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For psoriatic patients who need to receive nonlive or live vaccines, evidence-based recommendations are needed regarding whether to pause or continue systemic therapies for psoriasis and/or psoriatic arthritis. To evaluate literature regarding vaccine efficacy and safety and to generate consensus-based recommendations for adults receiving systemic therapies for psoriasis and/or psoriatic arthritis receiving nonlive or live vaccines. Using a modified Delphi process, 22 consensus statements were developed by the National Psoriasis Foundation Medical Board and COVID-19 Task Force, and infectious disease experts. Key recommendations include continuing most oral and biologic therapies without modification for patients receiving nonlive vaccines; consider interruption of methotrexate for nonlive vaccines. For patients receiving live vaccines, discontinue most oral and biologic medications before and after administration of live vaccine. Specific recommendations include discontinuing most biologic therapies, except for abatacept, for 2-3 half-lives before live vaccine administration and deferring next dose 2-4 weeks after live vaccination. Studies regarding infection rates after vaccination are lacking. Interruption of antipsoriatic oral and biologic therapies is generally not necessary for patients receiving nonlive vaccines. Temporary interruption of oral and biologic therapies before and after administration of live vaccines is recommended in most cases. [ABSTRACT FROM AUTHOR]

With expansion of academic cancer center networks across geographically-dispersed sites, ensuring high-quality delivery of care across all network affiliates is essential. We report on the characteristics and efficacy of a radiation oncology peer-review quality assurance (QA) system implemented across a large-scale multinational cancer network. Since 2014, weekly case-based peer-review QA meetings have been standard for network radiation oncologists with radiation oncology faculty at a major academic center. This radiotherapy (RT) QA program involves pre-treatment peer-review of cases by disease site, with disease-site subspecialized main campus faculty members. This virtual QA platform involves direct review of the proposed RT plan as well as supporting data, including relevant pathology and imaging studies for each patient. Network RT plans were scored as being concordant or nonconcordant based on national guidelines, institutional recommendations, and/or expert judgment when considering individual patient-specific factors for a given case. Data from January 1, 2014, through December 31, 2019, were aggregated for analysis. Between 2014 and 2019, across 8 network centers, a total of 16,601 RT plans underwent peer-review. The network-based peer-review case volume increased over the study period, from 958 cases in 2014 to 4,487 in 2019. A combined global nonconcordance rate of 4.5% was noted, with the highest nonconcordance rates among head-and-neck cases (11.0%). For centers that joined the network during the study period, we observed a significant decrease in the nonconcordance rate over time (3.1% average annual decrease in nonconcordance, P = 0.01); among centers that joined the network prior to the study period, nonconcordance rates remained stable over time. Through a standardized QA platform, network-based multinational peer-review of RT plans can be achieved. Improved concordance rates among newly added network affiliates over time are noted, suggesting a positive impact of network membership on the quality of delivered cancer care. [ABSTRACT FROM AUTHOR]

Background: Hidradenitis suppurativa (HS) is associated with comorbidities that contribute to poor health, impaired life quality, and mortality risk.Objective: To provide evidence-based screening recommendations for comorbidities linked to HS.Methods: Systematic reviews were performed to summarize evidence on the prevalence and incidence of 30 comorbidities in patients with HS relative to the general population. The screening recommendation for each comorbidity was informed by the consistency and quality of existing studies, disease prevalence, and magnitude of association, as well as benefits, harms, and feasibility of screening. The level of evidence and strength of corresponding screening recommendation were graded by using the Strength of Recommendation Taxonomy (SORT) criteria.Results: Screening is recommended for the following comorbidities: acne, dissecting cellulitis of the scalp, pilonidal disease, pyoderma gangrenosum, depression, generalized anxiety disorder, suicide, smoking, substance use disorder, polycystic ovary syndrome, obesity, dyslipidemia, diabetes mellitus, metabolic syndrome, hypertension, cardiovascular disease, inflammatory bowel disease, spondyloarthritis, and sexual dysfunction. It is also recommended to screen patients with Down syndrome for HS. The decision to screen for specific comorbidities may vary with patient risk factors. The role of the dermatologist in screening varies according to comorbidity.Limitations: Screening recommendations represent one component of a comprehensive care strategy.Conclusions: Dermatologists should support screening efforts to identify comorbid conditions in HS. [ABSTRACT FROM AUTHOR]

