Position Statement on Atopic Dermatitis in Sub-Saharan Africa:current status and roadmap

The first International Society of Atopic Dermatitis (ISAD) global meeting dedicated to atopic dermatitis (AD) in Sub-Saharan Africa (SSA) was held in Geneva, Switzerland in April 2019. A total of 30 participants were present at the meeting, including those from 17 SSA countries, representatives of the World Health Organization (WHO), the International Foundation for Dermatology (IFD) (a committee of the International League of Dermatological Societies, ILDS www.ilds.org), the Fondation pour la Dermatite Atopique, as well as specialists in telemedicine, artificial intelligence and therapeutic patient education (TPE)

How does age determine the development of human immune-mediated arthritis?

Does age substantially affect the emergence of human immune-mediated arthritis? Children do not usually develop immune-mediated articular inflammation during their first year of life. In patients with juvenile idiopathic arthritis, this apparent ‘immune privilege’ disintegrates, and chronic inflammation is associated with variable autoantibody signatures and patterns of disease that resemble adult arthritis phenotypes. Numerous mechanisms might be involved in this shift, including genetic and epigenetic predisposing factors, maturation of the immune system with a progressive modulation of putative tolerogenic controls, parallel development of microbial dysbiosis, accumulation of a pro-inflammatory burden driven by environmental exposures (the exposome) and comorbidity-related drivers. By exploring these mechanisms, we expand the discussion of three (not mutually exclusive) hypotheses on how these factors can contribute to the differences and similarities between the loss of immune tolerance in children and the development of established immune-mediated arthritis in adults. These three hypotheses relate to a critical window in genetics and epigenetics, immune maturation, and the accumulation of burden. The varied manifestation of the underlying mechanisms among individuals is only beginning to be clarified, but the establishment of a framework can facilitate the development of an integrated understanding of the pathogenesis of arthritis across all ages

Gale en milieu carceral a Parakou (Benin) en 2019 : Prevalence et facteurs associes : Scabies in prisons in Parakou, Benin in 2019: Prevalence and associated factors

Objectif : L’objectif était de déterminer la prévalence et les facteurs associés à la gale en milieu carcéral à Parakou en 2019.Patients et méthodes : Il s’est agi d’une étude transversale descriptive, qui s’est déroulé dans la Prison Civile de Parakou en 2019.Résultats : Sur 230 détenus examinés, 137 (59,57%) étaient atteints de gale. La tranche d’âge la plus touchée était celle de 18 à 27 ans, soit 37,39%. La prédominance était masculine avec une sex-ratio à 6,93. Les détenus ne se lavaient pas de façon quotidienne, plus de la moitié (76,96%) se lavaient 4 à 7 fois seulement par semaine. Le prurit était le signe le plus fréquent. La région inguinale était le siège le plus atteint (61,31%). Le sexe (p=0,007), l’hygiène corporelle (p=0,001) et changement de vêtement (p=0,01) étaient associés à la gale à la Prison Civile de Parakou.Conclusion : La scabiose est fréquente à la Prison Civile de Parakou. Les facteurs associés à la survenue de la gale dans la prison de Parakou étaient le sexe, le manque d’hygiène. La connaissance et la prise en compte de ces facteurs de risque de la gale permettra de réduire significativement la fréquence de la gale en milieu carcéral au Bénin. Objective: The objective was to determine the prevalence and factors associated with scabies in prisons in Parakou in 2019.Patients and Methods: This was a descriptive cross-sectional study, which took place in the Civil Prison of Parakou in 2019.Results: Out of 230 inmates examined, 137 (59.57%) had scabies. The most affected age group was 18 to 27 years old, 37.39%. The predominance was male with a sex ratio of 6.93. The inmates did not wash daily, more than half (76.96%) washed only 4 to 7 times a week. Pruritus was the most frequent sign. The inguinal region was the most affected site (61.31%). Sex (p=0.007), body hygiene (p=0.001) and change of clothing (p=0.01) were associated with scabies in the Civil Prison of Parakou.Conclusion: Scabiosis is common in the Civil Prison of Parakou. The factors associated with the occurrence of scabies in the prison of Parakou were sex, lack of hygiene. Knowledge and consideration of these risk factors for scabies will significantly reduce the frequency of scabies in prisons in Benin

Depistage clinique des infections sexuellement transmissibles chez les personnes vivant avec le VIH suivies au Centre de Traitement Ambulatoire du Centre National Hospitalier Universitaire Hubert Koutoukou Maga de Cotonou

