Search Results (1,074)

Systemic lupus erythematosus (SLE) is an autoimmune disease that predominantly affects women of childbearing age, and active disease during pregnancy is associated with increased maternal and fetal morbidity. Belimumab is an effective biologic therapy for active SLE; however, its use during pregnancy has long been limited by the scarcity of safety data. Recent evidence and updated international recommendations suggest that belimumab may be considered in selected cases when required to maintain maternal disease control. We report the case of a woman with SLE who experienced three consecutive pregnancies with live births between 2019 and 2024 while receiving belimumab, allowing an intra-individual comparison of different exposure strategies. During the first pregnancy, belimumab was discontinued at conception and was followed by a disease flare in late pregnancy and postpartum. In the second and third pregnancies, belimumab was continued until gestational week 20 following shared decision-making with the patient; nevertheless, disease flares occurred during the third trimester of both pregnancies. All pregnancies resulted in live births at term, with no congenital anomalies, placental insufficiency, or fetal growth restriction. One neonate from the third pregnancy developed early-onset neonatal sepsis and meningitis, which resolved completely after antibiotic treatment. All children are currently growing and developing normally. This case supports a risk-adapted approach to belimumab use during pregnancy. In selected women with SLE at high risk of disease reactivation, continuation of belimumab until mid-gestation may contribute to improved maternal disease control without evident adverse fetal outcomes. Full article

Background. Autoimmune sclerosing cholangitis (ASC) is a rare clinical entity characterized by overlapping features of autoimmune hepatitis and primary sclerosing cholangitis. It predominantly affects pediatric patients. Therapeutic management is often complex, requiring a multidisciplinary and individualized approach, especially in the context of associated autoimmune diseases. Case presentation. We present the case of a female patient diagnosed at the age of 10 with ASC, for which immunosuppressive therapy with prednisone, azathioprine (AZA), and ursodeoxycholic acid (UDCA) was initiated, with an initially favorable course. One year later, following a Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection, the patient experienced reactivation of liver disease and subsequently developed ulcerative pancolitis (UC), for which 5-aminosalicylic acid (5-ASA) therapy was initiated. Due to repeated hepatic flares and/or colitis relapses, therapy was escalated successively to mycophenolate mofetil, tacrolimus, and eventually infliximab (IFX). Despite treatment, the liver disease progressed, culminating in liver cirrhosis. Our patient developed portal hypertension and esophageal varices, with two episodes of upper gastrointestinal bleeding requiring endoscopic band ligation. At the age of 14, the patient developed recurrent episodes of non-infectious ulcerative stomatitis. Biopsy of the lesions revealed non-specific chronic inflammation, unrelated to colitis activity (confirmed microscopic remission of UC). By exclusion, an adverse drug reaction was suspected, with AZA being the most likely cause. Following its discontinuation, the lesions resolved. Beyond the physiological and therapeutic aspects, the patient displays marked emotional fragility due to prolonged and repeated hospitalizations (18 out of 60 months), which have impacted treatment adherence. Conclusions. This case highlights the complexity of managing pediatric patients with multiple autoimmune diseases. The necessary combination of immunosuppressive therapies may lead to significant adverse effects and further complicate disease progression. Moreover, psychological components play a crucial role in treatment compliance and therapeutic success, emphasizing the need for an integrated approach that includes specialized psychological support. Full article