Background: Psoriasis has been linked to obesity, although data on the incidence of psoriasis according to body mass index (BMI) are limited.Objective: To compare incidence of psoriasis among patients stratified by BMI category (normal or underweight, overweight, obese class 1, obese class 2/3).Methods: Retrospective cohort analysis of a demographically heterogeneous sample of over 1.5 million patients in the United States between January 1, 2008 and September 9, 2019.Results: Crude incidence of psoriasis per 10,000 person-years was 9.5 (95% confidence interval [CI], 9.1-10.0) among normal or underweight patients, 11.9 (95% CI, 11.4-12.4) among overweight patients, 14.2 (95% CI, 13.6-14.9) among obese class 1 patients, and 17.4 (95% CI, 16.6-18.2) among obese class 2/3 patients. Compared to patients with BMI < 25.0, those who were overweight (adjusted hazard ratio, 1.19; 95% CI, 1.12-1.27; P < .001), obese class 1 (adjusted hazard ratio, 1.43; CI, 1.34-1.53; P < .001) and obese class 2/3 (adjusted hazard ratio, 1.83; CI, 1.71-1.95; P < .001) significantly greater risks for developing psoriasis.Limitations: Influence of obesity on psoriasis severity could not be measured.Conclusion: BMI independently influences the development of psoriasis. There appears to be a graded association between BMI and risk of psoriasis. [ABSTRACT FROM AUTHOR]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2008.05.013 Byline: Daniel G. Hackam (a), Minh L. Duong-Hua (b), Muhammad Mamdani (b)(c), Ping Li (b), Sheldon W. Tobe (d), J. David Spence (a), Amit X. Garg (b)(e) Abstract: Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers effectively reduce blood pressure in patients with renovascular disease (RVD); yet, randomized cardiovascular prevention trials of these drugs typically exclude individuals with this condition. Author Affiliation: (a) Division of Clinical Pharmacology, University of Western Ontario, London, Ontario, Canada (b) Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (c) Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada (d) Division of Nephrology, University of Toronto, Toronto, Ontario, Canada (e) Division of Nephrology, University of Western Ontario, London, Ontario, Canada Article History: Received 28 January 2008; Accepted 6 May 2008 Article Note: (footnote) The study was supported by an unrestricted research grant from the University of Western Ontario, London, Ontario, Canada. None of the funding sources participated in the design or conduct of the research; collection, management, analysis, or interpretation of the data; or the preparation, review, and approval of the manuscript., No conflicts of interest exist for D.G.H., M.L.D., M.M., P.L., or A.X.G. J.D.S. has consulted for Novartis and received lecture fees from Solvay. SWT has participated in research studies, advisory panels, and lectures with support from AstraZeneca, Abbott, Boehringer-Ingelheim, Bristol-Myers Squibb, Sanofi-Aventis, Merck, and Novartis.

Background: Relationships of socioeconomic status (SES) and race to survival in acral lentiginous melanoma (ALM) are poorly characterized.Objective: To compare disease-specific survival in ALM across SES and race.Methods: Retrospective cohort study using the Surveillance, Epidemiology, and End Results database, 2000 to 2016.Results: We identified 2245 patients with a first ALM diagnosis. Five-year disease-specific survival was 77.8% (95% CI, 75.9%-79.9%). After adjustment, patients in the lowest and second-to-lowest SES quintile had 1.33 (95% CI, 0.90-1.96) and 1.42 (95% CI, 1.03-1.97) times the risk of death, respectively, compared to highest quintile patients. Hispanic White and Black patients had 1.48 (95% CI, 1.10-1.99) and 1.25 (95% CI, 0.88-1.79) times the risk of death, respectively, compared to non-Hispanic Whites. Hazard ratios for ALM-specific death decreased in Hispanic White and Black patients after adjusting for SES and American Joint Committee on Cancer stage at diagnosis.Limitations: Treatments could not be evaluated. SES was measured at the level of the census tract and does not account for individual level factors.Conclusion: Differences exist in ALM survival according to socioeconomic status and race. Differences in SES and American Joint Committee on Cancer stage at diagnosis contribute to survival disparities for Hispanic White and Black patients. Understanding factors driving survival disparities related to SES and race may improve ALM outcomes. [ABSTRACT FROM AUTHOR]

