UNASSIGNED: Inflammatory bowel disease (IBD) patients use a wide variety of immunosuppressive drugs, including biologics, but their effect on SARS-CoV-2 vaccine antibody levels remains a mystery.
UNASSIGNED: We analysed whether the drugs used in the treatment of IBD patients could affect the concentration of SARS-CoV-2 antibodies.
UNASSIGNED: This is a prospective, single-centre evaluation of the persistence of SARS-CoV-2 antibodies after vaccination at various time points: every 2 months throughout the 6th month after the first dose.
UNASSIGNED: We included a total of 346 vaccinated IBD patients in the study. A negative correlation between antibody level and time from full vaccination was confirmed for the following types of therapy: infliximab (rho = -0.32, p < 0.001), adalimumab (rho = -0.35, p = 0.025), and vedolizumab (rho = -0.50, p < 0.001). In the case of other, long-term drug administration, a negative correlation between antibody level and time from full vaccination was confirmed for mesalazine (rho = -0.35, p < 0.001), budesonide (rho = -0.58, p = 0.004), systemic glucocorticoids (rho = -0.58, p < 0.001), and azathioprine (rho = -0.44, p < 0.001).
UNASSIGNED: Due to the immunosuppressive and biological treatment, IBD patients are exposed to a shorter persistence of SARS-CoV-2 antibodies and require booster doses. The role of gastroenterologists in educating patients about the need to continue SARS-CoV-2 vaccination remains crucial.

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The sustainable management of landfill leachates remains a matter of important concern in many countries. We used as case study a medium-sized Greek landfill, and we initially investigated the performance of the existing secondary leachate treatment system. The activated sludge process removed chemical oxygen demand (COD), biochemical oxygen demand (BOD), NH4-N, and PO4-P by 55%, 84%, 94%, and 14%, respectively, but the effluents did not meet the legislation requirements for discharge or reuse. Afterwards, different management options of these effluents (co-treatment with sewage in the centralized treatment plant, onsite tertiary treatment with reverse osmosis, granular activated carbon (GAC), ozonation, photo-Fenton, or constructed wetlands) were evaluated regarding their operational costs and environmental footprint. The use of constructed wetlands presented the lower operational cost, energy requirements, and greenhouse gas (GHG) emissions, not exceeding 21.5 kg CO2eq/day. On the other hand, the power consumption and the GHG emissions of the other on-site technologies ranged from 0.37 kWh/m3 and 5.56 kg CO2eq/day (use of GAC) to 39.19 kWh/m3 and 588.6 kg CO2eq/day (use of ozonation), respectively. The co-treatment of the leachates with municipal wastewater required 0.6 kWh/m3 and emitted 30.18 kg CO2eq/day. For achieving zero-discharge of the treated leachates, a system consisting of constructed wetlands and evaporation ponds in series was designed.

Reports of leishmaniasis in immunosuppressed patients after visiting the Mediterranean Basin are becoming increasingly common. Still, awareness of the risk of infection and its clinical manifestations may be insufficient among healthcare professionals in the travellers\' home countries.
This observational, longitudinal study included 47 patients from Sweden with rheumatic disease and ongoing immunomodulatory treatment, who visited a rehabilitation centre in southern Spain where leishmaniasis is endemic. Patients were evaluated for clinical signs of leishmaniasis at baseline and after three years. Patients with leishmaniasis were followed for 4-5 years. The treatment outcome was assessed by clinical evaluation and determination of the cell-mediated immunological response to Leishmania by a whole blood cytokine release assay.
Seven patients (15%) were diagnosed with leishmaniasis. The median time from exposure to the onset of symptoms was 3 [1-17] months. The median delay between the onset of symptoms and treatment start was 9 [1-12] months. All patients with leishmaniasis responded well to treatment. Only one patient had a relapse, which occurred within the first year.
Healthcare professionals need to be aware of the increased risk of leishmaniasis for travellers who are immunosuppressed. Knowledge of the symptoms is crucial for a timely diagnosis and early treatment.

