Increased echogenicity of the pancreas, due to hemosiderosis, is a frequent laboratory finding in children and adolescents with beta-thalassemia. The aim of this study was to investigate whether increased echogenicity of the pancreas is associated with dysfunction. The ultrasonic image of the pancreas was examined in 34 children aged 12+/-3.8 years old and was compared to the endocrine and exocrine functioning of the gland. Oral glucose tolerance test (OGTT) was performed with simultaneous measurement of insulin and serum trypsin. Twenty-six of the 34 patients (76.5%) presented increased echogenicity, while 8 (23.5%) had a normal ultrasonic pancreatic image. 77% of the patients with increased echogenicity had abnormal OGTT, 46%, with subnormal or increased insulin values, and 32.5% manifested low levels of trypsin. Among the patients with normal ultrasound, 25% had abnormal OGTT and 37.5% abnormal insulin values. Statistical analysis with Student's t-test revealed that patients with increased echogenicity had significantly higher glucose values on OGTT at 60: 7.6 +/- 1.8 mmol/l (137.3 +/- 33.7 mg/dl) as compared to the patients with normal ultrasound: 6.1 +/- 1.2 mmol/l (110.75 +/- 21.72 mg/dl) (p<0.05). Insulin values were significantly affected at 30, 60, and 90 min: 570+/-301, 332+/-156, 294+/-158 pmol/l (79.54 +/- 42, 46.4 +/- 21.8, 41.04 +/- 22 mU/l) respectively in patients with increased echogenicity in comparison to those with normal ultrasonographic image of the gland: 301 +/- 170, 192 +/- 52, 135 +/- 63 pmol/l (42 +/- 23.7, 26.85 +/- 7.36, 18.9 +/- 8.8 mU/l) (p<0.05). No statistical significance was observed between the two groups regarding trypsin levels, even though abnormal values were observed in more children with increased echogenicity than in patients with a normal ultrasound. The above findings confirm that increased echogenicity of the pancreas is associated with disturbance of its function. This simple imaging method could be used as a rough early index of detection of an increased risk for developing diabetes mellitus in patients with beta-thalassemia.

Background Apremilast is an oral phosphodiesterase-4 inhibitor indicated for patients with moderate-to-severe chronic plaque psoriasis and active psoriatic arthritis.Objectives To examine the effectiveness of apremilast on Dermatology Life Quality Index (DLQI), Psoriasis Area and Severity Index (PASI) and nail, scalp and palmoplantar involvement, when administered prior to biologics.Methods This 52-week real-world study included biologic-naive adults with moderate psoriasis (psoriasis-involved body surface area 10% to <20%, or PASI 10 to <20 and DLQI 10 to <20). Apremilast was initiated ≤7 days before enrolment. Data from the first 100 eligible patients who completed 24 weeks (W24) of observation (or were prematurely withdrawn) are presented in this interim analysis using the last-observation-carried-forward imputation method. Results Eligible patients (mean age: 49.9 years; 71.0% males; median disease duration: 8.0 years) were consecutively enrolled between April and October 2017, by 18 dermatology specialists practising in hospital outpatient settings in Greece. Baseline DLQI (median: 12.0) and PASI (median: 11.7) scores improved (P < 0.001) at all postbaseline timepoints (Weeks 6, 16 and 24; W24 median decreases: 9.0 and 9.4 points respectively). At W24, DLQI ≤5, DLQI 0 or 1, and PASI-75 response rates were 63.0%, 25.0% and 48.0% respectively. The Nail Psoriasis Severity Index score in patients with baseline nail involvement (n = 57) decreased at all postbaseline timepoints (P < 0.001; W24 median decrease: 20.0 points). At W24, 50.0% and 51.7% of patients with baseline scalp (n = 76) and palmoplantar (n = 29) involvement respectively achieved postbaseline Physician's Global Assessment (PGA) score of 0 or 1 if baseline score was ≥3, or 0 if Clinicaltrials.gov number: NCT03059953

Sir: I read with interest the audit by Murray and Jones on bloodborne virus (BBV) services in Her Majesty's Prison Service that reported on hepatitis C virus (HCV) infections among female inmates. 1 Their findings are comparable to what have been reported with high prevalence of HCV infection among those with intravenous drug use (IVDU). 2,3 IVDU is now becoming the leading cause of HCV transmission. In our local setting, IVDU accounts for more than half of the aetiology for HCV infection and this is increasing as transmissions through haemodialysis and contaminated blood products are decreasing. All our incarcerated inmates are screened at entry for BBVs (HIV, hepatitis B, HCV and syphilis) and HCV infection represent the most common infection detected.The audit highlighted the importance of screening inmates for BBVs and the opportunities provided. There are several advantages for provision of such services. Screening helps to identify infected individuals who otherwise would not have presented themselves voluntarily for testing and would remain undetected and undiagnosed. HCV infection is a major public health problem and this is especially true in rehabilitation or correctional facilities due to the large pools of undiagnosed infections and high-risk behaviours. Undetected cases will place other inmates or even facilities staff at risk. Family members will also be at risk when inmates are released. In our local setting, family members of identified cases are offered screening. Identifications of infections allow for counselling and education on risk behaviour modifications. Treatment can be considered as treatment for IVDUs whether active or rehabilitated have been shown to be as effective as non-IVDUs. 4,5 Our own experience showed that treatment responses (sustained viral response) to standard combination therapy were comparable (IVDU, 64.7% versus non-IVDU, 63.6%, P ¼ ns). 4 Treatments during incarceration provide the assurance of compliance, which is an important predictor of response to therapy. Importantly, a large proportion of the inmates in our local setting remained rehabilitated once released. Therefore, the period of incarceration provides opportunities to rehabilitate, counsel, educate and treat those infected. As such, I believed such screening programme should be introduced to all correctional or rehabilitation facilities and even made compulsory as treatments are available. Furthermore, from the public health point of view, it helps to identify the groups of patients who contribute largely to the pools of HCV-infected persons. Parry JV. Prevalence of antibodies to hepatitis B, hepatitis C and HIV and risk factors in Irish prisoners: results of a national cross sectional survey. BMJ 2000;321:78 -82 3 Crofts N, Stewart T, Hearne P, Ping XY, Breshkin AM, Locarnini SA. Spread of blood-borne viruses among Australian prison entrants. Br Med J 1995;310:285-8 4 Chong VH, Jamaludin AZ, Jacob AP, Jalihal A. Treating intravenous drug users with hepatitis C infection: an opportunity in some settings. Eur...

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