Background: Information on prevalence of depression among children, adolescents, and adults with hidradenitis suppurativa (HS) is limited.Objective: To compare prevalence of depression in HS patients with that of controls.Methods: Cross-sectional analysis of 38,140 adult and 1162 pediatric HS patients and controls identified using data from electronic health records. Primary outcome was prevalent depression.Results: Prevalence of depression among adults with HS was 30.0% (95% Confidence interval [CI], 29.6-30.5), compared with 16.9% (95% CI, 16.7-17.1) among controls. Among children and adolescents with HS, prevalence of depression was 11.7% (95% CI, 10.0-13.7), compared with 4.1% (95% CI, 3.6-4.7) among controls. In adjusted analyses, adults and children/adolescents with HS had 1.26 (95% CI, 1.25-1.28; P < .001) and 1.42 (95% CI, 0.999-2.01; P = .051) times the odds of having depression relative to controls, respectively.Limitations: We could not evaluate the influence of disease severity on the outcome.Conclusion: Depression is prevalent among children, adolescents, and adults with HS. Periodic screening for depression may be warranted. [ABSTRACT FROM AUTHOR]

Background: Hidradenitis suppurativa (HS) disproportionately affects women of childbearing age. However, pregnancy and maternal outcomes for women with HS are unknown.Objective: To compare risk of adverse pregnancy and maternal outcomes among women with and without HS and to evaluate the influence of comorbid conditions.Methods: Retrospective cohort analysis between January 1, 2011, and September 30, 2015.Results: Compared to control pregnancies (n = 64,218), HS pregnancies (n = 1862) had a higher risk of spontaneous abortion (15.5% vs 11.3%), preterm birth (9.1% vs 6.7%), gestational diabetes mellitus (11.6% vs 8.4%), gestational hypertension (6.1% vs 4.4%), preeclampsia (6.6% vs 3.8%), and cesarean section (32.4% vs 27.1%). Relative risk of some pregnancy and maternal outcomes were attenuated after comorbidity adjustment. In the fully adjusted model, HS pregnancies were independently associated with spontaneous abortion (odds ratio, 1.20; 95% CI, 1.04-1.38), gestational diabetes mellitus (odds ratio, 1.26; 95% CI, 1.07-1.48), and cesarean section (odds ratio, 1.09; 95% CI, 1.004-1.17).Limitations: We could not evaluate potential influences of disease duration, activity, or severity. Newborn outcomes could not be evaluated.Conclusion: HS appears to be an independent risk factor for adverse pregnancy and maternal outcomes. This risk is influenced by comorbidities that may be modifiable with early identification and management. [ABSTRACT FROM AUTHOR]

Background: Limited information exists on mucocutaneous disease and its relation to course of COVID-19.Objective: To estimate prevalence of mucocutaneous findings, characterize morphologic patterns, and describe relationship to course in hospitalized adults with COVID-19.Methods: Prospective cohort study at 2 tertiary hospitals (Northwell Health) between May 11, 2020 and June 15, 2020.Results: Among 296 hospitalized adults with COVID-19, 35 (11.8%) had at least 1 disease-related eruption. Patterns included ulcer (13/35, 37.1%), purpura (9/35, 25.7%), necrosis (5/35, 14.3%), nonspecific erythema (4/35, 11.4%), morbilliform eruption (4/35, 11.4%), pernio-like lesions (4/35, 11.4%), and vesicles (1/35, 2.9%). Patterns also showed anatomic site specificity. A greater proportion of patients with mucocutaneous findings used mechanical ventilation (61% vs 30%), used vasopressors (77% vs 33%), initiated dialysis (31% vs 9%), had thrombosis (17% vs 11%), and had in-hospital mortality (34% vs 12%) compared with those without mucocutaneous findings. Patients with mucocutaneous disease were more likely to use mechanical ventilation (adjusted prevalence ratio, 1.98; 95% confidence interval, 1.37-2.86); P < .001). Differences for other outcomes were attenuated after covariate adjustment and did not reach statistical significance.Limitations: Skin biopsies were not performed.Conclusions: Distinct mucocutaneous patterns were identified in hospitalized adults with COVID-19. Mucocutaneous disease may be linked to more severe clinical course. [ABSTRACT FROM AUTHOR]

