bluuebunny/crossref_metadata_2025_split huggingface dataset:
BI44 Latent tuberculosis reactivation in a patient with chronic plaque psoriasis treated with ustekinumab with a review of the literature
Authors: Amini Sylvia , Hamed Fatma , Johnason Kate , Mahmoud Sarah 
Published: June 2024

Abstract
Ustekinumab, a monoclonal antibody against interleukin (IL)-12 and IL-23, is used for the treatment of psoriasis and psoriatic arthritis. The IL-12 pathway also plays an important role in regulating immunity to Mycobacterium tuberculosis. A multicentre, double-blind, randomized clinical trial study of 121 Korean patients with moderate-to-severe psoriasis revealed at least 75% improvement in Psoriasis Area and Severity Index (PASI) score after 12 weeks of ustekinumab treatment. Ten cases of latent tuberculosis infection (LTBI) were reported. Lupea-Chilom et al. [Lupea-Chilom DS, Solovan CS, Farcas SS et al. Latent tuberculosis in psoriasis patients on biologic therapies: real-world data from a care center in Romania. Medicina (Kaunas) 2023; 59: 1015] conducted a retrospective observational study on a total of 97 patients with severe psoriasis who were on different biologics. That study showed that two of seven patients on monotherapy ustekinumab developed LTBI. In this abstract, we present the case of a 49-year-old White woman with resistant moderate-to-severe chronic psoriasis without psoriatic arthritis who developed LTBI while on ustekinumab. She was diagnosed with psoriasis in 2012 with involvement of the scalp, flexural, vulval and gluteal regions as well as the nails. She was started on ustekinumab in October 2013 following a satisfactory prebiologics screen (including a negative QuantiFERON test). Her PASI score was zero at week 12. In 2017, she developed a malar rash and positive antinuclear antibody test, which was not tested prior to starting biologics. As lupus is a potential adverse effect of this medication, the ustekinumab was stopped in April 2017. Further rheumatological investigations ruled out lupus and ustekinumab was restarted in November 2017. As part of the screening process prior to restarting treatment, she had a repeat QuantiFERON test, which was positive. The respiratory team reviewed the patient and issued a 3-month course of rifampicin and isoniazid to treat LTBI. Following a few months of monitoring, it was deemed safe to restart ustekinumab in December 2018 and her PASI improved. In February 2020, due to the COVID pandemic, this medication had to be stopped. She was started on acitretin as an alternative in 2021 with a resulting worsening of her condition. In December 2021, the patient was restarted on ustekinumab. In this abstract, we illustrate that ustekinumab has the potential to reactivate latent tuberculosis, a phenomenon that is infrequently reported and attributed to its impact on the IL-12 pathway. To address this concern, we recommend conducting repeated annual screening during treatment in addition to a comprehensive baseline evaluation, including a chest X-ray and QuantiFERON test. Additionally, it is advisable to consider initiating isoniazid chemoprophylaxis concurrently with ustekinumab treatment as a precautionary measure.
GD04 Erythroderma: uncovering the culprit
Authors: Damani Namiz , Gold Adam , Krishnakumar S , Yesudian Paul Devakar 
Published: June 2024

