Conjunctival Disorders Among Fire Service Personnel in the Kumasi Metropolis, Ghana

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Occupational diseases are a major global concern. Firefighting is associated with numerous health hazards. However, the ocular problems that fire fighters endure are understudied. The purpose of this study was to determine conjunctival disorders and other ocular morbidities prevalent among fire service personnel in the Kumasi Metropolis of Ghana.A cross-sectional study was conducted in all five fire stations in the metropolis. A total of 150 personnel aged 20 to 60 years were examined. Comprehensive ocular examination was carried out which included ocular and occupational history, visual acuity measurement, ophthalmoscopy and visual field test by confrontation. The Statistical Package for Social Scientists (SPSS) version 16.0 was used to analyze the data. The tool employed was descriptive statistics and Chi- square test was used to find out significant differences between comparable categorical groups.

Out of the 150 personnel, 66.7% were male and 33.3% were female. The common ocular diseases were pinguecula (21.3%), pterygium (15.3%), allergic conjunctivitis (8.0%), dry eyes (5.3%) and retinal abnormalities (4.0%). The prevalence of ocular morbidities among the fire service personnel was 57.3%. Ocular diseases were found to be more prevalent among males (40.7%) than females (16.7%). Conjunctival disorders significantly increased with longer duration of service, but no significant association was found for non-conjuctival disorders.The study revealed a high ocular morbidity rate in the fire service personnel and underscores the need for regular screening procedures and strategies to identify and manage non-blinding conditions that interferes with productivity as well as potentially blinding conditions among personnel for timely intervention.

Some occupations are known to have serious harmful impact on health. Over a million workers in the UK suffer a health condition caused or worsened by their work. Occupational diseases like firefighting have an immediate adverse effect on work efficiency and productivity. Firefighting poses serious risks including ocular hazardsto personnel. People involved in occupations like firefighting, mining and construction sufferserious health conditions including cardiovascular disorders, musculoskeletal disorders, sleep disorders and traumatic injuries that could lead to sudden deaths Ocular morbidity can be referred to as the relative incidence of eye diseases. It can also be defined as a disease state, disability or poor health due to eye diseases. Fire service personnel in performing their duties face danger from exposure to smoke, dust, extremely high temperatures (1200°C to 1400°C) and issues surrounding personal protective equipment, all of which pose a threat to their ocular health. Occupation-related eye conditions contribute to the global statistics of ocular morbidity and the prevalence of such conditions among workers especially firemen can affect work output or productivity. 

Investigating the occupational association of eye diseases will increase knowledge about how these diseases are related to occupations and inform strategic planning and implementation of policies to prevent or minimize the risks and occurrence of these occupational disorders, which could increase health and productivityFirefighting has become very important in the Kumasi Metropolis of Ghana over the past few years. In 2015 alone, the Kumasi Central Market suffered not less than five major fire outbreaks, each of which required several hours of intense firefighting by fire service personnel to be quenched. Within the first week of January 2016, there had been three major fire outbreaks in suburbs such as Aboabo and Adum, notwithstanding minor household fires and burning accident vehicles on the Kumasi-Accra highway. Personal communication with firefighters and common observation has revealed that most firefighters wear protective clothing but not goggles in their line of work. This exposes their eyes to intense heat, smoke, dust, exhaust particles and soapy liquids that comes with regular firefighting. 

This study was done to determine ocular morbidities prevalent among fire service personnel in the Kumasi Metropolis of Ghana. Data from this study will create awareness among the fire personnel locally and globally and also aid in policy formulation.A descriptive cross-sectional study was conducted among fire service personnel in the Kumasi Metropolis, Ghana. There were five fire stations with a total population of 294. The sample size for the study was calculated to be 135 using Epi Info version 7.1.5.2 (expected frequency 20.3%, 5% limits, 95% confidence level). A total of 150 fire personnel were studied for various ocular morbidities between 7th July and 8th August, 2014. In each of the stations, the subjects were registered with a structured questionnaire administered by one of the researchers in the local (Twi) language. The questionnaire was used to obtain data on the personal, medical and occupational information of the personnel. A battery of eye examinations namely visual acuity measurement, external eye examination and fundoscopy were carried out on all subjects using Snellen’s chart (6metres), pentorch and ophthalmic loupe, and Welch Allyn Direct Ophthalmoscope. Visual field test by confrontation was also carried out for all participants. All examinations findings were detailed on structured record forms and cross-checked for completeness of data before each subject was discharged. Diagnoses were made on the presence of a condition in one or both eyes of a study subject. 

