Racial disparities in comorbidities of patients with psoriatic arthritis.

There have been significant advances in the treatment of psoriatic arthritis (PsA). Despite these advances, racial and ethnic disparities in clinical outcomes may still exist in patients with PsA. We aimed to examine the racial differences in clinical characteristics, medication usage and comorbidities in PsA patients. This retrospective study was conducted using the IBM Explorys platform. Search criteria included ICD diagnosis code for PsA and at least two visits with a rheumatologist, between 1999 and 2019. We further stratified by adding the following variables to the search: race, sex, laboratory data, and clinical characteristics, medication use, and comorbidities. Data sets were recorded as proportions and compared using chi-squared tests (p < 0.05). We identified 28,360 patients with PsA. AAs had a higher prevalence of hypertension (59% vs 52%, p < 0.0001), diabetes (31% vs 23% p < 0.0001), obesity (47% vs 30%, p < 0.0001), and gout (12% vs 8%, p < 0.0001). Caucasian patients were more likely to have cancer (20% vs 16%, p = 0.002), anxiety (28% vs 23%, p < 0.0001), and osteoporosis (14% vs 12%, p = 0.001). NSAIDs were used in 80% of Caucasians and 78% of AAs (p < 0.009), TNFs in 51% of Caucasians and 41% of AAs, and DMARDs in 72% of Caucasians and 98% of AAs (p < 0.0001). Our findings from a large US real-world database revealed that certain comorbidities were more frequent in AA patients with PsA, which warrants increased risk stratification. There was increased biologic use in Caucasians with PsA compared to AA who were more commonly on DMARDs.

Molecular spectrum of TSHß subunit gene defects in central hypothyroidism in the UK and Ireland.

OBJECTIVE: Homozygous mutations in the TSH beta subunit gene (TSHB) result in severe, isolated, central congenital hypothyroidism (CCH). This entity evades diagnosis in TSH-based congenital hypothyroidism (CH) screening programmes in the UK and Ireland. Accordingly, genetic diagnosis, enabling ascertainment of affected relatives in families, is critical for prompt diagnosis and treatment of the disorder. DESIGN, PATIENTS AND MEASUREMENTS: Four cases of isolated TSH deficiency from three unrelated families in the UK and Ireland were investigated for mutations or deletions in TSHB. Haplotype analysis, to investigate a founder effect, was undertaken in cases with identical mutations (c.373delT). RESULTS: Two siblings in kindred 1 were homozygous for a previously described TSHB mutation (c.373delT). In kindreds 2 and 3, the affected individuals were compound heterozygous for TSHB c.373delT and either a 5·4-kB TSHB deletion (kindred 2, c.1-4389_417*195delinsCTCA) or a novel TSHB missense mutation (kindred 3, c.2T>C, p.Met1?). Neurodevelopmental retardation, following delayed diagnosis and treatment, was present in 3 cases. In contrast, the younger sibling in kindred 1 developed normally following genetic diagnosis and treatment from birth. CONCLUSIONS: This study, including the identification of a second, novel, TSHB deletion, expands the molecular spectrum of TSHB defects and suggests that allele loss may be a commoner basis for TSH deficiency than previously suspected. Delayed diagnosis and treatment of profound central hypothyroidism in such cases result in neurodevelopmental retardation. Inclusion of thyroxine (T4) plus thyroxine-binding globulin (TBG), or free thyroxine (FT4) in CH screening, together with genetic case ascertainment enabling earlier therapeutic intervention, could prevent such adverse sequelae.

Cultural stability of Streptomyces fradiae in the production of xylose isomerase: studies in shake flasks.

Comprehensive studies of pure colonies of Streptomyces fradiae in the production of xylose isomerase by submerged fermentation at shake flask level revealed poor culture stability with respect to enzyme production, biomass formation, degree of pigmentation, quantity of glucose and xylose utilization, level of enzyme in cell-free culture broth and final pH of the fermentation medium. The results serve to stress obligatory evaluation of culture stability of Streptomyces strains in determining their suitability for use in developing fermentation processes for commercial exploitation.

Maternal deaths in a developing country: a study from the Aga Khan University Hospital, Karachi, Pakistan 1988-1999.

OBJECTIVE: The maternal deaths occurring over a twelve-year period (1988-1999) in a tertiary referral center were reviewed. The purpose of the study was to assess the causes of these maternal deaths. SETTING: The Aga Khan University Hospital (AKUH) Karachi, Pakistan. METHODS: The medical records of maternal deaths were reviewed. These were women who had either registered for delivery at the hospital; or were referred from another hospital or from home, when an emergency developed. They were either admitted to the Medicine, Surgery and the Obstetrics and Gynaecology Departments at the hospital. RESULTS: A total of 81 maternal deaths were identified, of which five were the registered patients. Causes of deaths were eclampsia, puerperal sepsis and pulmonary embolism. The maternal mortality ratio in the registered patients was 20 per 100,000 live births. Ninety percent of the women were between the age group of 15-35 years. Of these forty two percent were primigravidas, forty four percent of the women died due to direct causes, of which sepsis was the most common cause and accounted for twenty five percent of the total deaths. Indirect causes were responsible for 55.6% of the deaths, including hepatic failure in 21%, other infectious disease in 17% and malignancy in 5% of the cases. CONCLUSION: In developing countries other than obstetrical causes, infectious diseases contribute to the death of women during childbearing years. Comprehensive medical services and adequate obstetrical emergency services can lower maternal mortality rates at all levels.