Background: Pregnancy in women with systemic lupus erythematosus (SLE) carries an increased risk of maternal and obstetric complications. Current risk assessment often relies on disease activity measured at a single time point and may not reflect dynamic changes during pregnancy. The clinical value of longitudinal disease activity trajectories remains insufficiently defined. Methods: We conducted a retrospective cohort study of 245 pregnancies in women with SLE managed at a tertiary referral center. Disease activity was assessed longitudinally and classified into three trajectories: persistent low activity, early flare with subsequent control, and uncontrolled disease activity during pregnancy. The primary outcome was a composite of clinically actionable maternal or obstetric complications prompting medical intervention. Multivariable logistic regression was performed to evaluate associations between disease activity trajectories and the primary outcome. Results: Clinically actionable pregnancy complications occurred in 41 out of 245 pregnancies (16.7%). The incidence differed significantly across disease activity trajectories, occurring in 3.9% of pregnancies with persistent low activity, 11.6% with early flare followed by control, and 63.8% with uncontrolled disease activity during pregnancy (p < 0.001). After adjustment for relevant covariates, uncontrolled disease activity remained strongly associated with the primary outcome (adjusted odds ratio 13.45, 95% confidence interval 4.01–45.08), whereas early flare with subsequent control was not associated with increased risk. Conclusions: Disease activity trajectories during pregnancy are strongly associated with clinically actionable pregnancy complications in women with SLE. Uncontrolled disease activity confers a markedly increased risk, while early disease flare followed by effective control does not. Trajectory-based assessment may improve risk stratification and support more individualized management during SLE pregnancies. Full article

The incidence of ulcerative colitis, an entity belonging to the inflammatory bowel diseases, is rising worldwide. Due to the unpredictable nature of its clinical flares and the need for chronic treatment, ulcerative colitis has a huge burden of psychological impairment and reduced quality of life. Although several treatments are available to manage patients with ulcerative colitis, their efficacy is unpredictable, and long-term remission is often difficult to achieve. Moreover, the more recent and expensive drugs are not easily available in many countries. These facts have prompted the research in this field to focus on finding additional treatments for such patients. Among the putative repurposing drugs, metformin, an oral antidiabetic agent used for over seventy years, seems to represent a good candidate. While randomized controlled trials suggest that metformin, as an adjunct to conventional treatments, may improve clinical outcomes in mild-to-moderate ulcerative colitis, population-based observational and genetic studies offer mixed signals regarding its role in long-term disease modification or primary prevention. This, together with the wide availability and the low cost of metformin, might represent a good example of repurposing, as detailed in the present review. However, human mechanistic validation remains limited, underscoring the need for further research. Full article

Gas flaring, the burning off gas coming out of oil wells is a common practice in oil-producing developing countries. This practice is harmful to human health, especially because of pollutants. This research focuses on Nigeria, where over 10 percent of all gas produced is flared and about 2 million people are estimated to live within 4 kilometres of a flare site. This paper uses child health data from Demographic Health Surveys and satellite-detected data on gas flaring to examine associations between flaring exposure and child morbidity, nutritional outcomes, and mortality among children under 5 years of age. The findings show a positive association between flaring and the incidence of respiratory diseases and fever among children under 5 years of age but no robust association with mortality. The study contributes to the literature measuring the wider cost to society of oil and gas production and adds to the body of work using satellite data to understand well-being in places where conventional data sources are unavailable. Full article

Chronic obstructive pulmonary disease (COPD) is increasingly recognized as a systemic disorder with clinically significant extrapulmonary manifestations. Among these, renal dysfunction—manifesting as chronic kidney disease (CKD) and acute kidney injury (AKI)—is highly prevalent, frequently underdiagnosed, and strongly associated with adverse clinical outcomes. Meta-analytic data indicate that COPD is associated with more than a twofold increase in CKD prevalence, independent of shared risk factors such as age, smoking, hypertension, and diabetes. CKD in COPD is associated with increased mortality, exacerbation burden, and healthcare utilization. AKI represents a particularly severe expression of renal involvement, occurring most commonly during acute exacerbations of COPD (AECOPD). Although the reported incidence of AKI during AECOPD varies widely by clinical setting—from approximately 2% in population-based studies to over 20% in hospitalized cohorts—its presence is consistently associated with marked increases in mortality, respiratory failure, need for mechanical ventilation, and hospital length of stay. This review synthesizes current evidence supporting a lung–kidney interorgan crosstalk framework in COPD, whereby chronic and acute pulmonary pathophysiology generates systemic disturbances that progressively impair renal structure and function. The heart is incorporated as a physiological intermediary, modulating hemodynamic transmission and venous congestion, without constituting the primary disease axis. Recognizing the role of kidney complications in COPD is crucial, as it influences how we diagnose, predict outcomes, and treat patients—especially when there are sudden flare-ups. Full article

