[THE EFFECT OF BIOLOGIC THERAPY ON THE LIPID PROFILE OF RHEUMATOID ARTHRITIS (RA), PSORIATIC ARTHRITIS (PSA) AND ANKYLOSING SPONDYLITIS (AS) PATIENTS].

INTRODUCTION: Cardiovascular (CV) morbidity and mortality is elevated in rheumatoid arthritis (RA), psoriatic arthritis (PSA) and ankylosing spondylitis (AS) patients. The inflammation not only accelerates atherosclerosis, but also influences CV risk factors such as lipid profile, blood pressure and insulin resistance. RA and PSA patients are initially treated with DMARDS (disease modifying anti-rheumatic drugs). However, if remission is not achieved in RA, a variety of biologics (anti- TNF rituximab, tocilizumab, abatacept) are added to the treatment regimen. In PSA, only anti-TNF drugs are approved. AS is treated solely by NSAIDS and anti-TNF drugs. DMARDS were found to reduce the CV morbidity in RA patients, in addition to their anti-inflammatory affect. However, it has not been proven that anti-inflammatory therapy reduces the cardiovascular risk in PSA and AS patients. Anti-TNF drugs have been shown to reduce CV morbidity and mortality in RA and AS patients, however their effect on these patient's lipid profile in not yet clear. Despite the scarce evidence available, it seems that rituximab may have a positive influence on the patient's lipid profile. Even though tocilizumab adversely affects the lipid profile, this drug's overall CV effect is still being examined in clinical trials. There is not enough evidence to determine the effect of abatacept on the lipid profile. These issues are currently in the focus of many clinical trials and no doubt these issues will be clarified in the future.

Predictors of left ventricular hypertrophy and their cutoffs in peritoneal dialysis patients.

Cardiovascular complications are the main cause of morbidity and mortality in peritoneal dialysis (PD) patients. Left ventricular hypertrophy (LVH) is a major predictor of the development of cardiovascular events. This study aimed to identify risk factors that contribute to the development of LVH and to determine their cutoffs in patients on maintenance peritoneal dialysis.In this cross sectional study we evaluated the association of 23 variables including age, PD vintage, ultrafiltration, urine volume, residual renal function, mean daily SBP, mean daily DBP, fasting glucose, HbA1c, peritoneal glucose load index (PGLI), fluid overload (FO), plasma brain natriuretic peptide (BNP), plasma hsCRP and IL-6, serum albumin, white blood cell (WBC) count, hemoglobin, hematocrit, triglycerides, LDL-C (low density lipoprotein cholesterol), HDL-C (high density lipoprotein cholesterol), and PTH with LVH in 38 stable patients on maintenance PD ≥ 24 months.LVH was detected in 57.9% of patients. Logistic regression and receiver operating characteristics (ROC) analysis revealed that HbA1c, PGLI, FO, plasma BNP, hsCRP and IL-6 seem to be possible predictors of LVH. The cutoffs associated with the presence of LVH were: 7.5%, 3.2 g/kg/day, 1.7 L, 330 pg/mL, 7.5 mg/dL and 3.3 pg/mL for HbA1c, PGLI, FO, plasma BNP, hsCRP and IL-6, respectively (sensitivity 72.8 to 81.8% and specificity 75.0 to 93.8%).The results suggest that efforts should be made to reduce the peritoneal glucose load (PGL), to improve the hydration status, and to attenuate the inflammatory process in order to reduce the risk of the development of LVH among PD patients.

The impact of glucose load on left ventricular mass in peritoneal dialysis patients.

BACKGROUND: Cardiovascular (CV) complications are the main cause of morbidity and mortality in peritoneal dialysis (PD) patients. Left ventricular hypertrophy (LVH) is a well-known major CV risk factor. AIM: To evaluate the impact of peritoneal glucose load on left ventricular mass (LVM) in PD patients. METHODS: In this cross sectional study the glucose load and LVM were evaluated in 43 stable patients on maintenance PD for 24 - 78 months. Glucose load was calculated using a unique peritoneal glucose load index (PGLI) referred to g/kg/day glucose given in the daily PD prescription. LVM index (LVMI) was calculated using the Devereux et al. formula. RESULTS: The PGLI was positively correlated with HbA1c and LVMI (p < 0.001). Patients with PGLI > 3 g/kg/day had higher HbA1c and LVMI compared to those with PGLI ≤ 3 g/kg/day (p < 0.001). CONCLUSIONS: Higher PGLI values were associated with worse glycemic control and increased LVMI. Efforts should be made to minimize the PGL. All other risk factors that may contribute to the development of LVH in PD patients should be identified and treated. Additional multicenter, randomized control trials are needed to determine the target objectives of PGLI.

