The efficacy of apremilast in pemphigus: a systematic review of case reports

Pemphigus is a severe autoimmune blistering disorder that significantly affects patients’ quality of life. While corticosteroids and immunosuppressive agents are commonly used, they have substantial side effects, highlighting the need for safer alternatives. Apremilast, an oral phosphodiesterase 4 (PDE4) inhibitor, has shown efficacy in treating other autoimmune diseases and may offer promise for pemphigus. This systematic review evaluated the clinical outcomes, safety, and potential role of apremilast in pemphigus treatment by synthesizing available case reports and series. A literature search was conducted across multiple databases (PubMed, EMBASE, Cochrane, Web of Science, ScienceDirect, and Google Scholar) for case reports and series involving apremilast in pemphigus. Inclusion criteria were a confirmed pemphigus diagnosis and apremilast treatment. Five studies (four case reports and one case series) involving seven patients were included. Apremilast led to significant clinical improvement in four patients, with reductions in disease activity, lesion severity, and symptom scores (Pemphigus Disease Area Index, Autoimmune Bullous Skin Disorder Intensity Score, Visual Analog Scale, and Numerical Rating Score). Increases in regulatory T cells and decreases in anti-desmoglein antibodies were observed. No serious adverse events were reported, although one study noted treatment failure, possibly due to short follow-up or concurrent infections. Apremilast appears to be a promising treatment for therapy-resistant or corticosteroid-intolerant pemphigus patients. Although the evidence is limited, it supports apremilast’s efficacy and favorable safety profile. Further research with larger sample sizes and randomized controlled trials is necessary to confirm these findings

The Burden of Sickle Cell Disease in Saudi Arabia: A Single-Institution Large Retrospective Study

Amerah Bin Zuair, Sheikhah Aldossari, Rand Alhumaidi, Maha Alrabiah, Abdulmajeed Alshabanat Department of Internal Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh, Saudi ArabiaCorrespondence: Amerah Bin Zuair, Internal Medicine, King Saud University Medical City, Riyadh, Saudi Arabia, Tel +966558765609, Email [email protected]: Sickle cell disease (SCD) is a significant burden for patients and healthcare systems due to multiple factors, including high readmission rates. This study aimed to determine the general characteristics, etiology of admissions, annual admission rate, length of stay, and readmission rate of patients with SCD.Patients and Methods: This retrospective observational study included all adult patients with SCD admitted to the General Internal Medicine (GIM) unit between 2016 and 2021.Results: There were 160 patients (mean age, 31.08 ± 9.06 years; 51.25% female) with SCD included in this study. Most originated from southern Saudi Arabia (45.62%). The average annual number of emergency department (ED) visits was 4, and approximately 19% of patients had ≥ 3 annual admissions. The mean length of stay was 6 days. The readmission rates at 7, 30, 60, and 90 days were 8%, 24.5%, 13.6%, and 10.8%, respectively.Conclusion: SCD generates a significant economic burden on the Saudi society and the effects on the healthcare system and patients’ quality of life are evident in the high ED visits, readmission rates and prolonged hospitalization. Thereupon we advocate the implementation of sickle cell disease-specialized multidisciplinary clinics.Keywords: complications, readmission, quality of life, middle east, hemoglobinopath

Quantifying Food Loss and Waste in Saudi Arabia

Using the FAO model calculations proposed by Gustavsson et al. (2013) and FAO (2014), food loss and waste (FLW) is measured in Saudi Arabia with a special focus on wheat, rice, dates, poultry, vegetables, fruits, fish, and meat. Results show that the overall FLW rate is 33.1%, where the food loss rate is 14.2%, and the food waste rate is 18.9%. Acceding to the disaggregated results, we find that FLW rates are distributed as follows: 29.7% for wheat, 33.6% for rice, 21.4%, for dates 29.1% for poultry, 39.5% for vegetables, 39.6% for fruits, 33% for fish, and 31.3% for meat. The Sustainable Development Goal (SDG 12.3) target is to reduce the rates of food loss and waste by 50% in 2030, and to help achieve that goal, we employed a nonlinear optimisation simulation model with the objective function of reducing FLW by 50% over the period 2020–2030. Based on the findings achieved, recommendations are made to cover the various aspects of the whole food supply chain (FSC) and to aim at more efficiency and higher levels of productivity. Our findings have significant implications by estimating the FLW baseline indicator and providing the different stakeholders of FSC with the optimal actions to do to reduce FLW rates

Asthma and COPD Overlap Syndrome (ACOS): A Systematic Review and Meta Analysis

<div><p>Background</p><p>The combination of asthma and chronic obstructive pulmonary disease (COPD), or ACOS is a recently defined syndrome. The epidemiology of the condition is poorly described and previous research has suggested ACOS is associated with worse outcomes than either condition alone. We therefore decided to complete a systematic review of the published literature.</p><p>Methods</p><p>This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta- Analyses guidelines. A structured search was performed in the PubMed, Embase, and Medline databases up to Feb 2015 to identify studies reporting incidence, prevalence, health care utilization, morbidity, or mortality in COPD and asthma.</p><p>Results</p><p>A total of 19 studies were included in the present study. The pooled prevalence of overlap among COPD was 27% (95% CI: 0.16–0.38, p<0.0001) and 28% (95% CI: 0.09–0.47, p = 0.0032) in the population and hospital-based studies, respectively. We found no significant difference between ACOS and COPD in terms of gender, smoking status, lung function and 6mWD. However, in comparison to subject with only COPD, ACOS subjects were significantly younger, had higher BMI, healthcare utilization, and lower HRQoL.</p><p>Conclusion</p><p>ACOS is a common condition that exists in a substantial proportion of subjects with COPD. ACOS represents a distinct clinical phenotype with more frequent exacerbations, hospitalization, worse health-related quality of life, and higher healthcare costs than either disease alone. There is a critical need to better define the management and treatment of this syndrome.</p></div