Background: Information on recent trends in overall and subgroup incidences in psoriasis is limited.Objective: To estimate current incidence of psoriasis in the United States, compare incidences among demographic subgroups, and evaluate recent disease trends.Methods: Retrospective cohort analysis of psoriasis patients identified with electronic health records between 2014 and 2018.Results: Incidence rate in the overall population (n = 2,152,192) was 63.8 (95% confidence interval [CI] 61.8-65.8) per 100,000 person-years. Incidence increased with age and peaked among individuals aged 70 to 79 years (92.3 [95% CI 85.1-100.0] per 100,000 person-years). Incidence was similar between men (62.8 [95% CI 59.8-65.9] per 100,000 person-years) and women (64.8 [95% CI 62.2-67.4] per 100,000 person-years). Standardized incidence rate for Whites (75.3 [95% CI 72.7-78.0] per 100,000 person-years) was greater than that for Hispanic/Latino patients (52.2 [95% CI 44.9-60.3] per 100,000 person-years; P < .001), patients of other race (54.3 [95% CI 46.5-62.9] per 100,000 person-years; P < .001), and Blacks (24.9 [95% CI 21.4-28.8] per 100,000 person-years; P < .001). Incidence appears to be stable within a recent 5-year period.Limitations: Estimates were derived from approximately 15% of the health care-seeking US population.Conclusion: Psoriasis incidence in the United States appears to increase with age, is similar between sexes, and is greatest among Whites. [ABSTRACT FROM AUTHOR]

CO 2 capture and storage (CCS) is increasingly being viewed as an important part of India's energy transitions by several practitioners. Ensemble modeling scenarios consistent with the Paris Agreement indicate that investments by the end of this decade towards CO 2 transport and geologic storage would need to be $1–8 billion/year in India. These large-scale investments are accompanied by multiple technical, environmental, financial and societal interlinkages that interface with sustainable development. This review begins by summarizing some of these considerations in context of geologic CO 2 storage. It then devotes individual sections to discussing how sustainable development goals (SDGs) could align with these projects and play a synergistic role for decarbonization. Four SDGs are particularly of interest. SDG-17 on global partnerships would be instrumental in facilitating low-cost financing for CCS investments. At the same time, other SDGs could be strategically used as co-benefits to CCS projects. These include SDG-8 on decent work, SDG-6 on clean water and SDG-9 on industry. We posit that it is not possible to study these SDG interlinkages in the global hypothetical. As such, this review takes a view of Indian geologic formations for CCS but also offers generalizable insights across other developing economies. • Contextually-explicit linkages between SDGs and CCS are discussed. • SDG-17 is critical for financing CCS in developing countries such as India. • SDGs 6, 8 and 9 are particularly relevant for understanding holistic benefits of CCS. • Illustration of CCS in aiding just transition and industry decarbonization is provided. [ABSTRACT FROM AUTHOR]

Background: Little is known about mucocutaneous disease in acutely ill children and adolescents with COVID-19 and multisystem inflammatory syndrome in children (MIS-C).Objective: To characterize mucocutaneous disease and its relation to clinical course among hospitalized patients with COVID-19 and MIS-C.Methods: Descriptive cohort study of prospectively and consecutively hospitalized eligible patients between May 11, 2020 and June 5, 2020.Results: In COVID-19 patients, 4 of 12 (33%) had rash and/or mucositis, including erythema, morbilliform pattern, and lip mucositis. In MIS-C patients, 9 of 19 (47%) had rash and/or mucositis, including erythema, morbilliform, retiform purpura, targetoid and urticarial patterns, along with acral edema, lip mucositis, tongue papillitis, and conjunctivitis. COVID-19 patients with rash had less frequent respiratory symptoms, pediatric intensive care unit admission, invasive ventilation, and shorter stay versus COVID-19 patients without rash. MIS-C patients with rash had less frequent pediatric intensive care unit admission, shock, ventilation, as well as lower levels of C-reactive protein, ferritin, D-dimer, and troponin (vs MIS-C without rash). Neutrophil-to-lymphocyte ratio was similar for patients with and without rash in both groups. None of the MIS-C patients met criteria for Kawasaki disease.Limitations: Small sample sizes.Conclusions: Mucocutaneous disease is common among children and adolescents with COVID-19 and MIS-C. Laboratory trends observed in patients with rash may prognosticate a less severe course. [ABSTRACT FROM AUTHOR]

