To update and integrate the recommendations for ankylosing spondylitis and the recommendations for the use of tumour necrosis factor inhibitors (TNFi) in axial spondyloarthritis (axSpA) into one set ...applicable to the full spectrum of patients with axSpA. Following the latest version of the European League Against Rheumatism (EULAR) Standardised Operating Procedures, two systematic literature reviews first collected the evidence regarding all treatment options (pharmacological and non-pharmacological) that were published since 2009. After a discussion of the results in the steering group and presentation to the task force, overarching principles and recommendations were formulated, and consensus was obtained by informal voting. A total of 5 overarching principles and 13 recommendations were agreed on. The first three recommendations deal with personalised medicine including treatment target and monitoring. Recommendation 4 covers non-pharmacological management. Recommendation 5 describes the central role of non-steroidal anti-inflammatory drugs (NSAIDs) as first-choice drug treatment. Recommendations 6-8 define the rather modest role of analgesics, and disprove glucocorticoids and conventional synthetic disease-modifying antirheumatic drugs (DMARDs) for axSpA patents with predominant axial involvement. Recommendation 9 refers to biological DMARDs (bDMARDs) including TNFi and IL-17 inhibitors (IL-17i) for patients with high disease activity despite the use (or intolerance/contraindication) of at least two NSAIDs. In addition, they should either have an elevated C reactive protein and/or definite inflammation on MRI and/or radiographic evidence of sacroiliitis. Current practice is to start with a TNFi. Switching to another TNFi or an IL-17i is recommended in case TNFi fails (recommendation 10). Tapering, but not stopping a bDMARD, can be considered in patients in sustained remission (recommendation 11). The final two recommendations (12, 13) deal with surgery and spinal fractures. The 2016 Assessment of SpondyloArthritis international Society-EULAR recommendations provide up-to-date guidance on the management of patients with axSpA.
To update the Assessment of SpondyloArthritis international Society (ASAS)-EULAR recommendations for the management of axial spondyloarthritis (axSpA).
Following the EULAR Standardised Operating ...Procedures, two systematic literature reviews were conducted on non-pharmacological and pharmacological treatment of axSpA. In a task force meeting, the evidence was presented, discussed, and overarching principles and recommendations were updated, followed by voting.
Five overarching principles and 15 recommendations with a focus on personalised medicine were agreed: eight remained unchanged from the previous recommendations; three with minor edits on nomenclature; two with relevant updates (#9, 12); two newly formulated (#10, 11). The first five recommendations focus on treatment target and monitoring, non-pharmacological management and non-steroidal anti-inflammatory drugs (NSAIDs) as first-choice pharmacological treatment. Recommendations 6-8 deal with analgesics and discourage long-term glucocorticoids and conventional synthetic disease-modifying antirheumatic drugs (DMARDs) for pure axial involvement. Recommendation 9 describes the indication of biological DMARDs (bDMARDs, that is, tumour necrosis factor inhibitors (TNFi), interleukin-17 inhibitors (IL-17i)) and targeted synthetic DMARDs (tsDMARDs, ie, Janus kinase inhibitors) for patients who have Ankylosing Spondylitis Disease Activity Score ≥2.1 and failed ≥2 NSAIDs and also have either elevated C reactive protein, MRI inflammation of sacroiliac joints or radiographic sacroiliitis. Current practice is to start a TNFi or IL-17i. Recommendation 10 addresses extramusculoskeletal manifestations with TNF monoclonal antibodies preferred for recurrent uveitis or inflammatory bowel disease, and IL-17i for significant psoriasis. Treatment failure should prompt re-evaluation of the diagnosis and consideration of the presence of comorbidities (#11). If active axSpA is confirmed, switching to another b/tsDMARD is recommended (#12). Tapering, rather than immediate discontinuation of a bDMARD, can be considered in patients in sustained remission (#13). The last recommendations (#14, 15) deal with surgery and spinal fractures.
The 2022 ASAS-EULAR recommendations provide up-to-date guidance on the management of patients with axSpA.
Abstract
Context
Coronavirus disease 2019 (COVID-19) is a proinflammatory and prothrombotic condition, but its impact on adrenal function has not been adequately evaluated.
