the surfaces of the inferior clavicle and superior coracoid and its etiology is controversial. Reportedly, symptomatic patients demonstrate significant functional limitations including shoulder abduction loss and potential for brachial plexus compression and impingement.Purpose: To determine the prevalence of CCJ across age, gender and ethnicity, and to identify clinically useful morphological characteristics.Methods: 2,724 subjects with intact clavicles and scapulae from the Hamann-Todd Osteological Collection were evaluated for the presence of CCJ. Logistic regression was used to determine the effect of age, height, gender, and race on prevalence of CCJ. 354 clavicles with CCJ were measured for size and location of the CCJ facet.Results: CCJ was observed in 9% of subjects. CCJ was more prevalent in African-Americans (12%) than Caucasian-Americans (6%) (p < 0.001) and more prevalent in females (11%) than males (8%) (p = 0.055). Facet location along clavicle length was consistent (average 25%, range 15–35%). But, facet location along clavicle width varied (average 60%, range 10–90%), with males having a more posterior location. For every 10-year increase in age, facet elevation (p = 0.001) and surface area (p < 0.001) increased.Conclusions: CCJ prevalence was 9% in our large osseous population, found more commonly in African-Americans and females. Facet location is predictable with respect to clavicle length, but less so along clavicle width. The clavicular facet may develop at some point in life and continue to grow in size after its appearance.Clinical Relevance: Presence of a CCJ represents a potential overlooked source of anterior shoulder pain and supracoracoid impingement. Epidemiologic and morphological characteristics presented in our study can aid in the identification, clinical understanding, and surgical excision of a symptomatic CCJ. Level of Evidence: Level IV.

ABO Blood Groups and COVID-19 Infection

Introduction/Objective There exists contradictory evidence in the literature that ABO blood group may have some impact on risk of COVID-19 infection. Some argue that the blood group A may confer a higher susceptibility to infection and thus be overrepresented in those who test positive for COVID-19, though other studies in the literature do not support this. Therefore, we present a regional Veterans Administration Medical Center’s (VAMC) experience early in the pandemic to provide a reference on blood group and risk of testing positive early in the pandemic for a veteran population. Methods/Case Report A retrospective review of all positive SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR) was performed for all RT-PCR tests collected at a regional VAMC from March 17th, 2020 to May 20th, 2020 was performed to collect ABO blood group information. Patients with no known ABO blood group were excluded. Results (if a Case Study enter NA) There were 81 patients who tested positive for SARS-CoV-2 with a known ABO blood group during the study period. This group had an age range of 45 to 99, consisted of 80 males and 1 female, and was racially proportioned at 57 African Americans (70.3%), 2 Asian Americans (2.5%), 1 Hispanic American (1.2%), 20 Caucasian Americans (24.7%), and one of unknown race (1.2%). The blood group distribution among these 81 patients was as follows: 39 were O+ (48.1%), 3 were O- (3.7%), 15 were B+ (18.5%), 3 were AB+ (3.7%), 18 A+ (22.2%), and 3 were A- (3.7%). Conclusion Comparison with the known distribution of ABO groups in the general population reveals that the proportion of blood groups of those testing positive are similar. This provides support to the proposition that the ABO type may not predispose significantly to COVID-19 infection.

Causal inference multiple imputation investigation of the impact of cannabinoids and other substances on ethnic differentials in US testicular cancer incidence

