Land-based plastic leakage into the aquatic environment from municipal solid waste - Waste flow diagram applied to Tuy Hoa City, Phu Yen, Vietnam.

Plastic mismanagement and its subsequent pollution by rapid economic development and urbanisation pose significant challenges for modern world society. Notwithstanding one of the main sources for macro plastic leakage into the ocean from land, precise assessment of plastic pollution origins from Southeast Asia is yet to be clearly examined. In order to make informed decisions and prioritise areas of improvement it is required to better understand the waste leakage dynamics at the local level. In this work, the Waste Flow Diagram (WFD) was applied to understand the sources and fates of plastics leaking from the solid waste management system for the case of Tuy Hoa City, Phu Yen, Vietnam. The study shows scenarios of leakage into the aquatic environment ranging from 0.8 to 2.7 kg/cap/year, which originates mainly from the collection system. Targeted improvements to this stage of the service could reduce leakages and the overall environmental impacts of mismanaged plastic waste. The results of this study show the necessity and importance of having up to date and reliable data to better inform stakeholders and service planning, facilitating efficient action against plastic pollution. As the first peer-reviewed scientific article critically applying the WFD, this work highlights the steps and challenges of the methodology and critically analyses different methodological pathways.

PEGylated liposomes for diagnosis of polyethylene glycol allergy.

BACKGROUND: Polyethylene glycol (PEG) is a nonprotein polymer that is present in its native (unbound) form as an excipient in a range of products. It is increasingly being utilized clinically in the form of PEGylated liposomal medications and vaccines. PEG is the cause of anaphylaxis in a small percentage of drug reactions; however, diagnosis of PEG allergy is complicated by the variable and poor diagnostic performance of current skin testing protocols. OBJECTIVE: We assessed the diagnostic performance of PEGylated lipid medications as an alternative to currently described tests that use medications containing PEG excipients. METHODS: Nine patients with a strong history of PEG allergy were evaluated by skin testing with a panel of PEG-containing medications and with a PEGylated lipid nanoparticle vaccine (BNT162b2). Reactivity of basophils to unbound and liposomal PEG was assessed ex vivo, and specificity of basophil responses to PEGylated liposomes was investigated with a competitive inhibition assay. More detailed information is provided in this article's Methods section in the Online Repository available at www.jacionline.org. RESULTS: Despite compelling histories of anaphylaxis to PEG-containing medications, only 2 (22%) of 9 patients were skin test positive for purified PEG or their index reaction-indicated PEG-containing compound. Conversely, all 9 patients were skin test positive or basophil activation test positive to PEGylated liposomal BNT162b2 vaccine. Concordantly, PEGylated liposomal drugs (BNT162b2 vaccine and PEGylated liposomal doxorubicin), but not purified PEG2000, consistently induced basophil activation ex vivo in patients with PEG allergy but not in nonallergic controls. Basophil reactivity to PEGylated nanoparticles competitively inhibited by preincubation of basophils with native PEG2000. CONCLUSION: Presentation of PEG on the surface of a lipid nanoparticle increases its in vivo and ex vivo allergenicity, and improves diagnosis of PEG allergy.

Outcomes of Serum Food-Specific Immunoglobulin G 4 to Guide Elimination Diet in Patients With Eosinophilic Esophagitis.

INTRODUCTION: Eosinophilic esophagitis (EoE) is associated with atopy; however, recent studies have identified an association with food-specific immunoglobulin G 4 (FS-IgG 4 ) rather than immunoglobulin E antibodies. This study aimed to evaluate the role of serum FS-IgG 4 in guiding an elimination diet and its outcomes. METHODS: Patients with and without EoE were enrolled in a prospective, controlled, single tertiary center trial. Serum FS-IgG 4 titers, esophageal eosinophil counts, and dysphagia symptom questionnaire scores were assessed, and participants with elevated FS-IgG 4 (ImmunoCAP, cutoff of 10 mgA/L) commenced 6-week targeted elimination diet. Repeat serum FS-IgG 4 and endoscopic and histologic examination were performed at 6-week follow-up. RESULTS: Twenty-two patients with active EoE and 13 controls were recruited. Serum FS-IgG 4 to milk, wheat, soy, eggs, and nuts was significantly higher in EoE ( P = 0.0002, P = 0.002, P = 0.003, P = 0.012, and P < 0.001, respectively). Elevated serum FS-IgG 4 to 1 or more food groups (median 2) was identified in 21/22 (95.4%) patients with EoE; 20/21 underwent 6-week dietary elimination. Median reductions in dysphagia symptom questionnaire score and EoE endoscopic reference score after elimination were 8 ( P = 0.0007) and 1 ( P = 0.002), respectively. Nine (45%) patients had histological remission (<15 eosinophils per high-power field). Fall in median esophageal eosinophil count was not statistically significant (50 vs 23; P = 0.068). Serum FS-IgG 4 did not decline by 6-week follow-up. DISCUSSION: Serum FS-IgG 4 to milk, wheat, soy, egg, and nuts was present at higher levels in EoE, with targeted elimination resulting in 45% histologic remission rate. Serum FS-IgG 4 has potential as a noninvasive biomarker in EoE. When successful, FS-IgG 4 -led elimination diet can negate need for medications and be viewed more favorably by patients because of its smaller endoscopic burden compared with empirical elimination diets.