Abstract
A middle-aged man presented to clinic in South India with a 1-year history of a widespread rash involving his whole body. There was no pre-existing skin condition. It appeared to be a possible inflammatory dermatosis and he was prescribed fixed-dose combination topical agents, including topical steroids (clobetasol propionate), topical antibiotics (gentamicin and neomycin), and a combination of an oral antifungal (terbinafine) and topical antifungals (clotrimazole and miconazole). On examination, there were numerous large, scaly plaques coalescing to an erythrodermic morphology. He was reviewed by two dermatologists, who commenced him on a reducing course of prednisolone. Due to nonresponse he was then started on ciclosporin 2.5 mg kg−1 per day. However, the condition continued to worsen. A skin biopsy was taken; this demonstrated hyperkeratosis with multiple fungal filaments consistent with extensive dermatophytosis. Over the past decade, there has been a significant increase in recalcitrant dermatophytosis seen in India. A recent multicentre study notes that the inaccessibility of adequate antifungal susceptibility testing results in excessively long treatment durations with poorly selected drugs and experimentation in medication dosage and frequency, which in turn contribute to drug resistance and the emergence of new strains (Ebert A, Monod M, Salamin K et al. Alarming India-wide phenomenon of antifungal resistance in dermatophytes: a multicentre study. Mycoses 2020; 63: 717–28). Trichophyton indotineae (previously known as Trichophyton mentagrophytes genotype VIII) is a newly identified dermatophyte species and has outpaced Trichophyton rubrum as the major causative agent of tinea cruris, tinea corporis and tinea faciei in India (Uhrlaß S, Verma SB, Gräser Y et al. Trichophyton indotineae – an emerging pathogen causing recalcitrant dermatophytoses in India and worldwide – a multidimensional perspective. J Fungi 2022; 8: 757). It has since spread to many countries globally. It is particularly problematic due to its resistance to terbinafine as a result of point mutations within the squalene epoxidase gene. Clinically, T. indotineae infections are extensive, involving multiple sites with symptoms of pain, pruritis and localized burning. Infection characteristically follows a chronic and relapsing clinical course, with an average duration of 9 months. The drug of choice is itraconazole 100 mg twice daily for 4–8 weeks, with fluconazole and griseofulvin as second-line options. Adequate hygiene measures are crucial to avert transmission and reinfection. This case highlights the issue of recalcitrant dermatophytosis in the subcontinent, emphasizing the need for improved antifungal susceptibility testing and judicious use of medications to curb drug resistance.
GD06 An observational study of the impact of the Ukraine war in our dermatology department
Authors: Hegazy Sherok , Byrne Berbie , Laing Mary 
Published: June 2024

Abstract
We aimed to assess the cohort of patients attending our dermatology department who have been displaced by the war in Ukraine, to evaluate the impact of the conflict on the continuity of medical care, and to shed light on the challenges faced by political refugees in an unfamiliar medical system. Consenting Ukrainian refugees attending our department over a 3-month period answered questions regarding their displacement, medical history, and reason for referral to the dermatology service. We assessed the impact of their care on our department including translators, treatment plans and further follow-up appointments. We also present a single patient’s story, highlighting the devastating impact political conflict can have on patient care. Seventeen patients participated in the study. Most patients (82%) arrived in Ireland over 1 year ago. Thirteen of the presenting complaints (76%) occurred prior to displacement. Six patients were referred for assessment of a rash and 11 with lesions. Working diagnoses included benign naevi (35%), skin cancers (29%) and inflammatory dermatoses including eczema, psoriasis and tinea (35%). Four patients had translators booked, while the remainder communicated through family members or an online translator service. In total, seven patients required excisions, two required systemic treatment and one required biologic treatment. The remaining 10 patients were discharged from dermatology. We also present a single patient’s story. The patient was a 46-year-old woman referred to dermatology with psoriasis for which she was previously on maintenance treatment with methotrexate in Ukraine. She incidentally had a lesion recently excised in Ukraine, from which she never got the results due to the war. Following her displacement she subsequently developed pain and swelling around her surgical site. Investigation revealed what was likely metastatic melanoma. Political conflict can lead to fractured patient care, catastrophic outcomes and increased pressure on thinly stretched healthcare resources. Our hospital’s immediate catchment area has accommodated just under 10 000 Ukrainian refugees to date and we have seen some of the deleterious effects this conflict has had on patient care as a consequence. Nevertheless, we must continue supporting political refugees to the best of our ability, keeping in mind the impact of displacement on their care.
H03 (P068) A history of mycosis fungoides: from Alibert to mogamulizumab
Authors: Johnson Nicholas A , Venables Zoe C , Mistry Khaylen , Levell Nick J 
Published: June 2024

