Home » rheumatology » Page 3
Tag:

rheumatology

Health

Psoriasis Linked to Increased Metabolic Syndrome Risk, Mediated by Disease Activity

by Dr. Michael Lee – Health Editor
written by Dr. Michael Lee – Health Editor

Psoriasis Patients Face Elevated Metabolic Syndrome Risk

Individuals with psoriasis are at a heightened risk of developing metabolic syndrome, according to recent research. This finding underscores the need for vigilant monitoring and proactive health management within this patient population.

Psoriasis as a MetS Risk Factor

A new study reveals that psoriasis significantly increases the likelihood of metabolic syndrome (MetS). The study further suggests that the severity of the psoriasis directly impacts the risk of MetS. The greater the inflammatory burden, the higher the metabolic disorder risk, as noted by the research.

“Early recognition of MetS in psoriasis patients is critical for mitigating long-term health risks and improving clinical outcomes,”

—Xiaoyan Zhang, China-Japan Friendship Hospital

According to the Centers for Disease Control and Prevention, roughly 37% of U.S. adults have metabolic syndrome, highlighting the broad public health relevance of this research (CDC, 2024).

Study Methodology

Researchers conducted a thorough analysis of studies on psoriasis and MetS. The investigation considered articles from databases like CNKI, PubMed, and Web of Science. The search encompassed publications up to February 2025, aiming to find all relevant studies.

The inclusion criteria for the analysis consisted of observational designs, such as cross-sectional and prospective studies. Studies needed to feature a psoriasis case group and a control group. Furthermore, the diagnosis had to be clinically or pathologically confirmed.

Key Findings

The meta-analysis included 14 articles involving 9,641 patients with psoriasis. The collective prevalence of clinically significant metabolic dysregulation among the psoriasis cases reached 26.49%. When compared to control groups, psoriasis patients showed higher odds ratios for MetS.

In patients with severe psoriasis, a higher risk of developing MetS was identified. The study revealed a positive linear trend between PASI scores and MetS incidence. This indicated a link between disease severity and the chances of developing MetS.

Call to Action

The investigators concluded that clinicians should pay closer attention to the metabolic health of psoriasis patients. Regular monitoring, alongside early intervention measures, is vital to prevent the onset of MetS. They emphasized the importance of interdisciplinary collaborations to improve patient care.

0 comments
0 FacebookTwitterPinterestEmail
Health

Biologic Decision-Making in Asthma and COPD: Prioritizing Earlier, Precise Intervention

by Dr. Michael Lee – Health Editor
written by Dr. Michael Lee – Health Editor

New Respiratory Treatments Reshape Asthma and COPD Care

Advances in respiratory medicine are transforming asthma and chronic obstructive pulmonary disease (COPD) management, moving away from generalized treatments to personalized approaches. These changes are expanding treatment options and redefining long-term disease control for individuals once considered hard to treat.

Biologics Revolutionize Asthma Management

Biologic therapies have been central to this shift in asthma care. New drugs like dupilumab (Dupixent), benralizumab (Fasenra), and tezepelumab (Tezspire) have set new standards for effective intervention. The approval of tezepelumab in 2021, the first biologic for severe asthma not limited by eosinophil count, broadened treatment options. This progress is also strengthening collaboration between allergists and pulmonologists.

Joseph Khaabbaza, MD

COPD management is starting to see similar innovation, with the 2024 FDA approval of dupilumab for eosinophilic COPD marking a significant step. As the lines between asthma and COPD continue to blur, clinicians need to reevaluate traditional treatment pathways.

Expert Insights on Emerging Therapies

A recent clinical forum brought together pulmonologists and allergists to discuss the updates in respiratory care, led by pulmonologist Joseph Khabbaza, MD, of Cleveland Clinic. Panelists discussed the central role of biologics in modern asthma management, particularly for those with type 2 inflammation. The use of biomarkers like eosinophils and FeNO has also grown substantially.

“I’ve been more aggressive with, if my patient needs steroids more than twice in 6 months or so, I’m pulling the trigger faster and faster, even without long-acting muscarinic antagonist (LAMA), just because I first-hand know the major long-term side effects of steroids 10 years, 15 years down the road,”

—Forum Participant

Another shift is that pulmonologists are managing biologics more often, and initiating them earlier to reduce steroid use and prevent long-term problems, despite payer criteria. The global prevalence of COPD is estimated to be around 10% of adults aged 40 years and over, highlighting the scale of the issue (World Health Organization, 2024).

