Public health campaigns and obesity - a critique

<p>Abstract</p> <p>Background</p> <p>Controlling obesity has become one of the highest priorities for public health practitioners in developed countries. In the absence of safe, effective and widely accessible high-risk approaches (e.g. drugs and surgery) attention has focussed on community-based approaches and social marketing campaigns as the most appropriate form of intervention. However there is limited evidence in support of substantial effectiveness of such interventions.</p> <p>Discussion</p> <p>To date there is little evidence that community-based interventions and social marketing campaigns specifically targeting obesity provide substantial or lasting benefit. Concerns have been raised about potential negative effects created by a focus of these interventions on body shape and size, and of the associated media targeting of obesity.</p> <p>Summary</p> <p>A more appropriate strategy would be to enact high-level policy and legislative changes to alter the obesogenic environments in which we live by providing incentives for healthy eating and increased levels of physical activity. Research is also needed to improve treatments available for individuals already obese.</p

Cyclosporin-A in the treatment of atopic dermatitis: effects on the immune system and clinical efficiency

In order to evaluate the effect of Cyclosporin-A (CyA) at doses of 5 mg/kg per day in atopic dermatitis we studied clinical effects, immunoglobulin production, lymphocytes subset, immunphenotype and local cytokine production in seven patients before and after 3 months CyA therapy. Clinically CyA was very effective in eliminating pruritus, erythema and vescicles with no significant adverse side effects. Using flow cytometric analysis we demonstrated that CyA treatment restored an overexpression of circulating CD25-positive cells. Similar results have been recorded with HLA-DR expression. CyA normalized the number of CD29 cells which were reduced in the blood of patients before starting treatment. Furthermore, after treatment, several cytokines (IL-2, IL-1α and IL-1β) had diasappeared from the epidermis. © 1994

Cyclosporin-A in the treatment of atopic dermatitis: effects on the immune system and clinical efficiency

In order to evaluate the effect of Cyclosporin-A (CyA) at doses of 5 mg/kg per day in atopic dermatitis we studied clinical effects, immunoglobulin production, lymphocytes subset, immunphenotype and local cytokine production in seven patients before and after 3 months CyA therapy. Clinically CyA was very effective in eliminating pruritus, erythema and vescicles with no significant adverse side effects. Using flow cytometric analysis we demonstrated that CyA treatment restored an overexpression of circulating CD25-positive cells. Similar results have been recorded with HLA-DR expression. CyA normalized the number of CD29 cells which were reduced in the blood of patients before starting treatment. Furthermore, after treatment, several cytokines (IL-2, IL-1α and IL-1β) had diasappeared from the epidermis. © 1994

TH2 cytokines profile in severe adult atopic dermatitis [PROFILO DI CITOCHINE A TIPO TH2 IN CORSO DI DERMATITE ATOPICA GRAVE DELL'ADULTO]

Atopic dermatitis is a disorder in which both type I and type IV reactions are involved. The disease is characterized by eczematous lesions and an aspecific infiltrate, often rich in eosinophils. Inflammatory infiltrate is constituted of T cells of the TH1 subset, but many authors showed that the TH2 subtype is important in the early phase of the disease. On the basis of our and of other group studies we investigated, at a molecular level, the mRNA expression of IL-4, IL-5, IL-2 and IFN-γ, in order to define the immunological pattern of the inflammatory infiltrate. IL-2 and IFN-γ are important mediators of delayed immunity, whereas IL-4 and IL-5 are involved especially in early immunity mechanisms, but can also participate in type IV reaction. Interleukin-4 and IL-5 are both produced by the T helper-2 lymphocyte subset. On the other hand the TH1 subset produces IL-2 and IFN-γ. IL-4 and IL-5 have many functions that could be summarized in eosinophils chemoattraction and maturation, and support to immunoglobulin-E production. IL-4 and IFN-γ have opposite functions on IgE production and are counter regulatory each other. 11 patients affected by atopic dermatitis and 5 normal patients have been biopsied. Biopsies and blood samples were taken within 48 hours from the appearance of new lesions and snap frozen in liquid nitrogen. Messenger RNA was extracted from biopsies, reverse transcribed and amplified. β-actin was used as a semiquantitative control. All patients showed a TH2-like cytokine pattern with IL-4 and IL-5 expression in both blood and skin samples. Two patients, biopsied several days later than the others, showed a reduction of IL-4 and IL-5 with an increased production of IL-2 and IFN-γ. We suggest that after an early immune reactions supported by a TH2-like cytokine secrection, there is a switching in the cytokine pattern to a TH1-like cytokine pattern

Facial granuloma [IL GRANULOMA FACIALE]

Granuloma faciale is classified as a leukocytoclastic vasculitis. It typically occurs on the face as a reddish, elevated, well circumscribed, usually solitary nodule. Occasionally multiple lesions appear. The lesions are histologically characterized by a dense dermal inflammatory infiltrate separated from epidermis by a 'grenz zone' of uninvolved dermis. A case of a 50-year old man with a 3 cm nodular lesion on the chin and a papular lesion on the cheek is reported. In three years the lesions showed a very slow enlargement. No other diseases were associated. The histology was typical for granuloma faciale; an immunohistochemical study showed the presence of CD4 + CD45RO + cells with no CD4+CD45RA+ cells. This patient underwent an excision of the lesions, but after two years there was a recurrence of the lesion on the chin and two new lesions appeared on the cheek. Intralesional injection of triamcinolone (5 mg/ml) induced a regression of the lesions with no other recurrence

