Non-biological Treatment Research Articles

Revolutionizing Pediatric Dermatology: Dupilumab’s Impact on Atopic Dermatitis in Kids

Eczema, or atopic dermatitis, is a common, non-communicable, immune-mediated, inflammatory skin illness mainly affecting children. It is a chronic condition. It causes mental health problems like anxiety, sadness, anxiety, depression, hyperactivity, and obesity. It is the first skin ailment and the fifteenth non-fatal disease. The purpose of the present research study was to evaluate the Safety and Effectiveness of biological treatment for atopic dermatitis using monoclonal antibodies against non-biological treatment, including antibiotics, immunosuppressants, demards, histamine antagonists and corticosteroids. Patient information was gathered from FDA-approved clinical trials. The comparative analysis found that Biological therapies like Dupilumab, Omalizumab, and Ustekinumab improve symptoms and disease control in atopic dermatitis. Non-biological treatments may not be as effective. Early antibiotic exposure can increase infection vulnerability. Mild eczema infections require biological agents. Topical corticosteroids can be combined with Dupilumab for effective treatment of atopic dermatitis. Studies show that Dupilumab improves symptoms and quality of life, making it a better option than a placebo. FDA recommends using biological agents over immunosuppressants in paediatrics for improved immune results. FDA clinical trials showed that dupilumab is a safe and effective treatment for children with moderate-to-severe atopic dermatitis, reducing disease severity and improving quality of life in young AD patients.

Translated article] Approach to the Epidemiology, Disease Management, and Current Challenges in the Management of Generalized Pustular Psoriasis Through a Survey Conducted Among Spanish Dermatologists

BackgroundGeneralized pustular psoriasis (GPP) is a rare and severe inflammatory skin disease characterised by recurrent or intermittent flares. Epidemiological and disease management data in Spain are limited. Our goal was to estimate the epidemiology of GPP, explore its management, and reach consensus on the current challenges faced in Spain. MethodsAn electronic survey was submitted to dermatologists from the Spanish Academy of Dermatology and Venereology Psoriasis Working Group. This group is experienced in the management of GPP. It included a Delphi consensus to establish the current challenges. ResultsA total of 33 dermatologists responded to the survey. A 5-year prevalence and incidence of 13.05 and 7.01 cases per million inhabitants, respectively, were estimated. According to respondents, the most common GPP symptoms are pustules, erythema, and desquamation, while 45% of patients present > 1 annual flares. A total of 45% of respondents indicated that flares often require a length of stay between 1 and 2 weeks. In the presence of a flare, 67% of respondents often or always prescribe a non-biological systemic treatment as the first-line therapy [cyclosporine (55%); oral retinoid (30%)], and 45% a biological treatment [anti-TNFα (52%); anti-IL-17 (39%)]. The dermatologists agreed that the main challenges are to define and establish specific therapeutic goals to treat the disease including the patients’ perspective on the management of the disease. ConclusionOur study describes the current situation on the management of GPP in Spain, increasing the present knowledge on the disease, and highlighting the current challenges faced at the moment.

Aproximación a la epidemiología, manejo de la enfermedad y retos actuales en la gestión de la psoriasis pustulosa generalizada en España a través de un cuestionario dirigido a dermatólogos

BackgroundGeneralized pustular psoriasis (GPP) is a rare and severe inflammatory skin disease characterised by recurrent or intermittent flares. Epidemiological and disease management data in Spain are limited. Our goal was to estimate the epidemiology of GPP, explore its management, and reach consensus on the current challenges faced in Spain. MethodsAn electronic survey was submitted to dermatologists from the Spanish Academy of Dermatology and Venereology Psoriasis Working Group. This group is experienced in the management of GPP. It included a Delphi consensus to establish the current challenges. ResultsA total of 33 dermatologists responded to the survey. A 5-year prevalence and incidence of 13.05 and 7.01 cases per million inhabitants, respectively, were estimated. According to respondents, the most common GPP symptoms are pustules, erythema, and desquamation, while 45% of patients present > 1 annual flares. A total of 45% of respondents indicated that flares often require a length of stay between 1 and 2 weeks. In the presence of a flare, 67% of respondents often or always prescribe a non-biological systemic treatment as the first-line therapy [cyclosporine (55%); oral retinoid (30%)], and 45% a biological treatment [anti-TNFα (52%); anti-IL-17 (39%)]. The dermatologists agreed that the main challenges are to define and establish specific therapeutic goals to treat the disease including the patients’ perspective on the management of the disease. ConclusionOur study describes the current situation on the management of GPP in Spain, increasing the present knowledge on the disease, and highlighting the current challenges faced at the moment.