Bigger Brain Just Part of the Story in Human Intelligence

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New research challenges a long-held hypothesis that human knowledge advanced from greater brains alone. Australian scientists fight that advances in knowledge were firmly fixing to the amount of blood was accessible to the mind. By dissecting the measure of two gaps in the base of fossil skulls that permitted veins to go to the cerebrum, researchers could track increments in human insight more than 3 million years. "Cerebrum size has expanded around 350 percent over human advancement, yet we found that blood stream to the mind expanded a stunning 600 percent," venture pioneer Roger Seymour said. Seymour is a resigned teacher of biology and natural science at the University of Adelaide. 

"We trust this is potentially identified with the mind's have to fulfill progressively enthusiastic associations between nerve cells that permitted the development of complex thinking and learning," he clarified in a college news discharge. To be so astute, human brains require a steady supply of oxygen and supplements from the blood. "The all the more metabolically dynamic the mind is, the more blood it requires, so the supply courses are bigger. The openings in fossil skulls are precise gages of blood vessel size," Seymour said. 

"All through development, the development in our mind capacity seems, by all accounts, to be identified with the more extended time it removes for us to develop from adolescence. It is additionally associated with family participation in chasing, protecting region and taking care of our young," study co-creator Vanya Bosiocic said in the news discharge. "The rise of these characteristics appears to pleasantly take after the expansion in the cerebrum's requirement for blood and vitality," included Bosiocic, an undertaking officer on the Faculty of Science and Engineering at Adelaide. 

The mind is the most complex part of the human body. This three-pound organ is the seat of insight, mediator of the faculties, initiator of body development, and controller of conduct. Lying in its hard shell and washed by defensive liquid, the cerebrum is the wellspring of the considerable number of characteristics that characterize our humankind. The mind is the crown gem of the human body. 

For a considerable length of time, researchers and savants have been intrigued by the mind, yet as of not long ago they saw the cerebrum as almost unlimited. Presently, be that as it may, the mind is starting to give up its insider facts. Researchers have adapted more about the mind in the most recent 10 years than in all earlier hundreds of years as a result of the quickening pace of exploration in neurological and behavioral science and the advancement of new research procedures. Therefore, Congress named the 1990s the Decade of the Brain. At the cutting edge of exploration on the cerebrum and different components of the sensory system is the National Institute of Neurological Disorders and Stroke (NINDS), which leads and backings exploratory studies in the United States and around the world.This reality sheet is an essential prologue to the human mind. It might help you see how the solid mind functions, how to keep it sound, and what happens when the cerebrum is infected or broken.

Adrenal Leiomyoma: A Rare Tumor Presented as an Incidentaloma in a Patient with AIDS

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Adrenal leiomyoma is an extremely rare and benign tumor, usually presents as an incidental finding. Generally, this tumor is a non-functional large adrenal mass. The majority of leiomyomas of the adrenal gland are called as “incidentalomas” because they are found in absence of clinical symptoms and represents an unexpected finding during an abdominal ultrasound or computed tomography (CT) scan. Here we describe a 40-year-old man seropositive for the human immunodeficiency virus (HIV), under highly active antiretroviral therapy who presents a heterogeneously left adrenal mass in the context of a routine ultrasound abdominal scan. A CT abdominal scan confirms this finding. Laboratory results revealed that the tumor was non-functional. Because the possibility of adrenal carcinoma, the patient underwent a successful left adrenalectomy. Histopathology examination and immunohistochemistry techniques confirm the diagnosis of leiomyoma. Adrenal leiomyoma should be included in the differential diagnosis of unilateral, non-functional adrenal tumors in HIV patients.

Incidental adrenal tumors are often diagnosed during abdominal ultrasonography or computerized tomography (CT) studies for other pathologies. In human immunodeficiency virus (HIV) infected patients, leiomyomas are described with more frequency than in the general population. Also, in AIDS patients, these tumors have been well described in association with Epstein-Barr virus (EBV) A 40-year-old HIV seropositive man with diagnosis of AIDS infection. HIV-seropositive male with an inci dental adrenal mass that was diagnosed as a leiomyoma on histopathological and immunohistochemical (IHQ) studies. A literature review on adrenal leiomyoma was also made, including Pub Med, Medline and Embase for articles published until December 2015. pheochromocytoma. The patient underwent a left adrenalectomy because of the size of the lesion and the radiological appearance; macroscopic pathological examination of the surgical piece showed a well-circumscribed and encapsulated large mass; histopathological analysis revealed the smooth muscle origin of the tumor. Histologic feature includes a mesenchymal tumor characterized by the fusocellular proliferation of spindle cells with cigarshaped nuclei, eosinophilic cytoplasm with areas of hyalinosis, compatible with the diagnosis of smooth muscle tumor.