Background: Data on the risk of inflammatory bowel disease (IBD) among isotretinoin-exposed patients with acne vulgaris (AV) is controversial.Objective: To compare IBD risk in isotretinoin-exposed and unexposed patients with AV.Methods: Retrospective cohort analysis of patients with AV with and without isotretinoin exposure identified using electronic health records. Primary outcomes were 6-month and 1-year IBD incidence.Results: The crude 6-month IBD incidence was 0.08% (21/27,230) among isotretinoin-exposed patients with AV compared to 0.04% (254/631,089) among those unexposed. The crude 1-year IBD incidence was 0.10% (28/27,230) among isotretinoin exposed patients with AV and 0.08% (477/631,089) among those unexposed. The odds of developing IBD within 6 months were 87% higher among isotretinoin-exposed patients with AV compared to those unexposed (adjusted odds ratio, 1.87; 95% confidence interval [CI], 1.20-2.93), although the absolute difference was small (risk difference, 2.6 more cases per 10,000 patients; 95% CI, 0.7-4.5). There was no significant difference in the odds of developing IBD at 1 year between isotretinoin-exposed and unexposed patients with AV (adjusted odds ratio, 1.40; 95% CI, 0.95-2.05).Limitations: Isotretinoin-exposed patients may be more likely to have IBD detected by a health care provider.Conclusions: IBD incidence among isotretinoin-exposed patients with AV is very low, and the risk appears similar to that for unexposed patients with AV. [ABSTRACT FROM AUTHOR]

Background: Information on the risk of depression among children, adolescents, and adults with hidradenitis suppurativa (HS) is limited.Objective: To compare the risk of new-onset depression in patients with HS with that of control individuals.Methods: Retrospective cohort analysis of 49,280 adult and 3042 pediatric patients with HS and matched control individuals identified by using electronic health record data. The primary outcome was incident depression.Results: The crude incidence rate was 4.8 per 100 person-years in adult patients with HS compared to 3.0 per 100 person-years in control individuals. Among pediatric patients, the crude incidence rate was 4.2 per 100 person-years in patients with HS compared with 2.3 per 100 person-years in control individuals. In adjusted analysis, adults and pediatric patients with HS had a 10% (hazard ratio, 1.10; 95% confidence interval, 1.07-1.13; P < .001) and 26% (hazard ratio, 1.26; 95% confidence interval, 1.10-1.44; P < .001), respectively, increased risk of developing depression compared to control individuals. Among patients with HS, factors associated with depression included female sex, white race, smoking, and body mass index/obesity in adults and pediatric patients and substance abuse in adults only.Limitations: Patients not seeking care in health systems within the database were not captured.Conclusion: Children, adolescents, and adults with HS are at an increased risk for developing depression, independent of other common risk factors for depression. [ABSTRACT FROM AUTHOR]

Background: Information on the real-world risk of inflammatory bowel disease (IBD) among patients with psoriasis exposed to interleukin-17 inhibitor (IL-17i) is limited.Objective: To compare IBD risk in patients with psoriasis with and without IL-17i exposure.Methods: Retrospective cohort analysis of patients with psoriasis with and without IL-17i exposure identified by using electronic health records data. Primary outcomes were 6-month and 1-year IBD incidence.Results: Crude 6-month IBD incidence was 0.16% (3/1821) among patients with psoriasis exposed to any IL-17i, 0.24% (3/1246) among those exposed to secukinumab alone, and 0.11% (239/213,060) among those unexposed. Crude 1-year IBD incidence was 0.27% (5/1821) among IL-17i-exposed patients with psoriasis, 0.32% (4/1246) among those exposed to secukinumab alone, and 0.19% (412/213,060) among those unexposed. In adjusted analysis, there was no significant difference in odds of developing IBD at 6 months (odds ratio, 1.42; 95% confidence interval, 0.45-4.43) and 1 year (odds ratio, 1.37; 95% confidence interval, 0.57-3.33) between exposed and unexposed patients with psoriasis. Similarly, there was no significant difference in odds of developing IBD at 6 months and 1 year between secukinumab-exposed and -unexposed patients with psoriasis.Limitations: Analysis may have been limited by the low number of outcome events.Conclusion: The incidence of IBD among patients with psoriasis exposed to IL-17i is low, and the risk appears similar to that for unexposed patients with psoriasis. [ABSTRACT FROM AUTHOR]

Background: The disease burden of pyoderma gangrenosum (PG) is poorly understood.Objective: To determine standardized overall and age-, sex-, and race-specific prevalence estimates for PG among adults in the United States.Methods: Cross-sectional analysis of 1971 patients with PG identified using electronic health records data from a diverse population-based sample of more than 58 million patients.Results: The age- and sex-standardized prevalence of PG among the study population was 0.0058%, or 5.8 PG cases (95% confidence interval [CI], 5.6-6.1) per 100,000 adults. Adjusted prevalence was nearly twice as high among women (7.1 cases [95% CI, 6.7-7.5] per 100,000) than men (4.4 cases [95% CI, 4.0-4.7] per 100,000). Patients between the ages of 70 and 79 years had the highest standardized prevalence (9.8 cases [95% CI, 8.8-10.9] per 100,000), with patients aged ≥50 years representing nearly 70% of all PG cases. Standardized prevalence was similar among white and African American patients. The female-to-male ratio of PG was >1.8 across all age groups.Limitations: Analysis of electronic health records data may result in misclassification bias.Conclusion: PG is a rare disease that most commonly affects women and those aged ≥50 years. [ABSTRACT FROM AUTHOR]