Evaluation of serum Interleukin 36 in Iraqi patients with Rheumatoid arthritis

Rheumatoid arthritis is a worldwide inflammatory chronic autoimmune disease with varying severity. Due to no definitive cure for this disease, current therapies aim to decrease the pain and slow further damage. The interleukin (IL)‐36 cytokine was little known for its role in rheumatoid arthritis; this research aimed to evaluate the serum IL36 levels in RA patients compared to healthy controls. This study included 80 patients with rheumatoid arthritis registered at the Rheumatology Clinic in Baghdad teaching hospital. The patients were divided into three groups based on the treatments received. Group 1 included patients treated with biological therapy (etanercept, adalimumab), Group2 patients with non-biological treatment (methotrexate hydroxychloroquine and prednisone), Group3 patients without any treatment and compared with Group 4 healthy control group. Patients is all groups were assessed for their serum IL-36 concentration; the mean IL-36 serum level was significantly higher in three groups of RA patients which include the group of patients treated with biological therapy (Enbrel (etanercept) and Humira (adalimumab) means were (1132.41±475.2,), and group of non-biological therapy patients (Methotrexate hydroxychloroquine and prednisone) (G2) means was 553.95±307, than patients' group without any treatment (G3) means was 1044.01±575.3 compared to the control (341.38±113.1) p-value> 0.00001. The patient's age and BMI were not significantly different between three groups of patient Rheumatoid arthritis. Parameters for this disease also were tested which include RF, CRP, ESR, anti-CCP and disease activity score-28 (DAS 28), there were significant differences when compared with the control group. IL-36 serum level was significantly higher in three groups of rheumatoid arthritis than those in controls, and when compared between three patients groups there was less concentration in the non-biological therapy treatment group means was 553.95±307 than in the rest of the patient groups,biology tratment, without any treatment, means were (1132.41±475.2, 1044.01±575.3) respectively. This study found that Rheumatoid arthritis patients' serum IL36 levels increased, where a non-biologic therapies reduced this cytokine. IL-36's pathogenic involvement in Rheumatoid arthritis needs more study. Keywords: Rheumatoid arthritis, IL-36, IL-1,C‐reactive protein, RF, ESR and anti-CCP.

Impact of biological and non-biological treatment on hematological indices in patients with ankylosing spondylitis and psoriatic arthritis

BackgroundBlood dyscrasias are common in patients with rheumatic diseases, as bone marrow and blood cells can be targets for autoimmune processes. This in addition to the potentially adverse effect of the disease-modifying anti-rheumatic drugs used for the treatment of inflammatory arthritis as in psoriatic arthritis (PsA) and ankylosing spondylitis (AS) on blood counts.Aim of this studyThe aim of this study is to analyze the effect of biologic therapy on complete blood cell parameters, derived ratios, and cell volume indices in Egyptian patients with ankylosing spondylitis and psoriatic arthritis.ResultsOne hundred and twenty Egyptian patients had been included, 60 have ankylosing spondylitis (AS) and 60 have psoriatic arthritis (PSA). On comparing the blood indices between the biologics and non-biologics groups of PSA patients, there was a statistically highly significant reduction in red cell distribution width (RDW%) at the biologics group than non-biologics (p < 0.006), where there was a statistically highly significant increase in Hb (hemoglobin)/RDW ratio and Hb/platelets ratio at the biologics group than non-biologics (p < 0.005).ConclusionAs a result, biologic drugs used in rheumatology practice may have some effects on hematological parameters. In our study, no major negative effects on hematological parameters were observed in patients with AS and PsA who received Secukinumab, Adalimumab-atto, or Golimumab biologic therapy. However, the changes in the hematological indices correlates with their potent anti-inflammatory action in rheumatic patients.