Case report
A 46-year-old ...woman presented with abdominal pain, hypotension, and skin hyperpigmentation after COVID-19 infection. The patient had hyponatremia, serum cortisol <1.0 µg/dL, adrenocorticotropin (ACTH) of 807 pg/mL, and aldosterone <3 ng/dL. Computed tomography (CT) findings of adrenal enlargement with no parenchymal and minimal peripheral capsular enhancement after contrast were consistent with bilateral adrenal infarction. The patient had autoimmune hepatitis and positive antiphospholipid antibodies, but no previous thrombotic events. The patient was treated with intravenous hydrocortisone, followed by oral hydrocortisone and fludrocortisone.
Discussion
We identified 9 articles, including case reports, of new-onset adrenal insufficiency and/or adrenal hemorrhage/infarction on CT in COVID-19. Adrenal insufficiency was hormonally diagnosed in 5 cases, but ACTH levels were measured in only 3 cases (high in 1 case and normal/low in other 2 cases). Bilateral adrenal nonhemorrhagic or hemorrhagic infarction was identified in 5 reports (2 had adrenal insufficiency, 2 had normal cortisol levels, and 1 case had no data). Interestingly, the only case with well-characterized new-onset acute primary adrenal insufficiency after COVID-19 had a previous diagnosis of antiphospholipid syndrome. In our case, antiphospholipid syndrome diagnosis was established only after the adrenal infarction triggered by COVID-19.
Conclusion
Our findings support the association between bilateral adrenal infarction and antiphospholipid syndrome triggered by COVID-19. Therefore, patients with positive antiphospholipid antibodies should be closely monitored for symptoms or signs of acute adrenal insufficiency during COVID-19.
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•Tannery sludge was used as carbon precursor for preparation of activated carbon.•The pyrolysis step was carried out using microwave heating.•Adsorption of AB-210 and AR-357 dyes was ...studied using AMWCTS as adsorbent.•The Qmax values of AB-210 and AR-357 are 1108 and 589.5mgg−1, respectively.•AMWCTS is effective for treatment of simulated dye effluents.
An activated carbon was prepared by chemical activation of the sludge collected from tannery wastewater treatment plant (TWTP) using microwave heating. The sludge was mixed with ZnCl2 and lime to form a paste, which was inserted inside a quartz reactor and irradiated by microwave for 10min under N2. After the pyrolysis, the carbonized material was refluxed with a 6.0molL−1 HCl to obtain the activated carbon (AMWCTS). The AMWCTS was characterized by SEM, FTIR, TGA, XRD, BET and BJH analytical techniques. AMWCTS has high BET surface area of 491.0m2g−1 and total pore volume of 0.440cm3g−1 with mesoporous pore size distribution.
The studies of pH, kinetic and equilibrium for adsorption of Acid Black 210 (AB-210) and Acid Red 357 (AR-357) leather dyes onto AMWCTS were investigated at 298K. The kinetic data were best fitted to the Avrami kinetic model. The maximum sorption capacities of AMWCTS for AR-357 and AB-210 are 589.5 and 1108mgg−1, respectively.
Finally, the AMWCTS was tested using simulated effluents (complex mixture of dyes), obtaining an adsorption efficiency of at least 93.79%, showing the potentiality of AMWCTS as adsorbent for treatment real effluents.
Sapelli wood sawdust-derived magnetic activated carbon (SWSMAC) was produced by single-step pyrolysis using KOH and NiCl
2
as activating and magnetization agents. SWSMAC was characterized by several ...techniques (SEM/EDS, N
2
adsorption/desorption isotherms, FTIR, XRD, VSM, and pH
PZC
) and applied in the brilliant blue FCF dye adsorption from an aqueous medium. The obtained SWSMAC was a mesoporous material and showed good textural properties. Metallic nanostructured Ni particles were observed. Also, SWSMAC exhibited ferromagnetic properties. In the adsorption experiments, adequate conditions were an adsorbent dosage of 0.75 g L
−1
and a solution pH of 4. The adsorption was fast, and the pseudo-second-order demonstrated greater suitability to the kinetic data. The Sips model fitted the equilibrium data well, and the maximum adsorption capacity predicted by this model was 105.88 mg g
−1
(at 55 °C). The thermodynamic study revealed that the adsorption was spontaneous, favorable, and endothermic. Besides, the mechanistic elucidation suggested that electrostatic interactions, hydrogen bonding, π–π interactions, and n–π interactions were involved in the brilliant blue FCF dye adsorption onto SWSMAC. In summary, an advanced adsorbent material was developed from waste by single-step pyrolysis, and this material effectively adsorbs brilliant blue FCF dye.