We establish a general no-go theorem demonstrating that all traversable wormhole configurations in Unimodular Gravity necessarily require exotic matter. The proof relies solely on the geometric flaring-out condition, b′(r₀) ≤ 1, which directly implies that ρ(r₀) + p_r(r₀) ≤ 0 at the throat. This condition represents a violation of the Null Energy Condition and, consequently, of the Weak and Strong Energy Conditions, independently of the particular choice of shape function, redshift function, or equation of state. This result holds for both tidal and zero-tidal-force configurations, showing that the requirement of exotic matter is a fundamental geometric consequence of the traversability condition rather than an artifact of specific solution choices. Therefore, Unimodular Gravity shares this fundamental constraint with General Relativity. Full article

We report the stereoscopic observations of two recurrent streamer waves in a single streamer structure, utilizing coordinated observations from the SOHO, STEREO, and SDO missions. Contrary to the long-held view that fast coronal mass ejections (CMEs) are necessary drivers, we demonstrate that these recurrent waves were excited by two consecutive slow CMEs (<500 km s⁻¹ accompanied by only modest flare activity. Three-dimensional reconstruction reveals that the first and second waves propagated with significant decelerations of −7.93 m s⁻² and −10.26 m s⁻², respectively. Their average amplitudes were $0.41R_{\odot }$ and $0.77R_{\odot }$, wavelengths were $4.02R_{\odot }$ and $6.17R_{\odot }$, and periods were 2.66 and 2.53 h, respectively. While the amplitude of the first wave declined with heliocentric distance (consistent with conventional energy convection), the second wave exhibited an intriguing increasing trend in amplitude. Both waves showed a linear increase in wavelength and period with distance, indicating a non-stationary and dispersive medium. Crucially, despite the disparity in driver energy and wave scales, the periods and their change rates remained nearly identical for both events. This provides compelling case-specific evidence that the streamer wave period is primarily determined by the inherent eigenmodes of the streamer plasma slab rather than the specific characteristics of the trigger. We conclude that the generation of observable streamer waves is a combined consequence of the streamer’s structural stability and the energy transfer efficiency of the triggering disturbance. Full article

Recent evidence suggests that type I interferon (IFN) activity has prognostic relevance in systemic lupus erythematosus (SLE). This study investigated whether combining IFN activity with elevated peripheral blood plasmablast (PB) levels—another key feature of lupus pathophysiology—improves risk stratification for poor clinical outcomes. Clinical data were prospectively collected at a single lupus center. Flow cytometry was performed on freshly isolated peripheral blood mononuclear cells to investigate Sialic acid-binding Immunoglobulin-like Lectin 1 (SIGLEC-1) as a surrogate marker of IFN activity, alongside CD19⁺CD20⁻CD27^highHLA-DR⁺ PB frequencies. A total of 1276 samples from 121 patients were analyzed. At baseline, 48.8% of patients exhibited high IFN activity, including 27.3% with concurrent elevation in IFN and PB activity and 21.5% with isolated IFN activity. Patients with simultaneous IFN and PB activity showed higher anti-dsDNA antibody levels, were less frequently in DORIS remission (24.2% vs. 50.0%) and required higher daily prednisolone dosages (6.3 vs. 2.0 mg) than those with isolated IFN activity. During a median follow-up of 4.5 years (range 0.8–6.6), these patients experienced more flares (132 vs. 54, OR 1.42), required longer to achieve remission (median 399 vs. 140 days), and had a higher median time-adjusted prednisolone dose (5.6 vs. 3.0 mg). Concurrent elevation in IFN and PB activity identifies SLE patients with a poorer prognosis compared to isolated IFN activity. These findings suggest that combined IFN and PB assessment may improve prognostic stratification and support personalized treatment strategies in SLE. Full article