The Characteristics of COVID‐19 Symptoms and Skin Manifestations among Nonhospitalized COVID‐19 Patients with Psoriasis during the Omicron Pandemic in China: A Single‐Center Survey‐Based Study

Background. The global impact of coronavirus 2019 (COVID‐19) has raised concerns about the management of psoriasis patients, especially among those using biologics. Methods. We conducted a survey‐based research among Omicron‐infected (confirmed, probable, and suspected ones) psoriasis patients in the department of dermatology, West China Hospital, Sichuan University, from January 9th to January 22nd, 2023. We collected demographic and clinical information (psoriasis‐ and COVID‐19‐related) and conducted statistics analysis. Results. Of the 240 patients enrolled, they were classified by the psoriatic treatment, as biologics (n = 138), nonbiological systematic treatment (n = 52), and topical treatment or without pharmacological treatment (n = 50). This study showed the characteristics of Omicron‐related symptoms and cutaneous signs in patients. We observed that patients who received topical treatment or without pharmacological treatment had a lower risk of presenting with COVID‐19 symptoms in the fully adjusted logistic model (OR = 0.40, 95% CI: 0.18–0.90, and P = 0.025). Moreover, in the model for skin manifestations, nonbiological systematic treatment (OR = 2.15, 95% CI: 1.08–4.27, and P = 0.029) and high BMI (OR = 1.10, 95% CI: 1.00–1.20, and P = 0.042) were correlative factors. Conclusions. Our data suggested that differential psoriatic treatment might be a correlative factor in developing symptomatic or asymptomatic Omicron infection and presenting cutaneous signs.

A study on treatment timing selection and short-term efficacy prediction with changes in cytokine levels before and after non-biological artificial liver treatment in acute-on-chronic liver failure

Objective: To investigate the efficacy and diagnostic accuracy of changes in cytokine levels before and after non-biological artificial liver (referred to as ABL) treatment in patients with acute-on-chronic liver failure (ACLF) in order to establish a basis for treatment timing selection and short-term (28d) prognosis. Methods: 90 cases diagnosed with ACLF were selected and divided into a group receiving artificial liver treatment (45 cases) and a group not receiving artificial liver treatment (45 cases). Age, gender, first routine blood test after admission, liver and kidney function, and procalcitonin (PCT) of the two groups were collected. The 28-day survival of the two groups was followed-up for survival analysis. The 45 cases who received artificial liver therapy were further divided into an improvement group and a deterioration group according to the clinical manifestations before discharge and the last laboratory examination results as the efficacy evaluation indicators. Routine blood test, coagulation function, liver and kidney function, PCT, alpha fetoprotein (AFP), β-defensin-1 (HBD-1), 12 cytokines and other indicators were analyzed and compared. A receiver operating characteristic curve (ROC curve) was used to analyze the diagnostic efficacy of the short-term (28 d) prognosis and an independent risk factors affecting the prognosis of ACLF patients. According to different data, Kaplan-Meier method, log-rant test, t-test, Mann-Whitney U test, Wilcoxon rank-sum test, χ2 test, Spearman rank correlation analysis and logistic regression analysis were used for statistical analysis. Results: The 28-day survival rate was significantly higher in ACLF patients who received artificial liver therapy than that of those who did not receive artificial liver therapy (82.2% vs. 61.0%, P<0.05). The levels of serum HBD-1, alpha interferon (IFN-α) and interleukin-5 (IL-5) after artificial liver treatment were significantly lower in ACLF patients than those before treatment (P<0.05), while liver and coagulation function were significantly improved compared with those before treatment (P<0.05), and there was no statistically significant difference in other serological indexes before and after treatment (P＞0.05). Before artificial liver treatment, serum HBD-1 and INF-α levels were significantly lower in the ACLF improvement group than in the deterioration group (P<0.05) and were positively correlated with the patients' prognosis (deteriorating) (r=0.591, 0.427, P<0.001, 0.008). The level of AFP was significantly higher in the improved ACLF group than that in the deterioration group (P<0.05), and was negatively correlated with the prognosis (deteriorating) of the patients (r=-0.557, P<0.001). Univariate logistic regression analysis showed that HBD-1, IFN-α and AFP were independent risk factors for the prognosis of ACLF patients (P=0.001, 0.043, and 0.036, respectively), and that higher HBD-1 and IFN-α levels were associated with lower AFP level and a deteriorating prognosis. The area under the curve (AUC) of HBD-1, IFN-α, and AFP for short-term (28d) prognostic and diagnostic efficacy of ACLF patients was 0.883, 0.763, and 0.843, respectively, and the sensitivity and specificty was 0.75, 0.75, and 0.72, and 0.84, 0.80, and 0.83, respectively. The combination of HBD-1 and AFP had further improved the diagnostic efficiency of short-term prognosis of ACLF patients (AUC=0.960, sensitivity and specificity: 0.909 and 0.880 respectively). The combination of HBD-1+IFN-α+AFP had the highest diagnostic performance, with an AUC of 0.989, sensitivity of 0.900, and specificity of 0.947. Conclusion: Artificial liver therapy can effectively improve the clinical symptoms and liver and coagulation function of patients with ACLF; remove cytokines such as HBD-1, IFN-α, and IL-5 in patients with liver failure; delay or reverse the progression of the disease; and improve the survival rate of patients. HBD-1, IFN-α, and AFP are independent risk factors affecting the prognosis of ACLF patients, which can be used as biological indicators for evaluating the short-term prognosis of ACLF patients. The higher the level of HBD-1 and/or IFN-α, the higher the risk of disease deterioration. Therefore, artificial liver therapy should be started as soon as possible after the exclusion of infection. In diagnosing the prognosis of ACLF, HBD-1 has higher sensitivity and specificity than IFN-α and AFP, and its diagnostic efficiency is greatest when combined with IFN-α and AFP.

