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

Thiamine supplementation for the treatment of heart failure: A review of the literature

A systematic review of the literature was performed by searching Pubmed and EMBASE databases using the terms "thiamine," "vitamin B1," "heart failure," "systolic dysfunction," "ventricular dysfunction," "cardiomyopathy," "ventricular failure," and "systolic failure." Relevant trials and articles were evaluated pertaining to thiamine deficiency in patients with heart failure (HF) and references were searched for further inclusion of articles. A total of 20 articles were reviewed and summarized in detail. While more research is needed to fully elucidate the clinical thiamine deficiency in HF patients, recent evidence has indicated that supplementing with thiamine in HF patients has the potential to improve left ventricular ejection fraction. Thiamine deficiency appears to be not uncommon in patients with HF, and supplementation with thiamine has been shown to improve cardiac function, urine output, weight loss, and signs and symptoms of HF. Therefore, this simple therapy should be tested in large-scale randomized clinical trial to further determine the effects of thiamine in HF patients

Optimal aspirin dose in acute coronary syndromes: An emerging consensus

Numerous clinical trials testing the efficacy of aspirin for the secondary prevention of cardiovascular disease have been published. We reviewed the literature pertaining to aspirin dose in acute coronary syndrome patients. Clinical trials assessing the comparative efficacy of different doses of aspirin are scarce. This complex antiplatelet therapy landscape makes it difficult to identify the best aspirin dose for optimizing efficacy and minimizing risk of adverse events, while complying with the various guidelines and recommendations. Despite this fact, current evidence suggests that aspirin doses of 75-100 mg/day may offer the optimal benefit:risk ratio in acute coronary syndrome patients

Biorremediação de solo contaminado por isobutanol, Bis-2-etil-hexilftalato e Di-isodecilftalato

Embora os ftalatos sejam um dos poluentes mais frequentemente encontrados no meio ambiente, há escassez de dados na literatura sobre biorremediação de solos tropicais contaminados por esses compostos. Por esse motivo, este estudo avaliou a biorremediação de um solo contaminado com os plastificantes DEHP (Bis-2-etilhexilftalato), DIDP (Di-isodecilftalato) e álcool isobutílico, por uma indústria no Estado de São Paulo. A biorremediação ocorreu pela utilização de microrganismos presentes no solo e pela adição de inóculo adaptado em reator em fase de lama. O reator foi monitorado durante 120 dias, sendo corrigida apenas a umidade do solo. Os resultados indicaram que a biodegradação dos ftalatos seguiu uma cinética de primeira ordem e a biorremediação ocorreu na faixa de pH entre 7,4 e 8,4 e temperaturas entre 17 e 25 ºC, com eficiência de remoção de contaminantes acima de 70 %. Após 120 dias, o teor de DEHP estava abaixo de 4 mg kg-1, limite estipulado pela legislação brasileira para solo de uso residencial