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•Facile single-step synthesis of new magnetic activated carbon materials was carried out at 600 °C.•The combinations of ZnCl2/NiCl2 simultaneously provide excellent textural ...properties and high magnetization.•Maximum SBET and saturation magnetization of 1281 m2 g−1 and 13.29 emu g−1, respectively was attained.•The Qmax of 199.3 and 335.4 mg g−1 for nicotinamide and propranolol, respectively, was achieved.•The efficient total removal of simulated hospital effluents of 99.1 % was obtained.
The present research describes the synthesis of new nanomagnetic activated carbon material with high magnetization, and high surface area prepared in a single pyrolysis step that is used for the carbonization, activation, and magnetization of the produced material. The pyrolysis step of tucumã seed was carried out in a conventional tubular oven at 600 °C under N2-flow. It was prepared three magnetic carbons MT-1.5, MT-2.0, MT-2.5, that corresponds to the proportion of biomass: ZnCl2 always 1:1 and varying the proportion of NiCl2 of 1.5, 2.0, and 2.5, respectively. These magnetic nanocomposites were characterized by Vibrating Sample Magnetometer (VSM), X-ray diffraction, scanning electron microscopy, thermogravimetric analysis, hydrophobic/hydrophilic balance, CHN/O elemental analysis, modified Boehm titration, N2 adsorption-desorption isotherms; and pHpzc. All the materials obtained presented Ni particles with an average crystallite size of less than 33 nm. The MT-2.0 was employed for the removal of nicotinamide and propranolol from aqueous solutions. Based on Liu isotherm, the Qmax was 199.3 and 335.4 mg g−1 for nicotinamide and propranolol, respectively. MT-2.0 was used to treat simulated pharmaceutical industry effluents attaining removal of all organic compounds attaining up to 99.1 % of removal.
Multi-walled carbon nanotubes (MWCNT) and powder activated carbon (PAC) were used as adsorbents for adsorption of Direct Blue 53 dye (DB-53) from aqueous solutions. The adsorbents were characterised ...using Raman spectroscopy, N2 adsorption/desorption isotherms, and scanning and transmission electron microscopy. The effects of initial pH, contact time and temperature on adsorption capacity of the adsorbents were investigated. At pH 2.0, optimum adsorption of the dye was achieved by both adsorbents. Equilibrium contact times of 3 and 4 h were achieved by MWCNT and PAC adsorbents, respectively. The general order kinetic model provided the best fit of the experimental data compared to pseudo-first order and pseudo-second order kinetic adsorption models. For DB-53 dye, the equilibrium data (298–323 K) were best fitted to the Sips isotherm model. The maximum sorption capacity for adsorption of the dye occurred at 323 K, with the values of 409.4 and 135.2 mg g−1 for MWCNT and PAC, respectively. Studies of adsorption/desorption were conducted and the results showed that DB-53 loaded MWCNT could be regenerated (97.85%) using a mixture 50% acetone + 50% of 3 mol L−1 NaOH. Simulated dye house effluents were used to evaluate the application of the adsorbents for effluent treatment (removal of 99.87% and 97.00% for MWCNT and PAC, respectively, were recorded).
•Adsorption of DB-53 dye was studied using MWCNT and CAC as adsorbents.•MWCNT was characterised using Raman spectroscopy, SEM and TEM techniques.•Maximum adsorption capacities of MWCNT and CAC are 409.4 and 135.2 mg/g, respectively.•The adsorption processes are well described by general order kinetic model.•MWCNT and CAC have been proven effective for removal of DB-53 dye.
•Microwave-assisted cocoa shell activated carbon was prepared and characterized.•The anti-inflammatories, diclofenac and nimesulide, were adsorbed onto MWCS-1.0.•Adsorption maximum values are 63.47 ...(diclofenac) and 74.81mgg−1 (nimesulide).•General order kinetic model suitably explained the adsorption process.•MWCS-1.0 was effectively used for treatment of simulated hospital effluents.