Functional tests including a serum cortisol level at 08:00 h and at late-night were normal and ruled out the presence of a cortisol-producing adenoma. The patient was normotensive repeatedly during admission to exclude an asymptomaticDiagnosis was confirmed by a positive immunostaining for smooth muscle actin. The tumor cells showed strongly immunoreactive for specific antismooth muscle actin and partial desmin expressionLeiomyomas of the adrenal glands are very rare tumors except in AIDS population. They are benign tumors composed of smooth muscle cells. An adrenal incidentaloma is defined as a clinically unapparent adrenal tumor, generally of 1 cm or more, that is discovered during radiological studies performed for other causes. Adrenal incidentalomas are diagnosed in approximately 1% of abdominal CT scans. Also, in autopsy studies, asymptomatic adrenal masses are discovered in up to 9% of patients. Diagnosis criteria for adrenal incidentaloma have been well established and include test to determine the functional tumor status and the histopathology. Adrenal leiomyomas have a wide range of age at presentation, with a median of 38 years and female predominance (66, 6%). These tumors are typically an adrenal unilateral solitary mass lesion with a median size of 5 cm. 

Seqirus Receives FDA Approval for Afluria Quadrivalent (Influenza Vaccine) for People 18 Years of Age and Older

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Seqirus reported today that the US Food and Drug Administration (FDA) has endorsed Afluria Quadrivalent (Influenza Vaccine) for use in people 18 years old and more seasoned. Afluria Quadrivalent is an inactivated flu antibody showed for dynamic inoculation against flu malady brought about by flu A subtype infections and sort B infections contained in the immunization. Both Afluria Quadrivalent and Afluria (Influenza Vaccine), are accessible in the US for the 2016-2017 flu season. 

Afluria Quadrivalent is the second quadrivalent flu antibody that Seqirus is putting forth this season after the FDA affirmed Flucelvax Quadrivalent (Influenza Vaccine) in May. Afluria Quadrivalent comes in single-measurement, additive free pre-filled syringes while Afluria, demonstrated for people 5 years old and more established, is accessible in prefilled syringes and multi-dosage vials to give decision and comfort to patients and guardians who control it.As another quadrivalent regular flu immunization, Afluria Quadrivalent will give social insurance suppliers and their patients with an essential alternative to encourage widen their flu antibody offerings," said Gordon Naylor, President of Seqirus. "Seqirus is pleased to be a pioneer in the anticipation and control of regular flu by offering a scope of clinically demonstrated immunizations to secure individuals against the crippling impacts of the illness. Afluria Quadrivalent is the most recent case of how Seqirus is conveying on its guarantee to enhance general wellbeing around the globe." Seqirus has prior reported the accessibility of Fluad (Influenza Vaccine, Adjuvanted), Fluvirin (Influenza Virus Vaccine) and Flucelvax Quadrivalent for the 2016-2017 flu season. 

The trivalent forumation of Afluria is the main influenza immunization endorsed by the FDA to be controlled without a needle, utilizing the PharmaJet® Stratis® Needle‐Free Injector.1,2 The gadget conveys the antibody through a thin stream of liquid that infiltrates the skin in around a tenth of a second. This strategy is demonstrated to give an insusceptible reaction that is non-second rate compared to the invulnerable reaction to flu immunization given with a needle.3 Anyone 18 through 64 years old who can get Afluria may request without needle Afluria.1,2 Visit www.pharmajet.com for more information.In a randomized, twofold visually impaired, dynamic controlled clinical trial led in 3,449 subjects matured 18 years and more seasoned, Afluria Quadrivalent showed non-inadequacy to two TIV comparators for all flu strains contained in the antibody. Also, non-inadequacy was shown for both endpoints in both age sub-bunches, grown-ups matured 18 through 64 years and 65 years and more established for all strains. Prevalence of the invulnerable reaction over each of the flu B strains contained in Afluria Quadrivalent was appeared in relativity to the counter acting agent reaction after inoculation with TIV plan not containing B ancestry strains for subjects 18 years old and more seasoned. Prevalence against the other B strain was likewise shown for each of the flu B strains in both age sub-bunches; 18 through 64 years and 65 years and older.1 

