Trends in body mass index before and after diagnosis of hidradenitis suppurativa.

BACKGROUND: A temporal relationship between hidradenitis suppurativa (HS) and obesity has not been established. OBJECTIVES: To compare baseline body mass index (BMI) and change in BMI for patients with HS and controls before and after diagnosis. METHODS: We performed a retrospective case-control analysis of 1284 patients with HS and controls matched for age, sex, race and calendar year between 1 January 1999 and 9 September 2019. BMI 7 years prior to first HS diagnosis, and rate of BMI change, were compared for patients with HS and controls using linear mixed effects models. RESULTS: Baseline BMI was higher among patients with HS than controls [mean difference 3·03 kg m-2 , 95% confidence interval (CI) 2·44-3·62; P < 0·001)]. This difference was larger for women [mean difference 3·37 kg m-2 (95% CI 2·73-4·01)] than men [mean difference 1·27 kg m-2 (95% CI - 0·20-2·73; interaction P = 0·01)], and for patients with HS diagnosed before age 40 years [mean difference 4·10 kg m-2 (95% CI 3·15-5·06)] than those diagnosed after age 40 years [mean difference 2·38 kg m-2 (95% CI 1·63-3·12; interaction P < 0·001)]. Prior to diagnosis, average annual increase in BMI among patients with HS was slightly higher than controls. There was no statistically significant change in annual BMI among patients with HS following diagnosis. CONCLUSIONS: Baseline BMI and, to a lesser extent, rate of BMI change appear to be risk factors for developing HS. The influence of BMI may play a larger role among female patients and younger patients.

Incidence of hidradenitis suppurativa among tobacco smokers: a population-based retrospective analysis in the U.S.A.

BACKGROUND: The relationship between tobacco use and hidradenitis suppurativa (HS) is controversial. OBJECTIVES: To determine the incidence of HS among tobacco smokers. METHODS: Retrospective cohort analysis identifying incident HS cases among adult tobacco smokers and nonsmokers sampled from a demographically heterogeneous population-based sample of over 50 million unique patients across all census regions in the U.S.A. RESULTS: We identified 3 924 310 tobacco smokers, which included 7860 patients newly diagnosed with HS. Tobacco smokers diagnosed with HS were most commonly aged 18-39 years (3795 of 7860; 48·3%), women (5640 of 7860; 71·8%), white (5200 of 7860; 66·2%) and those with body mass index (BMI) ≥ 30 (5690 of 7860; 72·4%). Overall incidence of HS was 0·20% (7860 of 3 924 310) among tobacco smokers and 0·11% (8430 of 8 027 790) among nonsmokers (P < 0·001). Incidence was greatest among tobacco smokers who were aged 30-39 years (0·35%), women (0·28%), African Americans (0·46%) and those with BMI ≥ 30 (0·33%). The overall adjusted odds of developing HS was 1·90 (95% confidence interval 1·84-1·96) among tobacco smokers, compared with nonsmokers (P < 0·001). HS incidence among tobacco smokers remained increased within each demographic subgroup. CONCLUSIONS: Incidence of HS appears to be doubled among tobacco smokers. These findings may support evidence-based counselling efforts for the cessation of smoking in populations at risk for HS.

Prevalence of hidradenitis suppurativa among patients with Down syndrome: a population-based cross-sectional analysis.

BACKGROUND: Hidradenitis suppurativa (HS) has been linked to Down syndrome (DS). OBJECTIVES: To determine whether patients with DS have a higher prevalence of HS, and whether the diagnosis of HS occurs at an earlier age for these patients. METHODS: A cross-sectional analysis was performed for a population sample of 11 936 patients with DS and 16 813 290 patients without DS. The primary outcome was the diagnosis of HS. Systemized Nomenclature of Medicine-Clinical Terms were used to identify patients with DS and HS. We used logistic regression models and significant interaction terms to evaluate the relationship between DS and HS. We also compared the proportion of incident HS cases within 5-year age groups to determine whether patients with DS had received an earlier diagnosis of HS. RESULTS: Prevalence of HS among patients with DS was 2·1%, compared with 0·3% for patients without DS (P < 0·001). HS prevalence was greatest among patients with DS who were aged 18-29 years. After controlling for age, sex and obesity, there was no difference in the prevalence of HS between female and male patients with DS or between white and nonwhite patients with DS. Compared with patients without DS, patients with DS had increased odds of HS in unadjusted [odds ratio (OR) 7·84, 95% confidence interval (CI) 6·93-8·88] and adjusted (OR 5·24, 95% CI 4·62-5·94) analyses. HS was diagnosed by the age of 29 years in 81·8% of patients with DS, compared with 34·0% of patients without DS (P < 0·001). CONCLUSIONS: HS is strongly associated with DS across demographic subgroups and may present earlier in life for these patients.