Future Directions in Respiratory Care

COPD management is beginning to adopt similar principles, recognizing that some patients with type 2 inflammation may benefit from biologics. Panelists emphasized the need for longer-acting biologics, better phenotyping, and broader eligibility definitions, especially for COPD patients.

“Asthma and COPD have evolved over the last few years and with a lot of thinking about eosinophils and type 2 inflammation, and we now have more pathways and more treatments than ever before to try to help these patients. And we want to minimize prednisone, and minimize exacerbation. I think those are- If we can do those two things in asthma and COPD patients, that’ll be good for everyone in the system,” Khabbaza concluded.

0 comments
0 FacebookTwitterPinterestEmail
Health

Gout & Heart Health: New Management Insights

by Dr. Michael Lee – Health Editor
written by Dr. Michael Lee – Health Editor

“`html


Gout Treatment Advances: New Therapies and Cardiovascular Benefits Highlighted at EULAR 2025

Table of Contents

Barcelona, Spain – June 16, 2025 – New data presented at the European Alliance of Associations for Rheumatology (EULAR) annual congress in Barcelona showcases significant advancements in gout treatment, emphasizing the importance of achieving target serum urate levels and introducing novel therapeutic options. The research underscores the link between effective gout management and reduced cardiovascular risk, alongside the development of promising new urate-lowering drugs [[source: EULAR]].

Targeting Serum Urate Levels for Cardiovascular Protection

Gout flares have been linked to an increased risk of cardiovascular events. A study by Edoardo Cipolletta and colleagues,analyzing data from over 116,000 patients in England and Sweden,revealed that achieving a serum urate level of ≤360 μmol/L within the frist year of urate-lowering therapy significantly improved 5-year MACE-free survival and lowered the risk of major adverse cardiovascular events (MACE). This highlights the importance of proactive gout management in mitigating cardiovascular risks [[source: EULAR]].

Did You Know? Maintaining a serum urate level below 360 μmol/L can significantly reduce the risk of cardiovascular events in gout patients.

The study’s findings remained consistent across various analyses, including different MACE definitions and censoring follow-up upon therapy discontinuation. Notably, the beneficial effect was more pronounced in patients over 65 years old. These results reinforce the need for targeted urate-lowering strategies in gout management to improve overall patient outcomes.

Emerging Therapies for Urate Lowering

Several new therapies are under development to effectively lower urate levels in gout patients. Pozdeutinurad (AR882), a selective URAT1 inhibitor, has demonstrated sustained reductions in serum urate and significant reductions in tophi. A Phase 2 open-label trial presented by Robert Keenan evaluated the long-term safety and tolerability of pozdeutinurad, alone or combined with allopurinol, in patients with subcutaneous tophi [[source: EULAR]].

The trial results indicated that pozdeutinurad was generally safe and well-tolerated over 18 months, with most treatment-emergent adverse events (TEAE) being mild to moderate. Gout flares were the most frequent adverse event in the first six months, with a decreasing trend thereafter.There were no clinically significant liver function abnormalities or serum creatinine elevations reported.

Pro tip: Newer gout medications focus on selectively inhibiting URAT1, a key protein involved in uric acid reabsorption in the kidneys.

Another promising therapy, ruzinurad, also a URAT1 inhibitor, was evaluated in a Phase 3 study presented by Huihua ding.The study compared ruzinurad to allopurinol over a 16-week double-blind period. Results showed that a significantly greater proportion of patients in the ruzinurad group achieved the target serum urate level of ≤360 μmol/L at the last two monthly measurements compared to the allopurinol group (39.7% vs. 26.5%). This difference was maintained until Week 52 [[source: EULAR]].