In a randomized, comparator-controlled study that selected 1,250 subjects matured 18 through 64 years old, the trivalent plan of Afluria (Influenza Vaccine) regulated by the PharmaJet Stratis Needle-Free Injection System contrasted with organization of Afluria by needle and syringe showed non-mediocrity in the immunogenicity populace for all strains. Post-hoc examinations of immunogenicity by age demonstrated that more youthful subjects (18 through 49 years) inspired higher immunological reactions than more established subjects (50 through 64 years).The customary regular flu immunization is a trivalent recipe comprising of two strains of flu An infections and a solitary strain of flu B virus.4 However, since 1985, two unmistakable heredities of flu B infection have co-flowed with changing strength. 

The utilization of a four-strain flu immunization like Afluria Quadrivalent may now give security against both B lineagesInfluenza is a typical, exceedingly infectious irresistible ailment that can bring about extreme ailment and life-undermining difficulties in numerous individuals. Since transmission to others may happen one day before indications create and up to five to seven days in the wake of getting to be wiped out, the ailment can be effortlessly transmitted to others. Flu can prompt clinical side effects changing from mellow to direct respiratory sickness to serious complexities, hospitalization and now and again death.6 by and large, more than 200,000 individuals are hospitalized because of flu related entanglements in the US each year.Afluria Quadrivalent is an inactivated flu antibody demonstrated for dynamic vaccination against flu ailment brought about by flu A subtype infections and sort B infections contained in the immunization. Afluria Quadrivalent is affirmed for use in people 18 years old and more seasoned.

Abdominal Circumference Correlates with Postural Sway of the Antero-Posterior Axis in Pregnant Women.

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                     http://www.mathewsopenaccess.com/gynecology-obstetrics-articlesinpress.html

The correlation between physical features and body sway on standing upright was explored in women before and after the delivery. Body sway during upright standing was recorded in 18 women in the third trimester and 1 month after delivery. Height, body weight, body mass index (BMI), and abdominal circumference were also registered twice. In women at the 38th week of gestation on standing upright, the abdominal circumference was positively correlated with the total path length (LNG) and enveloped area (ENV-AREA) of body sway. The path length of body sway in antero-posterior axis (Y-LNG) was also correlated with the abdominal circumference, but the path length in medio-lateral axis showed no such correlation. These correlations were not observed at 1 month after delivery. The body weight and BMI did not correlate with parameters of body sway either in the 3rd trimester or postpartum. Fast Fourier transform (FFT) analysis of body sway showed that the percentile power of the frequency band of 1.0-10.0 Hz, stabilized by the somatosensory inputs, was smaller in the 3rd trimester than that postpartum. It is hypothesized that the reliance on somatosensory information for maintaining standing posture increases as the abdominal circumference increases during pregnancy.

In pregnant women, standing posture changes as the fetus develops. Increasing load onto the lumbar spine and abdominal muscles causes a shift of the head position in the posterior direction and increases lumbar lordosis and anterior pelvic tilt. These changes in body alignment influence the stability of standing posture. Indeed, an intervention in the USA showed that almost 25% of employed women sustain a fall at work during pregnancy. Stabilometric analyses of standing posture have coincidentally shown that the area of body sway increases during pregnancy. The path length of antero-posterior body sway increases during pregnancy and decreases between late trimester and postpartum. On the other hand, the path length of body sway in medio-lateral axis decreases or remains unchanged. Therefore, the increase in sway area during pregnancy is mainly caused by the increase in the path length of antero-posterior body swayWe have previously shown that the power of 1.0-10.0 Hz band of body sway is smaller in pregnant women than that in nonpregnant controls. Body sway of 1.0-10.0 Hz band is stabilized by somatosensory inputs. 