Introduction: Depuis l’avènement de l’infection à VIH/SIDA, les IST ont connu un regain d’intérêt parce qu’elles constituent des cofacteurs de celle-ci. Cette étude avait pour but de faire le point sur les différentes IST observées chez les PVVIH au Bénin, en se basant uniquement sur les signes et symptômes cohérents.Matériel et méthodes: Il s’agissait d’une étude transversale descriptive qui s’était déroulée au Centre de Traitement Ambulatoire (CTA) des PVVIH du Centre National Hospitalier et Universitaire Hubert Koutoukou MAGA (CNHU/HKM) de Cotonou durant une période de quatre mois. Etaient inclues toutes les PV VIH adultes vues pendant la période de collecte des données, et qui avaient donné leur accord de participation à l’étude.Résultats: Six cent-dix patients avaient été examinés ; l’âge moyen des PVVIH était de 38 ans, avec une sex-ratio H/F égale à 0,55. La prévalence des IST était de 20,33%. Les IST retrouvées chez les patients étaient par ordre décroissant les écoulements urétraux, les écoulements vaginaux, les ulcérations génitales et les condylomes.Conclusion: Les PVVIH suivies au CTA du CNHU-HKM de Cotonou avaient un faible niveau de connaissance sur les IST du fait de leur analphabétisme, leur bas niveau d’instruction et du fait d’un défaut de sensibilisation.Mots clés: Dépistage clinique, IST, VIH/SIDA, BéninEnglish Title: Clinical screening of sexually transmitted infections in people living with HIV at the Ambulatory Treatment Center of the National University Hospital Center Hubert Koutoukou Maga of CotonouEnglish AbstractIntroduction: Since the advent of HIV / AIDS, STIs have become more interesting because they are cofactors of HIV/AIDS. The aim of this study was to take stock of the different STIs observed in PLHIV in Benin, based solely on coherent signs and symptoms.Material and methods: This was a descriptive cross-sectional study that took place at the Ambulatory Treatment Center (ATC) of the PLHIV of the National University Hospital Center of Hubert Koutoukou MAGA (NUHC-HKM) in Cotonou during a period of four months. Included were all HIV-positive adults seen during the data collection period and who had agreed to participate in the study.Results: Six hundred and ten patients had been examined; mean age was 38 years and the sex-ratio 0.55. The prevalence of STI was 20.33%. STIs found in patients were in decreasing order of urethral discharge, vaginal discharge, genital ulceration and condyloma.Conclusion: PLHIVs attending the ATC at the NUHC-HKM in Cotonou had a low level of knowledge about STIs due to illiteracy, low educational attainment and lack of awareness.Keywords: Clinical screening, STI, HIV/AIDS, Beni

Psoriasis sur peau noire : Aspects epidemiologiques et cliniques en dermatologie a Cotonou (Benin)

Introduction : L’objectif de notre étude était de décrire le profil épidémiologique et clinique du psoriasis sur peau pigmentée en Dermatologie à Cotonou. Méthodes : Une étude rétrospective et descriptive a été réalisée sur 10 ans dans le service de dermatologie du Centre National Hospitalier et Universitaire Hubert Koutoukou Maga de Cotonou. Nous avons inclus tous les patients chez qui le diagnostic de psoriasis était retenu sur la base d’arguments cliniques. Les données ont été saisies et analysées avec le logiciel EPI-Info 7. Résultats : La prévalence du psoriasis était de 0,8% (84/10792). La sex-ratio était de 1,8. La moyenne d’âge était de 37,9 ans +/- 19,2. La tranche d’âge la plus représentée était celle des 18-40 ans, soit 46,4%. Les topographies fréquemment retrouvées étaient : cuir chevelu (39,3%), grands plis (38,1%), coudes (32,1%), genoux (29,8%), jambes (27,4%), thorax et organes génitaux externes (25%). Les formes morphologiques étaient dominées par le psoriasis en plaques (45,2%). Les formes topographiques étaient en majorité le psoriasis du cuir chevelu (16,7%), le psoriasis inversé (11,9%) et le psoriasis palmo-plantaire (10,7%). Les formes graves à type de psoriasis érythrodermique et de rhumatisme psoriasique ont été retrouvées dans des proportions respectives de 14,3% et 9,5%. Conclusion : Le psoriasis était rare dans le service de dermatologie à Cotonou. Il atteignait en majorité les adolescents et adultes jeunes de sexe masculin. Le psoriasis en plaques, le psoriasis du cuir chevelu et le psoriasis inversé étaient les formes cliniques les plus fréquentes. Mots clés : psoriasis, rhumatisme psoriasique, dermatose inflammatoire, peau pigmentée, Bénin English Abstract: Psoriasis on pigmented skin: Epidemiology and clinical features in dermatology in Cotonou (Benin) Introduction: The aim of our study was to describe the epidemiological and clinical features of psoriasis on pigmented skin in Dermatology in Cotonou. Methods: A retrospective and descriptive study was carried out in the dermatology department of Cotonou National and Teaching Hospital over 10 years. It included all patients for whom the clinical diagnosis of psoriasis was retained. Data were entered and analyzed with EPI-Info 7 software. Results: The prevalence of psoriasis was 0.8% (84/10792). The sex ratio was 1.8. The average age was 37.9 years +/- 19.2. The most represented age group was 18-40 years old, or 46. 4%. The topographies frequently found were: scalp (39.3%), folds (38.1%), elbows (32.1%), knees (29.8%), legs (27.4%), thorax and external genitalia (25%). The morphological forms were dominated by plaque psoriasis (45.2%). The topographic forms were mostly scalp psoriasis (16.7%), flexural psoriasis (11.9%) and palmoplantar psoriasis (10.7%). The severe forms of erythrodermic psoriasis and psoriatic arthritis were found in respective proportions of 14.3% and 9.5%. Conclusion: Psoriasis was rare in the dermatology department in Cotonou. It mainly reached adolescents and young adults of the male sex. Plaque psoriasis, scalp psoriasis and flexural psoriasis were the most common clinical forms. Keywords: psoriasis, psoriatic arthritis, inflammatory dermatosis, pigmented skin, Beni