The Interplay Between Use of Biological Therapies, Psychological State, and the Microbiome in IBD.

BackgroundThis study examines longitudinal bio-psychological dynamics and their interplay in IBD patients undergoing conventional and biological therapies.MethodsFifty IBD participants (24 UC, 26 CD) in clinical remission were followed for 12 months. Complete longitudinal datasets, biological samples, validated scores of psychological status were collected monthly for analysis of association. Microbiome analysis was performed to identify microbial dynamics and signatures. Patients were grouped on disease phenotype (CD, UC) and mode of treatment (biological therapies, non-biological treatment). General linear models, mixed models, cluster analysis, and analyses of variance were used to examine the longitudinal trends of the variables and their associations over time. Results were corrected for multiple testing.ResultsResults substantiated different interactions between biological therapy and longitudinal trends of inflammatory biomarkers in remission CD and UC patients as well as significant differences between CD and UC patients in their psychological measures during clinical remission, with UC patients having inferior condition compared to CD. A significant reduction in microbial diversity in CD patients compared to UC was identified. Results characterized considerable differences in longitudinal microbial profile between those taking and not taking biological treatment in UC patients, but not in CD patients.ConclusionA different trajectory of interdependence was identified between psychological state, sleep, and microbial dynamics with mode of treatment when compared between CD and UC patients. Further studies should investigate the causal relationships between bio-psychological factors for improved treatment purposes.

Non-Biological Slaughterhouse Wastewater Treatment with Membrane Processes-An Opportunity for Water Recycling.

The pressure-driven membrane separation processes ultrafiltration (UF) and reverse osmosis (RO) enable the effective purification of wastewater, in particular in combination, allowing organic and inorganic contaminants to be separated from the wastewater. Consequently, this work investigates the suitability of this technology for slaughterhouse wastewater (SWW) recycling. This was investigated by means of laboratory and bench-scale plant membrane experiments, whereby slaughterhouse wastewater (SWW) pre-treated by flotation was first treated with UF and then further purified with RO. Through the process combination UF + RO in the bench scale experiment, a reduction of the parameters total organic carbon (TOC), chemical oxygen demand (COD) of more than 98% and 97% for the parameter total nitrogen (TN) could be achieved. This means that wastewater reuse without product contact can be guaranteed. For direct process water reuse, only the concentration limit for ammonium could not be reached. In addition, scanning electron microscopy (SEM) images and energy dispersive X-ray spectroscopy (EDX) analyses of the RO membrane were carried out before and after the experiment, which did not indicate any scaling effects.

Perianal and Luminal Relapse Following Perianal Surgical Intervention in Crohn's Disease.