Background/Objectives: Chronic diseases, such as inflammatory bowel disease (IBD), influence patients’ sexuality. Therefore, the aim of this study was to analyze the sexual functioning (SF) of patients with IBD. Methods: We perform a prospective survey study on male and female individuals with IBD using an anonymous questionnaire including 60 inquiries concerning patients’ intimate relationships and SF. The following statistical tests were used: chi-square test of independence, Spearman’s rank correlation coefficient, and Wilcoxon and Mann–Whitney U tests. A significance level of p = 0.05 was assumed as statistically significant. Results: There were 110 respondents with IBD (41% with Crohn’s disease and 57% with ulcerative colitis): 52 women (47%) and 58 men (53%), with a mean age of between 31 and 40 (45%). In 34% of respondents, the assessment of satisfaction with sex after diagnosis decreased, and the difference was statistically significant (p = 0.007). Statistically significant correlations were found between IBD clinical activity and the impact of the disease on sexual desire (p < 0.001), the need for sex after diagnosis (p < 0.001), satisfaction with sex after diagnosis (p = 0.003), the average frequency of intercourse (p = 0.004), the average duration of intercourse after diagnosis (p = 0.001), feeling guilty in the sexual sphere due to the disease (p = 0.006), assessment of one’s attractiveness since diagnosis (p = 0.032), and change in the partner’s erotic perception after diagnosis (p < 0.001). The more aggressive the course of the disease, the more negative the impact on patients’ sexuality. Conclusions: The diagnosis of IBD has a negative impact on patients’ SF—disease flare leads to a decrease in sexual needs, worse experiences and negative body image. Full article

Myasthenia gravis (MG) is a prevalent autoimmune disorder affecting neuromuscular junctions, typically characterized by muscle weakness due to autoantibodies targeting acetylcholine receptors (AChR) or muscle-specific kinase (MuSK). Generalized MG is a more severe form of the condition than ocular MG. Although MG can strike at any age, young adult women are typically affected, especially in their reproductive years. MG is rare during pregnancy, with the first trimester and the postpartum period being the most common times for exacerbations. The influence of MG on pregnancy outcomes remains ambiguous, with some studies finding larger prevalence of issues such as preterm birth and small-for-gestational-age babies, while others indicate results similar to the general population. Management of MG during pregnancy necessitates careful monitoring and drug adjustments. Teratogenic concerns make several immunosuppressive drugs, such mycophenolate mofetil and methotrexate, contraindicated. In contrast, medications like prednisolone and pyridostigmine are generally recognized as safe. Women with MG may have flare-ups after giving birth, and infants may have transient neonatal myasthenia gravis. Comprehensive prenatal treatment and multidisciplinary assistance are crucial for promoting maternal and fetal health during pregnancy in women with MG. This paper examines the relevance of immunological biomarkers, RNAs, and other novel biomarkers in myasthenia gravis (MG). It emphasizes the need for more investigation to determine their role in the pathogenesis of MG, evaluate biomarker profiles across subgroups, and look at changes after treatment. The study also underlines the significance of high-throughput investigations to detect new biomarkers and reveal genetic variables impacting MG pathogenesis. Full article

Gout is the most common form of inflammatory arthritis in men, driven by hyperuricemia and the deposition of monosodium urate (MSU) crystals. The innate immune response to these crystals leads to acute inflammatory episodes, called flares, characterized by intense joint pain, swelling, and temporary disability. Although gout flares are self-limiting, they impose a considerable burden on patients’ quality of life and contribute to increased healthcare utilization. A detailed understanding of the inflammatory processes triggered by MSU crystals is critical for developing targeted therapies to prevent and manage flares effectively. This review provides an overview of experimental models used to study the inflammatory phase of gout, with a focus on both in vivo and in vitro models of MSU crystal-induced inflammation. We concentrate on models that reproduce the acute inflammatory response following MSU crystal deposition, including the air pouch, intraarticular injection, and peritonitis rodent models, alongside the larval zebrafish model. In addition, we discuss in vitro approaches using primary immune cells and cell lines. We discuss the strengths, limitations, and translational relevance of these models and highlight some examples of how they have contributed to our understanding of the etiology of gout. Of note, models of hyperuricemia are not included here as these have been extensively reviewed elsewhere. Full article

