Causes of mortality in patients with psoriasis in Malaysia - Evidence from the Malaysian Psoriasis Registry.

BACKGROUND: Patients with severe psoriasis, namely those requiring phototherapy or systemic treatment, have an increased risk of death. The aim of this study was to determine the prevalence, aetiology and risk factors for mortality among adult patients aged 18 years and above with psoriasis in Malaysia. METHODS: This was a retrospective study involving adult patients notified by dermatologists to the Malaysian Psoriasis Registry between July 2007 and December 2013. Data were cross-checked against the National Death Registry. Patients certified dead were identified and the cause of death was analysed. Multivariate analysis using multiple logistic regression were conducted on potential factors associated with higher risk of mortality. RESULTS: A total of 419 deaths were identified among the 9775 patients notified. There were four significant risk factors for higher mortality: age>40 years (age 41-60 years old, Odds Ratio (OR) 2.70, 95%CI 1.75, 4.18; age>60 years OR 7.46, 95%CI 4.62, 12.02), male gender (OR 1.72, 95%CI 1.33,2.22), severe psoriasis with body surface area (BSA) >10% (OR 1.52, 95%CI 1.19, 1.96) and presence of at least one cardiovascular co-morbidity (OR 1.67, 95% CI 1.30, 2.14). Among the 301 patients with verifiable causes of death, the leading causes were infection (33.9%), cardiovascular disease (33.6%) and malignancy (15.9%). CONCLUSION: Infection was the leading cause of death among psoriasis patients in Malaysia. Although cardiovascular diseases are well-known to cause significant morbidity and mortality among psoriasis patients, the role of infections and malignancy should not be overlooked.

Abnormal Sylvian fissure on prenatal cerebral imaging: significance and correlation with neuropathological and postnatal data.

OBJECTIVE: To illustrate and determine the significance of abnormal Sylvian fissure development (or abnormal operculization) in cases in which prenatal cerebral imaging is suggestive of underlying cortical dysplasia. METHODS: This was a retrospective study of 15 fetuses at 24-34 weeks in which abnormal operculization was identified on prenatal cerebral imaging and for which follow-up data were available. The imaging findings were correlated to macro- and microscopic neuropathological data (n = 11) or to postnatal clinical and imaging findings (n = 4). RESULTS: On microscopic examination of fetuses from 11 terminated pregnancies, abnormal operculization was associated with cortical dysplasia in four cases and the cortex was normal in seven. Abnormal operculization was associated with cortical dysplasia in only one of the four liveborn infants. Cases of abnormal Sylvian fissure development with normal cortical architecture were classified, according to associated anomalies of the central nervous system, into one of five groups: those with neural tube defects, microcephaly or frontal hypoplasia, glutaric aciduria, other cerebral abnormalities, and extracerebral anomalies. CONCLUSION: Abnormal operculization on prenatal imaging does not systematically reflect underlying cortical dysplasia. It may be related to extracortical factors such as abnormal cerebral volume or other developmental anomalies of the central nervous system. An understanding of the significance of abnormal Sylvian fissure development could be useful in integrating its analysis into a more general one of the whole central nervous system.

[Attitude of the French female population to cancer screening]. / Attitudes de la population féminine française face au dépistage des cancers.

UNLABELLED: Attitudes of the French female population towards screening of different types of cancer were studied by means of a telephone survey conducted among a random sample of the French population aged 18 to 75 (n = 2,099). MAIN RESULTS: Cancer remains the most highly feared disease among the population. This fear is more apparent among women than men (61.5% average or strong fear vs 52.6%). In addition, women are more frequently prone to disclosing cancer cases among relatives. Over the last three years, respectively 28.4% and 70.5% of the 1,075 women in the sample had undergone a mammography and a Pap smear. Results suggest that there is still a discrepancy between current screening practices and official recommendations for systematic screening policies in France, as well as a trend towards "overutilization" among younger women and insufficient coverage among older women. Women living in French administrative districts where systematic screening campaigns for breast cancer are in place, had a better access to mammography (40.5% vs 26.2% in the rest of the sample). Multidimensional analysis confirms that social isolation is related with a poor access to either type of screening, although systematic screening campaigns have helped to reduce socio-cultural inequities in access to mammography for the target population of women aged 50 to 69. This analysis also suggests that when an individual adopts some preventive behaviors (such as giving up smoking), it may have a reassuring effect which in turn discourages access to screening; therefore the need for a greater coherence in the various sectors of preventive action against cancer is advocated by the authors.