This study has served as more encouraging signs that constructed wetlands (CWs) can incorporate microbial fuel cells (MFCs) into their design to produce electrical energy while treating wastewater. Two 3.7 L CW-MFCs have been constructed to treat swine wastewater with one (System 1) operated in batch mode while the other (System 2) was operated in continuous, upward flow mode and incorporated air diffusion heads to aerate the cathode.

The patient's condition was managed with corticosteroids and methotrexate. No residual tumor or evidence of metastatic disease have been detected in the 1.5 years since the initial presentation of her rheumatic symptoms.

No abstract

The objectives of this study are to assess: (a) the prevalence of vitamin D deficiency among new patients attending rheumatology outpatient departments, (b) the age profile of these low vitamin D patients and (c) whether any diagnostic category had a particularly high number of vitamin D-deficient patients. All new patients seen consecutively in general rheumatology clinics between January to June 2007 inclusive were eligible to partake in this study, and 231 out of 264 consented to do so. Parathyroid hormone, 25-hydroxyvitamin D, creatinine, calcium, phosphate, albumin and alkaline phosphatase levels were measured. We defined vitamin D deficiency as ≤53 nmol/l and severe deficiency as ≤25 nmol/l. Overall, 70% of 231 patients had vitamin D deficiency, and 26% had severe deficiency. Sixty-five percent of patients aged ≥65 and 78% of patients aged ≤30 years had low vitamin D levels. Vitamin D deficiency in each diagnostic category was as follows: (a) inflammatory joint diseases/connective tissue diseases (IJD/CTD), 69%; (b) soft tissue rheumatism, 77%; (c) osteoarthritis, 62%; (d) non-specific musculoskeletal back pain, 75% and (e) osteoporosis, 71%. Seasonal variation of vitamin D levels was noted in all diagnostic groups apart from IJD/CTD group, where the degree of vitamin D deficiency persisted from late winter to peak summer. Very high prevalence of vitamin D deficiency was noted in all diagnostic categories (p = 0.006), and it was independent of age (p = 0.297). The results suggest vitamin D deficiency as a possible modifiable risk factor in different rheumatologic conditions, and its role in IJD/CTD warrants further attention.

The experience with anti-TNF agents is relatively short; and with time, we are learning more about the frequency of occurrence of different adverse events as the original trials were either too small or too brief. We report a case series of four patients who suffered from chronic inflammatory arthritis [rheumatoid arthritis (n = 3) and psoriatic arthritis (n = 1)]. Their inflammatory arthritis remained refractory to increasing doses of methotrexate up to 20 mg weekly and required an advance in treatment to TNF antagonists. However, within a few weeks of commencing these patients on adalimumab, they developed newly diagnosed recurring sinusitis. All these patients were assessed by otorhinolaryngologists, and had clinically confirmed diagnosis. The sinusitis remained refractory to standard medications; however, it resolved after the discontinuation of adalimumab. Although FDA and Irish Pharmaceutical Health Association describe that adalimumab use increases the risk of non-serious infections marginally and most of the patients continued on Humira (adalimumab) after the infection was resolved, however, our recent observation raises the concern of probable higher incidence.

BPOP, although a benign lesion, behaves aggressively with rapid growth and has a high risk of local recurrence after local resection (Nora et al. in Am J Surg Pathol 7(3):245-250, 1983; Meneses et al. in Am J Surg Pathol 17(7):691-697, 1993). Its clinical presentation can be confused with glomus tumour, subungual exostosis and enchondroma. The distinguishing features of BPOP and several relevant different differential diagnoses are discussed in this case report.

No abstract

The increased prevalence of these comorbidities may serve as a reminder to the rheumatologists that many of their patients will have coexistent disease of which they need to be aware to properly plan their management.