The role of major and minor determinants in penicillin allergy testing: Time to revisit an old friend?

Background: Skin testing is an important step in evaluation of penicillin allergic reactions. It includes testing to the following: amoxicillin, benzyl penicillin, and products generated in vivo after penicillin administration, the major determinant hapten penicilloyl-polylysine (PPL) and the minor determinant mixture (MDM). Although PPL and MDM are available as a commercial kit, their supply and cost remain problematic. Objective: We aimed to evaluate the performance and utility of PPL and MDM in penicillin allergy testing. Methods: A retrospective audit over a 5-year period was undertaken for those with penicillin testing in a tertiary immunology unit. Results: In all, 214 patients were identified. Of those patients, 151 (70.6%) were female and the average age was 58 years. Unspecified penicillin was the most common index drug (n = 127 [59.3%]), followed by amoxicillin (n =3 [24.8%]) and amoxicillin-clavulanic acid (n = 21 [9.7%]). The result of skin testing was positive in 23 patients (10.7%); skin prick testing was positive in 10 patients (4.7%), and intradermal testing (IDT) was positive in 13 patients (6.1%), the majority of whom had identified amoxicillin or amoxicillin-clavulanic acid as the index drug (n = 22 [95.7%]). The result of testing to PPL and/or MDM was positive with IDT only (n=5 [23.8%]). PPL and MDM positivity coexisted with a positive reaction to amoxicillin IDT in 2 patients, 1 of whom passed an amoxicillin challenge. Additionally, 2 positive tests to PPL were present with a negative result for MDM; of these 2 positive results, 1 was positive to amoxicillin IDT. In only 1 case were the results of testing for MDM and PPL both positive, with negative results to all native ß-lactams tested; the patient tolerated an amoxicillin challenge. Overall, the negative predictive value for both skin prick testing and IDT was 89.5%. Conclusion: Benzyl penicillin and amoxicillin alone may be sufficient for in vivo testing in suspected individuals with penicillin allergy.

The development of Jack Jumper ant venom immunotherapy: our 25 years' experience.

Jack Jumper ant venom allergy is a uniquely Australian medical issue. The stinging ant is a leading cause of insect venom allergy in south-eastern Australia. An effective venom immunotherapy-based treatment was successfully developed by the Tasmanian Jack Jumper Allergy Research group. This paper provides a synopsis of our 25 years' research journey in developing this evidence-based treatment modality.

Developing mango powders by foam mat drying technology.

Using mango purée from overripe mangoes to produce powders helped to solve agricultural product stagnation. The research investigates the effect of thickening additives, convection drying, and heat pump drying on bioactive compounds such as total phenolic content (TPC), total flavonoid content (TFC), color, and solubility of the final product. The obtained results showed that the mixture (gum arabic and maltodextrin in the ratio 50:50 w/w) at a concentration of 15% gave a good quality powder texture when dried by hot air convection at 55°C with TPC (21.24 ± 1.58 mg GAE/g dry weight [DW]) and TFC (0.34 ± 0.02 mg QE/g DW), respectively. In addition, the product has a high solubility of 64.35%, with the highest pass-through point of 17.11.

Prevalence and factors associated with long COVID and mental health status among recovered COVID-19 patients in southern Thailand.