IL-1α, IL-6 and TNF-α in cutaneous lesions of lupus erythematosus are inhibited by topical application of calcipotriol

Lupus Erythematosus (LE) is an autoimmune disorder with an unknown. etiology and pathogenesis. Skin lesions of LE express several cytokines which correlate to histological findings such as IL-1 and IL-6 which are mediators of epidermal growth and proliferation. Skin lesions of LE are generally treated with immunosuppressive agents such as oral or topically applied corticosteroids. Recently a new drug, calcipotriol, a vitamin D3 analogue has been useful in treatment of psoriasis with no adverse effect on calcium metabolism. This drug shares immunomodulatory effects with vit. D3 by inhibiting several cytokines produced by keratinocytes. In order to test the clinical effectiveness of calcipotriol in cutaneous lesions of LE we have investigated several proinflammatory cytokines such as: IL-1α, IL-1β, IL-4, IL-5, IL-6, IL-8, MCP-1, TNF-α. Using an avidin-biotin immunoperoxidase system we have found IL-1 in both forms, IL-6 and TNF-α in basal keratinocytes in patients affected with LE, after treatment they were reverted to normal. This inhibition is induced at a molecular level as demonstrated by reduced IL-1, IL-6 and TNFα mRNA expression. This is the first report showing that calcipotriol is effective in cutaneous lesions of LE and suggesting that this action is due to an inhibition of protein synthesis and mRNA expression for IL-1α, IL-6 and TNFα

IL-1α, IL-6 and TNF-α in cutaneous lesions of lupus erythematosus are inhibited by topical application of calcipotriol

Lupus Erythematosus (LE) is an autoimmune disorder with an unknown. etiology and pathogenesis. Skin lesions of LE express several cytokines which correlate to histological findings such as IL-1 and IL-6 which are mediators of epidermal growth and proliferation. Skin lesions of LE are generally treated with immunosuppressive agents such as oral or topically applied corticosteroids. Recently a new drug, calcipotriol, a vitamin D3 analogue has been useful in treatment of psoriasis with no adverse effect on calcium metabolism. This drug shares immunomodulatory effects with vit. D3 by inhibiting several cytokines produced by keratinocytes. In order to test the clinical effectiveness of calcipotriol in cutaneous lesions of LE we have investigated several proinflammatory cytokines such as: IL-1α, IL-1β, IL-4, IL-5, IL-6, IL-8, MCP-1, TNF-α. Using an avidin-biotin immunoperoxidase system we have found IL-1 in both forms, IL-6 and TNF-α in basal keratinocytes in patients affected with LE, after treatment they were reverted to normal. This inhibition is induced at a molecular level as demonstrated by reduced IL-1, IL-6 and TNFα mRNA expression. This is the first report showing that calcipotriol is effective in cutaneous lesions of LE and suggesting that this action is due to an inhibition of protein synthesis and mRNA expression for IL-1α, IL-6 and TNFα

Nail psoriasis therapy. Review of the literature [Terapia della psoriasi ungueale. Revisione della letteratura]

Incidence of nail involvement in psoriasis ranged, in the literature, from 10 to 55%. Therapy of nail psoriasis is often unsatisfying and great cooperation of patients is required. A great number of topical or systemic chemotherapies are reported in the literature such as: steroids, 5- fluorouracil, calcipotriol, PUVA-therapy, radiotherapy, methotrexate, retinoids, cyclosporin A. Topical steroids, 1% solution of 5-fluorouracil and systemic cyclosporin A, at this moment, seems to be the more effective drugs in nail psoriasis, but side effects are frequent due to their prolonged use in order to reduce relapse. Topical calcipotriol seems to be a promising treatment for subungueal hyperkeratosis and onycholysis especially on account of its high tolerability. Preliminary results about clinical trials of a combination of systemic cyclosporin A and local application of calcipotriol are reported

Role of Th2 cytokines, Rantes and eotaxin in AIDS-associated eosinophilic folliculitis

The pathogenesis of AIDS-associated eosinophilic folliculitis is still unknown. The expression of chemokines and Th2-type cytokines is increased in other conditions associated with tissue eosinophilia and in allergic reactions. We evaluated the mRNA expression by reverse transcriptase polymerase chain reaction of two Th2 cytokines (interleukin-4 and interleukin-5) and of two chemokines (RANTES and eotaxin) in the skin of 6 patients with AIDS-associated eosinophilic folliculitis; the tissue localization of eotaxin was shown by immunohistochemistry. We demonstrated the increased expression of interleukin-4, interleukin-5, RANTES and eotaxin in lesional skin of the patients compared to normal skin of HIV+ individuals. We concluded that a Th2 pattern is present in AIDS-associated eosinophilic folliculitis. The cytokine milieu in this disease may favour a Th2 immune response to an unknown antigen, whereby RANTES and eotaxin act in synergy with interleukin-4 and interleukin-5 to mediate tissue inflammation