Ag-CuO-Decorated Ceramic Membranes for Effective Treatment of Oily Wastewater.

Although ultrafiltration is a reliable method for separating oily wastewater, the process is limited by problems of low flux and membrane fouling. In this study, for the first time, commercial TiO2/ZrO2 ceramic membranes modified with silver-functionalized copper oxide (Ag-CuO) nanoparticles are reported for the improved separation performance of emulsified oil. Ag-CuO nanoparticles were synthesized via hydrothermal technique and dip-coated onto commercial membranes at varying concentrations (0.1, 0.5, and 1.0 wt.%). The prepared membranes were further examined to understand the improvements in oil-water separation due to Ag-CuO coating. All modified ceramic membranes exhibited higher hydrophilicity and decreased porosity. Additionally, the permeate flux, oil rejection, and antifouling performance of the Ag-CuO-coated membranes were more significantly improved than the pristine commercial membrane. The 0.5 wt.% modified membrane exhibited a 30% higher water flux (303.63 L m-2 h-1) and better oil rejection efficiency (97.8%) for oil/water separation among the modified membranes. After several separation cycles, the 0.5 wt.% Ag-CuO-modified membranes showed a constant permeate flux with an excellent oil rejection of >95% compared with the unmodified membrane. Moreover, the corrosion resistance of the coated membrane against acid, alkali, actual seawater, and oily wastewater was remarkable. Thus, the Ag-CuO-modified ceramic membranes are promising for oil separation applications due to their high flux, enhanced oil rejection, better antifouling characteristics, and good stability.

Environmental magnetic signatures in mangrove ecosystems in northern Persian Gulf: Implication for pollution assessment in marine environment.

Magnetic properties of root, bark, and leaf of mangrove (Avicenna marina) and sediment were determined for pollution assessment at three locations in the northern coast of the Persian Gulf. The study revealed that the sources of the particles deposited on leaf surfaces can be discriminated via saturation isothermal remanent magnetization (SIRM) values and heavy metal. However, different factors including wind direction, size of the magnetic particles and crown density, play a role using SIRM for biomonitoring of atmospheric particulate matter. For leaves, the significant correlations between SIRM and leaf elemental contents indicated that the deposited particles on their surface mainly have geogenic sources. The magnetic analyses revealed that leaves are more suitable than bark for monitoring atmospheric pollution using mangrove trees due to the effect of different factors including dense crown of trees, washing of tree trunk by sea waves, and elements translocation from roots and sediments. Instead, the positive and significant correlation between the SIRM values for sediments and mangrove roots, and no or negative correlation between sediments and roots with barks and leaves indicates that the magnetic properties of the sediments and mangrove roots are suitable indicators of pollution in aquatic environment.

An overview of microalgae biomass as a sustainable aquaculture feed ingredient: food security and circular economy.

Sustainable management of natural resources is critical to food security. The shrimp feed and fishery sector is expanding rapidly, necessitating the development of alternative sustainable components. Several factors necessitate the exploration of a new source of environmentally friendly and nutrient-rich fish feed ingredients. Microalgal biomass has the potential to support the growth of fish and shrimp aquaculture for global food security in the bio-economy. Algal biorefineries must valorize the whole crop to develop a viable microalgae-based economy. Microalgae have the potential to replace fish meal and fish oil in aquaculture and ensure sustainability standards. Microalgae biomasses provide essential amino acids, valuable triglycerides such as lipids, vitamins, and pigments, making them suitable as nutritional supplements in livestock feed formulations. Fish and microalgae have similar nutritional profiles, and digestibility is a critical aspect of the aquafeed formulation. A highly digestible feed reduces production costs, feed waste, and the risk of eutrophication. Due to low input costs, low carbon footprint, wastewater treatment benefits, and carbon credits from industrial CO2 conversion, microalgae-based fish and shrimp feeds have the potential to provide significant economic benefits. However, several challenges must be addressed before microalgal biomass and bioproducts may be used as fish feeds, including heavy metal bioaccumulation, poor algal biomass digestion, and antinutrient effects. Knowledge of biochemical composition is limited and diverse, and information on nutritional value is scattered or contradictory. This review article presents alternative approaches that could be used in aquaculture to make microalgal biomass a viable alternative to fish meal.

