Squamous cell carcinoma in the Afro-Caribbean community: an 11-year retrospective study.

BACKGROUND: Squamous cell carcinoma (SCC) is considered the most frequent skin cancer in Black people. Its incidence is not known in the Afro-Caribbean population. OBJECTIVE: To assess the incidence of SCC in Guadeloupe, the largest island of the Lesser Antilles (405 000 inhabitants, mostly Black people of African and European descent). The second objective was to characterize clinical and histological patterns of SCC occurring in the Afro-Caribbean community. METHODS: This retrospective study was conducted over an 11-year period (2000-2010). Data regarding 723 histological confirmed cases of SCC identified using the three Guadeloupean pathology laboratories' computerized databases were retrieved from the records of 551 patients. Private practice dermatologists and general practitioners were contacted to obtain any missing data. RESULTS: The annual age-adjusted incidence of SCC was 15 per 100.000 residents in Guadeloupe. In the Afro-Caribbean community, SCC had a greater size (i.e. 2.8 ± 2.8 cm vs. 1.5 ± 1.0 cm, P < 0.001), was more often located on the anogenital area (i.e. 48/79-60.8% vs. 14/320-4.4%, P < 0.001) in association with an underlying dermatosis due to HPV infection (15/71-21.1% vs. 3/366, 0.8%, P < 0.001) and led more frequently to metastasis (13/84-15.5% vs. 10/366-2.7%, P < 0.001) and/or fatal evolution (11/83-13.3% vs. 7/365-1.9%, P < 0.001). CONCLUSIONS: The results of this original study, which first estimated the incidence of SCC in West Indies, suggest that anogenital examination should be routinely performed in skin cancer screening of Afro-Caribbean people to detect the presence of SCC at an early stage. IMPLICATION FOR PRACTICE: Squamous cell carcinoma is the most frequent skin cancer in Black people. Its incidence is not known in the Afro-Caribbean population. In Guadeloupe, the largest island of the Lesser Antilles, the annual age-adjusted incidence of SCC was estimated to be 15.0 per 100 000 residents, 95% CI:[13.8; 16.2]. In the Guadeloupean Afro-Caribbean community, SCC seems to more frequently occur in the anogenital area, due to HPV infection. These results support to include a routine genital urinary examination in the skin cancer screening of people of Afro-Caribbean descent.

[Incidence of skin and non-skin cancers in Afro-Caribbean renal transplant recipients: Guadeloupe data from 2004 to 2011]. / Incidence des cancers cutanés et non cutanés chez les transplantés rénaux afro-caribéens : données guadeloupéennes de 2004 à 2011.

BACKGROUND: Cancer is the main complication of transplantation surgery. The literature concerning renal transplant recipients among the Afro-Caribbean population is scant. The aim of this study was to determine the incidence of cancer in these patients, with the secondary objective being to identify predisposing factors for cancer. PATIENTS AND METHODS: This was an epidemiological and retrospective study that included all Guadeloupians of phototype V-VI undergoing renal transplantation from 01/01/2004 to 31/12/2011. Skin cancer screening was performed before transplantation and during an annual dermatological consultation following transplantation. Screening for non-cutaneous cancers was guided by clinical symptoms or by the results of the screening examinations recommended in the current guidelines. At the study time-point (31/12/2011), all patients were examined by a dermatologist. RESULTS: One hundred and two patients were included : 42 women and 60 men (mean age: 52.1±11.6 years at transplantation). Eight cancers were diagnosed. The cumulative incidence of cancer was 7.8% at 3 years. Three factors were associated with more rapid onset of cancer: personal history or familial history of cancer, and genital lesion induced by HPV. CONCLUSION: Our results suggest a low incidence of cancer in Afro-Caribbean renal transplant patients. Personal or family history of cancer and HPV-induced genital lesions would appear to accelerate the onset of cancer in this population.

[Two cases of iatrogenic cutis and subcutis calcinosis after calcium-containing heparin injection]. / Calcinose cutanée et sous-cutanée après injection d'héparine calcique : à propos de deux cas.