BACKGROUND: The tick-borne bacterium, Neoehrlichia mikurensis (N. mikurensis) can cause severe febrile illness and thromboembolic complications in immunocompromised individuals. We investigated the presence of N. mikurensis DNA in retrospectively collected plasma from a well-characterized cohort of Danish immunocompromised patients.
METHODS: Plasma samples from 239 patients with immune dysfunction related to hematological or rheumatological disease or due to immunosuppressive therapy, were retrieved from a transdisciplinary biobank (PERSIMUNE) at Rigshospitalet, Copenhagen, Denmark. Serving as immunocompetent controls, plasma samples from 192 blood donors were included. All samples were collected between 2015 and 2019. Real-time PCR targeting the groEL gene was used to detect N. mikurensis DNA. Sequencing was used for confirmation. Borrelia burgdorferi sensu lato IgG antibodies were detected by ELISA as a proxy of tick exposure. Prevalence was compared using Fisher\'s exact test.
RESULTS: Neoehrlichia mikurensis DNA was detected in 3/239 (1.3%, 95% confidence interval (CI): 0.3 - 3.6%) patients, all of whom primarily had a hematological disease. Follow-up samples of these patients were negative. N. mikurensis DNA was not detected in any of the blood donor samples. IgG antibodies against B. burgdorferi s.l. were detected with similar prevalence in immunocompromised patients and blood donors, i.e., 18/239 (7.5%, 95% CI: 4.8-11.5%) and 11/192 (5.7%, 95%: CI 3.2-10.0%).
CONCLUSIONS: In this study, patients with N. mikurensis were not identified by clinical indication and N. mikurensis may therefore be underdiagnosed in Danish patients. Further investigations are needed to explore the clinical significance and implications of this infection.

Decentralized handlooms are being traditionally practised throughout India. Siripuram village known for traditional Pochampally/Ikat work was considered as a case study for detailed investigation towards providing a sustainable solution. Nearly 65% of village population solely depend on weaving and dyeing works as primary occupation based on the household survey and generated wash water of 127 KLD on an average from the dyeing operations. Initially, a topographical survey (Aerial drone; PHANTOM 4 RTK UAV) was carried out to understand the drainage pattern, elevations, contours and interlinked with domestic and dyeing functions. The characteristics of combined wastewater and dye wash water were studied at lab scale using sequential batch (SBR) operation under aerobic (SBRAe) and aerobic-anoxic (SBRAex) microenvironments. SBRAex microenvironment showed effective organic and nutrients removal due to infused anoxic microenvironment. Treatment studies depicted 76.2% of organic fraction, 73.3% of phosphate, and 81.6% of nitrate removal. Based on the lab scale studies a closed-loop decentralized effluent treatment system was designed to ensure zero-liquid discharge (ZLD).

This study investigated physico-chemical interactions among Cu(II), biogenic materials, and Fe2O3 in a continuous-flow biofilm reactor system under a well-controlled environment. The effects of Fe2O3 and bacterial biofilms on the distribution of Cu(II) in a simulated aquatic environment were studied. To control biological and abiotic elements in the marine environment, a biofilm reactor was designed to understand the metal speciation of Cu(II) and its distribution. The reactor consisted of a biofilm chamber equipped with glass slides for biofilms attachment. Due to its ability to grow as biofilm in the medium, Pseudomonas atlantica was cultivated to adsorb trace Cu(II) to attached and suspended cells. It was found that biofilms with 170-285 mequiv chemical oxygen demand (COD) concentration/m2 of total oxidizable materials accelerated the Cu(II) adsorption to the surface of the reactor significantly by a factor of five. A significant inhibition to the bacterial growth took place (p ≤ 0.05; t-test) when Cu(II) concentration was higher than 0.5 mg/L. In the absence of Cu(II), bacterial cells grew normally to 0.075 of optical density (OD). However, at the Cu(II) concentration of 0.2 mg/L, the cells grew to a lower OD of 0.58. The presence of glycine and EDTA substantially reduced the toxicity of Cu(II) on bacterial growth (p ≤ 0.05; paired t-test). Their complexation with Cu(II) rendered the metal ions less available to bacterial cells. This implies that the Fe2O3 and bacterial biofilm affected Cu(II) distribution and speciation in the aquatic environment.

BACKGROUND: Clinical experience indicates that secukinumab has significant efficacy in the treatment of moderate-to-severe psoriasis and psoriatic arthritis, demonstrating a rapid onset of action, sustained response, a favourable safety profile, and an improvement of patients\' quality of life.
OBJECTIVE: To analyse the effects of skin lesions, signs and symptoms of arthritis, quality of life and safety of treatment in patients with psoriasis and psoriatic arthritis treated with secukinumab.
METHODS: The study included 38 subjects, 21 with psoriasis (PV) and 17 with psoriatic arthritis (PsA) who received ≥ 1 dose of secukinumab. We assessed response to secukinumab treatment by the Psoriasis Area and Severity Index (PASI), body surface area (BSA), the Dermatology Life Quality Index (DLQI), moreover in patients with PsA, we also assessed 5-point Likert scale and joint tenderness and swelling. We evaluated the safety profile of secukinumab by assessing laboratory tests and monitoring adverse reactions.
RESULTS: In patients with PV a statistically significant decrease in PASI (from 21.46 points to 0.84 point), BSA (from 22.38% to 0.8%), DLQI (from 20.57 points to 0.33 point) was observed. In patients with PsA a statistically significant decrease in PASI (from 13.41 points to 0.0 point), BSA (from 14.59% to 1.0%) and DLQI (from 17.76 points to 0.67 point) was observed. We noticed three incidences of adverse events.
CONCLUSIONS: Our results prove that secukinumab offers a good therapeutic opportunity and may be a preferred treatment option for patients with moderate-to-severe psoriasis and psoriatic arthritis.