Acute kidney injury associated with metamizole sodium ingestion.

Metamizole sodium, a nonsteroidal anti-inflammatory drug, has been widely used in the last 100 years. Its efficacy as an analgesic and antipyretic is unquestionable. Only few cases of acute kidney injury (AKI) induced by metamizole sodium were reported in the medical literature. We report 11 adult patients with AKI that resulted from metamizole sodium ingestion. The data suggest a good prognosis in these cases of AKI. Renal biopsies, corticosteroids treatment, or renal replacement therapy seem to be not necessary. Hydration was sufficient to ensure spontaneous recovery.

Takotsubo cardiomyopathy associated with peritonitis in peritoneal dialysis patient.

Takotsubo cardiomyopathy (TTC) is characterized by clinical and electrocardiographic features that mimic acute myocardial infarction, normal or mildly elevated cardiac enzymes, distinctive left ventricular wall motion abnormalities, and absence of significant obstructive coronary artery disease. Often there is a history of emotional stress and usually encountered in postmenopausal women. Excessive catecholamine stimulation plays an important role in the pathogenesis of TTC. Usually, this condition is reversible within several weeks to months. Only two cases of TTC were described in patients on hemodialysis. To our knowledge, we report the first case of TTC in peritoneal dialysis and the first case associated with peritonitis.

Effects of omega-3 on lipid profile and inflammation markers in peritoneal dialysis patients.

INTRODUCTION: Cardiovascular complications are the main cause of mortality in patients with end-stage renal disease (ESRD). Peritoneal dialysis (PD) patients generally have a more atherogenic serum lipid profile. Although statins are the cornerstone of lipid-lowering therapy, there is an important role of fibrates in the treatment of hypertriglyceridemia. Fibrates increased the risk of rhabdomyolysis. ESRD patients are at risk for inadequate omega-3 intake as a result of renal dietary recommendations. In the general population omega-3 fatty acids play an important modulatory role in lipid regulation, immune and inflammatory responses, progression of arteriosclerosis, and cardiovascular disease. AIM: To evaluate the effect of oral omega-3 administration on plasma lipid levels and inflammatory markers in PD patients. PATIENTS AND METHODS: Fifteen adult and stable PD patients who did not receive omega-3 or fibrates treatment before were included in the study. All subjects followed the usual dialysis diet and regimen and continued with the same cholesterol-lowering statins. The patients were treated with daily oral 2.4 g docosahexaenoic acid and 1 g eicosapentaenoic acid supplementation in three divided doses with meals for 8 weeks. Triglycerides, LDL-C, HDL-C, and inflammation markers were evaluated before the administration of omega-3 and at 8 weeks. RESULTS: Triglyceride levels were decreased significantly (p = 0.001). Total, HDL and LDL cholesterol levels were not affected. ESR, CRP, IL-6, TNF-α, 4-hydroxynonenal, and malondialdehyde levels reduced insignificantly. CONCLUSIONS: This short-term pilot study demonstrated the efficacy, safety, and well tolerability of omega-3 in the treatment of hypertriglyceridemia in PD patients.

Effects of anti-TNF-α treatment on lipid profile in rheumatic diseases: an analytical cohort study.

