Changes in body mass index and lipid profile in psoriatic patients after treatment with standard protocol of infliximab

Psoriasis is a chronic and inflammatory dermatologic disease. Psoriasis may predispose to cardiovascular disease and diabetes. However, the role of tumor necrosis factor (TNF) inhibitor in mediating this risk is controversial. Regarding frequent use of infliximab in psoriasis, and the hypothesis that anti TNF-α treatment may increase Body Mass Index (BMI) and alter lipid profile in these patients, the aim of this study was to assess changes in BMI and Lipid Profile and level of leptin in Psoriatic Patients under Treatment of Standard Protocol of Infliximab in a 24 week period. This study was accomplished as a before-after study. Twenty-seven psoriatic patients were included, and standard infliximab therapy was applied. All patients underwent 3 times of blood collection and in each session; LDL, HDL, Total Cholesterol, Triglycerides, Leptin, and PASI score were measured at the start of the study and at the 12th and 24th week of follow-up. Twenty-five patients consisted of 18 (72) male and 7 (28) female subjects were evaluated. The mean age of the patients was 36.91±13.31 years. PASI score demonstrated significant decrease after 24 weeks; however, BMI and HDL and leptin showed a significant increase during treatment. Significant negative correlation was seen between Leptin and PASI score changes (r=0.331, P=0.042). HDL and BMI had the most correlations with leptin (positive correlation) and PASI score (negative correlation). Results demonstrated a dramatic decrease in PASI, increase in BMI and HDL and increased in leptin; somewhat correlated to each other. These results suggest that patients taking infliximab should take more care of their weight and lipid profile, while on treatment. © 2016 Tehran University of Medical Sciences. All rights reserved

Tracking development assistance for health and for COVID-19 : a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990-2050

Background The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020. Methods We estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050. Findings In 2019, health spending globally reached$8. 8 trillion (95% uncertainty interval [UI] 8.7-8.8) or $1132 (1119-1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total,$40.4 billion (0.5%, 95% UI 0.5-0.5) was development assistance for health provided to low-income and middle-income countries, which made up 24.6% (UI 24.0-25.1) of total spending in low-income countries. We estimate that $54.8 billion in development assistance for health was disbursed in 2020. Of this,$13.7 billion was targeted toward the COVID-19 health response. $12.3 billion was newly committed and$1.4 billion was repurposed from existing health projects. $3.1 billion (22.4$2.4 billion (17.9%) was for supply chain and logistics. Only $714.4 million (7.7$1519 (1448-1591) per person in 2050, although spending across countries is expected to remain varied. Interpretation Global health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

The global burden of cancer attributable to risk factors, 2010–19: a systematic analysis for the Global Burden of Disease Study 2019

BACKGROUND: Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. METHODS: The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk–outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. FINDINGS: Globally, in 2019, the risk factors included in this analysis accounted for 4·45 million (95% uncertainty interval 4·01–4·94) deaths and 105 million (95·0–116) DALYs for both sexes combined, representing 44·4% (41·3–48·4) of all cancer deaths and 42·0% (39·1–45·6) of all DALYs. There were 2·88 million (2·60–3·18) risk-attributable cancer deaths in males (50·6% [47·8–54·1] of all male cancer deaths) and 1·58 million (1·36–1·84) risk-attributable cancer deaths in females (36·3% [32·5–41·3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20·4% (12·6–28·4) and DALYs by 16·8% (8·8–25·0), with the greatest percentage increase in metabolic risks (34·7% [27·9–42·8] and 33·3% [25·8–42·0]). INTERPRETATION: The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden

Demographic and histopathologic characteristics of Marjolin�s ulcers in Razi Hospital, Tehran, Iran: A 5-year survey