Background Ethnic differences in testicular cancer rates (TCRs) are recognized internationally. Cannabis is a known risk factor for testicular cancer (TC) in multiple studies with dose-response effects demonstrated, however the interaction between ancestral and environmental mutagenic effects has not been characterized. We examined the effects of this presumed gene-environment interaction across US states. Methods State based TCR was downloaded from the Surveillance Epidemiology and End Results (SEER) website via SEERStat. Drug use data for cigarettes, alcohol use disorder, analgesics, cannabis and cocaine was taken from the National Survey of Drug Use and Health a nationally representative study conducted annually by the Substance Abuse and Mental Health Services Administration (SAMHSA) with a 74.1% response rate. Cannabinoid concentrations derived from Drug Enforcement Agency publications. Median household income and ethnicity data (Caucasian-American, African-American, Hispanic-American, Asian-American, American-Indian-Alaska-Native-American, Native-Hawaiian-Pacific-Islander-American) was from the US Census Bureau. Data were processed in R using instrumental regression, causal inference and multiple imputation. Results 1975–2017 TCR rose 41% in African-Americans and 78.1% in Caucasian-Americans; 2003–2017 TCR rose 36.1% in Hispanic-Americans and 102.9% in Asian-Pacific-Islander-Americans. Ethnicity-based scatterplot-time and boxplots for cannabis use and TCR closely mirrored each other. At inverse probability-weighted interactive robust regression including drugs, income and ethnicity, ethnic THC exposure was the most significant factor and was independently significant (β-estimate = 4.72 (2.04, 7.41), P = 0.0018). In a similar model THC, and cannabigerol were also significant (both β-estimate = 13.87 (6.33, 21.41), P = 0.0017). In additive instrumental models the interaction of ethnic THC exposure with Asian-American, Hispanic-American, and Native-Hawaiian-Pacific-Islander-American ethnicities was significant (β-estimate = − 0.63 (− 0.74, − 0.52), P = 3.6 × 10− 29, β-estimate = − 0.25 (− 0.32, − 0.18), P = 4.2 × 10− 13, β-estimate = − 0.19 (− 0.25, − 0.13), P = 3.4 × 10− 9). After multiple imputation, ethnic THC exposure became more significant (β-estimate = 0.68 (0.62, 0.74), P = 1.80 × 10− 92). 25/33 e-Values > 1.25 ranging up to 1.07 × 105. Liberalization of cannabis laws was linked with higher TCR’s in Caucasian-Americans (β-estimate = 0.09 (0.06, 0.12), P = 6.5 × 10− 10) and African-Americans (β-estimate = 0.22 (0.12, 0.32), P = 4.4 × 10− 5) and when dichotomized to illegal v. others (t = 6.195, P = 1.18 × 10− 9 and t = 4.50, P = 3.33 × 10− 5). Conclusion Cannabis is shown to be a TC risk factor for all ethnicities including Caucasian-American and African-American ancestries, albeit at different rates. For both ancestries cannabis legalization elevated TCR. Dose-response and causal relationships are demonstrated.

Sarcoidosis: Review of Diagnosis and Treatment

Background: Sarcoidosis is a systemic heterogenous granulomatous disease of unknown etiology that results in inflammation of pulmonary and extrapulmonary sites. In a minority of patients it can result in fibrosis and permanent organ damage. Most commonly mentioned causes of sarcoidosis include atypical mycobacterium, proprionobacterium and inorganic dusts. Once exposed to an organic or inorganic, an Antigen Presenting Cell (APC) prepares and presents the antigen to a T cell and its respective HLA locus. In a susceptible person, this provides cytokine production, differentiation into T helper cells and provokes an immune response that in its early stages is allayed by corticosteroids or other immunomodulatory agents. In the majority of patients appropriate immunomodulatory therapy will control the disease and prevent progression. However, in 20-25 % the disease can progress and lead to organ damage or compromise and fibrosis. Sarcoidosis is a relatively common disease with an incidence of 2.3-17.8 per 100,000. It is 2-4 times more common in African Americans than Caucasian Americans with the mean age of onset of 45-50 years of age. Unlike autoimmune rheumatic disease the disease occurs almost as commonly in men than women. Sources: A Medline, Pub Med review from 1999-2021. Spectrum of Disease: Sarcoidosis occurs in 90-98 % of patients during the course of their disease. Eleven to twenty two percent of patients have involvement of either the liver, Skin, ocular (uveitis), Lymph nodes and spleen. The upper airway, liver, CNS and heart comprise <10% of cases each and the bone, joints/ muscle, and hypercalcemia < 5%. Diagnosis: With the exception of Lofgren’s and Heerfordt’syndromes the presence of non-caseating/necrotizing granuloma must be present on biopsy of at least one site and mycobacterial or fungal infections or malignancy must be ruled out. If clinically suspicious, Skin and peripheral lymph nodes are the least invasive areas for biopsy and if hilar or mediastinal nodes are suggestive, an EBUS approach is recommended. In organs such as the heart and CNS where biopsy is either insensitive or invasive, a Cardiologist and Neurologist in concert with a Rheumatologist can make a probable diagnosis based on clinical presentation, PET or MRI and exclusion of alternative diseases.