Abstract
In 1806, French physician Baron Jean-Louis Alibert treated a 56-year-old man with a desquamating rash and skin tumours. Alibert considered this to be a variant of yaws. In 1829 Alibert named the condition mycosis fungoides (MF), meaning ‘mushroom-like fungal disease’. Over 100 years later, French dermatologist Albert Sézary published papers from 1938 to 1949 detailing a mysterious disease that caused erythroderma and ‘cellules monstrueuses’, describing cutaneous ‘monster cells’. In 1961, these clinical findings were collated together into ‘Sézary syndrome’. Over this time there was widespread confusion between these conditions, fungal infections and yaws. In the 1870s English dermatologist William Tilbury Fox published a dermatology atlas detailing cases similar to what we know now as MF, with the name ‘fibroma fungoides’. The atlas described MF as a type of fungus, before giving a description of yaws and painting a clinical picture that differed from that of a lymphoma. In 1975, Pierre-Antoine-Ernest Bazin and associates in suggested the classification system and term we now recognize as cutaneous T-cell lymphoma (CTCL). Neoplastic cells have been thought to arise from chronic activation of T cells via antigen-presenting cells, yet the antigen to trigger this response remains unknown. Several potential bacterial, viral, fungal and iatrogenic causes have been studied, but no reliable triggers have been discovered. In 2018, the World Health Organization and European Organisation for Research and Treatment of Cancer officially recognized four types of MF. These are the classic Alibert–Bazin type (representing 88.6% of cases) and its three subtypes; folliculotropic MF (11.4%), Pagetoid reticulosis, and granulomatous slack skin (both with a combined 1% prevalence). CTCL has an incidence of approximately 0.2–0.6 per 100 000 person-years, with MF being the most common subtype. MF is twice as common in male as in female patients. It is twice as common in those of Black ethnic background than in White and Asian ethnicities. Development of immunohistochemistry and polymerase chain reaction for the T-cell receptor gene in the 1980s improved the diagnosis of CTCL. However, diagnosis of MF remains challenging due to its heterogeneous presentation, often mimicking inflammatory dermatoses. Advanced disease therapies have evolved from cytotoxic chemotherapy in the 1970s to novel monoclonal antibodies such as mogamulizumab, targeting proteins on T-cell lymphoma cells (CCR4). Reflection on the past two centuries from Alibert to mogamulizumab offers insight into the challenges that accompany the aetiology, diagnosis, classification and management of MF.
PS08 Exploring the health inequality gap in atopic dermatitis among LGBTQ+ and minority ethnicity communities
Authors: Ho Bernard , Aftab Yousaf , Wright Owen , Moloney Susan , Corner Lynne 
Published: June 2024

Abstract
Research evidence suggests inequities in access to specialist atopic dermatitis (AD) care for LGBTQ+ and minority ethnicity groups, who can experience poorer outcomes and higher consultation rates with a general practitioner before being referred to a specialist. Understanding of why such inequities exist is limited. The research that exists is largely quantitative and lacks both patient and professional perspectives. This study aimed to address this gap through in-depth exploration of the patient journey and generation of novel insight. We used qualitative methods involving one-to-one interviews and focus groups with members of LGBTQ+ and minority ethnicity groups aged ≥ 18 years and living in the UK with a medical diagnosis of AD. People registered their interest in the study via Voice, a public engagement platform, followed by purposive sampling and selection of 20 patient participants (10 LGBTQ+ and 10 minority ethnic) to maximize diversity and generation of a broad perspective. Five healthcare professionals representing a range of clinical practice were identified from known academic sources, and/or snowball sampling to take part in an interview. Ethical approval and full participant consent were obtained. Interviews and focus groups were conducted remotely via Zoom; they were recorded then transcribed anonymously. Interviews followed a semistructured topic guide covering screening, diagnosis, general views of healthcare professionals, treatment, management and symptoms. Data were analysed thematically and compared for commonalities and differences both across and within groups. To date, 10 interviews have been completed, with six LGBTQ+ participants and four minority ethnic participants (seven female, two male, one nonbinary, one trans-female), age range 24–47 years. Preliminary results suggest that while discrimination-based barriers are not prevalent, the care system can be perceived as lacking empathy and understanding of the patient experience for people living with AD. Participants expressed personal expertise in their condition, with a desire for access to a more holistic approach to AD care that includes preventative measures. However, short consultation times with primary care givers deterred discussion beyond episodic treatment. Participants were unaware of such care options being available through alternative sites of care (pharmacies). This study is ongoing but has already generated deeper insight into the patient journey for people living with AD. Further analysis will illuminate perceived barriers to specialist care for members of LGBTQ+ and minority ethnicity groups and how these might be addressed. The findings will inform general patient-centric recommendations for practice and guide further qualitative work specific to subcommunity needs. Pfizer sponsored and funded this study.
The 2022 ICJ Judgment in Nicaragua v. Colombia: Towards a Theory of Exclusivity in Allocating Rights and Jurisdiction between the Coastal and Other States?
Authors: Zhang Xinjun , Chen Xidi 
Published: June 2024

