Systematic Review and Meta-Analysis of the Relationship between Proton Pump Inhibitors and Esophageal Adenocarcinoma

INTRODUCTION AND AIM

Esophageal adenocarcinoma (EAC) mortality continues to increase across the world. This meta-analysis was aimed to investigate the relationship between proton pump inhibitors (PPIs) and the risk of EAC.

METHODS

This meta-analysis was done as per the PRISMA checklist using relevant keywords. To this end, an extensive search was done on 29/6/2022 in EMBASE, Web of Science (ISI), PubMed, and Scopus. In this study, 95% confidence interval (CI) and standardized mean difference (SMD) were used to estimate the overall effect size. Analysis of the odds ratio (OR) for EAC was done using a random effects model.

RESULTS

A total of 20 studies were included in the review. Compared to the group that received PPIs, the OR of EAC in the recipients of the PPIs group was obtained at 0.67 (95% CI = 0.39-1.29, P = 0.240). The meta-regression, including year, follow-up time, study design, sample size, quality of the study, study period, and geographical location, demonstrated no source of heterogeneity (P > 0.10).

CONCLUSION

No significant relationship was found between PPIs use and the risk of EAC. Accordingly, PPIs do not have a protective or risk factor effect on EAC.

The Role of Vitamin D in Carpal Tunnel Syndrome Risk and Supplementation Outcomes: A Systematic Review

BACKGROUND

Carpal tunnel syndrome (CTS) is a debilitating neuropathy that accompanies pain and other physical limitations and disrupts the normal functioning of the victims' lives.

OBJECTIVE

We aimed to investigate Vitamin D's preventive and therapeutic effects on the occurrence and remission of CTS symptoms.

METHODS

In this systematic review the PRISMA statement has been designed primarily. An extensive search was undertaken in various databases, including PubMed, Cochrane library, Web of Science, EMBASE, and Scopus. After considering the inclusion and exclusion criteria of the study, finally, 19 articles were retrieved. The raw data were extracted and entered into an Excel form, and the study outcomes were investigated.

RESULTS

The main symptoms and tests, including functional score, nerve conduction, and pain, were improved after Vitamin D supplementation in CTS patients. However, they revealed worse scores in people with low Vitamin D levels. In addition, the scores of mentioned indices were worsened in people with lower serum Vitamin D levels. Nevertheless, some studies did not find a significant relationship between low serum 25(OH)D and more significant pain scores in CTS patients. In addition, Vitamin D inserts its effects on CTS by regulating cell proliferation, nerve growth factor, suppression of oxidative stress and inflammatory cytokines, and improvement in cartilage and microvascular damage.

CONCLUSION

Vitamin D supplementation can improve the symptoms in CTS patients, and low serum 25(OH)D can aggravate the symptoms of the disease and could be a risk factor for its occurrence. However, more observational studies and clinical trials are needed.

Recent progress in cancer immunotherapy: Overview of current status and challenges

Cancer treatment is presently one of the most important challenges in medical science. Surgery, chemotherapy, radiotherapy, or combining these methods is used to eliminate the tumor. Hormone therapy, bone marrow transplantation, stem cell therapy as well as immunotherapy are other well-known therapeutic modalities. Immunotherapy, as the most important complementary method, uses the immune system for treating cancer followed by surgery, chemotherapy, and radiotherapy. This method is systematically used to prevent malignancies development mainly via potentiating antitumor immune cells activation and conversely compromising their exhaustion with the lowest negative effects on healthy cells. Active immunotherapy can be employed for cancer immunotherapy by directly using the ingredients of the immune system and activating immune responses. On the other hand, inactive immunotherapy is utilized by indirect induction and using immune cell-based products consisting of monoclonal antibodies. It has strongly been proved that combination therapy with immunotherapies and other therapeutic means, such as anti-angiogenic agents, could be a rational plan to treat cancer. Herein, we have focused on recent findings concerning the therapeutic merits of cancer therapy using immune checkpoint inhibitors (ICIs), adoptive cell transfer (ACT) and cancer vaccine alone or in combination with other approaches. Also, we offer a glimpse into the current challenges in this context.