Background and AimsFistula relapse occurs in 20–30% of patients with perianal Crohn’s disease (PCD) despite optimal medico-surgical management. We aimed in this study to assess the rate of perianal and luminal relapse after surgically induced remission and to determine factors associated with fistula relapse.MethodsConsecutive perianal CD patients who achieved clinical remission after surgery for fistulising PCD from January 2013 to January 2019 were included. The cumulative probabilities of relapse-free survival were estimated using the Kaplan–Meier method.ResultsA total of 130 patients were included. Sixty-six of 130 patients received infliximab (IFX) therapy after perianal surgery. After a median follow-up of 62 months (interquartile range [IQR]: 28–117 months), perianal relapse occurred in 30 of 64 (46.9%) nonbiological medication-treated cases and in 14 of 66 (21.1%) cases in the IFX therapy group. The cumulative probabilities of perianal relapse-free survival in patients with nonbiological treatment were 77.1% at 1 year, 54.6% at 3 years, and 30% at 5 years. The rates of survival without perianal fistula relapse in the IFX-treated group were 91.6%, 69.2%, and 59.3% at 1, 3 and 5 years, respectively. In patients treated with IFX after perianal surgery, discontinuation of IFX therapy (odds ratio [OR]=2.43, p=0.036), a penetrating CD phenotype (OR=4.324, p=0.019), and a complex perianal fistula (OR=3.392, p=0.026) were independently associated with perianal relapse in multivariate analysis.ConclusionInfliximab therapy reduced the risk of perianal relapse after surgical remission in PCD patients compared with nonbiological treatment. However, approximately 40% of patients using infliximab experienced perianal relapse at 5 years, and patients who discontinued use of IFX or experienced a penetrating phenotype or a complex perianal fistula were associated with increased relapse rate.

Association of sex and systemic therapy treatment outcomes in psoriasis: a two-country, multicentre, prospective, noninterventional registry study.

Few systematic data on sex-related treatment responses exist for psoriasis. To evaluate sex differences with respect to systemic antipsoriatic treatment. Data from patients with moderate-to-severe psoriasis in the PsoBest or Swiss Dermatology Network of Targeted Therapies (SDNTT) registries were analysed. Treatment response was defined as achieving a≥75% reduction in Psoriasis Area and Severity Index (PASI 75) or PASI ≤ 3 at treatment months 3, 6 and 12, supplemented by patient-reported outcomes [i.e. Dermatology Life Quality Index (DLQI) ≤ 1 and delta DLQI ≥ 4]. In total, 5346 patients registered between 2007 and 2016 were included (PsoBest, n=4896; SDNTT, n=450). The majority received nonbiological treatment (67·3% male, 69·8% female). Women showed slightly higher PASI response rates after 3 (54·8% vs. 47·2%; P≤0·001), 6 (70·8% vs. 63·8%; P≤0·001) and 12months (72·3% vs. 66·1%; P≤0·004). A significantly higher proportion of women achieved a reduction in DLQI ≥ 4 [month 3: 61·4% vs 54·8% (P≤0·001); month 6: 69·6% vs. 62·4% (P≤0·001); month 12: 70·7% vs. 64·4% (P≤0·002)]. Regarding PASI ≤ 3, women on biologics showed a significantly superior treatment response compared with men at 3 (57·8% vs. 48·5%; P≤0·004) and 6months (69·2% vs. 60·9%; P≤0·018). Women in the nonbiological treatment group had a significantly better treatment response (PASI response, PASI 75 and PASI ≤ 3) over 12months compared with men. We provide evidence that women experience better treatment outcomes with systemic antipsoriatic therapy than men.

Effect of coagulation on bio-treatment of textile wastewater: Quantitative evaluation and application

To address the challenge of high water consumption, massive wastewater discharge and high pollution risk in textile industries, different countries have chosen various treatment method for textile wastewater according to the location and management of textile enterprises. It is not economical purposely to build separate wastewater treatment plants (WWTPs) for each small-scale enterprise, hence, it is common to treat the wastewater for a group of factories and then complete the treatment via a municipal wastewater treatment plant. However, the complex characteristics of textile wastewater brings some new problems for WWTPs: Textile wastewater contains over 300 mg/L COD, 100 μg/L antimony, 1000 μg/L aniline, some of which are toxic to microbes or non-biodegradable. Coagulation plays an important role in the pretreatment of textile wastewater for removing hydrophobic dyes, decreasing the SS and COD. In this paper, Poly Ferric Sulfate (PFS), Poly Aluminum Chloride (PAC) and Poly Aluminum Ferric Chloride (PAFC) were chosen to improve the biodegradability of the textile wastewater. And then, quantitatively evaluate the biodegradability of wastewater before and after coagulation treatment by analyzing the proportion of different organic pollution, which could be divided into four parts including rapid bio-treated, easy bio-treated, normal bio-treated and non-biological treatment. Results showed that the biodegradability of textile wastewater could be improved by coagulation process, and the contents of organic matter of rapid bio-treated and easy bio-treated could be maximizing when the control condition of coagulation process was optimized. Moreover, because of its characteristics of simple, easy to use, and rapidly online implement, this approach holds a great promise for applications such as investigate wastewater feature deeply, treatment technology optimization, risk control and management.