Abstract
In Alleged Violations of Sovereign Rights and Maritime Spaces in the Caribbean Sea (Nicaragua v. Colombia), the International Court of Justice delves into the matter of exclusivity when assessing alleged violations committed by foreign States within an Exclusive Economic Zone. Additionally, the Court examines the legality of legislative acts concerning the contiguous zone and outlines criteria for the drawing of straight baselines. The Court’s aim seems to be establishing a comprehensive theory of exclusivity, seeking to allocate and balance the rights and jurisdiction of coastal States and other States involved. In this context, it becomes apparent that the abstract notion of freedom of navigation imposes limitations on coastal States, preventing them from enacting legislation that expands the scope of their jurisdiction or adopts a liberal interpretation of permissible conditions within relevant regulatory frameworks. The implications of this theory for the evolution of the legal order pertaining to maritime spaces warrant significant attention.
Clinical and imaging presentations are associated with function in incidental adrenocortical adenomas: a retrospective cohort study
Authors: Hamidi Oksana , Shah Muhammad , Zhang Catherine D , Lazik Natalia , Li Dingfeng , Singh Sumitabh , Iñiguez-Ariza Nicole M , Raman Ram , Hurtado Maria D , Carafone Lindsay , Khanna Aakanksha , Yan Qi , Natt Neena , Hartman Robert P , McKenzie Travis , Young William F , Bancos Irina 
Published: June 2024

Abstract

Objective
The aim of this study is to assess whether clinical and imaging characteristics are associated with the hormonal subtype, growth, and adrenalectomy for incidental adrenal cortical adenomas (ACAs).

Design
This is a single-center cohort study.

Methods
Consecutive adult patients with incidental ACA were diagnosed between 2000 and 2016.

Results
Of the 1516 patients with incidental ACA (median age 59 years, 62% women), 699 (46%) had nonfunctioning adenomas (NFAs), 482 (31%) had mild autonomous cortisol secretion (MACS), 62 (4%) had primary aldosteronism (PA), 39 (3%) had Cushing syndrome, 18 (1%) had PA and MACS, and 226 (15%) had incomplete work-up. Age, sex, tumor size, and tumor laterality, but not unenhanced computed tomography Hounsfield units (HU), were associated with hormonal subtypes. In a multivariable analysis, ≥1 cm growth was associated with younger age (odds ratio [OR] = 0.8 per 5-year increase, P = .0047) and longer imaging follow-up (OR = 1.2 per year, P &lt; .0001). Adrenalectomy was performed in 355 (23%) patients, including 38% of MACS and 15% of NFA. Adrenalectomy for NFA and MACS was more common in younger patients (OR = 0.79 per 5-year increase, P = .002), larger initial tumor size (OR = 2.3 per 1 cm increase, P &lt; .0001), ≥1 cm growth (OR = 15.3, P &lt; .0001), and higher postdexamethasone cortisol (OR = 6.6 for &gt;5 vs &lt;1.8 μg/dL, P = .002).