Association of thyroid dysfunction and COVID-19: A systematic review and meta-analysis

This systematic review and meta-analysis was conducted to evaluate the effect of COVID-19 on thyroid function and the role of thyroid hormones alterations in predicting the severity of COVID-19. Online databases, including Scopus, Medline/PubMed, EMBASE, Google Scholar, and Cochrane were searched up to August 2, 2022. After screening titles, abstracts, and full manuscripts, respectively, 30 reports were enrolled. The risk of bias (ROB) was evaluated using the QUADAS-2 tool. In addition, odds ratio (OR) and hazard ratio (HR) analysis for assessing the OR of abnormal thyroid function tests (TFT) in predicting the COVID-19 severity and poor outcomes. Among 30 enrolled studies, ROB of the current study is estimated low to moderate. The average number of patients in each study was 325 (range: 40-3,703), with an overall mean age of 57.6, and the female proportion of 40.4%. Overall, the pooled analysis showed that the prevalence of thyroid dysfunction among 9,707 COVID-19 cases was 15%. Among mild to moderate COVID-19 patients, 6.2% had abnormal TFT, and among patients who experienced severe to critical COVID-19, 20.8% had abnormal TFT. The pooled OR for abnormal TFT and the severity of COVID-19 obtained from 3,865 COVID-19 patients was 3.77 (2.03, 6.99). The pooled HR of TSH level of COVID-19 mortality was 1.57 (0.91, 2.72). Our results demonstrate a high prevalence of thyroid dysfunction in COVID-19, and that among patients severe cases had a 3.77-fold higher risk of abnormal TFT compared to mild to moderate COVID-19. Further studies are required to evaluate the longer-term prognostic role of thyroid dysfunction in severe COVID-19, and investigate potential therapeutic strategies.

Fully understanding the efficacy profile of the COVID-19 vaccination and its associated factors in multiple real-world settings

We performed a review study according to recent COVID-19 vaccines' real-world data to provide comparisons between COVID-19 vaccines regarding their relative efficacy. Although most vaccine platforms showed comparable effectiveness and efficacy, we highlight critical points and recent developments generated in studies that might affect vaccine efficacy including population-dependent effects of the vaccine (transplantation, adiposity, and specific comorbidities, as well as older age, male sex, ethnicity, and prior infection), vaccine type, variants of concern (VOC), and an extended vaccine schedule. Owing to these factors, community-based trials can be of great importance in determining vaccine effectiveness in a systematic manner; thus, uncertainty remains regarding vaccine efficacy. Long immune protection of vaccination with BNT162b2 or ChAdOx1 nCoV-19 has been demonstrated to be up to 61 months and 5-12 months after the previous infection, and boosting infection-acquired immunity for both the first and second doses of the BNT162b2 and ChAdOx1 nCoV-19 vaccines was correlated with high and durable protection. However, large cohort and longitudinal studies are required for the evaluation of immunity dynamics and longevity in unvaccinated, vaccinated, and infected individuals, as well as vaccinated convalescent individuals in real-world settings. Regarding the likelihood of vaccine escape variants evolving, an ongoing examination of the protection conferred against an evolving virus (new variant) by an extended schedule can be crucial.

Evaluation of the total antioxidant capacity of <em>Oliveria decumbens</em> and <em>Capparis spinosa</em>

The anti-oxidative potential of extracts from two Iranian medicinal plants, Oliveria decumbens and Capparis spinosa, is assessed in this study. The Oliveria genus is part of the Apiaceae family and contains only one species, O. decumbensVent. Capers are either wild or cultivated plants that are found in many tropical and subtropical countries. Oliveria decumbens and Capparis spinosa aerial parts were dried and ground. The herbal solution was then created by combining herbal powder and methanol. Finally, the total antioxidant capacity of the plants was determined using the Ferric Iron Reducing Antioxidant Power (FRAP) assay and the ELISA reader at 570 nm. The total antioxidant capacities of O. decumbens, C. spinosa fruit, and C. spinosa leaves, respectively, were 3.82 mmol Fe2+/L, 1.96 mmol Fe2+/L, and 1.65 mmol Fe2+/L. These plants' essential oils are secondary metabolites that are widely used in the food, pharmaceutical, and health industries as antioxidant and antimicrobial compounds. In general, the traditional Iranian edible plants studied are good sources of natural antioxidant compounds.

