National epidemiology of digital papillary adenocarcinoma in England 2013-2020: a population-based registry study.

BACKGROUND: Digital papillary adenocarcinoma (DPA), formerly known as aggressive DPA, is a rare adnexal cancer of sweat gland differentiation with metastatic potential. DPA epidemiology and patient outcome data are a prerequisite to develop diagnostic and therapeutic guidance, which is lacking for this rare cancer. OBJECTIVES: To report the incidence, patient demographics and treatment of patients with DPA in England from 1 January 2013 to 31 December 2020 using national cancer registry data. METHODS: DPA diagnoses in England during 2013-2020 were identified from the National Cancer Registration Dataset using morphology and behaviour codes. These were registered from routinely collected pathology reports and cancer outcomes and services datasets. The 2013 European age-standardised incidence rates (EASRs) were calculated. RESULTS: In total, 36 DPA (7 in females and 29 in males) were diagnosed. The median age at diagnosis for the cohort was 54 years (interquartile range 46-64). The most frequently affected sites were upper limbs (81%). All patients in the cohort received surgical excisions. The European age-standardised incidence rate (EASRs) was 0.10 [95% confidence interval (CI) 0.07-0.14] per 1,000,000 person-years (PY)]. CONCLUSION: This study reports the incidence and variation of DPA in England between 2013 and 2020. DPA was more common in older men and predominantly affected the upper limbs. This supports the need to develop a national policy for the reporting and management of DPA as well as clinical guideline development.

A case report on the use of topical cysteamine 5% cream in the management of refractory postinflammatory hyperpigmentation (PIH) resistant to triple combination cream (hydroquinone, topical corticosteroids, and retinoids).

BACKGROUND: Postinflammatory hyperpigmentation (PIH) occurs as a result of different inflammatory dermatoses and exogenous factors in individuals with darker skin types. With current skin lightening treatments, there are concerns about irritation leading to worsening of their underlying inflammatory skin condition or worsening of PIH. CASE: A 20-year-old woman with Fitzpatrick skin type (FST) V presented with facial hyperpigmented patches since childhood following an intermittent erythematous, pruritic facial rash. Skin biopsy confirmed PIH secondary to possible burnt-out morphea. Treatment with topical adapalene 0.1% gel and triple combination cream (containing hydroquinone, topical corticosteroids, and retinoids) proved unsuccessful. Treatment with cysteamine 5% cream over 4 months resulted in significant improvement with a reduction in the melanin index. DISCUSSION: The current recommendation for first-line treatment in PIH is hydroquinone or triple combination cream containing hydroquinone, which can be associated with significant short- and long-term side effects. Cysteamine 5% cream is one of the latest cosmetic skin lightening products. It is hypothesized that cysteamine reduces melanin production by inhibiting key melanogenic enzymes required in melanogenesis. Its efficacy and tolerability have been demonstrated in two randomized controlled trials against placebo in patients with melasma. This report demonstrates a successful use of cysteamine 5% cream in a patient with chronic severe PIH.

Determinants of bed net use among older people in Nigeria: results from a nationally representative survey.

INTRODUCTION: the use of bed nets is a well-recognized and cost-effective preventive measure against malaria. However, little is known about factors associated with the use of bed nets among older people in Nigeria. Therefore, this study aimed to examine the determinants of bed net use among older Nigerian adults. METHODS: data from the first wave of the Nigeria General Household Survey-Panel were used, which included 3,439 participants aged 50 years and above. Log-binomial models were used to model the association between participants' sociodemographic characteristics and the use of bed nets. RESULTS: the frequency of bed net use was 26%. The adjusted prevalence ratio (PR) of bed net use was lower in women (PR = 0.83, 95% CI: 0.73-0.96), older age groups (60-69 years: PR=0.85, 95% CI:0.75-0.97; 70 years and above: PR = 0.80, 95% CI: 0.69-0.94), female-headed households (PR = 0.69, 95% CI: 0.53-0.89) and among those in the highest tertiles of per-capita household expenditure (PR=0.77, 95% CI: 0.66-0.90). However, the frequency of bed net use was higher among older adults residing in the rural areas (PR = 1.84, 95% CI: 1.55-2.18) and those who reported never having attended school (PR=1.15, 95% CI: 1.01-1.30). CONCLUSION: the prevalence of bed net use among older adults is lower compared to previously reported data for younger adults, suggesting an increased risk of the older adults of exposure to malaria. Female sex, age ≥ 60 years, level of education, economic status, and rural vs urban residence were important determinants of bed net use among older adults.

Maternal education and child immunization: the mediating roles of maternal literacy and socioeconomic status.

INTRODUCTION: Previous studies in Nigeria have documented significant association between maternal education and child immunization. However, little is known about the pathway through which maternal education improves immunization uptake. This study aims to examine whether maternal literacy and socioeconomic status mediates the relationship between maternal education and complete immunization coverage in children. METHODS: Nationally representative data from the first wave of the Nigeria General Household Survey-Panel were used, which includes 661 children aged one year and below. Regression analyses were used to model the association between maternal education and child's immunization uptake; we then examined whether maternal literacy and household economic status mediates this association. RESULTS: Of the 661 children, 40% had complete immunization. The prevalence ratio (PR) of complete immunization in children whose mothers were educated versus those whose mothers were not educated was 1.44 (95% CI: 1.16-1.77). Maternal literacy substantially reduced the estimated association between maternal education and complete immunization by 90%, whereas household economic status reduced the estimates by 27%. CONCLUSION: These findings suggest that complete immunization was higher in children whose mothers were educated, partly because maternal education leads to acquisition of literacy skills and better health-seeking behavior which then improves immunization uptake for their children. Socioeconomic status is an alternative pathway but with less substantial indirect effect.