Apremilast inhibits inflammatory osteoclastogenesis

Objectives: Psoriatic arthritis (PsA) is associated with bone erosion and inflammation-induced bone loss, which are mediated by osteoclasts (OC) and modulated by inflammatory cytokines. Apremilast (APR) (a selective phosphodiesterase 4 inhibitor) is efficacious in PsA and acts by inhibiting cytokine production. However, there are no direct data informing whether and how APR affects osteoclast formation in humans. Methods: Osteoclastogenic cytokine production by activated human peripheral blood mononuclear cells (PBMCs) was measured in the presence and absence of APR. Effects of APR on osteoclast differentiation were tested (i) in co-cultures of activated PBMCs and human CD14+ blood monocytes as well as (ii) in CD14+ blood monocytes stimulated with activated-PBMCs supernatant, TNF or IL-17A. Bone resorption was measured on OsteoAssay plates. Effects of APR on ex vivo osteoclast differentiation were compared in PsA, pre-PsA and psoriasis patients, as well as in healthy controls. Results: APR significantly impaired the expression of key osteoclastogenic cytokines in activated PBMCs. Furthermore, APR dose-dependently and significantly inhibited activated PBMC-driven osteoclast differentiation and ex vivo osteoclast differentiation of PBMCs derived from PsA and pre-PsA patients, but not from psoriasis patients or healthy controls. TNF and IL-17A-enhanced osteoclastogenesis and osteolytic activity of CD14+ blood monocytes from PsA patients was also significantly inhibited by APR. Finally, APR inhibited expression of the key osteoclast fusion protein dendritic cell-specific transmembrane protein. Conclusion: Phosphodiesterase 4 targeting by APR not only inhibits osteoclastogenic cytokine production, but also directly suppresses inflammation-driven osteoclastogenesis. These data provide initial evidence that APR has the potential to provide a direct bone protective effect in PsA

Enabling patient-reported outcome measures in clinical trials, exemplified by cardiovascular trials

Abstract Objectives There has been limited success in achieving integration of patient-reported outcomes (PROs) in clinical trials. We describe how stakeholders envision a solution to this challenge. Methods Stakeholders from academia, industry, non-profits, insurers, clinicians, and the Food and Drug Administration convened at a Think Tank meeting funded by the Duke Clinical Research Institute to discuss the challenges of incorporating PROs into clinical trials and how to address those challenges. Using examples from cardiovascular trials, this article describes a potential path forward with a focus on applications in the United States. Results Think Tank members identified one key challenge: a common understanding of the level of evidence that is necessary to support patient-reported outcome measures (PROMs) in trials. Think Tank participants discussed the possibility of creating general evidentiary standards depending upon contextual factors, but such guidelines could not be feasibly developed because many contextual factors are at play. The attendees posited that a more informative approach to PROM evidentiary standards would be to develop validity arguments akin to courtroom briefs, which would emphasize a compelling rationale (interpretation/use argument) to support a PROM within a specific context. Participants envisioned a future in which validity arguments would be publicly available via a repository, which would be indexed by contextual factors, clinical populations, and types of claims. Conclusions A publicly available repository would help stakeholders better understand what a community believes constitutes compelling support for a specific PROM in a trial. Our proposed strategy is expected to facilitate the incorporation of PROMs into cardiovascular clinical trials and trials in general