An unusual cause of reactive arthritis with urticarial: A case report.

Reactive arthritis (ReA) is a syndrome of arthritis and tenosynovitis with defined extra-articular manifestations following certain infections. Despite being recognized a long time ago, debates still surrounds its definition. It is still unclear if the spectrum of the disease should include arthritis induced by other than the classical organisms. Here, we present an unusual cause of ReA. A young healthy female patient presented with acute polyarthritis and acute urticaria after 2 weeks of diarrheal illness. She was found to have blastocystis in the stool microscopy. Extensive evaluation ruled out other causes of her arthritis. She received metronidazole with a short course of NSAIDS and steroids with complete resolution of her skin and joint symptoms. She was followed for six months with no recurrence of arthritis or urticaria. Blastocystis sp. is a parasite that is prevalent in developing countries. It has been linked to isolated ReA or isolated urticaria among a few other case reports. This is the very first case to have blastocystis induced ReA that coexisted with acute urticaria. Upon review of the literature, we found that blastocystis induced ReA affects mainly young and middle-aged females such as in our case. The arthritis is usually settled with the parasite eradication. Finally, urticaria might be a distinguishing feature for blastocystis induced ReA that requires specific antimicrobial therapy.

Concurrent Oxidation-Reduction Reactions in a Single System Using a Low-Plasma Phenomenon: Excellent Catalytic Performance and Stability in the Hydrogenation Reaction.

The catalytic activity and stability of metal nanocatalysts toward agglomeration and detachment during their preparation on a support surface are major challenges in practical applications. Herein, we report a novel, one-step, synchronized electro-oxidation-reduction "bottom-up" approach for the preparation of small and highly stable Cu nanoparticles (NPs) supported on a porous inorganic (TiO2@SiO2) coating with significant catalytic activity and stability. This unique embedded structure restrains the sintering of CuNPs on a porous TiO2@SiO2 surface at a high temperature and exhibits a high reduction ratio (100% in 60 s) and no decay in activity even after 30 cycles (>98% conversion in 3 min). This occurs in a model reaction of 4-nitrophenol (4-NP) hydrogenation, far exceeding the performance of most common catalysts observed to date. More importantly, nitroarene, ketone/aldehydes, and organic dyes were reduced to the corresponding compounds with 100% conversion. Density functional theory (DFT) calculations of experimental model systems with six Cu, two Fe, and four Ag clusters anchored on the TiO2 surface were conducted to verify the experimental observations. The experimental results and DFT calculations revealed that CuNPs not only favor the adsorption on the TiO2 surface over those of Fe and AgNPs but also boost the adsorption energy and activity of 4-NP. This strategy has also been extended to the preparation of other single-atom catalysts (e.g., FeNPs-TiO2@SiO2 and AgNPs-TiO2@SiO2), which exhibit excellent catalytic performance.

Quantitative Determination of Pitavastatin in Tablets Using FTIR and RP-HPLC Analysis: A Comparative Study.

BACKGROUND: Fourier Transform Infrared (FTIR) spectroscopy and reverse phase highperformance liquid chromatography, RP-HPLC analysis have been used for the quantitative determination of local l commercially available Pitavastatin products. METHODS: The FTIR method of analysis is not widely used in pharmaceutical quality control laboratories. This technique is non-destructive, reliable, precise, and efficient, and the samples can be prepared easily. These features emphasized that the FTIR technique can be considered as a potential analytical method for quantitative analysis in pharmaceutical laboratories. RESULTS: It is strongly recommended that FTIR analytical method can be applied simultaneously with RP-HPLC techniques for quality control purposes of drug analysis. Both methods of analysis have shown comparable precision and good repeatability and reproducibility for analysis of Pitavastatin which can be generalized for other pharmaceutical products. CONCLUSION: In addition, FTIR is not only used for the determination of vibrational modes and structure in the fingerprint region, but it can be also generally applied in quantitative analysis for many pharmaceutical products.

A Case Series and Literature Review of the Association of COVID-19 Vaccination With Autoimmune Diseases: Causality or Chance?