Therefore, we thought that some changes in physical features during pregnancy would increase the reliance on somatosensory inputs and help to maintain the standing posture. Indeed, it has been reported that body weight positively correlates with the antero-posterior body sway in obese women on standing. The body weight and fat mass increase as pregnancy proceeds. The abdominal circumference also increases as the fetus develops. Therefore, in the present experiments, we explored the correlation between physical features such as body weight, body mass index (BMI) and abdominal circumference, and parameters of body sway during pregnancy employing a within-subject paradigm. Fast Fourier transform (FFT) analysis of body sway was also introduced in order to evaluate the rationale contribution of sensory inputs to maintain the standing posture, i.e., visual, somatosensory, and vestibular inputs. These sensory inputs with different modalities influence the power spectrum of body sway. 

Participants were 18 women who gave birth at Yamanashi Red Cross Hospital and Fujiyoshida Municipal Hospital, Yamanashi, Japan. Ten women were primiparous and 8 were multiparous. Data for the 3rd trimester were collected once after the obstetric examination on a weekly basis, and data postpartum at 1 month after delivery (Table 1).All experimental procedures were performed in accordance with the Ethics Committee of the Faculty of Nursing, Yamanashi Prefectural University on the basis of the Declaration of Helsinki, and informed consent of all participants was obtained in written form. Postural sway was recorded by detecting the body’s center of gravity continuously with a force platform equipped with a data processor (Gravicorder G-5500, Anima, Tokyo, Japan). Participants were requested to stand on the platform with their feet parallel, gazing at a target, a black circle with a diameter of 12 cm on a white background, fixed at a 1.5 m distance and at the height of the participant’s eyes. This arrangement of the visual target provided a visual angle of 4.58 degrees. The body sway of each participant was recorded for 1 min, first with the eyes open and next with the eyes closed.  

14 Genes That May Affect Cancer Treatment

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Scientists say they've distinguished 14 qualities that may figure out if a tumor treatment could help a patient. The scientists likewise say the discoveries recommend it could be conceivable to individuals stay away from superfluous disease medications that won't likely profit them. "The historical backdrop of tumor treatment is loaded with eruption," said central specialist Gary Karpen, a senior researcher at the U.S. Branch of Energy's Lawrence Berkeley National Laboratory in Berkeley, Calif. "It is a piece of the morals of tumor treatment to fail in favor of overtreatment, yet these medications have genuine reactions connected with them. For a few people, it might bring about more inconvenience than if the development was left untreated," Karpen said in a Berkeley Lab discharge. 

Be that as it may, there has not been a dependable approach to figure out which early stage disease patients will react to chemotherapy and radiation treatment, as per study creator Weiguo Zhang. He's a venture researcher at Berkeley Lab. "For specific sorts of early stage lung tumor patients, there are appraisals that adjuvant chemotherapy enhances five-year survival just around 10 percent, by and large, which is not extraordinary considering the blow-back created by this treatment (chemotherapy)," Zhang clarified. "Notwithstanding for early stage growth patients, for example, lung tumors, adjuvant chemotherapy and radiotherapy are routinely utilized as a part of treatment, yet overtreatment is a noteworthy test," Zhang said. 

The analysts discovered 14 qualities that reliably "over-express" in countless. At the point when a quality "communicates," it's basically discharging an arrangement of directions, as indicated by the U.S. National Human Genome Research Institute. The study group then made a scoring framework taking into account the level of over-expression. A higher score implied more over-expression in those qualities. For a few sorts of real malignancies, the higher the score, the more terrible the anticipation for patients. In any case, "another discovering - one that is illogical - is that high articulation of these qualities is additionally identified with more viable chemotherapy and radiation treatment," said Karpen. The scores could then prompt foreseeing tolerant reaction to particular tumor medications, as indicated by the study group. A hereditary marker could demonstrate important when choosing whether to utilize a specific treatment or not, but rather making an interpretation of these study discoveries into clinical practice will require more research, the study creators noted.

Specialists say they've distinguished 14 qualities that may figure out if a disease treatment could help a patient. 

The specialists likewise say the discoveries propose it could be conceivable to individuals keep away from pointless growth medicines that won't likely profit them. "The historical backdrop of disease treatment is loaded with overcompensation," said important agent Gary Karpen, a senior researcher at the U.S. Branch of Energy's Lawrence Berkeley National Laboratory in Berkeley, Calif. "It is a piece of the morals of disease treatment to blunder in favor of overtreatment, however these medicines have genuine reactions connected with them. For a few people, it might bring about more inconvenience than if the development was left untreated," Karpen said in a Berkeley Lab discharge. 