Evaluation of genetic diversity of colistin-resistant Acinetobacter baumannii by BOX-PCR and ERIC-PCR: the first report

Aim: To control the spread of Acinetobacter baumannii in hospitals, it is necessary to identify the reservoir of organisms and the way they are transmitted. This study analyzed samples by BOX-PCR and enterobacterial repetitive intergenic consensus PCR techniques. Methods: Isolated strains were identified using the Microgen kit and blaOXA-51 gene. The genetic diversity of strains that were sensitive or resistant to colistin was evaluated by BOX-PCR and enterobacterial repetitive intergenic consensus PCR methods. Results: A total of 13% of the isolates were resistant to colistin, whereas 87% of the strains were sensitive to this medication. A. baumannii strains that were resistant or sensitive to colistin were divided into five groups using the BOX-PCR method and six groups using the enterobacterial repetitive intergenic consensus PCR method. Conclusion: Rapid identification and the use of appropriate tools to control colistin-resistant clones are essential to prevent the further spread of A. baumannii.

Identification of Knockdown Resistance Mutations in the Cimex hemipterus (Hemiptera: Cimicidae) in Iran

The worldwide resurgence of tropical bed bug Cimex hemipterus beginning in the late 1990s has led to growing concern. Molecular data on pyrethroid resistance, which is essential for the control strategies, is unknown for C. hemipterus in Iran. The current study evaluated the deltamethrin resistance status of C. hemipterus by bioassay and molecular tests. Live bed bugs were collected from sleeping quarters (dormitories) in the city of Tehran and used for insecticide bioassay tests. For bioassay evaluation, mixed-sex pools of adult bugs were exposed to deltamethrin (0.025%)-treated paper. Polymerase chain reaction assay evaluated resistance-related mutations in the voltage-gated sodium channel gene (VGSC) gene of studied populations. On the basis of the bioassay test within the 48-h exposure to deltamethrin, C. hemipterus were determined to be resistant. Knockdown time ratios (KR50) in the studied populations of C. hemipterus was 5.5-fold compared with those of the C. lectularius Teh strain. DNA sequencing of the VGSC gene revealed the presence of mutations at M918I and L1014 in C. hemipterus. According to the bioassay and molecular results of current study, C. hemipterus showed a high degree of pyrethroid resistance. The application of multiple approaches including physical, biological, and chemical tests should be regarded in future bed bug control strategies.

Efficacy of Red Blood Cell Exchange as Adjunctive Treatment for Hypoxemia and Survival Rate of Patients With Severe Coronavirus-2 Disease: An Open-Labeled Phase 2 Randomized Clinical Trial

Background

Severe acute respiratory syndrome (SARS) coronavirus-2 may infect red blood cells (RBCs) and impact oxygenation. We aimed to evaluate the efficacy of RBC exchange as an adjunctive treatment for hypoxemia and the survival rate of patients with severe coronavirus disease 2019 (COVID-19).

Methods

In a randomized clinical trial, we divided sixty patients with severe COVID-19 into two groups. The intervention group received the standard treatment of severe COVID-19 with RBC exchange three to four times in 2 days. The control group only received the standard treatment. Our primary outcomes were improving hypoxemia in 7 days, recovery or discharge, and death in 28 days. We conducted Chi-square test, independent samples t-test, and Fisher’s exact test to analyze the results. The ethical committee of Aja University of Medical Sciences approved the study (IR.AJAUMS.REC.1399.054), and the Iranian clinical trial registration organization registered it (IRCT20160316027081N2).