Mental health disorders have become a growing public health concern among individuals recovering from COVID-19. Long COVID, a condition where symptoms persist for an extended period, can predict psychological problems among COVID-19 patients. This study aimed to investigate the prevalence of long COVID and mental health status among Thai adults who had recovered from COVID-19, identify the association between the mental health status and long COVID symptoms, and investigate the risk factors associated with the correlation between long COVID and mental health outcomes. A cross-sectional study was conducted among 939 randomly selected participants in Nakhon Si Thammarat province, southern Thailand. The Depression, Anxiety, and Stress Scale-21 was used to investigate mental health symptoms, and a checklist comprised of thirteen common symptoms was used to identify the long COVID among participants. Logistic regression models were used to investigate the risk factors associated with mental health status and long COVID symptoms among participants. Among the 939 participants, 104 (11.1%) had depression, 179 (19.1%) had anxiety, and 42 (4.8%) were stressed. A total of 745 participants (79.3%) reported experiencing at least one symptom of long COVID, with fatigue (72.9%, SE±0.02), cough (66.0%, SE±0.02), and muscle pain (54.1%, SE±0.02) being the most frequently reported symptoms. All long COVID symptoms were significantly associated with mental health status. Shortness of breath, fatigue, and chest tightness were the highest risk factors for mental health status among COVID-19 patients. The final multivariable model indicated that female patients (OR = 1.89), medical history (OR = 1.92), and monthly income lower than 5,000 Thai baht (OR = 2.09) were associated with developing long COVID symptoms and mental health status (all p<0.01). This study provides valuable insights into the potential long-term effects of COVID-19 on mental health and enhances understanding of the mechanisms underlying the condition for predicting the occurrence of mental health issues in Thai COVID-19 patients.

Prevalence and predictors of depression, anxiety, and stress among recovered COVID-19 patients in Vietnam.

Background: During the COVID-19 pandemic, a high prevalence of mental health distress has been reported among people who have recovered from the disease. Objectives: To assess the prevalence of depression, anxiety, and stress as well as identify predictors among recovered COVID-19 patients after more than six months of being discharged in Dong Thap Province, Vietnam. Material and methods: The cross-sectional study was conducted among 549 eligible participants recruited by stratified sampling. Data was collected using the depression, anxiety and stress scale - 21 items had Content Validity Index = 0.9, and Cronbach's alpha for depression, anxiety and stress sub-scales were 0.95, 0.81, and 0.86, respectively. Descriptive statistics were used to measure the prevalence levels and distribution of characteristics of the participant, while factors influencing depression, anxiety, and stress were predicted using binary logistic regression. Results: The overall prevalence of depression, anxiety, and stress were 24.8% (95% CI: 21.2-28.6), 41.5% (95% CI: 37.4-45.8), and 25.3% (95% CI: 21.7-29.2), respectively. The predictors of depression were living in urban area (OR = 1.97; 95% CI: 1.27-3.08), holding a bachelor's degree (OR:3.51; 95% CI: 1.13-10.8), having a high monthly income (OR: 2.57; 95% CI: 1.03-6.38), diabetes (OR: 2.21; 95% CI: 1.04-4.68), heart disease (OR: 3.83; 95% CI: 1.79-8.17), respiratory disease (OR: 3.49; 95% CI: 1.24-9.84), and diarrhea (OR: 4.07; 95% CI: 1.06-15.6). Living in the urban area (OR: 1.57; 95% CI: 1.07-2.29), having sleep disturbance (OR: 2.32; 95% CI: 1.56-3.46), and fatigue (OR: 1.57; 95% CI: 1.03-2.39) were predictors for anxiety. Having respiratory disease (OR: 3.75; 95% CI: 1.47-9.60) or diarrhea (OR: 4.34; 95% CI: 1.18-15.9) were predictors of stress. Conclusion: People who have recovered from COVID-19 should be assessed for symptoms of depression, anxiety, and stress. Primary healthcare providers should develop interventions to support their recovery.

Lenalidomide Desensitization for Delayed Cutaneous Reaction: A Case Series and Review of the Literature.

