Excessive Dynamic Airway Collapse After Entecavir Use in a Patient With Pegylated Interferon-Induced Undifferentiated Connective Tissue Disease and Entecavir Use to Prevent Hepatitis B Virus Reactivation Upon Giving Rituximab.

Pegylated interferon-alpha (PEG-IFN-α) is an antiviral medication used to treat chronic hepatitis C virus (HCV) and hepatitis B virus (HBV) infections. It may result in rare but severe side effects, such as undifferentiated connective tissue disease (UCTD) and excessive dynamic airway collapse (EDAC), which can occur as delayed complications of PEG-IFN-α-induced UCTD. In cases where these complications arise, entecavir, employed for treating HBV infection, may be considered. A 49-year-old female patient, monitored for nine years with HCV and a viral load of 1.5 million, genotype 3, and normal liver function tests (LFTs), possibly acquired the infection from her HCV-positive husband. The patient was initially treated with PEG-IFN-α (IFN-α-2b, 100 µg/week subcutaneously) and ribavirin (RBV, 500 mg/twice daily). Following the sixth injection, the patient exhibited symptoms, including shortness of breath and cough, leading to limited daily activities. Subsequent high-resolution computed tomography (HRCT) showed interstitial pneumonitis (IP) signs. She was given a high dose of steroids. Over the next two to four weeks, the patient experienced Raynaud's phenomenon, skin tightening, joint pains, and dryness of the eyes and mouth. The antinuclear antibody (ANA) test was negative, while the extractable nuclear antigen (ENA) test showed equivocal anti-Smith antibodies (6.38). Rheumatoid factor (RA) factors were mildly positive, and pulmonary function tests (PFTs) indicated a restrictive pattern. The patient was intolerant to hydroxychloroquine (HCQ) and azathioprine (Imuran) 500 mg, subsequently receiving mycophenolate mofetil 500 mg/thrice daily. Despite four years of treatment, UCTD due to PEG-IFN-α remained difficult to control; however, IP responded well to steroids. Rituximab pulse therapy was planned before the initiation; serological tests showed positive anti-HBs with a titer of 17.02, positive anti-HBc, but negative HBsAg and undetectable HBV viral load, indicating immunity to HBV due to natural infection. Given the potential for rituximab to cause immunosuppression and HBV reactivation, entecavir treatment was started and continued for 18 months. The patient was followed for another five years, during which her LFTs and viral markers showed stability. However, after nine years of PEG-IFN-α-induced UCTD disorder, she experienced a reoccurring cough but was unresponsive to steroids that were against her suspicion of a flare of IP. A subsequent dynamic CT scan detected a 75% trachea collapse while in a supine position, indicating a potential complication termed EDAC. This EDAC could not be linked to PEG-IFN-α-induced UCTD disorder or EDAC after the use of entecavir in a patient with PEG-IFN-α-induced UCTD disorder. Treatment of such complex patients requires flexible, specific treatment plans and continuous monitoring. This case emphasizes the need for caution in patients with a history of IFN-induced disease and the possibility of late effects and possible effects of the use of entecavir in a patient with PEG-IFN-α-induced UCTD. To the best of our knowledge, this is the first case reported as EDAC, a possible delayed complication of PEG-IFN-α plus ribavirin or entecavir in a patient with PEG-IFN-α-induced UCTD.

Efficient degradation and mineralization of aniline in aqueous solution by new dielectric barrier discharge non-thermal plasma.

Aniline is a priority pollutant that is unfavorable to the environment and human health due to its carcinogenic and mutagenic nature. The performance of the dielectric barrier discharge reactor was examined based on the aniline degradation efficiency. Different parameters were studied and optimized to treat various wastewater conditions. Role of active species for aniline degradation was investigated by the addition of inhibitors and promoters. The optimum conditions were 20 mg/L initial concentration, 1.8 kV applied voltage, 4 L/min gas flow rate and a pH of 8.82. It was observed that 87% of aniline was degraded in 60 min of dielectric barrier discharge treatment at optimum conditions. UV-Vis spectra showed gradual increase in the treatment efficiency of aniline with the propagation of treatment time. Mineralization of AN was confirmed by TOC measurement and a decrease in pH during the process. To elicit the aniline degradation route, HPLC and LC-MS techniques were used to detect the intermediates and byproducts. It was identified that aniline degraded into different organic byproducts and was dissociated into carbon dioxide and water. Comparison of the current system with existing advanced oxidation processes showed that DBD has a remarkable potential for the elimination of organic pollutants.

Degradation of the nonylphenol aqueous solution by strong ionization discharge: evaluation of degradation mechanism and the water toxicity of zebrafish.

Nonylphenol (NP) is a typical environmental endogenous disrupter with low concentration and high toxicity. This paper describes the mechanism of NP degradation in solution by strong ionization dielectric barrier discharge (SIDBD). Furthermore, the degradation performance of NP by SIDBD was tested by changing the equipment voltage, the initial concentration of NP in aqueous solution, pH, and inorganic ions. Degradation pathways of NP were detected using a high-performance liquid chromatography-mass spectrometer. The biological effects of NP degradation were assessed by detecting indicators of embryonic development in zebrafish (survival rate, fetal movement, heartbeat, the body length, behavior, deformity) and adult fish (sex differentiation, weight, ovarian testes pathological section analysis). The results showed when the input O2 was 5 L/min and the voltage was 3.2 kV, the degradation efficiency of NP can reach 99.0% after 60 min of experiment. Equipment voltage, initial concentration of NP in solution, pH, inorganic ions and other factors can influence the degradation efficiency of NP by DBD. At the higher concentration of NP, the greater influence on embryonic development in zebrafish was noticed. Although the effects of NP on zebrafish sex differentiation were not obvious, it showed significant male weight inhibition and decrease in sperm number.

Experimental study of nitrobenzene degradation in water by strong ionization dielectric barrier discharge.

Nitrobenzene (NB) is toxic and carcinogenic aromatic compound widely used in several industries which is ultimately found in their effluents. In this work, dielectric barrier discharge (DBD) reactor was employed for the degradation of nitrobenzene in aqueous solution. Active species like O3 and •OH produced by DBD reactor were mixed with water which degraded the NB. The results indicated that the lower NB concentrations slightly acidic conditions and high voltage ranges showed the optimum efficiencies. Moreover, the impacts of active species inhibitors isopropyl alcohol (IPA), tert-butanol (TBA), inorganic ions for instance sulfates ( S O 4 2 - ), bicarbonates ( H C O 3 - ), nitrates ( N O 3 - ), carbonates ( C O 3 2 - ) and chlorides (Cl-) on the degradation of NB were examined. This analysis showed that the hydroxyl radical was captured by the addition of these inhibitors and resulted in the decrease in efficiencies. Byproducts produced during the degradation of nitrobenzene were assessed by analytical techniques of high-performance liquid chromatography (HPLC), liquid chromatography-mass spectrometry (LC-MS), UV-visible spectroscopy and total organic carbon (TOC) analysis. Main intermediate products were nitrophenols and low molecular weight organic acids including oxalic acid and acetic acid that were eventually mineralized to CO2 and H2O. The dielectric barrier discharge technology was found productive for the degradation of nitroaromatic compounds.