P604 Evaluation of management heterogeneity and complications of Crohn’s disease in Catalonia. A population quality care study

Abstract Background Heterogeneity in the treatment of a disease is a marker of suboptimal quality of care. Recent studies suggest that there is a marked heterogeneity in the management of inflammatory bowel disease. The aim of this study is to evaluate the heterogeneity in the treatment used and the outcomes (rate of hospitalization and surgery) for Crohn’s disease (CD) in the different health areas of Catalonia. Methods All patients with CD included in the Catalan Health Surveillance System (CHSS) including data on more than 7 million individuals from 2011 to 2017 were identified using with the ICD-9-CM codes. The different Catalonian health areas were grouped into 19 groups according to the reference hospital (figure 1). Exposures to different treatments were retrieved from the electronic dispensation records. Data on hospitalizations and surgeries were also extracted from the CHSS according to ICD-9-CM codes. Treatment used rates (systemic corticosteroids, non-biological and biological immunosuppressant) and outcome rates (hospitalization and surgery) were calculated. Results The use of systemic corticosteroids presented a decreasing trend over the study period, with an average rate of use of the total number of patients in the different territories between 10% and 16% (figure 2). The use of non-biological immunosuppressant treatment has remained stable, with an average rate of use ranging from 20% to 40% (figure 3). On the other hand, the use of biological immunosuppressant treatment increased, with an average rate of use in the different territories ranging from 10 to 22% (figure 4). Hospitalizations for any reason showed an increasing trend between 2011–2017 with an average rate between 19% and 30% per year depending on the area. Contrarily, hospitalizations for CD presented a decreasing trend, with an average rate between 5% and 10% per year. Surgical treatment (both resections and ostomies) remained stable over time. Rates per year were between 1% and 2%. Conclusion In this population study we appreciated an important heterogeneity in the use of non-biological and biological immunosuppressant treatments, identifying use rates of almost the double in some of the areas. There is also a remarkable variability in the rate of hospitalizations for CD between certain areas of Catalan territory.

Integration of eHealth Into Pediatric Inflammatory Bowel Disease Care is Safe: 3 Years of Follow-up of Daily Care.

The aim of the study was to evaluate integration of an eHealth solution, www.young.constant-care.com, into daily care (I-eHealth). The I-eHealth solution was offered to inflammatory bowel disease (IBD) patients ages 10 to 17 years old in nonbiological treatment. The application was used monthly and in case of flare-ups. Blood and fecal calprotectin (FC) were tested every 3 months and during flare-ups. A total inflammation score (based on symptoms and FC) was visualized for the patient in a traffic light curve. An IBD nurse followed up on the registrations every 2 weeks. Patients had 1 yearly planned visit at the hospital. On-demand visits were arranged depending on the total inflammation. I-eHealth results were compared with data from a previous randomized clinical trial (RCT)-eHealth study (the control group of which had 4 planned annual visits). Thirty-six IBD patients were followed by I-eHealth, mean age 14.7 years (SD 7.75). The median (interquartile range [IQR]) duration of using I-eHealth was 1.9 years (0.29-2.51), equal to 66.11 patient-years, compared with 40.45 in the RCT-eHealth group and 46.49 in the RCT-control group. On-demand visits per patient-year did not differ between the groups: 1.13 (I-eHealth), 1.16 (RCT-eHealth), and 0.84 (RCT-control) (P = 0.84/0.85). Hospitalizations and acute outpatient visits per patient-year did not differ between the groups: 0.11 and 0.11 (I-eHealth), 0.05 and 0.02 (RCT-eHealth), 0.11 and 0.11 (RCT-control) (P = 0.17/0.81 and 0.12/0.81). Time to first escalation of medication, and time to first on-demand visit, did not differ between the I-eHealth group and data from the clinical trial (Log rank: P = 0.25 and P = 0.61). I-eHealth is comparably with results from eHealth under RCT supervision.