The coronavirus disease 2019 (COVID-19) pandemic has been a challenging time for the whole world. Ever since the start of the pandemic, vaccine development has been underway and now there are several approved COVID-19 vaccines bringing hope for the end of the pandemic. However, there have been been a few individuals who have been affected in some other ways by the COVID-19 vaccinations. Here in this case series, we present 16 cases of autoimmune diseases with a strong temporal relation with the COVID-19 vaccine. We would like to emphasize that COVID-19 vaccines are essential to alter the course of the pandemic and save lives and the temporal relation is not by any means proof of causation. However, we must be vigilant for the occurrence of these conditions.

Post-COVID-19 vaccine medium-vessel vasculitis and acute anterior uveitis, causation vs temporal relation; case report and literature review.

INTRODUCTION: and importance: Multiple immunologic phenomena were reported following the administration of COVID-19 vaccines. However, the important point is that their possible association with medium-vessel vasculitis involving the celiac trunk and its branches with acute anterior uveitis in the same patient has not been reported before. CASE PRESENTATION: In this manuscript, we are reporting a case of a middle-aged gentleman who developed vasculitis involving the celiac trunk and its branches, and acute anterior uveitis one week and three weeks after the second dose of Pfizer BioNTech COVID-19 vaccine, respectively. The patient showed significant clinical and radiographic improvement after receiving corticosteroids and azathioprine. CLINICAL DISCUSSION: Previously reported cases of vasculitis following COVID-19 vaccines included both renal-limited and more generalized vasculitis with some being positive and others negative for ANCA (anti-neutrophil cytoplasmic antibodies). Nevertheless, it is worth mentioning that most cases responded to immunosuppressive treatment. Post-COVID-19 vaccine uveitis was reported in patients with different age spans including both anterior and posterior uveitis, with remission being achieved after the use of corticosteroids. CONCLUSIONS: Multiple cases of vasculitis and acute anterior uveitis were reported following COVID-19 vaccines; however, it is important to mention that more research is needed to establish an association between the COVID-19 vaccine and both vasculitis and acute anterior uveitis. In our opinion, the benefits of the COIVID-19 vaccine largely outweigh the expected risks.

Neuromyelitis Optica Spectrum Disorder and Autoimmune Rheumatological Diseases: A Report of Two Cases and Literature Review.

Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune disorder, and its association with other autoinflammatory diseases has been reported in this study. In this article, we are discussing two patients with neuromyelitis optica who show evidence of autoimmune rheumatic diseases. The first case presented with acute myelitis and was diagnosed with NMOSD; she developed clinical features of Behçet's disease during follow-up, making it the second reported case worldwide. The second case presented with neuromyelitis optica and was found to have strongly positive Sjogren's serology.

Formulation and in vitro evaluation of self-nanoemulsifying liquisolid tablets of furosemide.

Self-nanoemulsifying drug delivery systems (SNEDDS) were used to enhance the dissolution rate of furosemide as a model for class IV drugs and the system was solidified into liquisolid tablets. SNEDDS of furosemide contained 10% Castor oil, 60% Cremophor EL, and 30% PEG 400. The mean droplets size was 17.9 ± 4.5 nm. The theoretical model was used to calculate the amounts of the carrier (Avicel PH101) and coating materials (Aerosil 200) to prepare liquisolid powder. Carrier/coating materials ratio of 5/1 was used and Ludipress was added to the solid system, thus tablets with hardness of 45 ± 2 N were obtained. Liquisolid tablets showed 2-folds increase in drug release as compared to the generic tablets after 60 min in HCl 0.1 N using USP apparatus-II. Furosemide loaded SNEDDS tablets have great prospects for further in vivo studies, and the theoretical model is useful for calculating the adequate amounts of adsorbents required to solidify these systems.

Clinical utility of ANA-ELISA vs ANA-immunofluorescence in connective tissue diseases.