Investigating a high ozone episode in a rural mountain site.

A very high ozone episode with observed hourly values above 350 µg m(-3) occurred in July 2005 at the Lamas d'Olo air quality monitoring station, located in a mountainous area in the north of Portugal. Aiming to identify the origin and formation of this ozone-rich episode, a statistical analysis and a modelling approach were applied. A cross-spectrum analysis in the frequency domain and a synoptic analysis of the meteorological and air quality time series were performed. In order to go further in this analysis, a numerical modelling approach was applied. The results indicate that the transport of ozone and its precursors is the main responsible for the high ozone concentrations. Together with the local mountain breeze and subsidence conditions, the sea-breeze circulation transporting pollutants from the coastal urban and industrialized areas that reach the site during late afternoon turn out to be the driving forces for the ozone peaks.

An aid to the diagnosis of genetic disorders underlying adult-onset renal failure: a literature review.

Several genetic disorders can present in adult patients with renal insufficiency. Genetic renal disease other than ADPKD accounts for ESRD in 3% of the adult Dutch population. Because of this low prevalence and their clinical heterogeneity most adult nephrologists are less familiar with these disorders. As a guideline to differential diagnosis, we provide an overview of the clinical manifestations and the pathogenesis of the main genetic disorders with chronic renal insufficiency surfacing in adulthood and add an algorithm plus 4 tables. We also indicate where molecular genetics nowadays can be of aid in the diagnostic process. The following disorders are discussed by mode of inheritance: 1) Autosomal dominant: autosomal dominant polycystic kidney disease, nephropathies associated with uromodulin (medullary cystic disease and familial juvenile hyperuricemic nephropathy), renal cysts and diabetes syndrome, nail-patella syndrome, glomerulopathy with fibronectin deposits. 2) Not autosomal dominant: Nephronophthisis, Fabry disease, primary oxalosis, Adenine Phosphoribosyl Transferase deficiency, Alport syndrome, Lecithin-cholesterol acyltransferase deficiency, adult-onset cystinosis.

Autonomic nervous system tone measured by baroreflex sensitivity is depressed in patients with end-stage liver disease.

OBJECTIVES: Chronic liver disease is often associated with impairment of autonomic nervous system (ANS) reflexes. Baroreflex sensitivity (BRS) testing is an inexpensive, relatively noninvasive test that can be used to assess ANS tone. The aims of the present study were to determine the prevalence of ANS dysfunction in cirrhotics who are being considered for liver transplantation and to explore the potential use of BRS as a prognostic tool in identifying patients awaiting transplantation who are at increased risk for death. METHODS: We studied nine cirrhotics who were awaiting liver transplantation and seven controls without liver disease. BRS (ms/mm Hg) was measured using the phenylephrine method. RESULTS: BRS (mean +/- SEM) (ms/mm Hg) was significantly lower in cirrhotics compared with controls (4.2 +/- 0.9 vs 21.1 +/- 3.8 ms/mm Hg; p < 0.05). Furthermore, BRS was lower in cirrhotics with hepatic encephalopathy compared with those without (2.6 +/- 0.9 vs 6.1 +/- 1.0 ms/mm Hg; p < 0.05) and there was a trend toward lower BRS values in Child-Pugh class C patients as compared with class B (3.8 +/- 1.3 vs 5.3 +/- 1.2 ms/mm Hg; p = 0.3). At follow-up (9 months), one patient had died and one underwent liver transplantation. These two patients also had the most severely impaired vagal tone (BRS = 0 and 1.2 ms/mm Hg, respectively). CONCLUSIONS: Vagal tone, as assessed by BRS, is markedly depressed in cirrhotic patients awaiting liver transplantation.