Impact of a COPD comprehensive case management program on hospital length of stay and readmission rates

Abdulmajeed Alshabanat,1 Michael C Otterstatter,2,3 Don D Sin,4,5 Jeremy Road,5,6 Carmen Rempel,6 Jane Burns,6 Stephan F van Eeden,4,5 JM FitzGerald5&ndash;7 On behalf of the COPD Transition Team Program 1Department of Experimental Medicine, University of British Columbia, 2British Columbia Centre for Disease Control, 3School of Population and Public Health, 4Department of Medicine, Centre for Heart Lung Innovation, St Paul&rsquo;s Hospital, 5Division of Respirology, Department of Medicine, 6Department of Medicine, Faculty of Medicine, Institute for Heart and Lung Health, University of British Columbia, 7Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Institute, Vancouver, BC, Canada Background: COPD accounts for the highest rate of hospital admissions among major chronic diseases. COPD hospitalizations are associated with impaired quality of life, high health care utilization, and poor prognosis and result in an economic and a social burden that is both substantial and increasing.Aim: The aim of this study is to determine the efficacy of a comprehensive case management program (CCMP) in reducing length of stay (LOS) and risk of hospital admissions and readmissions in patients with COPD.Materials and methodology: We retrospectively compared outcomes across five large hospitals in Vancouver, BC, Canada, following the implementation of a systems approach to the management of COPD patients who were identified in the hospital and followed up in the community for 90&nbsp;days. We compared numbers, rates, and intervals of readmission and LOS during 2&nbsp;years of active program delivery compared to 1&nbsp;year prior to program implementation.Results: A total of 1,564 patients with a clinical diagnosis of COPD were identified from 2,719 hospital admissions during the 3&nbsp;years of study. The disease management program reduced COPD-related hospitalizations by 30% and hospitalizations for all causes by 13.6%. Similarly, the rate of readmission for all causes showed a significant decline, with hazard ratios (HRs) of 0.55 (year 1) and 0.51 (year 2) of intervention (P&lt;0.001). In addition, patients&rsquo; mean LOS (days) for COPD-related admissions declined significantly from 10.8 to 6.8 (P&lt;0.05).Conclusion: A comprehensive disease management program for COPD patients, including education, case management, and follow-up, was associated with significant reduction in hospital admissions and LOS. Keywords: COPD, CCP, admission, readmission, length of stay&nbsp

Review process (PRISMA Flow Diagram): details of review process.

<p>Review process (PRISMA Flow Diagram): details of review process.</p

Quantifying Food Loss and Waste in Saudi Arabia

Using the FAO model calculations proposed by Gustavsson et al. (2013) and FAO (2014), food loss and waste (FLW) is measured in Saudi Arabia with a special focus on wheat, rice, dates, poultry, vegetables, fruits, fish, and meat. Results show that the overall FLW rate is 33.1%, where the food loss rate is 14.2%, and the food waste rate is 18.9%. Acceding to the disaggregated results, we find that FLW rates are distributed as follows: 29.7% for wheat, 33.6% for rice, 21.4%, for dates 29.1% for poultry, 39.5% for vegetables, 39.6% for fruits, 33% for fish, and 31.3% for meat. The Sustainable Development Goal (SDG 12.3) target is to reduce the rates of food loss and waste by 50% in 2030, and to help achieve that goal, we employed a nonlinear optimisation simulation model with the objective function of reducing FLW by 50% over the period 2020–2030. Based on the findings achieved, recommendations are made to cover the various aspects of the whole food supply chain (FSC) and to aim at more efficiency and higher levels of productivity. Our findings have significant implications by estimating the FLW baseline indicator and providing the different stakeholders of FSC with the optimal actions to do to reduce FLW rates.</jats:p

Forest Plot: polled prevalence of overlap among COPD patients in population based studies.

<p>Study 1 = Shirtcliffe et al [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0136065#pone.0136065.ref010" target="_blank">10</a>], study 2 = Menezes et al [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0136065#pone.0136065.ref011" target="_blank">11</a>], study 3 = Marsh et al [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0136065#pone.0136065.ref012" target="_blank">12</a>], study 4 = Johannessen et al [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0136065#pone.0136065.ref016" target="_blank">16</a>], study 5 = Danielsson et al [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0136065#pone.0136065.ref017" target="_blank">17</a>], study 6 = Methvin et al [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0136065#pone.0136065.ref018" target="_blank">18</a>], study 7 = Miravitlles et al [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0136065#pone.0136065.ref019" target="_blank">19</a>], study 8 = Y. Zhou+CESCOPD et al [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0136065#pone.0136065.ref020" target="_blank">20</a>], study 9 = Jyrki-Tapani al [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0136065#pone.0136065.ref021" target="_blank">21</a>].</p

Characteristics of included studies.

<p>Abbreviations and definitions: COPD = chronic obstructive pulmonary disease; FEV1 = forced expiratory volume in 1 second; FVC = forced vital capacity, ICD: International Classification of Diseases.</p><p>Characteristics of included studies.</p