Results

Twenty-nine men and thirty-one women with a mean age of 67.5 years entered the study. The frequency of hypertension and diabetes mellitus was 86.7 and 68.3%, respectively. The most common symptoms of severe COVID-19 were dyspnea (91.6%), cough (75%), and fever (66.6%). Our results showed that hypoxemia improved in 21 of the 30 patients (70%) in the intervention group and 10 of the 30 patients (33.3%) in the control group (P < 0.004). The recovery and discharge rates were 19 of 30 patients (63.3%) in the intervention group and 2 of 30 patients (6.7%) in the control group (P < 0.001).

Conclusion

The RBC exchange improved the oxygenation and survival rate in patients with severe COVID-19.

SARS-CoV-2 Lambda (C.37): An emerging variant of concern?

Many SARS-CoV-2 variants have high infectivity and transmissibility. The viral genome data show that the COVID-19 curves of daily case numbers were shaped by the emergence of the variants, including Alpha 202012/01 GRY (B.1.1.7; the U.K.), Beta GH/501Y.V2 (B.1.351, B.1.351.2, and B.1.351.3; South Africa), Gamma GR/501Y.V3 (P.1, P.1.1, and P.1.2; Japan, Brazil), Eta G/484K.V3 (B.1.525; Nigeria, the U.K.), Delta G/478K.V1 (B.1.617.2, AY.1, AY.2, and AY.3; India), Iota GH/253G.V1 (B.1.526; the U.S.A.), and Kappa G/452R.V3 (B.1.617.1; India). The Lambda (C.37) variant was reported in Peru initially; this has spread to 41 countries in four continents. Seven out of eight mutations in this variant are associated with the viral spike protein, akin to mutations in the other variants. These mutations have implications for effectiveness of the vaccines and neutralizing antibodies in immunized subjects and those previously infected with the virus and are thought to facilitate the viral invasion into host cells and help the virus evade the host immune system. Widespread dissemination of the viral variants may cause severe clinical consequences, lengthy hospitalizations, and unfavorable prognoses. Healthcare systems will be stretched, and health workers will be fatigued. Fast, equitable, and widespread vaccination with strict adherence to hygiene protocols will control the rising curves of the pandemic due to the new variants.

Guillain-Barré Syndrome Associated with SARS-CoV-2 Infection: A Case Report

A 56-year-old man was referred to the emergency department for the subacute onset of and weakness in the lower extremities, paraesthesia and pain. He was diagnosed with SARS-CoV-2 pneumonia and then, he received the necessary treatment according to national protocol. Radiographic, laboratory, and electroneurographic findings indicated an acute polyradiculoneuritis with prominent demyelination and suggesting the diagnosis of Guillain-Barr syndrome associated with COVID-19 infection.

Overt hematochezia : A rare gastrointestinal presentation in patients with corona virus disease 2019

World health care systems are affected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and its associated disease, coronavirus disease 2019 (COVID-19). This new human pathogen mostly affects the respiratory system, but various extrapulmonary pathologies have been reported in the literature. It seems that the gastrointestinal system is one of the target organs for SARS-CoV- 2. Diarrhea as a long-term bowel symptom is not rare, although its occurrence is not as high as that of fever and cough.

Moxifloxacin-Loaded Lipidic Nanoparticles for Antimicrobial Efficacy

BACKGROUND

Pulmonary infections are an increasing problem in individuals and current therapies are lacking. Liposomes are spherical lipidic vesicles composed of phospholipid and cholesterol. Liposomes have numerous advantages, such as biodegradability, biocompatibility, non-immunogenicity, lack of toxicity, controlled release properties and high stability.

OBJECTIVE

This work was carried out to construct a novel liposomal moxifloxacin formulation and examine its antimicrobial effects against Pseudomonas aeruginosa and Staphylococcus aureus.