BACKGROUND: Lenalidomide is commonly used for treatment of multiple myeloma (MM) as well as other hematological disorders. Cutaneous adverse reactions occur frequently and withholding lenalidomide treatment may have implications for prognosis. OBJECTIVE: To evaluate the role of lenalidomide desensitization in patients with cutaneous adverse reactions. METHODS: A retrospective review of patients referred for lenalidomide desensitization between May 2019 and May 2022 at a tertiary hospital. All patients underwent a 6-week outpatient desensitization with premedication. RESULTS: There were 12 patients: 10 males and 2 females with a median age of 65 years. All had MM with autologous stem cell transplantation and lenalidomide 10 mg daily added for maintenance therapy. Most patients (n = 8) had a generalized maculopapular exanthem with or without pruritus. All patients had delayed cutaneous reactions; the median time to onset was 14 days (range 2-28 d). Six patients tolerated desensitization: 5 on the first attempt and 1 after 3 attempts and supplementary oral prednisolone. Four patients underwent multiple (≤3) attempts at desensitization owing to breakthrough symptoms. In patients who failed desensitization, recurrence of symptoms occurred variably, either early (within days), within weeks, or delayed by more than 1 month. CONCLUSIONS: Lenalidomide desensitization is worthwhile and allows continuation of treatment. In our MM cohort, lenalidomide desensitization was successful in only 50% of cases, including some cases in whom ongoing symptoms were mitigated by cotreatment with antihistamine.

Variability of Microcystin-LR Standards Available from Seven Commercial Vendors.

Microcystins (MCs) are a large group of heptapeptide cyanobacterial toxins commonly produced in harmful algal blooms (HABs) and associated with adverse health effects in wildlife, livestock, pets, and humans. MC chemical standards are extracted from cyanobacteria biomass rather than produced synthetically and are used in water assessment methods and toxicological studies. MC standards are generally supplied in less than 1 mg quantities, and verification of the mass can only be accomplished by analytical chemistry methods using a certified reference of the specific MC for comparison. Analytical quantification of MCs in environmental samples and toxicology studies using accurate doses of test chemicals administered to experimental animals rely on the availability and accuracy of chemical standards. To check the accuracy and purity of available standards, seven individual microcystin-LR (MCLR) standards were purchased from separate commercial vendors and analyzed to determine the actual mass supplied and identify the presence of potential contaminants. To determine the effect of varying toxin mass in toxicological studies, each MCLR standard was administered to CD-1 mice in doses based on mass purchased, by a single 40 µg/kg intraperitoneal injection. The measured mass purchased varied from the vendor label mass by more than 35% for two of the seven MCLR standards. Contaminants, including trifluoroacetic acid (TFA), were identified in four of the seven samples. Comparative in vivo hepatotoxicity between vendor samples closely reflected the actual amount of MCLR present in each standard and demonstrated the toxicological impact of varying cyanotoxin mass.

COVID vaccination can be performed in patients with a history of allergic reactions to the vaccines or their components: experience from a specialist clinic in South Australia.

BACKGROUND: The development of vaccines against SARS-CoV2 has been a key public health response to the COVID-19 pandemic. However, since their introduction, there have been reports of anaphylactic reactions to vaccines in individuals with history of allergic reactions to other vaccines, excipients or to COVID vaccines. AIM: A dedicated adult COVID vaccine allergy clinic with a standardised allergy testing protocol was set up to investigate safety and suitability of available COVID vaccines in Australia. METHODS: Patients referred to a state-wide COVID-19 vaccine allergy clinic between March and August 2021 with a history of allergy underwent skin-prick testing and intradermal testing to both available vaccine formulations (BNT162b2 and ChAdOx1-S), excipients (polyethylene glycol and polysorbate 80), excipient-containing medications and controls. Basophil activation testing was conducted in few subjects with convincing history of immediate type reactions. RESULTS: Fifty-three patients underwent testing for possible excipient allergy (n = 19), previous non-COVID vaccine reaction (n = 13) or previous reaction to dose 1 of COVID-19 vaccine (n = 21). Patients were predominantly female (n = 43, 81%), aged 18-83 (median 54) years. Forty-four patients tested negative and 42 of these received at least their first dose of a COVID-19 vaccine. Nine patients tested positive to excipients or excipient-containing medication only (n = 3), or vaccines (n = 6). Five patients were positive to just BNT162b2, 3/5 have been vaccinated with ChAdOx1-S. One who was skin test positive to both vaccines, but negative BAT to ChAdOx1-S was successfully vaccinated with ChAdOx1-S. CONCLUSION: Even in a high-risk population, most patients can be vaccinated with available COVID-19 vaccines. This paper reports local experiences using a combined allergy testing protocol with skin testing and BAT during the pandemic.