During the 52-week treatment period, TEAE occurred in 89.7% and 91.7% of patients in the ruzinurad and allopurinol groups,respectively. The most common adverse events included gout flares, increased alanine aminotransferase, upper respiratory tract infection, and increased blood creatinine. The study concluded that ruzinurad demonstrated superior urate-lowering efficacy compared to allopurinol and exhibited a well-tolerated safety profile in patients with hyperuricemia associated with primary gout.

gout Treatment Comparison

Therapy Mechanism of Action Efficacy (Target Urate ≤360 μmol/L) Common Adverse Events
Allopurinol Urate-lowering therapy [[2]] 26.5% (at week 16) Gout flares, increased alanine aminotransferase
R

0 comments
0 FacebookTwitterPinterestEmail
Health

Early Sclerosis: Predicting Disease Progression From First Signs

by Dr. Michael Lee – Health Editor
written by Dr. Michael Lee – Health Editor

Early Systemic sclerosis Diagnosis Key to Preventing Severe Outcomes

Table of Contents

Barcelona, Spain - New data presented at the European Alliance of Associations for Rheumatology (EULAR) congress underscores the critical role of early diagnosis in managing systemic sclerosis (SSc). Research indicates that early intervention can significantly minimize the impact of SSc, a chronic autoimmune disease, on patients' lives by preventing severe complications.Moreover, a seperate study reveals an elevated risk of hematological malignancies among individuals with SSc, particularly in men and those diagnosed at a younger age.

VEDOSS Project Highlights Early Disease Progression

the VEDOSS (Very Early Diagnosis of Systemic Sclerosis) project has been instrumental in identifying individuals at high risk of developing ssc. A previous VEDOSS study indicated that 70% of patients exhibiting Raynaud's phenomenon, along with at least one "red flag" such as SSc-specific antibodies, puffy fingers, or an SSc pattern on nailfold capillaroscopy, would meet the 2013 ACR/EULAR SSc criteria within five years. However,researchers emphasize that meeting classification criteria doesn't always reflect clinically relevant disease progression. Rather,early events like digital ulcers,skin fibrosis,or interstitial lung disease (ILD) might potentially be more reliable indicators.

Stefano Di Donato and his team evaluated the progression of 442 VEDOSS patients who did not initially meet the 2013 criteria and had no clinical endpoints at the start of the study.Progression was defined by the first occurrence of any of the following within five years: digital ulcer or gangrene, modified Rodnan skin score (mRSS) ≥1, scleroderma renal crisis (SRC), new ILD on CT scan, new pulmonary arterial hypertension, new synovitis, left ventricular ejection fraction <50%, or forced vital capacity (FVC) or diffusing capacity for carbon monoxide (DLCO) below 80% of predicted. The study found that 51.1% of patients developed one of these clinically significant events during the follow-up period. The cumulative progression probability was 11.1% at 12 months, increasing to 41.5% at 36 months and 65.6% at 60 months.

Did You Know? The modified Rodnan Skin Score (mRSS) is a tool used to assess the thickness of the skin in patients with systemic sclerosis.A higher score indicates more severe skin involvement.

The most frequent events observed were mRSS ≥1 (31.5%),DLCO decline (29.8%), and first digital ulcer or gangrene (15.1%). Notably, almost two-thirds of patients experienced a clinically significant event before meeting the full classification criteria for SSc. These findings underscore the importance of early diagnosis and intervention to minimize the impact of SSc on patients' lives.

Increased risk of Hematological Malignancies in SSc Patients

Systemic sclerosis is associated with high mortality, partly due to heart and lung complications, and also related comorbidities. Recent research has highlighted a significantly higher cancer risk for individuals with an SSc diagnosis.Karin Gunnarsson presented findings from Swedish population-based healthcare registers, shedding light on the increased risk of hematological malignancies in SSc patients. The study compared 1,720 individuals with SSc to a control group matched by sex, age, and residential area. The researchers identified first-time hematological malignancies in 1.6% of individuals with SSc compared to 0.9% in the control group. This translates to a crude incidence rate of 2.3 versus 1.2 per 1000 person-years, with elevated hazard ratios for lymphoid, plasma cell, myeloid, and B cell malignancies.

The risk differences were most pronounced in men and individuals diagnosed with SSc at a young age (18-49 years). These findings emphasize the need for increased vigilance and monitoring for hematological malignancies in SSc patients,particularly in these higher-risk groups. According to the American Cancer Society, hematological malignancies account for approximately 10% of all new cancer diagnoses in the United States each year American Cancer Society.

Pro Tip: Regular check-ups and screenings are essential for individuals with systemic sclerosis,especially those with additional risk factors for hematological malignancies.