METHODS

The liposomal moxifloxacin formulation was prepared by the thin-film hydration method. The bilayer was composed of cholesterol and phospholipid at 30:70 molar ratio. To prepare cationic liposomes, 5% cationic agent (CTAB) was added. The liposomes were reduced in size with the bath sonication technique. The liposomal characterizations were tested regarding vesicle size, surface charge and drug encapsulation efficacy. Microdilution method was used to determine the Minimum Inhibitory Concentration (MIC) against Pseudomonas aeruginosa and Staphylococcus aureus of the free drug, neutral and cationic moxifloxacin liposomes.

RESULTS

The size of the liposomes was 50-70 nm. The zeta potential of neutral and cationic vesicles was ∼0 and +22 mV. The MIC values against Pseudomonas aeruginosa of the free drug, neutral and cationic moxifloxacin liposomes were 10, 5 and 2.5, respectively. The MICs against Staphylococcus aureus of the free drug, neutral and cationic moxifloxacin liposomes were 1, 1 and 0.5, respectively.

CONCLUSION

This study demonstrates that the encapsulation of moxifloxacin into liposomes (especially cationic vesicles) could enhance antimicrobial properties.

Perichondritis due to a herpes zoster Infection after an Ear Piercing: a Case Report

Nowadays piercing has become one of the most popular fashionable and cultural customs and people of all ages are interested in this cosmetic procedure. One of the common sites of piercing is ears which, like any other piercing, can bring about many complications like infection, inflammation, allergic reaction, keloid formation, and traumatic tearing. In this paper, we report a case of perichondritis due to Staphylococcal secondary infection to a primary herpes zoster infection following ear piercing.

Current Understanding and Unknown Aspects of the Treatment of Granulomatosis with Polyangiitis (Wegener's Granulomatosis): Opportunities for Future Studies

Granulomatosis with polyangiitis (GPA) is a rare and systemic autoimmune disease, causing necrotizing vasculitis of small arteries and veins. The majority of diagnosed patients with GPA have circulating anti-neutrophil cytoplasmic antibodies (ANCA) directed against proteinase 3 (PR3). Here, we have reviewed the last findings and uncertainties regarding the treatment of GPA. Between the available treatments, in addition to corticosteroids, cyclophosphamide (CYP) is effective for remission-induction, while it is associated with some serious side effects, such as infertility and increased risk of malignancies. On the other side, rituximab (RTX) seems a safer alternative option and as effective as CYP. It could be used as both remission-induction and maintenance therapy in GPA patients, especially in women of childbearing age. Pregnant patients, who must not be exposed to the CYP and RTX could be well-managed with intravenous immunoglobulin (IVIg). Co-trimoxazole, which is widely used to treat certain bacterial infections or as prophylaxis in immunosuppressed patients, could be effective in preventing disease relapse. In the meantime, 15- deoxyspergualin, plasma exchange are other therapeutic options with a low level of evidence. Regarding potential treatments, ofatumumab, ocrelizumab, belimumab, atacicept, tabalumab, abatacept (CTLA4-Ig), and Janus kinase inhibitors seem to be effective. Renal involvement, older age, the presence of baseline organ damage, delayed-diagnosis of disease, rising in creatinine level, and higher neutrophil/lymphocyte ratio is associated with poor outcomes. Optimum doses of medications, prediction of treatment response and disease relapse, explaining lack of response in some patients, treating children with GPA, and management of GPA during the pregnancy are controversial issues, which need further studies.

Intractable airsickness associated with COVID-19: A case report

A 29-yr-old male Melicopter co-pilot with high flight hours in air transport missions of the patients with COVID-19 tested positive for his RT-PCR due to clinical suspicion. With the diagnosis of SARS-CoV-2, he was treated based on the national protocol and stayed in the home quarantine for two weeks. Having been released for flying, he faced nausea, vomiting, facial cold sweat and pallor, dizziness, and imbalance that eventually caused flying avoidance during the three first flights. He has never had a similar problem or any predisposing factors during his pilot's training and afterwards. All the probable reasons ruled out after a complete assessment. Following the diagnosis of moderate airsickness, he was abstained from flying and treated with different prevention and rehabilitation techniques. None of them had enough clinical efficacies, applying the United States Air Force Preventive Airsickness Protocol as the last choice. Despite the three separate consecutive therapeutic courses, no significant clinical improvement was observed, and could not return to fly, yet. That is the first reported case of intractable airsickness in a flight crew that may be associated with SARS-CoV-2 infection.

