Clinical visible signs of disease activity in vitiligo: a systematic review and meta-analysis.

Vitiligo is an unpredictable depigmenting disorder for which a static method to assess disease activity is lacking. Presence of certain skin manifestations may be indicative of disease activity. Here, we evaluated the current evidence for an association between clinical signs and reported disease activity in vitiligo. A systematic review and meta-analysis was performed based on a search in PubMed, Embase and Cochrane Library. Literature reporting skin manifestations and disease activity was analysed based on descriptive analyses and, if applicable, odd ratios. Forty-six observational studies were selected and analysed, including 28 case reports. Reported clinical signs in relation to active vitiligo were as follows: Koebner's phenomenon, confetti-like depigmentations, tri- and hypochromic lesions (including poorly defined borders), inflammatory borders/areas, itch and leukotrichia. Based on this search, strong evidence was found for Koebner's phenomenon. Poorly defined borders and confetti lesions are potential markers, although more data are needed to confirm this. Evidence for other skin manifestations was inconclusive, whereas case reports on inflammatory borders were indicative of active disease. Limitations included the lack of randomized controlled trials, large-scale prospective studies and heterogeneity due to inconsistent definitions. This systematic review urges the vitiligo community to come forward with consensus-based definitions as well as a reliable scoring system to assess these clinical signs and to design optimal trials to investigate their true predictive value.

Occurrence patterns of pharmaceutical residues in wastewater, surface water and groundwater of Nairobi and Kisumu city, Kenya.

Emerging organic contaminants have not received a lot of attention in developing countries, particularly Africa, although problems regarding water quantity and quality are often even more severe than in more developed regions. This study presents general water quality parameters as well as unique data on concentrations and loads of 24 pharmaceuticals including antibiotic, anti(retro)viral, analgesic, anti-inflammatory and psychiatric drugs in three wastewater treatment plants, three rivers and three groundwater wells in Nairobi and Kisumu. This allowed studying removal efficiencies in wastewater treatment, identifying important sources of pharmaceutical pollution and distinguishing dilution effects from natural attenuation in rivers. In general, antiretrovirals and antibiotics, being important in the treatment of common African diseases such as HIV and malaria, were in all matrices more prevalent as compared to the Western world. Wastewater stabilization ponds removed pharmaceuticals with an efficiency between 11 and 99%. Despite this large range, a different removal is observed for a number of compounds, as compared to more conventional activated sludge systems. Total concentrations in river water (up to 320 µg L(-1)) were similar or exceeded concentrations in untreated wastewater, with domestic discharges from slums, wastewater treatment plant effluent and waste dumpsites identified as important sources. In shallow wells situated next to pit latrines and used for drinking water, the recalcitrant antiretroviral nevirapine was measured at concentrations as high as 1-2 µg L(-1). Overall, distinct pharmaceutical contamination patterns as compared to the Western world can be concluded, which might be a trigger for further research in developing regions.

Selective accurate-mass-based analysis of 11 oxy-PAHs on atmospheric particulate matter by pressurized liquid extraction followed by high-performance liquid chromatography and magnetic sector mass spectrometry.

An innovative analytical method based on high-performance liquid chromatography and atmospheric pressure chemical ionization magnetic sector mass spectrometry was developed and optimized to determine trace concentrations of 11 compounds belonging to the group of the seldom-analyzed oxy-PAHs (phenanthrene-9,10-dione, chrysene-5,6-dione, benzo[a]pyrene-4,5-dione, benzo[a]pyrene-1,6-dione, benzo[a]pyrene-3,6-dione, benzo[a]pyrene-6,12-dione, 4-oxa-benzo[def]chrysene-5-one, pyrene-1-carboxaldehyde, benzo[de]anthracene-7-one, benzo[a]anthracene-7,12-dione, and napthacene-5,12-dione) on airborne particulate matter (PM(10)). The mass spectrometer was operated in multiple ion detection mode, allowing for selective accurate mass detection (mass resolution of 12,000 full width at half maximum) of the oxy-PAHs characteristic ions. Optimization of both the vaporizer (450 °C) and capillary temperature (350 °C) resulted into instrumental detection limits in the range between 7 (benzo[a]pyrene-1,6-dione) and 926 pg (benzo[a]anthracene-7,12-dione). The advanced pressurized liquid extraction (PLE) and the more traditionally used ultrasonic extraction (USE) were compared using ethyl acetate as an extraction solvent. For both techniques, high recoveries from spiked quartz fiber filters (PLE, 82-110%; USE, 67-97%) were obtained. Recoveries obtained from real PM(10) samples were also high (76-107%), and no significant matrix effects (ME) on the ionization process (enhancement or suppression) were found (ME, 89-123%). Method limits of quantification (S/N = 10) were in the range between 2 and 336 pg/m(3). This method was used to analyze real PM samples collected at several urban and rural locations in the Antwerp area. For the first time, concentrations for Belgium are provided. Concentrations of individual oxy-PAHs are in the lower pictograms per cubic meter to 6 ng/m(3) range. High concentration differences between individual compounds are found as exemplified by the 75th percentile of the phenanthrene-9,10-dione and benzo[de]anthracene-7-one concentrations being a factor of 4 to 22 higher compared with the other target oxy-PAHs.