Anti-Mullerian Hormone Levels in Regularly Menstruating Nigerian Women

Background: Studies have shown that serum levels of Anti-Mullerian Hormones (AMH) decrease with age as it is also an early and sensitive marker of ovarian reserve in women in the North American, European and Asian regions. Various research works have also generated data about AMH in the Caucasian, Americans and Asians There was a need to compare these known data with African data. Objectives: To assess the serum levels of AMH in healthy women of reproductive age and determine the relationship between AMH, age, Body Mass Index, parity and menstrual cycle in healthy regularly menstruating women. Methods: A cross-sectional study of 200 apparently healthy women aged 21-45 years was carried out between January and May 2014. Serum AMH and FSH levels were measured in the participants using Enzyme-Linked Immunosorbent Assay. Results: The median AMH value was 4.07ng/mL, while the median FSH value was 9.65mIU/mL. The reference 90% CI of AMH was 0.60 -9.71 ng/ml. There was a significant negative correlation between serum level of AMH and age (r = - 0.718, p<0.001). Conclusion: The serum AMH levels gradually declined throughout the reproductive lifespan of a woman.

Preinvasive Colorectal Lesions of African Americans Display an Immunosuppressive Signature Compared to Caucasian Americans

BackgroundAfrican Americans (AAs) have higher colorectal cancer (CRC) incidence and mortality rate than Caucasian Americans (CAs). Recent studies suggest that immune responses within CRCs contribute to the disparities. If racially distinct immune signatures are present in the early phases of carcinogenesis, they could be used to develop interventions to prevent or slow disease.MethodsWe selected a convenience sample of 95 patients (48 CAs, 47 AAs) with preinvasive colorectal adenomas from the surgical pathology laboratory at the Medical University of South Carolina. Using immunofluorescent-conjugated antibodies on tissue slides from the lesions, we quantified specific immune cell populations: mast cells (CD117+), Th17 cells (CD4+RORC+), and NK cell ligand (MICA/B) and inflammatory cytokines, including IL-6, IL-17A, and IFN-γ. We compared the mean density counts (MDCs) and density rate ratios (RR) and 95% CI of immune markers between AAs to CAs using negative binomial regression analysis. We adjusted our models for age, sex, clinicopathologic characteristics (histology, location, dysplasia), and batch.ResultsWe observed no racial differences in age or sex at the baseline endoscopic exam. AAs compared to CAs had a higher prevalence of proximal adenomas (66% vs. 40%) and a lower prevalence of rectal adenomas (11% vs. 23%) (p =0.04) but no other differences in pathologic characteristics. In age, sex, and batch adjusted models, AAs vs. CAs had lower RRs for cells labeled with IFNγ (RR 0.50 (95% CI 0.32-0.81); p=0.004) and NK cell ligand (RR 0.67 (0.43-1.04); p=0.07). In models adjusted for age, sex, and clinicopathologic variables, AAs had reduced RRs relative to CAs for CD4 (p=0.02), NK cell ligands (p=0.01), Th17 (p=0.005), mast cells (p=0.04) and IFN-γ (p&lt; 0.0001).ConclusionsOverall, the lower RRs in AAs vs. CAs suggests reduced effector response capacity and an immunosuppressive (‘cold’) tumor environment. Our results also highlight the importance of colonic location of adenoma in influencing these differences; the reduced immune responses in AAs relative to CAs may indicate impaired immune surveillance in early carcinogenesis. Future studies are needed to understand the role of risk factors (such as obesity) in influencing differences in immune responses by race.

Moderation Effects of Ethnic-Racial Identity on Disordered Eating and Ethnicity Among Asian and Caucasian Americans

Background: The current study was designed to examine whether ethnic-racial identity (ERI) moderated the relationship between disordered eating and primary ethnic identification.Methods: Three hundred and ninety-eight undergraduate women (Mage = 19.95, SD = 3.09) were recruited from a large university in Hawai‘i. Participants completed the Eating Disorder Examination Questionnaire (EDE-Q), the ERI measure, and reported their primary ethnicity as an index of ethnicity.Results: There was a significant correlation between eating concerns and centrality, r(357) = 0.127, p &lt; 0.05. Moderation analyses indicated that only ERI centrality moderated the predictive effect of ethnicity on the importance of eating concerns, b = 0.05, t(347) = 2.37, p = 0.018.Conclusions: The results suggest that the relationship between self-reported primary ethnicity and EDEQ scores is greater when ethnicity is more central to the individual's identity or when the in-group affect is important to an individual. Findings underscore the need for further research on the underlying mechanisms that account for the differing ways that ERI may affect eating concerns.