Physicians' own screening practices might affect screening in their patients. We conducted a population-based study to evaluate whether family physicians who underwent colorectal cancer testing were more likely to have patients who underwent colorectal cancer testing. We collected demographic and health care information on residents of Ontario, Canada from administrative databases; the sample was restricted to individuals at average risk of colorectal cancer who were 52–74 years old as of April 21, 2016. We obtained a list of all registered physicians in the province; physicians (n = 11,434) were matched with nonphysicians (n = 45,736) on age, sex, and residential location. Uptake of colorectal tests was defined by a record of a fecal occult blood test in the past 2 years, flexible sigmoidoscopy in the past 5 years, or colonoscopy in the past 10 years. Patients were assigned to family physicians based on billing claim frequency, and then the association between colorectal testing in family physicians and their patients was examined using a modified Poisson regression model. Uptake of colorectal tests by physicians and nonphysicians (median age 60 years; 71% men) was 67.9% (95% confidence interval [CI], 67.0%–68.7%) and 66.6% (95% CI, 66.2%–67.1%), respectively. Physicians were less likely than nonphysicians to undergo fecal occult blood testing and were more likely to undergo colonoscopy; prevalence ratios were 0.44 (95% CI, 0.42–0.47) and 1.24 (95% CI, 1.22–1.26), respectively. Uptake of colorectal tests by family physicians was associated with greater uptake by their patients (adjusted prevalence ratio, 1.10; 95% CI, 1.08–1.12). Approximately one-third of physicians and nonphysicians are overdue for colorectal cancer screening. Patients are more likely to be tested if their family physician has been tested. There is an opportunity for physicians to increase their participation in colorectal cancer screening, which could, in turn, motivate their patients to undergo screening. [ABSTRACT FROM AUTHOR]

Background: A needs assessment for patients with hidradenitis suppurativa (HS) will support advancements in multidisciplinary care, treatment, research, advocacy, and philanthropy.Objective: To evaluate unmet needs from the perspective of HS patients.Methods: Prospective multinational survey of patients between October 2017 and July 2018.Results: Before receiving a formal HS diagnosis, 63.7% (n = 827) of patients visited a physician ≥5 times. Mean delay in diagnosis was 10.2 ± 8.9 years. Patients experienced flare daily, weekly, or monthly in 23.0%, 29.8%, and 31.1%, respectively. Most (61.4% [n = 798]) rated recent HS-related pain as moderate or higher, and 4.5% described recent pain to be the worst possible. Access to dermatology was rated as difficult by 37.0% (n = 481). Patients reported visiting the emergency department and hospital ≥5 times for symptoms in 18.3% and 12.5%, respectively. An extreme impact on life was reported by 43.3% (n = 563), and 14.5% were disabled due to disease. Patients reported a high frequency of comorbidities, most commonly mood disorders. Patients were dissatisfied with medical or procedural treatments in 45.9% and 34.6%, respectively.Limitations: Data were self-reported. Patients with more severe disease may have been selected.Conclusion: HS patients have identified several critical unmet needs that will require stakeholder collaboration to meaningfully address. [ABSTRACT FROM AUTHOR]

Background: Cardiac surgery induces hemodynamic stress on the myocardium, and this process can be associated with significant post-operative morbidity and mortality. Soluble suppression of tumorigenicity 2 (sST2) and galectin-3 (gal-3) are biomarkers of myocardial remodeling and fibrosis; however, their potential association with post-operative changes is unknown.Methods: We measured peri-operative plasma sST2 and gal-3 levels in two prospective cohorts (TRIBE-AKI and NNE) of over 1800 patients who underwent cardiac surgery. sST2 and gal-3 levels were evaluated for association with a composite primary outcome of cardiovascular event or mortality over median follow-up periods of 3.4 and 6.0 years, respectively, for the two cohorts. Meta-analysis of hazard ratio estimates from the cohorts was performed using random effects models.Results: Cohorts demonstrated event rates of 70.2 and 66.8 per 1000 person-years for the primary composite outcome. After adjustment for clinical covariates, higher post-operative sST2 and gal-3 levels were significantly associated with cardiovascular event or mortality [pooled estimate HRs: sST2 1.29 (95% CI 1.16, 1.44); gal-3 1.26 (95% CI 1.09, 1.46)]. These associations were not significantly modified by pre-operative congestive heart failure or AKI.Conclusions: Higher post-operative sST2 and gal-3 values were associated with increased incidence of cardiovascular event or mortality. These two biomarkers should be further studied for potential clinical utility for patients undergoing cardiac surgery. [ABSTRACT FROM AUTHOR]