Nonetheless, there has not been a dependable approach to figure out which early stage tumor patients will react to chemotherapy and radiation treatment, as indicated by study creator Weiguo Zhang. He's a venture researcher at Berkeley Lab. "For specific sorts of early stage lung disease patients, there are assessments that adjuvant chemotherapy enhances five-year survival just around 10 percent, by and large, which is not incredible considering the inadvertent blow-back brought on by this treatment (chemotherapy)," Zhang clarified. "Notwithstanding for early stage malignancy patients, for example, lung tumors, adjuvant chemotherapy and radiotherapy are routinely utilized as a part of treatment, however overtreatment is a noteworthy test," Zhang said. 

The study group then made a scoring framework in light of the level of over-expression. A higher score implied more over-expression in those qualities. 

For a few sorts of significant diseases, the higher the score, the more awful the guess for patients. In any case, "another discovering - one that is irrational - is that high articulation of these qualities is likewise identified with more powerful chemotherapy and radiation treatment," said Karpen. The scores could then prompt foreseeing persistent reaction to particular growth medicines, as indicated by the study group. A hereditary marker could demonstrate significant when choosing whether to utilize a specific treatment or not, but rather making an interpretation of these study discoveries into clinical practice will require more research, the study creators noted.

New Therapeutic Agents for Psoriasis

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                    http://www.mathewsopenaccess.com/dermatology-current-issue.html

During the last decades, inside and deep knowledge of the pathogenesis of psoriasis, has led to new therapeutic agents for the treatment of the disease, resulting in a revolutionary and holistic therapeutic approach. For many years the anti-TNF agents as well as the agents that target the IL12/23 pathway, have changed the armamentarium of drugs in the treatment of psoriatic disease with excellent results. In the present article we will present all available data about new agents that are under development for the treatment of psoriasis, like anti-IL17 and anti-IL23 biologics, as well as the small molecules, like JAK inhibitors and inhibitors of phosphodiesterase-4 (PDE4).

During the last decades, new targeted therapeutic agents for the treatment of psoriasis are available, the biologic agents. Three anti-TNF-a agents are available (adalimumab, etanercept, infliximab) and one antiIL-12/23 drug (ustekinumab). All these drugs have long-term high efficacy for the treatment of psoriasis, increased safety profile and low toxicity. The advantage of biologics is the concurrent very good control, not only of psoriasis, but also of all the other comorbidities that are related with psoriasis, like psoriatic arthritis (all four agents mentioned above are indicated also for psoriatic arthritis). Another important advantage is the luck of organ toxicity with biologics, compared with the wellknown toxicity of either cyclosporine or methotrexate after long-term use. There are many reports in the literature about the protective role of anti-TNF agents against cardiovascular events and especially myocardial infarction.New drugs are under development or have recently been approved for the treatment of psoriasis, like IL-17, IL-23, phosphodiesterase-4 (PDE4) and JAK inhibitors.It is a fully human antibody against IL-17A. Secukinumab has recently been approved and is indicated for the treatment of moderate to severe plaque psoriasis in adult patients who are candidates for systemic treatment. 

The approved dosageis 300 mgr subcutaneously in weeks 0-4 and once monthly thereafter. ERASURE και FIXTURE are the two studies on which the approval has been based on. In the ERASURE study, double-blind phase, two different doses of Secukinumab where compared (150 and 300 mgr, once weekly for 5 doses and once monthly thereafter), with placebo. At week 12, the percentage of patients who achieved PASI (Psoriasis Area Severity Index) 75 was 81. 6% (with 300 mgr Secukinumab), 71. 6% (with 150 mgr Secukinumab) και 4.5% (with placebo). Moreover, PASI 90 was achieved in 59.2% and 39.1% of patients under 300 and 150 mgr Secukinumab, respectively, compared with 1.2% of patients under placebo. With regards to IGA (Investigator’s Global Assessment) 0/1 index (almost or total clearance of psoriasis) at week 12, the percentages were 65.3%, 51.2% και 2.4% for 300, 150 mgr Secukinumab and placebo, respectively. In the FIXTURE study, Secukinumab (150 and 300 mgr, once weekly for 5 doses and once monthly thereafter) was compared with Etanercept (50 mgr twice weekly for 12 weeks and 50 mgr once weekly thereafter), with placebo. With regards to PASI 75 at week 12, the percentage of patients who achieved PASI 75 was 77.1% (300 mgr Secukinumab), 67% (150 mgr Secukinumab), 44% (etanercept) and 4.9% (placebo). In 4.7% and 2.3% of patients under Secukinumab(300 and 150 mgr respectively), mild Candida infections were reported and the percentage for Etanercept patients was 1.2%. 3rd grade neutropenia was reported in 1% of patients under Secukinumab, with 0 cases in the etanercept group. IL-17A is implicated in the innate immunity against Candida albicans and in some haemopoiesis pathways.3 Up to now there is no safety concern about these two parameters and Secukinumab. All Candida infections were mild and only topical or in a few cases systematic antifungal treatment was needed, without being necessary to discontinue Secukinumab in any case. Neutropenia was also not important in all cases as well.