BACKGROUND: The aim was to assess the influence of long-term treatment with tumor necrosis factor alpha (TNF-α) inhibitors on total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and atherogenic index (AI) in rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS) patients. METHODS: A retrospective cohort study was conducted on RA, PsA, and AS patients treated with TNF-α inhibitors for at least 270 days between 2001 and 2011. Levels of TC, TG, LDL, and HDL and the AI were compared with baseline values at 0-6, 6-12, 12-18, and 18-24 months. Patients were further subdivided into three groups according to their HMG CoA reductase inhibitor (statin) treatment status in order to assess their effect on the results. RESULTS: The records of 311 patients (152 RA, 90 PsA, and 69 AS) were reviewed. TC and TG increased following treatment with TNF-α inhibitors, from 180.85 ± 2.12 mg/dl and 116.00 ± 3.55 mg/dl at baseline to 188.12 ± 2.35 mg/dl (p = 0.02) and 132.02 ± 4.63 mg/dl at 0-6 months (p < 0.01), respectively, and to 184.88 ± 2.09 mg/dl (p = 0.02) and 129.36 ± 4.32 mg/dl at 18-24 months (p < 0.01), respectively. AI increased following treatment with TNF-α inhibitors, from -0.032 ± 0.017 at baseline to 0.004 ± 0.019 at 18-24 months (p < 0.01). LDL decreased significantly in patients who were treated with statins before and during the entire study period, from 119.97 ± 2.86 mg/dl at baseline to 104.02 ± 3.57 mg/dl at 18-24 months (p < 0.01), in contrast to an increase in LDL values in patients who did not receive statins during the study. CONCLUSIONS: TNF-α inhibitor treatment was associated with a significant increase in TC and TG levels and the AI. Adding statins to the treatment was associated with a significant decrease in LDL levels.

Unusual presentation of gallstones.

Gallstones are usually asymptomatic in the majority of patients. Gallstones can migrate through a cholecysto-duodenal fistula and may cause an intestinal obstruction anywhere along the gastrointestinal tract. The obstruction usually occurs at the level of the ileocecal valve. In most cases, the clinical presentation includes symptoms related to the intestinal obstruction including abdominal pain and vomiting. We report an unusual case of gallstones presented with acute prerenal azotemia as the major manifestation.

The impact of the peritoneal glucose load index on hydration status and inflammation in peritoneal dialysis patients.

OBJECTIVE: To evaluate the impact of the peritoneal glucose load (PGL) on hydration status and inflammation in peritoneal dialysis (PD) patients. METHODS: This cross-sectional study evaluated stable PD patients using a novel PGL index (PGLI), which was calculated as the net glucose content (g) in the PD solutions administered in the daily PD prescription divided by the dry body weight (kg) assessed by whole-body bioimpedance spectroscopy. The relationship between PGLI and glycosylated haemoglobin (HbA1c), fluid overload (FO), and inflammatory markers was investigated. RESULTS: A total of 43 stable PD patients participated in the study. Significant positive correlations were found between PGLI and HbA1c, FO, plasma high sensitivity C-reactive protein (hsCRP), and plasma interleukin-6 (IL-6) levels. HbA1c, FO, plasma hsCRP and plasma IL-6 levels were significantly higher in patients with PGLI >3 g/kg/day compared with those with PGLI ≤3 g/kg/day. CONCLUSIONS: PGLI values >3 g/kg/day may be associated with poor glycaemic control, over hydration and augmented inflammation. PGLI might be a useful tool for the quantitative assessment of the PGL and could be applied when managing PD patients.

Unusual case of pancreatic inflammatory myofibroblastic tumor associated with spontaneous splenic rupture.

BACKGROUND: Spontaneous splenic rupture considered a relatively rare but life threatening. The three commonest causes of spontaneous splenic rupture are malignant hematological diseases, viral infections and local inflammatory and neoplastic disorders. We describe a unique and unusual case of inflammatory myofibroblastic tumor of the tail of pancreas presented with massively enlarged spleen and spontaneous splenic rupture. CASE PRESENTATION: A 19 years old male patient with no significant past medical history presented to emergency room with abdominal pain and fatigue. Massively enlarged spleen was detected. Hypotension and rapid reduction of hemoglobin level necessitated urgent laparatomy. About 1.75 liters of blood were found in abdominal cavity. A large tumor arising from the tail of pancreas and local rupture of an enlarged spleen adjacent to the tumor were detected. Distal pancreatectomy and splenectomy were performed. To our knowledge, we report the first case of massively enlarged spleen that was complicated with spontaneous splenic rupture as a result of splenic congestion due to mechanical obstruction caused by an inflammatory myofibroblastic tumor of the tail of pancreas. A review of the literature is also presented. CONCLUSION: Inflammatory myofibroblastic tumor of the tail of pancreas should be included in the differential diagnosis of the etiological causes of massively enlarged spleen and spontaneous splenic rupture.