The International Dermatology Outcome Measures established a set of core domains to be measured in all psoriasis trials. This set requires that symptoms of psoriatic arthritis (PsA) be measured in all psoriasis studies. To identify the approach to PsA screening and the most appropriate outcome measure for capturing PsA symptoms. Following guidelines (ie, the COnsensus-based Standards for the selection of health Measurement INstruments, Core Outcome Measures in Effectiveness Trials Initiative, and Outcome Measures in Rheumatology Handbook), we conducted a consensus-building study that included patients, physicians, industry partners, and patient association representatives. The process consisted of a literature review and quality appraisal of measures for PsA symptoms, a pre-Delphi exercise, a Delphi survey, and a consensus meeting. Among the 297 expert participants in the Delphi survey, 87.5% agreed that all patients in a psoriasis trial should be screened for PsA with a validated screening tool. Regarding the measurement of PsA symptoms, the preferred instrument was the Psoriatic Arthritis Impact of Disease-9 (PsAID9), with the Routine Assessment Patient Index Data-3 (RAPID3) representing an acceptable alternative. Only International Dermatology Outcome Measures members participated in the consensus meeting. The overwhelming majority of expert stakeholders agreed that all psoriasis trial participants should be screened for PsA, with PsA symptoms measured by using PsAID9 (or alternatively with RAPID3). [ABSTRACT FROM AUTHOR]

Background: The mortality risk for patients with hidradenitis suppurativa (HS) is largely unknown.Objective: To compare mortality risk among individuals with and without HS in the United States.Methods: Retrospective cohort study in a population sample identified by using electronic health records data between January 1, 2012, and December 31, 2016. Primary outcome was incidence of 5-year all-cause mortality.Results: The crude 5-year mortality rate among patients with HS was 2.4% (321/13 289), compared with 2.7% (18 508/685 573) among control individuals. In the fully adjusted model, the increase in HS mortality risk was 14% (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.01-1.28). Overall, excess risk of death attributable to HS was 3.1 deaths per 1000 patients (95% CI, 0.2-6.0) during the study period. Characteristics associated with mortality among patients with HS included age (OR, 1.05; 95% CI, 1.04-1.06), male sex (OR, 1.40; 95% CI, 1.09-1.79), ever-smoking status (OR, 1.48; 95% CI, 1.16-1.92), and Charlson Comorbidity Index score (OR, 1.25; 95% CI, 1.21-1.29).Limitations: The follow-up period may not have been long enough to assess the influence of disease severity or duration on mortality.Conclusion: HS appears to confer an independent risk of all-cause mortality. This risk is also influenced by tobacco smoking and comorbidities, which may be modifiable. [ABSTRACT FROM AUTHOR]

Background: Herpes zoster (HZ) incidence is linked to immunosuppression. Patients with psoriasis or psoriatic arthritis (PsA) on systemic therapy might be at an increased risk for HZ.Objective: To assess HZ risk in patients with psoriasis and PsA by systemic treatment and provide recommendations regarding HZ vaccination.Methods: A systematic literature search was performed for HZ in patients with psoriasis and PsA. HZ vaccination guidelines were reviewed, and the medical board of the National Psoriasis Foundation made consensus recommendations in psoriasis and PsA patients using graded evidence.Results: In total, 41 studies met inclusion criteria. Systemic corticosteroids (strong, 1), tofacitinib (strong, 1), and combination therapy with biologic and conventional synthetic disease-modifying antirheumatic drugs (weak, 2a) carry increased HZ risk while monotherapy does not. There is insufficient evidence to determine risk with interleukin 12/23, 17, and 23 inhibitors or apremilast (weak, 2a). Recombinant zoster vaccine is recommended for all psoriasis and PsA patients >50 years old and patients <50 years old on tofacitinib, systemic steroids, or combination systemic treatment. Vaccination of patients <50 years old on other systemic therapies may be considered on a case-by-case basis.Limitations: There was significant heterogeneity between studies.Conclusion: HZ risk depends on disease severity and treatment class. Recombinant zoster vaccine should be given to all psoriasis and PsA patients >50 years old and younger patients at increased risk. [ABSTRACT FROM AUTHOR]