Background: Approximately 0.77 to 2 of cutaneous ulcers and post-burn scars will develop malignant degeneration. When squamous cell carcinoma (SCC) emerges in a chronic scar or ulcer, it often is referred to as Marjolin�s ulcer (MU). Methods: This cross-sectional study assessed demographic information and pathological features of MU in Razi Hospital during 2009 to 2014. We reviewed 5150 chronic scar/ulcer cases and found 30 MU cases. Results: Patients had an average age of 59.2±19.9 years. Most cases were males Among 30 cases of MU, well-differential SCC accounted for 43.3 of cases. Moderately-differentiated SCC comprised 13.3 of cases, whereas there was invasive SCC in 10 of MUs. Only 3.3 of patients showed poorly-differentiated SCC and 9 (30) had undifferentiated SCC. The average latency between burn and malignancy was 32.4±18.5 years In the majority (90) of cases, the initial injury was a burn. The lower and upper limbs comprised 53.3 and 26.7 of cases, respectively. There was one case with a history of melanoma. Among the 4 measured concurrent risk factors for malignancy, sun exposure was the most prevalent. Conclusion: Since there is a high possibility of SCC formation in burn lesions and other identical lesions, rapid follow-up and appropriate treatment in acute burn lesions is necessary. © 2016 Iranian Society of Dermatology

Trend of C-reactive protein and erythrocyte sedimentation rates in psoriatic patients on treatment of standard protocol of infliximab

Background: Psoriasis is a chronic and inflammatory dermatologic disease. Inflammatory biomarkers such as C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR) are known as immediate and delayed inflammatory biomarkers, respectively. Due to the fact that anti-inflammatory drugs such as Infliximab are widely used in psoriasis treatment, the aim of this study was to evaluate ESR, CRP and PASI scores in patients treated with Infliximab in a 24 week trend. Materials and Methods: This study was accomplished as a before-after study. Twenty seven psoriatic patients were included and standard Infliximab therapy was applied. All patients underwent 3 times of blood collection and in each session CRP, ESR and PASI scores were measured at the beginning of study and at the 12th and 24th weeks of follow-up Results: A total of 19 (70.4) men and 8 (29.6) women were evaluated. Mean age was 37.85±13.68 years. All three parameters had significant decrease in treatment course (p < 0.001); however, no significant correlation was found between PASI and inflammatory biomarkers. Trends of ESR and CRP were significantly correlated in all patients (r=0.504, P =0.007) and males (r=0.739, P =0.036). Conclusion: Our study demonstrated that CRP and ESR decreased in Infliximab treatment, in accordance but non-regarded to PASI score decease. Regarding other studies results, using these biomarkers for treatment follow-up might need more caution. © 2013 Galen Medical Journal

Evaluation of primary cutaneous malignant melanoma according to Breslow and Clarke pathological indices

Background: Malignant melanoma is one of the fatal cutaneous neoplasms which are curable by early diagnosis. This neoplasm is diagnosed by the biopsy of the suspected lesion. It is essential to classify the tumor based on its histology, thickness, phase of growth, level of invasion, mitotic rate, presence of regression, inflammatory infiltration and ulceration. These descriptions yield some knowledge about the progression of disease and suggest an estimate of the status of the screening system for early diagnosis. Methods: This is a cross-sectional retrospective descriptive study. Pathological slides with diagnosis of malignant melanoma from 1377 to 1379 that present in the pathology department were assessed according to mentioned pathological indices and the 10-year survival calculated in this regard. Results: We assessed 47 cases with mean age of 57.38 (SD=5.85) and the gender distribution was 51.1% male and 42.2% female. More than 42% of cases were in Clarke level I, 2.1% Clarke level II, 6.4% Clarke level III, 40.4% Clarke level IV and 8.5% Clarke level V. Fifty three percent of patients were breslow thickness equal to or less than 0.75 millimeter(mm) , 8.5% between 0.76 to 1.69 mm , 27.7% between 1.7 to 3.6 mm and 10.6% greater than 3.61 mm. Mean breslow thickness show no significant difference between males and females but there is a significant relation between thickness and age of the patients. Mean 10-year survivals of patients were 75% and were greater in females than males. We found a linear relation between patient age and breslow thickness that is calculated by the following equation: Log Breslow thickness (mm) = - 0.625 + 0.016×age (year) Conclusion: Complete recording of clinical and pathological data of patients with malignant melanoma make a proper stream to reach a surveillance system