Key Progression Events in Systemic Sclerosis

Event Percentage of Patients
mRSS ≥1 31.5%
DLCO Decline 29.8%
First Digital Ulcer or Gangrene 15.1%

The Importance of Early Intervention

Early identification and intervention are crucial in managing SSc due to its potential for severe complications and high mortality. The progression to clinical signs in people with VEDOSS red flags validates the importance of very early diagnosis. by identifying and addressing the disease in its early stages, healthcare professionals can work to minimize the impact of SSc on patients' lives and improve their overall outcomes.

What steps can be taken to improve early diagnosis of systemic sclerosis?

How can healthcare providers better monitor SSc patients for hematological malignancies?

Evergreen Insights: Understanding Systemic Sclerosis

Systemic sclerosis (SSc),also known as scleroderma,is a chronic autoimmune disease characterized by hardening and tightening of the skin and connective tissues. The disease can affect various organs, including the heart, lungs, and kidneys.while the exact cause of SSc is unknown, it is believed to involve a combination of genetic and environmental factors.The disease is more common in women than in men, and typically develops between the ages of 30 and 50 Johns Hopkins Medicine.

Past trends in SSc research have focused on improving diagnostic criteria and developing targeted therapies to manage specific complications of the disease.Early diagnosis and intervention have become increasingly recognized as critical factors in improving patient outcomes. Ongoing research efforts are aimed at identifying novel biomarkers for early detection and developing more effective treatments to slow disease progression and prevent organ damage.

Frequently Asked Questions About Systemic Sclerosis

What are the early symptoms of systemic sclerosis?
Early symptoms of systemic sclerosis can include Raynaud's phenomenon (fingers and toes turning white or blue in response to cold or stress), puffy fingers, and thickening of the skin. Other symptoms may include fatigue, joint pain, and heartburn.
How is systemic sclerosis diagnosed?
systemic sclerosis is diagnosed based on a combination of clinical findings, such as skin thickening and Raynaud's phenomenon, as well as blood tests to detect SSc-specific antibodies. Nailfold capillaroscopy, a non-invasive test that examines the small blood vessels in the nail folds, can also be used to aid in diagnosis.
What are the treatment options for systemic sclerosis?
There is currently no cure for systemic sclerosis, but various treatments are available to manage symptoms and prevent complications. These may include medications to suppress the immune system, treat Raynaud's phenomenon, and manage organ-specific complications such as lung disease and kidney problems.Physical therapy and occupational therapy can also help improve function and quality of life.
What is the prognosis for individuals with systemic sclerosis?
The prognosis for individuals with systemic sclerosis varies depending on the extent and severity of organ involvement. Some individuals may experience mild symptoms and slow disease progression, while others may develop more severe complications that can affect their quality of life and survival. Early diagnosis and treatment can help improve outcomes.
Can lifestyle changes help manage systemic sclerosis?
Yes, certain lifestyle changes can help manage systemic sclerosis symptoms. These may include avoiding smoking, protecting the skin from sun exposure, staying warm in cold weather, and maintaining a healthy diet and exercise routine.It is also important to manage stress and get adequate rest.

This article provides general information and should not be considered medical advice. Consult with a qualified healthcare professional for diagnosis and treatment of any medical condition.

Share this article to raise awareness about the importance of early systemic sclerosis diagnosis. Leave a comment below with your thoughts or experiences!

0 comments
0 FacebookTwitterPinterestEmail
Health

New data reveals insights into cancer and cardiovascular safety of JAK inhibitors

by Dr. Michael Lee – Health Editor
written by Dr. Michael Lee – Health Editor

Rheumatoid Arthritis Treatment: Cancer Risk Stable, GLP-1 Drugs Show Promise

New Research Offers Reassurance on JAK Inhibitors and Hints at Cardiovascular Benefits

Recent findings presented at the 2025 European Alliance of Associations for Rheumatology (EULAR) congress are providing updated insights into the safety and potential benefits of treatments for rheumatoid arthritis (RA). Studies address concerns about cancer risk with JAK inhibitors and explore the cardioprotective effects of GLP-1 receptor agonists.