Microbial Contamination after Cardiac Surgery in a Hospital Cardiac Surgery Ward

Surgery site infection is one of the most common postoperative complications which is associated with increased morbidity, mortality and admission costs. It is considered a priority to determine the level of nosocomial infection and its control in reflecting the quality of care. Therefore, this study aimed to evaluate the microbial contamination after cardiac surgery at a hospital cardiac surgery ward of Besat Hospital, Tehran.

In this cross-sectional descriptive-analytic study (2013-2017), 610 patients underwent surgery at the Department of Cardiac Surgery of Besat Hospital. All necessary information such as urine culture, surgical site, histopathologic examination for the diagnosis of microbial contamination and microorganisms were collected from the patient records and inserted in the questionnaire. The data were analyzed using SPSS (version 25).

The incidence of nosocomial infections following cardiac surgery reportedly ranged from 17% to 23%. Accordingly, pneumonia (51.2%) and local infections (22%) were the most common infections in the studied population. The mortality rate in our population was 11.4%. Moreover, 64.3% of the total mortality cases were reported in patients with sepsis. The mean age and duration of admission of patients with catheter infection were significantly higher than other subjects.

Given the relatively high prevalence of the infection and its importance, it is necessary to take more serious measures to prevent and control these infections.

Tuberculous Sacroiliitis after a Penicillin Injection: A Case Report

Tuberculosis is one of the major health problems in developing countries affecting different organs such as bone and joints. One of the most important involvements of osteoarticular tuberculosis is that of the sacroiliac joint. In addition, its incidence has increased over the past several years. Early diagnosis is necessary to prevent further disorders such as neurological and surgical complications. We report a tuberculous arthritis case in the right sacroiliac joint, which developed after penicillin injection.

The patient was a 32-year-old man admitted to Besat hospital, Tehran, Iran. He complained of pain, erythema and swelling in his right buttock starting approximately 17 years previously, after a penicillin injection, which was followed by the emergence of an orifice with yellow secretions. Over the years, the secretions continued but the pain, swelling and erythema were resolved. At the time of admission, his vital signs were stable and normal. In the physical examination, an orifice with a small amount of yellow secretion was detected on the right buttock as claimed by the patient. Lung auscultation was clear. No lymphadenopathy was detected. Laboratory data were normal.

During hospitalization, initial antibiotic therapy was prescribed. After Mycobacterium tuberculosis was detected in culture, a 4-drug anti-TB therapy encompassing rifampin, isoniazid, ethambutol and pyrazinamide was prescribed for 18–24 months, in addition to daily vitamin B6 and pantoprazole.

Comparing the Efficacy and Safety of Treating Chronic Hepatitis B Infection during Pregnancy with Lamivudine, Telbivudine, and Tenofovir: A Meta-analysis