It is a humanized IgG4 monoclonal antibody against IL-17A. A phase 2, double-blind, compared with placebo study, reports at week 12 achievement of PASI 75 in 82.1% of patients under Ixekizumab 150 mgr, 82.8% under 75 mgr, 76.7% under 25 mgr against 7.7% under placebo (the administration of drug was performed at weeks 0, 2, 4, 8, 12 and 16, subcutaneously). Ixekizumab was compared with Etanercept (in studies phase ΙΙΙ UNCOVER 2, 3). At week 12 (UNCOVER 2), patients under Ixekizumab achieved PASI 75 in a percentage of 90% (administration every 2 weeks), 78% (administered every 4 weeks), compared with 42% under etanercept and 2% under placebo. In UNCOVER 3 these percentages were 87%, 84%, 53% and 7%, respectively.It is a fully human antibody against the receptor of IL-17 (IL- 17A και IL-17F). Brodalumab was compared with placebo in a phase III study (AMAGINE-1) and the results of efficacy with regards to PASI 75 at week 12 were 83.3%, 60.3% and 2.7% for doses of Brodalumab 210mgr and 140 mgr every two weeks subcutaneously and placebo, respectively. In studies AMAGINE 2 and 3, Brodalumab was compared to Ustekinumab and to placebo. At week 12 the percentage of patients who achieved a PASI 75 improvement was 86% and 67% for Brodalumab dose of 210 mgr and 140 mgr respectively, in comparison with 70% for Ustekinumab and 8% for placebo (AMAGINE 2). In AMAGINE 3 study, the results were 85.1%, 69.2%, 69.3% and 6%, respectively. In May 2015, all studies of Brodalumab for psoriasis were paused, worldwide, because of some cases of suicidal ideation and changIt is a humanized IgG1 monoclonal antibody that blocks the p19 subunit of IL-23. The drug was compared with placebo in a phase 2b study with primary endpoint PASI 75 at week 16. Patients were randomized in 5 groups with doses of 200, 100, 25, 5 mgr Tildrakizumab or placebo.

The results for PASI 75 were 74%, 66%, 64% and 33% for Tildrakizumab and 4.9% for placebo, respectively. The most common adverse event was rhinofaringitis. At the time that this paper is written, phase ΙΙΙ clinical trials are under development. 2.2 Guselkumab It is a human monoclonal IgG1 antibody against the p19 subunit of IL-23. In a double-blind phase I study, the drug was compared to placebo. One dose of 10 mgr was administered to 5 patients, one dose of 30 mgr to 5 patients, one dose of 100 mgr to 5 more and 300 mgr to 5 patients also. Placebo was administered to 4 patients. At week 12, the percentage of patients that achieved PASI 75 was 50%, 60%, 60%, 100%, respectively, for the four doses of guselkumab and 0% for placebo. The drug was also compared with adalimumab in a phase II study with a 52-week duration. 293 patients were randomized to receive either Guselkumab 5 mgr at weeks 0, 4 and every 12 weeks thereafter, 15 mgr every 8 weeks, 50 mgr at weeks 0, 4 and every 12 weeks thereafter, 100 mgr every 8 weeks or 200 mgr at weeks 0, 4 and every 12 weeks thereafter, until week 40, or placebo, or adalimumab (with the administration program that is indicated for psoriasis). At week 16, the placebo group patients were initiated guselkumab 100 mgr every 8 weeks. The primary endpoint was the evaluation of PGA 0 or 1 at week 16. The results regarding this index were 34% for 5-mg guselkumab group, 61% for 15-mg group, 79% for 50-mg group, 86% for 100-mg group and 83% for 200- mg group, compared with 7% for the placebo group. The percentage for adalimumab was 58%.