Management of inflammatory neurologic and psychiatric manifestations of systemic lupus erythematosus: A systematic review.

BACKGROUND: The neurological and psychiatric manifestations of systemic lupus erythematosus (NPSLE) are a heterogeneous group of conditions with variable clinical presentation and significant morbidity and mortality. OBJECTIVES: Our aim was to comprehensively assess and present the evidence for treatments used in the management of inflammatory NPSLE. METHODS: Medline, Embase, CINHAL and Cochrane CENTRAL were searched from 1990 to end of March 2019 using key words that related to NPSLE and treatment. Included studies comprised clinical trials, observational studies or case series with ≥5 patients and sufficient data related to treatment and outcome in NPSLE patients. RESULTS: There were 7222 studies identified in the search, of which 90 were included in the review. There was a notable paucity of clinical trials, with only two randomised controlled trials and one pilot study. Treatment categories included corticosteroids (14 studies), cyclophosphamide (18 studies), synthetic DMARDs (7 studies), biologic therapies (14 studies), therapeutic plasma exchange (6 studies), intravenous immunoglobulin (2 studies), autologous stem cell transplant (3 studies), other therapies (8 studies), combination therapies (6 studies), studies with grouped outcome data (5 studies) and observational studies with therapy-specific associations (7 studies). Corticosteroids are accepted as first line treatment in NPSLE and there is low-moderate evidence supporting their benefit. Moderate evidence, based on consistent data in numerous studies and some trial data, supports the use of cyclophosphamide in the treatment of NPSLE. Limited data support some synthetic DMARDs such as mycophenolate, azathioprine and intrathecal methotrexate. In refractory disease, low-moderate evidence supports rituximab therapy and limited evidence supports benefit following autologous stem cell transplant. Regarding adjuvant treatments, limited evidence favours addition of plasma exchange, intravenous immunoglobulin and hydroxychloroquine. There exists very limited data for other therapies. CONCLUSION: There are multiple therapeutic options for the management of inflammatory NPSLE including systemic, biologic and interventional therapies; however, currently there is a paucity of high-quality trial data to guide firm recommendations. In order to better understand the optimal treatment of NPSLE and its different subtypes, further well-designed clinical trials are needed.

Aedes albopictus (Skuse, 1895) (Diptera: Culicidae) in Greece: 13 years of living with the Asian tiger mosquito.

Aedes (Stegomyia) albopictus (Skuse, 1895) (Diptera: Culicidae), commonly known as the Asian tiger mosquito, is an invasive mosquito species of public health significance, well established in many countries worldwide. In Greece, it was first recorded in Corfu and Thesprotia between 2003 and 2004. In the following years, further distribution and establishment of Ae. albopictus in Greece have been confirmed in many Regional Units of the country. In the current study, we report the invasion history of Ae. albopictus in Greece, until 2016. The results from the entomological investigation following imported virus cases in 2014, 2015, and 2016 are also included. Moreover, its presence in Greece is demonstrated in a thematic map based on (a) information provided by pest control companies and/or citizens, (b) the official samples sent to Benaki Phytopathological Institute (BPI) and the National School of Public Health (NSPH), and

"Gold" Pressed Essential Oil: An Essay on the Volatile Fragment from Citrus Juice Industry By-Products Chemistry and Bioactivity.

Present essay explores the potentials of Citrus juice industry's by-products as alternative bioactive natural products resources. Four crude Cold Pressed Essential Oils (CPEOs), derived from orange, lemon, grapefruit, and mandarin, were studied. All CPEOs were subjected to water distillation, in order to obtain the volatile fragment, which was further fractionated with respect to distillation period in two parts, concluding to eight samples. These samples along with the four original CPEOs were assessed in relation to their phytochemical content and their repellent and larvicidal properties against Asian Tiger Mosquito. The volatiles recovery rates ranged from 74% to 88% of the CPEO. Limonene presented a significant increase in all samples ranging from 8% to 52% of the respective CPEO's content and peaked in mandarin's 2nd volatile fragment which comprised 97% of the essential oil. The refinement process presented clear impacts on both bioassays: a significant increase in larvicidal potency was observed, annotated best by the improvement by 1100% and 1300% of the grapefruit volatile fractions; repellence testing provided only one significant result, the decrease of landings by 50% as a response to mandarin's second volatile fraction. The applied methodology thus may be considered for the improvement of Citrus juice industry's by-products chemistry and bioactivity.

Seasonal variation and bioactivity of the essential oils of two Juniperus species against Aedes (Stegomyia) albopictus (Skuse, 1894).

The seasonal variation in respect to the yield and chemical composition of 24 essential oils (EOs) isolated from various parts (leaves and fruits) of two indigenous Greece Juniperus species (family Cupressaceae), namely Juniperus drupacea and Juniperus phoenica, were determined by GC and GC/MS analysis. The larvicidal properties of these EOs were evaluated against 3rd and early 4th instar larvae of Aedes (Stegomyia) albopictus (Skuse, 1894) at one screening dose (29 mg L(-1)). Moreover, the repellent activity against adult mosquitoes was also evaluated at one screening dose. The analytical data indicated that the EOs mainly consisted of monoterpenes, mostly cyclic and only occasionally aliphatic and to a lesser percent diterpenes. The EOs yield was sharply increased when the plant material was subjected to pre-treatment before steam distillation. Finally, the influence of plant material collection period on their yield and chemical content was also determined. Bioactivity assessments indicated that three EOs possess very potent larvicidal properties and 12 EOs display significant repellent activities since they were proved to be "DEET-like." Therefore, they represent an inexpensive source of natural mixtures of larvicidal and repellent mixture of natural compounds, with potentials for application for utilization in mosquito control schemes in order to prevent the expansion of viral infections.

Intravenous cyclophosphamide as a therapeutic option for severe refractory gastric antral vascular ectasia in systemic sclerosis.

Gastric antral vascular ectasia (GAVE) is a rare but important cause of upper gastrointestinal bleeding. It is commonly associated with autoimmune conditions such as systemic sclerosis, and standard treatment involves both supportive measures, as well as endoscopic interventional therapies. While the current therapies are effective for most patients, a few patients develop severe and refractory bleeding. Herein we report two cases of refractory GAVE in patients with diffuse scleroderma, which improved significantly after the administration of intravenous cyclophosphamide. One of these cases is, to our knowledge, the first reported case of cyclophosphamide being used specifically for the treatment of refractory GAVE.