Background and Aims: The perinatal transmission of hepatitis B virus (HBV) remains an important global health problem. Here, a systematic review and meta-analysis were conducted to evaluate the evidence regarding the efficacy and maternal/fetal safety of treating pregnant women with lamivudine, telbivudine (LdT), and tenofovir (TDF). Methods: A PubMed and Scopus search resulted in 1,076 records, which were reduced to 36, containing 7,717 pregnant women with chronic HBV infection and 7467 infants meeting the inclusion criteria. The latest search was in August 2019. Results: Treatment with LdT, but not lamivudine and TDF, could significantly reduce the hepatitis B virus surface antigen-positive rate (odds ratio (OR) = 0.37) in infants; it also led to higher rates of hepatitis B e antigen loss (OR = 12.14), hepatitis B e antigen seroconversion (OR = 8.93), and alanine aminotransferase normalization in mothers (OR = 1.49). Each of these treatments was able to significantly reduce HBV DNA positivity at birth (total OR = 0.19) and mother-to-child-transmission of HBV (total OR = 0.15), and to cause higher rates of HBV DNA suppression in mothers (total OR = 25.53). However, nucleos(t)ide analogues might also be involved in creatine kinase elevation (total OR = 7.48). In contrast, no significant association was found between nucleos(t)ide analogue therapy and preterm/premature births, congenital malformation, low birth weight, and abortion or fetal/infant death. The results suggested LdT's high capability of preventing mother-to-child-transmission. However, TDF failed to show significant associations to a reduced risk of mother-to-child-transmission, probably due to the low number of patients included. Conclusions: Although using either lamivudine, LdT, or TDF could lead to more favorable maternal/fetal outcomes, LdT seemed to show more potential in resolving certain infant- and maternal-related outcomes. More studies on the safety profile of such treatments are required.

Pharmacogenetics: A strategy for personalized medicine for autoimmune diseases

For many years, a considerable number of patients with autoimmune diseases (ADs) have suffered from a lack of drug response and drug-related toxicity. Despite the emergence of new therapeutic options such as biological agents, patients continue to struggle with these problems. Unfortunately, new challenges, including the paradoxical effects of biological drugs, have complicated the situation. In recent decades, efforts have been made to predict drug response as well as drug-related side effects. Thanks to the many advances in genetics, evaluation of markers to predict drug response/toxicity before the initiation of treatment may be an avenue toward personalizing treatments. Implementing pharmacogenetics and pharmacogenomics in the clinic could improve clinical care; however, obstacles remain to effective personalized medicine for ADs. The present study attempted to clarify the concept of pharmacogenetics/pharmacogenomics for ADs. After an overview on the pathogenesis of the most common types of treatments, this paper focuses on pharmacogenetic studies related to the selected ADs. Bridging the gap between pharmacogenetics and personalized medicine is also discussed. Moreover, the advantages, disadvantages and recommendations related to making personalized medicine practical for ADs have been addressed.

A comprehensive review of rituximab therapy in rheumatoid arthritis patients

Rituximab (RTX) is an approved treatment for rheumatoid arthritis (RA) patients that do not respond adequately to disease-modifying antirheumatic drugs. However, different new concerns, such as efficacy, optimum dose, safety issues, prediction of response to RTX, and pregnancy outcomes have attracted a lot of attention. The PubMed database was systematically reviewed for the last published articles, new findings, and controversial issues regarding RTX therapy in RA using "Rheumatoid arthritis" AND "rituximab" keywords, last updated on June 18, 2019. From 1812 initial recorders, 162 studies met the criteria. Regarding the optimum dose, low-dose RTX therapy (2 × 500 mg) seems as effective as standard dose (2 × 1000 mg), safer, and more cost-effective. The most common reported safety challenges included de novo infections, false negative serologic tests of viral infections, reactivation of chronic infections, interfering with vaccination outcome, and development of de novo psoriasis. Other less reported side effects are infusion reactions, nervous system disorders, and gastrointestinal disorders. Lower exposure to other biologics, presence of some serological markers (e.g., anti-RF, anti-CCP, IL-33, ESR), specific variations in FCGR3A, FCGR2A, TGFβ1, IL6, IRF5, BAFF genes, and also EBV-positivity could be used to predict response to RTX. Although there is no evidence of the teratogenic effect of RTX, it is recommended that women do not expose themselves to RTX at least 6 months before the conception. Only a reversible reduction of B cell-count in the offspring may be the pregnancy-related outcome. Although RTX is an effective therapeutic option for RA, more studies on optimum doses, prevention of RTX-related side effects, prediction of RTX response, and safety during the pregnancy are required.