We investigated the performance of ANA-ELISA for CTDs screening and diagnosis and comparing it to the conventional ANA-IIF. ANA-ELISA is a solid-phase immune assay includes 17 ANA-targeted recombinant antigens; dsDNA, Sm-D, Rib-P, PCNA, U1-RNP (70, A, C), SS-A/Ro (52 and 60), SS-B/La, Centromere B, Scl-70, Fibrillarin, RNA Polymerase III, Jo-1, Mi-2, and PM-Scl. During the period between March till December 2016 all requests for ANA from primary, secondary, and tertiary care centers were processed with both techniques; ANA-IIF and ANA-ELISA. The electronic medical record of these patients was reviewed looking for CTD diagnosis documented by the Senior rheumatologist. SPSS 22 is used for analysis. Between March and December 2016, a total of 12,439 ANA tests were requested. 1457 patients were assessed by the rheumatologist and included in the analysis. At a cut-off ratio ≥ 1.0 for ANA-ELISA and a dilutional titre ≥ 1:80 for ANA-IIF, the sensitivity of ANA-IIF and ANA-ELISA for all CTDs were 63.3% vs 74.8% respectively. For the SLE it was 64.3% vs 76.9%, Sjogren's Syndrome was 50% vs 76.9% respectively. The overall specificity of ANA-ELISA was 89.05%, which was slightly better than ANA-IIF 86.72%. The clinical performance of ANA-ELISA for CTDs screening showed better sensitivity and specificity as compared to the conventional ANA-IIF in our cohort.

Increased Fracture Risk After Bariatric Surgery: a Case-Controlled Study with a Long-Term Follow-Up.

PURPOSE: Bariatric surgeries are common procedures due to the high prevalence of obesity. This study aimed to investigate whether bariatric surgery increases fracture risk. MATERIAL AND METHODS: It was a case-controlled study. Patients who underwent bariatric surgery during 2011 and 2012 were matched for age (± 5 years) and gender to patients on medical weight management during the same period with a ratio of 1:2. The index date was defined as the date of bariatric surgery for both groups. The subject's electronic medical records were reviewed retrospectively to identify fractures documented by radiology during January 2020. RESULTS: Randomly selected 403 cases were matched to 806 controls with a median age of 36.0 years (IQR 14.0) and 37.0 years (IQR 14.0), respectively. Seventy per cent of the cohort were females. Eighty per cent received sleeve gastrectomy, and the remaining (17%) underwent gastric bypass. The mean duration of follow-up was 8.6 years. The fracture rate was higher in the surgical group as compared to the controls (9.4% vs 3.5%) with a crude odds ratio of 2.71 (95% CI 1.69-4.36). The median duration for time to fracture was 4.17 years for the surgical group and 6.09 years for controls (p-value = 0.097). The most common site of fractures was feet, followed by hands. Apart from a few wrist fractures, there was no typical osteoporotic sites fracture. CONCLUSION: Subjects who underwent bariatric procedures had more non-typical osteoporotic site fractures affecting mainly feet and hands, and fractures tend to occur earlier as compared to controls.

Isolation, Structural characterization, and antiproliferative activity of phycocolloids from the red seaweed Laurencia papillosa on MCF-7 human breast cancer cells.

Hydrocolloids from seaweeds (phycocolloids) have interesting functional properties like antiproliferative activity. Marine algae consumptions are linked to law cancer incidences in countries that traditionally consume marine products. In this study, we have investigated water-soluble sulfated polysaccharides isolated from the red seaweed Laurencia papillosa and determined their chemical characteristics and biological activities on the human breast cancer cell line MCF-7. Total polysaccharides were extracted and fractionated from L. papillosa and characterized using FTIR-ATR and NMR spectrometry. In addition, their approximate molar mass was determined by GPC method. The chemical characterization of purified polysaccharides reveals the presence of sulfated polysaccharides differentially dispersed in the algal cell wall. They are the three types of carrageenan, kappa, iota and lambda carrageenans, named LP-W1, -W2 and -W3 respectively. Biological effects and cytotoxicity of the identified of the three sulfated polysaccharide fractions were evaluated in MCF-7 cell line. Our results showed a significant inhibition of MCF-7 cell viability by dose-dependent manner for cells exposed to LP-W2 and LP-W3 polysaccharides for 24h. The mechanistic of LP fractions-mediated apoptosis in MCF-7 cells was demonstrated. The biological effects of L. papillosa SPs indicate that it may be a promising candidate for breast cancer prevention and therapy.

Kikuchi-Fujimoto Disease Associated with Sjögren's Syndrome: A Case Report.