BACKGROUND: Benralizumab, a monoclonal antibody targeting the human interleukin-5 (IL-5) receptor (IL-5R), was used before marketing authorisation in Spain in a real world setting as part of an early-access programme (EAP) to treat patients with severe eosinophilic asthma with prior insufficient response or intolerance to anti-IL5 treatment (mepolizumab or reslizumab). The objective of this study is to describe the patient profile candidate for treatment and to assess benralizumab effectiveness.
METHODS: This is an observational, retrospective, multicentre study in severe eosinophilic asthma patients refractory to other biological agents targeting the IL-5 pathway. Baseline characteristics included closest data, from the previous 12 months, to benralizumab treatment onset (index date). Patients were followed until the last treatment dosage while EAP was active (March to December 2018). Effectiveness was evaluated versus baseline, in patients who received at least three doses, with asthma control test (ACT), Mini Asthma Quality of Life Questionnaire (MiniAQLQ), annual severe exacerbation rate, oral corticosteroids treatment (OCS) and asthma-related healthcare resources utilization.
RESULTS: Twenty-seven patients treated with benralizumab were included in the analysis. Effectiveness was assessed in 19 patients. Both questionnaires showed clinically meaningful differences, i.e. ACT score ≥ 3 and MiniAQLQ score ≥ 0.5, compared with baseline [mean (SD), 3.3 (6.8) and 1.2 (1.9), respectively]. Patients treated with OCS decreased during follow-up from 88.9% (n = 24/27) at baseline to 78.9% (n = 15/19) and 31.6% (n = 6/19) had an OCS dose reduction ≥ 50%. The difference in annual severe exacerbation rate during follow-up showed a significant reduction vs. baseline (2.12 per patient-year, 95% CI 0.99-3.24, p = 0.002). The differences in annual rate of non-scheduled primary care and specialist visits during follow-up indicated a significant decrease [2.28 per patient-year (95% CI 1.55-3.01; p < 0.001) and 1.47 per patient-year (95% CI 0.65-2.30; p = 0.004), respectively], as well as the difference in annual rate of number of emergency department visits [1.18 per patient-year (95% CI 0.51-1.85; p = 0.007)].
CONCLUSIONS: These results suggest that severe eosinophilic asthma patients receiving benralizumab, presented clinically meaningful improvement in asthma control and asthma-related QoL as well as OCS dose reduction. Results also aim to significant reductions in annual severe exacerbation rates, non-scheduled primary care and specialist visits, and emergency department visits rates.

BACKGROUND: Therapeutic management of inflammatory bowel diseases (IBD) is rapidly evolving, with an expanding armoury of biological drugs at our disposal. However, real-world findings about treatment persistence and the impact of biologicals on surgery remain inconsistent.
OBJECTIVE: This study aimed to investigate trends in biological use and surgery rates in a nationwide cohort of biological-naïve IBD patients.
METHODS: Patients with IBD who initiated biological treatment between 2011 and 2018 were identified in the Danish National Patient Registry. Data on use of biologicals, surgeries and healthcare costs were retrieved and analysed for time trends.
RESULTS: Between 2011 and 2018, a total of 6,036 IBD (51% ulcerative colitis (UC), 49% Crohn\'s disease (CD)) patients received biological treatment for the first time. Cumulative use of biologicals increased from 5.0% to 10.8% among UC and 8.9%-14.5% among CD patients. Infliximab remained the most-prescribed first-line biological for UC and CD. Treatment persistence was 44.3% and 16.9% after 1 and 3 years in UC, compared to 59.9% and 33.6% in CD patients. Overall, 32.8% of patients switched to a second biological. Surgery rates decreased in both UC (P = 0.015) and CD (P = 0.008) patients and remained significant for UC in the Cox regression model (P = 0.002). Outpatient and surgical costs also fell among both UC and CD patients.
CONCLUSIONS: Persistence rates for first-line biologicals among IBD patients were low and one-third switched treatment. Surgery rates and direct costs decreased over time, but whether this is related to the use of biologicals has yet to be determined.