Cancer Risk with JAK Inhibitors Remains Largely Unchanged

A large-scale, real-world study involving over 33,000 RA patients revealed no significantly elevated cancer risk among those treated with JAK inhibitors compared to those on biologic disease-modifying anti-rheumatic drugs (bDMARDs). Researchers, including Romain Aymon and colleagues, analyzed data from 13 registers, tracking cancer incidence for up to five years after treatment initiation.

The study identified 53,169 treatment initiations and reported 219 non-melanoma skin cancers and 638 other cancers. While the crude incidence of non-melanoma skin cancer was slightly lower with TNF inhibitors, statistical analysis showed no significant differences in cancer rates between JAK inhibitors and either TNF inhibitors or bDMARDs with other mechanisms of action.

A sub-analysis focused on patients aged 50 and older with cardiovascular risk factors—mirroring the inclusion criteria of the ORAL Surveillance trial—showed a higher cancer incidence across all treatment groups. However, again, no significant difference was found between JAK inhibitors and bDMARDs.

Aymon and team plan further analyses with expanded data sets to strengthen statistical power and evaluate cancer incidence over varying exposure durations. Initial findings, however, are considered reassuring.

Keratinocyte Cancer Risk with JAK Inhibitors Requires Monitoring

Separate research focusing on keratinocyte cancers—primarily basal and squamous cell carcinomas—indicated a potential increased risk with JAK inhibitor use. Analyzing data from the Swedish Rheumatology Quality Register, Viking Huss and colleagues found a 1.72-fold higher hazard ratio for a first keratinocyte cancer diagnosis with JAK inhibitors compared to TNF inhibitors.

“these findings suggest that people with RA treated with a JAKi have a higher incidence of a first keratinocyte cancer, primarily driven by basal cell carcinoma. Additionally – although based on a limited number of events – we saw a higher incidence of a second cancer of this type with JAKi compared to TNFi.”

—Viking Huss

The incidence of keratinocyte cancer is rising in the general population, potentially due to UV exposure and immune alterations. According to the American Academy of Dermatology, an estimated 1 in 5 Americans will develop skin cancer by the age of 70. American Academy of Dermatology

Researchers recommend skin examinations and monitoring for skin cancer risks in patients undergoing JAK inhibitor treatment.

GLP-1 Receptor Agonists May Offer Cardiovascular Protection

Given the cardiovascular risks associated with RA and previous concerns with JAK inhibitors, researchers investigated the potential cardioprotective effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs). Asmaa Beltagy presented findings from a retrospective analysis of over 2,400 RA patients aged 40 and older taking JAK inhibitors.

The study compared patients who subsequently initiated GLP-1RA therapy to those who did not, assessing the incidence of cardiovascular events over five years. Results showed that patients taking GLP-1RAs had a significantly lower risk of acute coronary syndromes and deep venous thrombosis.

While trends toward lower risks of cerebral infarction and peripheral arterial disease were observed, they weren’t statistically significant. Overall, the incidence of cardiovascular events was significantly reduced in the GLP-1RA group.

These findings suggest GLP-1RAs could mitigate certain cardiovascular risks in RA patients treated with JAK inhibitors, but further research is needed to confirm these results.

0 comments
0 FacebookTwitterPinterestEmail
Health

Masked Taper & CBT-I: Reducing Reliance on Sleep Meds | Expert Advice

by Dr. Michael Lee – Health Editor
written by Dr. Michael Lee – Health Editor

Masked Tapering Boosts Benzodiazepine Discontinuation for Insomnia Patients: SLEEP 2025

SEATTLE, WA – A novel approach to benzodiazepine deprescribing, combining masked tapering with augmented cognitive behavioral therapy for insomnia (CBT-I), shows promising results in helping older adults discontinue long-term use of these medications. The findings, presented at SLEEP 2025, highlight the potential of this method to improve sleep quality and reduce reliance on benzodiazepines (BZRA) among individuals with insomnia.

The Masked Tapering Approach

researchers,led by Dr. Constance Fung from the David Geffen School of Medicine at UCLA,developed a Masked Taper plus cognitive behavioral therapy-augmented program (MTcap) to minimize placebo effects and boost discontinuation. The study involved 188 adults aged 55 and older (average age 69.2 years, 34.6% female) who had been using alprazolam, lorazepam, temazepam, or zolpidem for at least two nights per week for a minimum of three months. Participants used a BZRA an average of 5.9 days a week.