AstraZeneca ChAdOx1-S COVID-19 vaccine can be safely administered in patients with EDTA allergy.

BACKGROUND: Immediate hypersensitivity reactions to COVID-19 vaccines have been postulated to be linked to their excipients, such as polyethylene glycol (PEG) in Pfizer Comirnaty, or polysorbate 80 and ethylenediaminetetracetic acid (EDTA) in AstraZeneca ChAdOx1-S [recombinant] (Vaxzevria). These excipients are found in a range of other products, including injectable and oral medications as well as intravenous radiocontrast media (RCM) and various cosmetic products. Patients with proven excipient allergy may be advised to avoid a COVID-19 vaccine containing that excipient and/or potentially cross-reactive excipients. This may result in individual patients not receiving vaccines, especially if an alternate option is not available, and on a broader level contribute to vaccine hesitancy. We present two cases of previously confirmed EDTA anaphylaxis with positive intradermal testing, who had negative Vaxzevria vaccine in-vivo testing and subsequently tolerated the vaccine. CASE 1: A patient with history of anaphylaxis to RCM and local anaesthetics (LA) had positive intradermal test (IDT) to EDTA nine years earlier. Skin testing to Vaxzeria vaccine (up to 1:10 IDT), Comirnaty vaccine (up to 1:10 IDT) and EDTA 0.3 mg/mL IDT were negative. However, following EDTA 3 mg/ml IDT, he developed immediate generalised urticaria without anaphylaxis. Basophil activation testing was negative to disodium EDTA, Vaxzevria and Cominarty vaccines. Given the negative in-vitro and in-vivo testing to Vaxzevria vaccine, he proceeded to Vaxzevria immunisation and tolerated both doses. CASE 2: A patient with history of anaphylaxis to RCM had positive skin testing to EDTA and RCM containing EDTA six years earlier. Following referral to COVID19 vaccine clinic, Vaxzevria vaccine (1:10 IDT) and Cominarty vaccine (1:10 IDT) were negative whilst EDTA was positive at 0.3 mg/mL IDT. He subsequently tolerated both Vaxzevria vaccinations. CONCLUSION: Excipient allergy does not necessarily preclude a patient from receiving a vaccine containing that excipient. Allergy testing can help identify excipient-allergic patients who may still tolerate vaccination, which is important in situations where COVID-19 vaccination options are limited.

Real-world off-label use of icatibant for acute management of non-hereditary angioedema.

We retrospectively examined the indications and efficacy of off-label use of the bradykinin B2 receptor antagonist icatibant. The clinical heterogeneity, variability of response to icatibant and lack of efficacy of adrenaline described in this audit highlights both the need for biomarkers that can rapidly distinguish between histaminergic and non-histaminergic angioedema, and for guidelines to improve the utility of icatibant in the non-hereditary angioedema setting.

Anakinra desensitisation in patients with cryopyrin-associated periodic syndromes.

Cryopyrin-associated periodic syndrome (CAPS) is rare and patients experience rashes, arthralgias and fevers despite supportive treatment. In these cases, anakinra subcutaneous therapy is indicated which provides symptom control. However, adverse reactions notably injection-site related, are common resulting in treatment cessation in these patients. Ongoing symptoms lead to morbidity and predispose patients to complications such as amyloidosis. We describe our experience with anakinra desensitisation in two cases with CAPS who had injection-site related reactions. We also propose a 34-day outpatient desensitisation protocol.

Vogt-Koyanagi-Harada syndrome presenting with bilateral optic disc swelling and leptomeningeal enhancement.

Vogt-Koynagi-Harada (VKH) disease is a clinical syndrome with classical ocular and extraocular findings that is not uncommonly described in Asian, Middle-Eastern and South American populations. We describe a case of VKH in an elderly Polish-Australian distinguished by prominent bilateral disc swelling rather than uveitis and marked leptomeningeal enhancement on MRI which led to extensive investigation including brain biopsy. Both disc oedema and MRI abnormalities improved dramatically with systemic steroid therapy. VKH disease is an important differential to consider in older patients with an uveo-meningeal picture and atypical eye findings where other causes have been excluded.