Kikuchi-Fujimoto disease (KFD) or Kikuchi histiocytic necrotizing lymphadenitis, is an extremely rare, benign and self-limiting disease which can be confused with lymphoma and sometime with infections such as tuberculosis. It has also been infrequently reported in association with autoimmune diseases. KFD shares sex and age predisposition as well as histological features with systemic lupus erythematosus. The co-existence of KFD with primary Sjögren's syndrome has only been rarely reported. Here we describe the case of a 33-year-old woman who was diagnosed with KFD and also found to have primary Sjögren's syndrome. LEARNING POINTS: To understand the relationship between Kikuchi-Fujimoto disease (KFD) and Sjögren's syndrome.KFD shares some characteristics with autoimmune diseases.It is important to maintain a high index of suspicion of Sjögren's syndrome and diffuse lymphadenopathy in patients with KFD.

Posterior Reversible Encephalopathy Syndrome (PRES) in Rheumatic Autoimmune Disease.

Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological entity with many causes. The primary abnormality is cerebral vasogenic oedema. Here we describe the management of five patients with PRES syndrome who presented to our hospital. LEARNING POINTS: Posterior reversible encephalopathy syndrome (PRES) presents with cerebral vasogenic oedema.PRES resolves when blood pressure is controlled.Patients with a history of autoimmune disorder who present with confusion may have PRES.

Seropositive Rheumatoid Arthritis with Very Unusual X-ray Findings.

We described the case of a 23-year-old Nepalese man with seropositive rheumatoid arthritis and abnormal x-ray findings, found to be due to a very rare bone disease: Camurati Engelmann disease or progressive diaphyseal dysplasia (PDD). This is the first case reported in the Gulf area, although approximately 300 cases have been described worldwide. These patients usually present with limb pain and easy fatigability. Our patient first presented with bilateral, symmetrical inflammatory polyarthritis involving the knees, ankles and wrists but sparing the hands and feet. The diagnosis of PDD in our case was based on the classic radiological findings and a bone scan. LEARNING POINTS: Rheumatoid arthritis is a common condition with typical radiological findings.Any unusual radiological finding should be carefully assessed and explained.In our case the unusual findings were due to progressive diaphyseal dysplasia.

Seronegative Bilateral Symmetrical Inflammatory Polyarthritis: Think Twice Before Starting Immunosuppression.

The most common cause of bilateral symmetrical polyarthritis in the small joints is rheumatoid arthritis. However, if seronegative arthritis is involved, it could be the case that other underlying causes need to be diagnosed. This is particularly important for those coming from or living in developing countries where infectious causes should always be considered. The case of a young Nepali woman is presented in this article. She was referred as a case of seronegative rheumatoid arthritis for DMARDs therapy but this was not the case due to her origin from Nepal and seronegativity for RF, Anti-ccp, and ANA as well as faint macular skin lesions over her face and upper extremities, which the patients are not aware of. Consequently, skin biopsy was carried out which subsequently confirmed that the infectious cause of her polyarthritis was leprosy. LEARNING POINTS: Bilateral symmetrical seronegative inflammatory arthritis of rheumatoid type is very common.However, when both RF and anti-ccp are negative, other possible secondary causes including infection should be considered, especially in patients from areas where disease is endemic.In this case lepromatous leprosy was the cause of the patient's presumed rheumatoid arthritis and all her arthritis resolved after her leprosy had been treated.

An Unusual Case of Large-Vessel Vasculitis.

We report the case of a previously healthy 35-year-old man who presented with severe abdominal pain, nausea, vomiting and subjective fever and was found to have acute kidney injury, haematuria, leukocytosis and elevated inflammatory markers. An abdominal CT scan showed lobar nephronia of the left kidney complicated by infarction. Subsequent MRI also revealed splenic infarction. Despite IV antibiotics and US-guided perinephric collection drainage, the condition of the patient continued to deteriorate so he underwent total nephrectomy. Serial follow-up CT scans showed multi-level vascular occlusions, bowel ischaemia and splenic infarction. Large-vessel vasculitis was suspected, and pulse steroid therapy was planned. However, the histopathology report of the resected kidney revealed mucor-like fungal infection suggestive of invasive mucormycosis as a cause for the widespread vasculitis. Although IV amphotericin B and caspofungin were started immediately, the patient died a few days later. We report this case to raise awareness that invasive fungal infection can cause large-vessel vasculitis. Immunosuppression for patients from endemic areas should only be considered after an infectious aetiology for vasculitis has been excluded. LEARNING POINTS: Although the cause of vasculitis is not usually known, infectious agents can be implicated.Infectious causes should always be considered in patients from endemic areas.We report mucormycosis as a cause of widespread large-vessel vasculitis.