Microwave-induced chemical activation process was used to prepare an activated carbon from cocoa shell for efficient removal of two anti-inflammatories, sodium diclofenac (DFC) and nimesulide (NM), from aqueous solutions. A paste was obtained from a mixture of cocoa shell and inorganic components; with a ratio of inorganic: organic of 1 (CSC-1.0). The mixture was pyrolyzed in a microwave oven in less than 10min. The CSC-1.0 was acidified with a 6molL−1 HCl under reflux to produce MWCS-1.0. The CSC-1.0 and MWCS-1.0 were characterized using FTIR, SEM, N2 adsorption/desorption curves, X-ray diffraction, and point of zero charge (pHpzc). Experimental variables such as initial pH of the adsorbate solutions and contact time were optimized for adsorptive characteristics of MWCS-1.0. The optimum pH for removal of anti-inflammatories ranged between 7.0 and 8.0. The kinetic of adsorption was investigated using general order, pseudo first-order and pseu do-second order kinetic models. The maximum amounts of DCF and NM adsorbed onto MWCS-1.0 at 25°C are 63.47 and 74.81mgg−1, respectively. The adsorbent was tested on two simulated hospital effluents. MWCS-1.0 is capable of efficient removal of DCF and NM from a medium that contains high sugar and salt concentrations.
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► Multi-wall carbon nanotube (MWCNT) and powdered activated carbon (PAC) adsorbents. ► Reactive Red M-2BE textile dye adsorbate. ► Kinetics was followed by Avrami fractional-order. ...► The maximum adsorption capacities were 335.7 and 260.7
mg
g
−1 for MWCNT and PAC. ► Synthetic effluents treatment.
Multi-walled carbon nanotubes and powdered activated carbon were used as adsorbents for the successful removal of Reactive Red M-2BE textile dye from aqueous solutions. The adsorbents were characterised by infrared spectroscopy, N
2 adsorption/desorption isotherms and scanning electron microscopy. The effects of pH, shaking time and temperature on adsorption capacity were studied. In the acidic pH region (pH 2.0), the adsorption of the dye was favourable using both adsorbents. The contact time to obtain equilibrium at 298
K was fixed at 1
h for both adsorbents. The activation energy of the adsorption process was evaluated from 298 to 323
K for both adsorbents. The Avrami fractional-order kinetic model provided the best fit to the experimental data compared with pseudo-first-order or pseudo-second-order kinetic adsorption models. For Reactive Red M-2BE dye, the equilibrium data were best fitted to the Liu isotherm model. Simulated dyehouse effluents were used to check the applicability of the proposed adsorbents for effluent treatment.
Summary
Metacommunity structure may be strongly influenced by spatial dynamics and environmental factors, as well as biogeographic effects. Here, we examined variation in lake cladoceran communities ...associated with floating macrophytes in the four major Brazilian floodplain systems (Amazônia, Araguaia, Pantanal and Paraná) in relation to local environmental factors, spatial components, climate variables and basin identity.
Moran's eigenvector maps were used as a proxy to examine spatial structures within each drainage basin. The final sets of local environmental, climate and spatial variables were selected for constrained ordination models, using a forward selection method. We used variation partitioning to decompose variation in cladoceran community composition in relation to the four sets of predictor variables. Beta‐diversity indices were calculated to quantify the contributions of turnover and nestedness components to total beta diversity of cladocerans within each basin and across the basins.
Variation partitioning showed that the pure fractions were relatively small, ranging from around zero for spatial and basin identity variables to 2% for climate variables and 4% for local environmental variables. The shared effect of local environmental, climate and basin identity was considerable, accounting for 17% of the total variance. Furthermore, the shared effect of climate and basin identity was also considerable (6%). In total, 32% of variation in cladoceran community structure could be explained by our predictor variables. Cladoceran metacommunities showed high levels of beta diversity attributed to the turnover component, within each floodplain and across all four floodplains.
Our finding showed that species sorting was likely to be the main agent structuring cladoceran communities. Spatial processes were not important at very large spatial scales, contrary to what has been found in previous studies. This finding was most likely due to the inclusion of climatic variables in our analysis, combined with the high dispersal ability of cladocerans.
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