Clinical characteristics and biological treatment of adult patient with juvenile idiopathic arthritis

OBJECTIVE To explore the clinical characteristics and biological treatment of juvenile Idiopathic arthritis (JIA) after adulthood. METHODS Selected 358 patients with previous medical history diagnosed by JIA who were hospitalized in the Department of Rheumatology and Immunology, West China Hospital of Sichuan University from January 1, 2009 to January 1, 2019. Perform retrospective analysis of basic information, clinical symptoms, diagnostic indicators, treatment plans, outpatient follow-up (inpatients require outpatient follow-up treatment) and diagnosis and treatment process of 90 eligible cases included, and observe different ages and different courses of disease. The clinical characteristics of young and middle-aged idiopathic arthritis in adults and the outpatient situation of using biological agents for 6 months. RESULTS According to age, they were divided into ≤26 years old group (42 cases) and >26 years old group (48 cases). Under examination [rheumatoid factor (RF), anti-nuclear antibody (ANA), anti-neutrophil antibody (ANCA), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin-1β (IL-1β), interleukin 6 (IL-6), hemoglobin (HGB), white blood cell count (WBC), human leukocyte antigen-B27 (HLA-B27), complement 3 (C3), etc.], concurrent in terms of symptoms, treatment and prognosis, the ≤26-year-old group was generally lighter than the >26-year-old group; that was, the older the age, the heavier the onset of inflammation and other symptoms, the more complications, the worse the treatment effect, and the worse the prognosis, and there were statistical differences academic significance (P 19 years group (44 cases). In terms of examination (RF, ANA, ANCA, ESR, CRP, IL-1β, IL-6, HGB, HLA-B27, C3, etc.), complications, treatment and prognosis, the course of disease ≤19 years group was compared with the disease course> 19 years group Overall mild; that was, the longer the course of the disease, the more severe the onset of symptoms such as inflammation, the more complications, the worse the treatment effect, and the worse the prognosis, P < 0.05, the difference was statistically significant. After 6 months of outpatient treatment with biological agents, it was found that biological agents could improve some of the patients' clinical symptoms and delay the further development of the disease. Compared with the non-biological agent treatment group (48 cases), the biological agent group (42 cases) benefited, and the difference was statistically significant (P < 0.05). CONCLUSION Through retrospective analysis, this article believes that although adult JIA is diagnosed as connective tissue disease, it has special clinical characteristics with the course of the disease and age. Therefore, it should be recommended to give special attention to JIA patients after adulthood, require regular medical treatment in the adult rheumatology department, according to the corresponding connective tissue disease or JIA diagnosis, and standard treatment; at the same time, pay attention to the history of JIA. In the comparison of biological and non-biological treatment, it is proved that biological treatment can effectively improve some of the clinical symptoms of JIA patients after adulthood. Therefore, it is recommended that biological treatment be used as soon as possible if economic conditions permit to delay the development of the disease.

An industrial insight on treatment strategies of the pharmaceutical industry effluent with varying qualitative characteristics

Abstract This study aims to provide non-biological treatment solutions to the pharmaceutical industry, depending on the quantitative and qualitative aspects of the wastewater. Commonly overlooked aspects of industrial wastewater such as its fluctuating characteristics, selection of suitable sampling points, and adopting an appropriate treatment methodology are addressed. Different units in a drug-producing industry and chief ingredients at each stage were identified. An appropriate sampling point was finalized following a series of systematic and repeated samplings of prominent industrial locations, at different periods. High organic and solids strength industrial wastewater samples were characterized and subjected to various physico-chemical and oxidative techniques, namely electrocoagulation (EC), chemical coagulation, photocatalytic oxidation, electro-Fenton’s (EF), Photo-Fenton’s (PF), and Fenton’s oxidation. The highest total organic carbon (TOC) reduction efficiencies about 47, 23, and 62 % were obtained from Fenton’s oxidation for distinct samplings. The variation in quality of effluent heavily influences the treatment efficacies of individual treatment schemes. Hence, rigid treatment protocols are inadvisable to propose for industrial perspectives to handle diurnal variations in effluent characteristics. Rather, industry-specific solutions may be provided, depending on the type of wastewater generated.

Non-biological methods for phosphorus and nitrogen removal from wastewater: A gap analysis ofreinvented-toilet technologies with respect to ISO 30500.