Conclusions
Age, sex, tumor size, and laterality were associated with ACA hormonal subtype and can guide diagnosis and management. Tumor growth was more common with younger age and longer follow-up. Unenhanced HU did not predict hormonal subtype or growth. Adrenalectomy for MACS and NFA was mainly performed in younger patients with larger tumor size, growth, and elevated postdexamethasone cortisol.
Re-examining the adaptive function of nausea and vomiting in pregnancy
Authors: Emmott Emily H 
Published: July 2024

ABSTRACT
Nausea and vomiting in pregnancy (NVP) have been proposed to have a prophylactic function. In this review, I re-examine NVP from an evolutionary perspective in light of new research on NVP. First, current evidence suggests that the observed characteristics of NVP does not align well with a prophylactic function. Further, NVP is typically associated with high costs for pregnant women, while moderate-to-severe NVP is associated with increased risks of poorer foetal/birth outcomes. In contrast, mild NVP limited to early pregnancy may associate with improved foetal outcomes—indicating a potential evolutionary benefit. Second, researchers have recently identified growth differentiation factor 15 (GDF15) to cause NVP, with implications that low-levels of pre-conception GDF15 (associated with lower cellular stress/inflammation) may increase risks/symptoms of NVP. If so, NVP in contemporary post-industrialized populations may be more severe due to environmental mismatch, and the current symptomology of NVP in such populations should not be viewed as a typical experience of pregnancy.
Comparative Genomic Analysis of the Pattern of Evolution of Male and Female Reproductive Proteins in Seed Beetles
Authors: Papachristos Konstantinos , Sayadi Ahmed , Arnqvist Göran 
Published: June 2024

Abstract
Male seminal fluid proteins often show signs of positive selection and divergent evolution, believed to reflect male–female coevolution. Yet, our understanding of the predicted concerted evolution of seminal fluid proteins and female reproductive proteins is limited. We sequenced, assembled, and annotated the genome of two species of seed beetles allowing a comparative analysis of four closely related species of these herbivorous insects. We compare the general pattern of evolution in genes encoding seminal fluid proteins and female reproductive proteins with those in digestive protein genes and well-conserved reference genes. We found that female reproductive proteins showed an overall ratio of nonsynonymous to synonymous substitutions (ω) similar to that of conserved genes, while seminal fluid proteins and digestive proteins exhibited higher overall ω values. Further, seminal fluid proteins and digestive proteins showed a higher proportion of sites putatively under positive selection, and explicit tests showed no difference in relaxed selection between protein types. Evolutionary rate covariation analyses showed that evolutionary rates among seminal fluid proteins were on average more closely correlated with those in female reproductive proteins than with either digestive or conserved genes. Gene expression showed the expected negative covariation with ω values, except for male-biased genes where this negative relationship was reversed. In conclusion, seminal fluid proteins showed relatively rapid evolution and signs of positive selection. In contrast, female reproductive proteins evolved at a lower rate under selective constraints, on par with genes known to be well conserved. Although our findings provide support for concerted evolution of seminal fluid proteins and female reproductive proteins, they also suggest that these two classes of proteins evolve under partly distinct selective regimes.
National Identity and the Limits of Platform Power in the Global Economy
Authors: Girard Tyler 
Published: June 2024

Abstract
Among the defining features of the contemporary global economy are the digital disruption of economic sectors and the accompanying political and regulatory conflicts. Across the world, multinational technology firms have mobilized consumers as a key ally in these conflicts, a critical element of the platform power they wield. In this article, I examine how non-consumer identities can limit the exercise of platform power by such firms. By synthesizing the concept of platform power with research on political consumerism and national identity, I argue that activating national identity can generate opposition to policies favorable to multinational technology firms and, in turn, curtail their ability to appeal to public support. Empirically, this article uses an online, nationally representative survey fielded in Canada. I explore the determinants of support for global regulatory cooperation and the domestic policy status quo, as well as the causal effect of consumer and national identity framing using vignette experiments across three issue areas: banking, telecommunications, and taxation. The findings reveal that activating consumer identities consistently shifts support but the effect of national identity is more variable. This article thus contributes to scholarship on the digital economic transformation and the exercise of business power in the global economy.