BACKGROUND: Subcutis calcinosis, characterized by abnormal calcium deposition in the skin, is a rare side effect of calcium containing heparins. PATIENTS AND METHODS: Two patients with renal failure presented skin lesions after receiving a calcium-containing heparin treatment. The first patient exhibited erythematous nodules on the abdomen and the second a large erythematous induration of the abdomen and nodules on the thighs. Both had normal blood analysis. The diagnosis of subcutis calcinosis was confirmed by the histological exam showing calcium deposit in the dermis and hypodermis. Outcome was unfavourable in one of the patients who developed a superinfection and skin necrosis lesion requiring surgery at 2 months. DISCUSSION: Subcutis calcinosis is a rare and probably underdiagnosed disease. To our knowledge, only 10 cases have been reported. The pathogenesis is not well-known, tissue damage and calcium disorders are considered as risk factors. The differential diagnoses that can be suspected include calciphylaxis, such as calcifying panniculitis and other local side effects of heparins. Outcome is usually favourable without treatment. CONCLUSION: We describe two cases of iatrogenic subcutis calcinosis after injections of calcium-containing heparins, including the second case of poor outcome. Clinicians should be aware of this adverse effect since other heparins such as fondaparinux or low-weight molecular heparins are contraindicated in patients with renal failure, leading to a large prescription of calcium-containing heparins in this population.

Níveis de fibra em detergente neutro na dieta de cordeiros: consumo, digestibilidade e fermentação ruminal / Levels of neutral detergent fiber in lambs diets: intake, digestibility and ruminal fermentation

Foram utilizados oito cordeiros castrados (35,0±6,0kg peso vivo) em um delineamento duplo quadrado latino 4 ´ 4 para avaliar o efeito de quatro níveis de fibra em detergente neutro (FDN) na dieta (25, 31, 37 e 43 por cento da matéria seca (MS)) sobre o consumo e parâmetros digestivos. O consumo de nitrogênio (N) variou de forma quadrática; o de MS, matéria orgânica (MO) e energia diminuíram (P<0,05) e de FDN aumentou (P<0,01) linearmente com o aumento de fibra na dieta. A digestibilidade da FDN e do N, assim como o pH e as concentrações de peptídeos no fluído ruminal foram similares em todos os tratamentos. A digestibilidade aparente da MS, da MO e da energia, assim como as concentrações ruminais de açúcares diminuíram linearmente (P<0,01) e a síntese de proteína microbiana ruminal, as concentrações ruminais de amônia e de aminoácidos variaram quadraticamente (P<0,05) com o aumento do teor de FDN das dietas. A redução do consumo e da digestibilidade foram mais evidentes somente pela inclusão do nível mais alto de FDN (43 por cento) e, sob o aspecto nutricional, a inclusão em torno de 30 por cento de FDN representa o nível mais adequado para formulação de dietas a base de silagem de sorgo e concentrado oferecido a cordeiros confinados.

Eight castrated raw lambs (35.0± 6.0kg live weight) were used in a replicated 4 ´ 4 latin square design to evaluate the effect of four neutral detergent fiber (NDF) levels (25, 31, 37 and 43 percent of dry matter (DM)) on intake and digestion traits. Nitrogen (N) intake varied quadratically; intake of DM, organic matter (OM) and energy decreased (P<0.05) and that of NDF increased (P<0.01) as fibre level increased. NDF and N digestibility, as well as pH and ruminal concentrations of peptides were similar for all treatments. Apparent digestibility of DM, OM and energy, as well as ruminal concentrations of sugars decreased (P<0.01) and, ruminal microbial protein synthesis and ruminal concentrations of ammonia and amino acids varied in a quadratic way (P<0.05) with increased levels of NDF. The effect of NDF in decreasing intake and digestibillity was more evident only at the highest level (43 percent). The inclusion of about 30 percent NDF represents the most adequate level for sorghum silage and concentrate based diets fed to feedlot lambs.