The aims of the Reinvent the Toilet Challenge (RTTC) include creation of an off-the-grid sanitation system with operating costs of less than US$0.05 per user per day. Because of the small scale at which many reinvented toilets (RT) are intended to operate, non-biological treatment has been generally favored. The RTTC has already instigated notable technological advances in non-sewered sanitation systems (NSSS). However, increasingly stringent liquid effluent standards for N and P could limit the deployment of current RT in real-world scenarios, despite the urgent need for these systems. The newly adopted ISO 30500 standards for water reuse in NSSS dictate minimal use of chemical/biological additives, while at the same time requiring a 70% and 80% reduction in total nitrogen and phosphorus, respectively. This document provides a brief overview of the mature and emerging technologies for N and P (specifically ammonia/ammonium and orthophosphate) removal from wastewater. At present, the dearth of nutrient removal methods proven to be effective at small scales is a significant barrier to meeting ISO 30500 standards. Closing the gap between RTs and ISO 30500 will require significant investments in basic R&D of emerging technologies for non-biological N and P remediation and/or increased reliance on biological processes. Adaptation of existing nutrient-removal technologies to small-scale NSSS is a viable option that merits additional investigation.

Use of antidepressants and benzodiazepine-related hypnotics before and after initiation of TNF-\u03b1 inhibitors or non-biological systemic treatment in patients with rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis

BackgroundRheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) are autoimmune disorders associated with an increased risk for depression, anxiety and sleeping problems. The objective of this study was to analyze use of antidepressants and benzodiazepine-related hypnotics (BRH) in Sweden before and after first time treatment with anti-TNF and non-biological systemic (NBS) treatments among patients with the above diagnoses, and to correlate such use with that of randomly selected population controls.MethodsPatients and dispensed drugs were identified in nationwide Swedish healthcare registers. Proportions of subjects filling prescriptions of antidepressants and BRH from 2 years before start of treatment (index-date), and 2 years after index date were assessed. Using the period -6 months to index-date as reference, prevalence rate ratios were computed for 6 months’ intervals before and after index. For up to ten randomly selected population controls per patient, the same measures were calculated.ResultsA total of 6256 patients started anti-TNF treatment, and 13,241 NBS treatment. The mean age at index was 52.0 for the anti-TNF group and 56.1 for NBS. Use of antidepressants and BRH was similar in both treatment groups (10.4–12.8%), significantly more common than in the controls (6.6 to 7.6%). For all patients, proportions filling prescriptions for antidepressants and BRH decreased directly or soon after the index; no such changes were seen in the controls, who all showed a slow but steady increase in use over time. Starters of anti-TNF treatment did not show clearer decreases in use of psychotropics than those initiating NBS.ConclusionsDecreased rates of dispensed psychotropic drugs after the time of anti-TNF and NBS treatment initiation were seen among patients with autoimmune disorders but not population controls. This may correspond to treatment effects of anti-TNF and NBS also on psychiatric symptoms among these patients.

Impact of psoriasis severity on patient-reported clinical symptoms, health-related quality of life and work productivity among US patients: real-world data from the Corrona Psoriasis Registry

ObjectivesThis analysis examined the association between psoriasis severity, assessed by body surface area (BSA) and the Investigator’s Global Assessment (IGA; previously used only in clinical trials), and patient-reported outcomes (PROs)...

Non-biological methods for phosphorus and nitrogen removal from wastewater: A gap analysis ofreinvented-toilet technologies with respect to ISO 30500.

The aims of the Reinvent the Toilet Challenge (RTTC) include creation of an off-the-grid sanitation system with operating costs of less than US$0.05 per user per day. Because of the small scale at which many reinvented toilets (RT) are intended to operate, non-biological treatment has been generally favored. The RTTC has already instigated notable technological advances in non-sewered sanitation systems (NSSS). However, increasingly stringent effluent standards for N and P could limit the deployment of current RT in real-world scenarios, despite the urgent need for these systems. The newly adopted ISO 30500 standards for water reuse in NSSS dictate minimal use of chemical/biological additives, while at the same time requiring a 70% and 80% reduction in total nitrogen and phosphorus, respectively. This document provides a brief overview of the mature and emerging technologies for N and P removal from wastewater. At present, the dearth of nutrient removal methods proven to be effective at small scales is a significant barrier to meeting ISO 30500 standards. Closing the gap between RTs and ISO 30500 will require significant investments in basic R&D of emerging technologies for non-biological N and P remediation and/or increased reliance on biological processes. Adaptation of existing nutrient-removal technologies to small-scale NSSS is a viable option that merits additional investigation.