Did You Know? Benzodiazepines are associated with a 36% increased risk of dementia in older adults, according to a 2012 study in JAMA Internal medicine.

Study Results: MTcap vs. Standard Tapering

The multi-site trial compared eight weeks of MTcap with standard, gradual tapering. Six months after treatment, the MTcap group showed a significantly higher BZRA discontinuation rate (73.4%) compared to the standard tapering group (58.6%). Both groups experienced improvements in insomnia severity, as measured by the Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index.

Specifically, baseline epworth Sleepiness Scale scores increased from 6.32 and 6.21 at baseline for MTcap and standard taper,respectively,to 3.98 and 3.92 at 1 week and 4.54 and 3.91at 6 months. Pittsburgh Sleep Quality index scores also showed improvements from baseline to week 1 and month 6 in both arms.

Comparison of MTcap and Standard tapering Results
Outcome MTcap Standard Tapering
BZRA discontinuation (6 months) 73.4% 58.6%
Average Age of Participants 69.2 years 69.2 years

Challenging Thoughts About Medication

A key element of the masked tapering program involved a diary where participants recorded their perceived nightly dosage compared to their baseline dose. This approach encouraged patients to question the actual effectiveness of their medication.

Pro Tip: Gradual tapering, combined with behavioral therapies, is recommended by the American Academy of Family Physicians for safe benzodiazepine discontinuation.

Dr. Fung emphasized the importance of patients asking themselves, “Is this pill really doing something for me?” The goal is for patients to recognize that they may not be sleeping well and may not necessarily need a sleeping pill after completing the MTcap program.

Future Research Directions

Further analyses are planned to gain a better understanding of the factors contributing to the sustained discontinuation rates observed in the study. researchers aim to identify the specific mechanisms through which masked tapering and augmented CBT-I promote long-term success.

What strategies have you found most effective in managing insomnia without medication? How can healthcare providers better support patients in safely discontinuing benzodiazepines?

Benzodiazepines and Insomnia: An Evergreen Perspective

Benzodiazepines are a class of psychoactive drugs primarily used to treat anxiety, insomnia, and seizures. While effective for short-term relief, long-term use can lead to dependence, tolerance, and a range of adverse effects, particularly in older adults.Insomnia, characterized by difficulty falling or staying asleep, affects millions worldwide and can significantly impact quality of life. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a non-pharmacological treatment that addresses the underlying causes of insomnia through behavioral and cognitive techniques. Studies have shown that CBT-I is as effective as medication in the short term and more effective in the long term, without the risks associated with drug dependence and side effects. The increasing awareness of the risks associated with long-term benzodiazepine use has led to a growing emphasis on deprescribing strategies and alternative treatments like CBT-I.

Frequently Asked Questions About Benzodiazepine Discontinuation

What are the risks of long-term benzodiazepine use?
Long-term use can lead to dependence, tolerance, cognitive impairment, increased risk of falls, and paradoxical effects like increased anxiety or insomnia.
What is Cognitive Behavioral Therapy for Insomnia (CBT-I)?
CBT-I is a structured program that helps individuals identify and change thoughts and behaviors that contribute to insomnia. it includes techniques like sleep restriction, stimulus control, and relaxation training.
How does masked tapering work?
Masked tapering involves gradually reducing the dosage of a medication without the patient’s knowledge of the specific tapering schedule,minimizing potential placebo effects and psychological dependence.
Is it safe to stop benzodiazepines abruptly?
Abruptly stopping benzodiazepines can lead to withdrawal symptoms, including anxiety, insomnia, seizures, and rebound symptoms. Gradual tapering under medical supervision is recommended.
where can I find more facts about CBT-I?
You can find more information about CBT-I from healthcare providers,sleep specialists,and organizations like the National Sleep Foundation.

Disclaimer: This article provides general information and should not be considered medical advice. Consult with a healthcare professional for personalized guidance on benzodiazepine discontinuation and insomnia treatment.

share this article to spread awareness about safe benzodiazepine deprescribing strategies. What are your thoughts on the masked tapering approach? Leave a comment below!

0 comments
0 FacebookTwitterPinterestEmail
Newer Posts
Older Posts
@2025 - All Right Reserved.

Hosted by Byohosting – Most Recommended Web Hosting – for complains, abuse, advertising contact: contact@world-today-news.com