Thermal contextual algorithms for 375 m VIIRS active fire detection can produce substantial commission errors over persistent non-wildfire heat sources (e.g., refineries, gas flares, and volcanoes), and globally fixed thresholds may be suboptimal under heterogeneous thermal backgrounds. We present a lightweight spatiotemporal prior layer that augments by applying prior-guided, pixel-level parameter switching during the discrimination stage. The layer combines: (i) a persistent non-wildfire thermal anomaly mask (PFM) derived from multi-year VNP14IMG recurrence and seasonality statistics on a 0.004° grid, and (ii) a short-term heat-source mask (SHM) based on nighttime VIIRS I4/I5 brightness temperature stability to capture newly emerged or rapidly intensifying static sources. Pixels flagged by either prior are processed with a stricter parameter set, while other pixels follow the baseline setting. We evaluate the method using a stratified validation dataset (N = 3435) spanning industrial/urban clusters, volcanic regions, forest/grassland wildfires, and fragmented crop residue burning, with validation supported by independent high-resolution imagery (Sentinel-2/Landsat) and external POI datasets. The framework markedly reduces false positives in high-interference zones (industrial/urban false positive rate from 88.6% to 22.7%; volcanic from 100.0% to 57.3%) while preserving high performance for forest/grassland wildfires (F1 ≈ 0.999). For fragmented residue burning, omission error decreases from 11.2% to 1.3%, improving detection completeness without an apparent increase in commission errors. Overall, the results suggest that integrating long- and short-term spatiotemporal priors via threshold switching can improve the robustness and interpretability of contextual VIIRS fire detection under complex thermal backgrounds in the evaluated scenarios. Full article

Human skin and hair act as multifunctional barriers but are highly sensitive to environmental pollutants originating from air, water, and cosmetic products. Epidemiological studies report that exposure to particulate matter (PM_2.5–PM₁₀), nitrogen oxides (NO_x), and volatile organic compounds increases the risk of skin and hair disorders. For instance, women in high-traffic areas (N = 211) show significantly more pigment spots and nasolabial wrinkles compared to those in rural areas (N = 189), indicating accelerated skin ageing. Children aged 9–11 exposed to PM₁₀, benzene, and NO_x exhibit increased incidence of atopic dermatitis. Systemic exposure to dioxins causes chloracne, while co-exposure to polycyclic aromatic hydrocarbons (PAHs) and UVA radiation elevates skin cancer risk. Psoriasis flares are associated with mean pollutant concentrations over the 60 days preceding flare events in 957 patients, and hyperpigmentation prevalence increases in populations exposed to traffic-related PM and ROS-inducing pollutants. Hair loss is linked to oxidative stress from PM and PAHs absorbed on hair fibers, with in vitro studies showing keratinocyte apoptosis in scalp hair follicles. This review evaluates natural adsorbents such as zeolites, clays, activated carbon, and polyphenol-rich plant extracts for anti-pollution cosmetic formulations. Adsorption capacities range from 60 to 150 mg·g⁻¹ depending on the pollutant, with removal efficiencies of 30–55% in model topical systems. Mechanisms include ion exchange, surface adsorption, hydrophobic interactions, and radical scavenging. Incorporating 2–5% w/w of these adsorbents in cosmetic formulations significantly reduces pollutant deposition on skin and hair. These findings support the development of evidence-based, sustainable anti-pollution cosmetic strategies that quantitatively mitigate environmental stressor effects. Full article

An 87-year-old woman was referred to our ophthalmology ward due to decreased visual acuity and intense right orbital pain, which had been present for four weeks. The anamnesis was not contributory, except that she had been vaccinated against severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) four weeks prior to symptom onset. Her best-corrected visual acuity was hand movements in the right eye and 20/20 in the left eye. Intra-ocular pressure was 34 mmHg and 16 mmHg, respectively. Right eye slit lamp examination revealed palpebral oedema, chemosis, and temporal scleral thickening with conjunctival injection. The cornea was edematous with endothelial precipitates. The anterior chamber was shallow with a closed angle, associated with grade 1+ cells and 1+ flare, according to the SUN grading system. Mild vitreous inflammation was present (grade 0.5+ vitreous cells), and a total choroidal detachment was visible. In the absence of any other plausible cause, unilateral choroidal effusion with secondary angle-closure due to severe panuveitis was considered a possible adverse event following vaccination against SARS-CoV2. Full article