Background: Disease burden in chronic urticaria (CU) is poorly understood.Objective: To estimate standardized overall and sex-, age-, and race-specific prevalence estimates for CU among adults in the United States.Methods: A cross-sectional analysis with electronic health records data for a demographically heterogeneous population-based sample of >55 million patients across all 4 census regions.Results: The overall CU prevalence was 0.23%, or 230 CU cases/100,000 adults. The adjusted prevalence in women was 310 (95% confidence interval [CI] 307-312) cases/100,000 adults, more than twice that of men (146 [95% CI 143-148] cases/100,000 adults, P < .001). CU prevalence was highest among patients aged 40-49 years (256 [95% CI 252-261] cases/100,000 adults) and 50-59 years (246 [95% CI 242-251] cases/100,000 adults) compared with all other age groups (P < .0001). Adjusted prevalences for black (292 [95% CI 285-298] cases/100,000 adults) and other (331 [95% CI 323-338] cases/100,000 adults) patients were higher than that for white patients (262 [95% CI 260-264] cases/100,000 adults; P < .001).Limitations: Use of administrative data has the potential to underestimate burden.Conclusion: There are >500,000 people estimated to have CU in the United States, most of whom are women or adults ≥40 years of age. [ABSTRACT FROM AUTHOR]

Background: Hidradenitis suppurativa (HS) and pyoderma gangrenosum (PG) are reported to coexist, although the prevalence of PG among patients with HS has not been systematically evaluated.Objective: To evaluate PG prevalence among patients with HS.Methods: Cross-sectional analysis of adults with PG among patients with HS and patients without HS through use of electronic health records data from a population-based sample of 55 million patients.Results: The prevalence of PG among 68,232 patients with HS was 0.18% (125 of 68,232), compared with 0.01% (1835 of 31,435,166) among those without HS (P < .0001). Prevalence was markedly higher among patients with HS and Crohn's disease (CD) (3.68%) than among patients with HS but without CD (0.12%). The odds of having PG were 21.14 (95% confidence interval [CI], 17.51-25.51) times greater among patients with HS than among those without HS. Patients with HS with CD had 12.38 (95% CI, 9.15-16.74) times the odds of having PG than did patients without HS but with CD. Among patients without CD, compared with patients without HS, those with HS had 26.51 (95% CI, 21.07-33.36) times the odds of having PG.Limitations: We could not establish HS phenotype among those having coexistent PG, nor could we distinguish syndromic from nonsyndromic cases.Conclusion: Patients with HS have an increased prevalence of PG, regardless of CD status. Painful ulcerations among patients with HS warrant additional evaluation for PG. [ABSTRACT FROM AUTHOR]

Background: The decision to administer prophylaxis to patients receiving immunosuppression against pneumocystosis remains a dilemma.Objective: To determine overall and age-specific 5-year pneumocystosis incidence within a population exposed to immunosuppressants.Methods: Retrospective cohort analysis identifying incident pneumocystosis cases among adults without HIV, AIDS, or cancer exposed to immunosuppressant, corticosteroid therapy, or both.Results: We identified 406 new cases among patients prescribed an immunosuppressant, corticosteroid, or both. Overall incidence of pneumocystosis was 0.012% (406/3,366,086). Incidence was highest in those exposed to immunosuppressant and corticosteroid medications (0.199%), followed by those exposed to immunosuppressant alone (0.012%), corticosteroid alone (0.008%), and neither medication (0.001%) (P < .001). The greatest risk differences were noted between groups exposed to immunosuppressant and corticosteroid compared with neither (0.198%, 95% confidence interval [CI] 0.166%-0.230%) or immunosuppressant alone (0.188%, 95% CI 0.155%-0.221%). The greatest relative risks (RRs) were noted among those receiving immunosuppressant and corticosteroid compared with those exposed to neither (RR 122.5, 95% CI 100.9-148.8) or immunosuppressant alone (RR 16.5, 95% CI 7.3-37.4).Limitations: We could not confirm dose and duration of exposures.Conclusion: Incidence of pneumocystosis among patients exposed to immunosuppressants is very low. Prophylaxis for patients receiving combination immunosuppressant and corticosteroid therapy, the group at highest risk, might be warranted. [ABSTRACT FROM AUTHOR]