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Sharma SK, Mor J. Free Volume Mediated Decoupling of Ionic Conduction from Segmental Relaxation Leading to Enhancement in Ionic Conductivity of Polymer Electrolytes at Low Temperatures. ACS Macro Lett 2024; 13:1211-1217. [PMID: 39225260 DOI: 10.1021/acsmacrolett.4c00467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Coupling between segmental relaxation and ionic conduction has limited the ionic conductivity of flexible polymers like poly(ethylene oxide), PEO, based electrolytes especially at low temperatures where segmental relaxation becomes extremely slow. In the present study, we show that ionic conduction becomes decoupled from segmental relaxation in PEO-based electrolytes simply by loading succinonitrile (SN). As a result of SN interactions induced rigid chain packing of PEO, the semicrystalline morphology of PEO is completely altered along with the enhancement in number density of free volumes having smaller size and narrower size distribution. These free volumes provide additional pathways for ionic diffusion independent of segmental relaxations of PEO leading to decoupling of ionic diffusion from the segmental relaxation process. The decoupling finally leads to nearly two orders higher ionic conductivity (∼10-11 Scm-1)at glass transition temperature (Tg ∼ 210 K), than what is expected in the case of complete coupling.
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Clavé E, Beyssac O, Bernard S, Royer C, Lopez-Reyes G, Schröder S, Rammelkamp K, Forni O, Fau A, Cousin A, Manrique JA, Ollila A, Madariaga JM, Aramendia J, Sharma SK, Fornaro T, Maurice S, Wiens RC. Radiation-induced alteration of apatite on the surface of Mars: first in situ observations with SuperCam Raman onboard Perseverance. Sci Rep 2024; 14:11284. [PMID: 38760365 PMCID: PMC11101483 DOI: 10.1038/s41598-024-61494-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/06/2024] [Indexed: 05/19/2024] Open
Abstract
Planetary exploration relies considerably on mineral characterization to advance our understanding of the solar system, the planets and their evolution. Thus, we must understand past and present processes that can alter materials exposed on the surface, affecting space mission data. Here, we analyze the first dataset monitoring the evolution of a known mineral target in situ on the Martian surface, brought there as a SuperCam calibration target onboard the Perseverance rover. We used Raman spectroscopy to monitor the crystalline state of a synthetic apatite sample over the first 950 Martian days (sols) of the Mars2020 mission. We note significant variations in the Raman spectra acquired on this target, specifically a decrease in the relative contribution of the Raman signal to the total signal. These observations are consistent with the results of a UV-irradiation test performed in the laboratory under conditions mimicking ambient Martian conditions. We conclude that the observed evolution reflects an alteration of the material, specifically the creation of electronic defects, due to its exposure to the Martian environment and, in particular, UV irradiation. This ongoing process of alteration of the Martian surface needs to be taken into account for mineralogical space mission data analysis.
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Mor J, Sharma SK. Decoupling of ion-transport from polymer segmental relaxation and higher ionic-conductivity in poly(ethylene oxide)/succinonitrile composite-based electrolytes having low lithium salt doping. Phys Chem Chem Phys 2024; 26:13306-13315. [PMID: 38639464 DOI: 10.1039/d4cp00735b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Only limited enhancement in room-temperature ionic-conductivity for poly(ethylene oxide), PEO, based electrolytes is possible due to coupling between ionic-conductivity and segmental relaxation. In the present study, we have achieved ionic-conductivity of 1.07 × 10-3 and 6.20 × 10-4 S cm-1 at 313 and 298 K, respectively, by adding 45 wt% of succinonitrile (SN) in PEO having low LiTFSI loading (Li : EO = 1 : 20). This enhancement in the ionic-conductivity is attributed to faster ion transport (diffusion coefficient, D = 3.63 × 10-5 cm2 s-1) occurring through the ion-transport channels as confirmed by positron annihilation lifetime spectroscopy. The ionic-transport through these channels is observed to be highly decoupled from the segmental relaxations as confirmed using broadband dielectric spectroscopy through Ratner's approach. The observed decoupling of ionic-conductivity from PEO segmental relaxation in PEO-SN composite-based electrolytes would be useful to design rather inexpensive all solid-state polymer electrolytes for Li ion batteries.
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Lahiri D, Krishna KVM, Verma AK, Modak P, Vishwanadh B, Chattopadhyay S, Shibata T, Sharma SK, Sarkar SK, Clifton PH, Biswas A, Garg N, K Dey G. Comprehensive characterization of the structure of Zr-based metallic glasses. Sci Rep 2024; 14:4911. [PMID: 38418473 PMCID: PMC10902397 DOI: 10.1038/s41598-024-53509-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/01/2024] [Indexed: 03/01/2024] Open
Abstract
Structure of metallic glasses fascinates as the generic amorphous structural template for ubiquitous systems. Its specification necessitates determination of the complete hierarchical structure, starting from short-range-order (SRO) → medium-range-order (MRO) → bulk structure and free volume (FV) distribution. This link has largely remained elusive since previous investigations adopted one-technique-at-a-time approach, focusing on limited aspects of any one domain. Reconstruction of structure from experimental data inversion is non-unique for many of these techniques. As a result, complete and precise structural understanding of glass has not emerged yet. In this work, we demonstrate the first experimental pathway for reconstruction of the integrated structure, forZr 67 Ni 33 andZr 52 Ti 6 Al 10 Cu 18 Ni 14 glasses. Our strategy engages diverse (× 7) multi-scale techniques [XAFS, 3D-APT, ABED/NBED, FEM, XRD, PAS, FHREM] on the same glass. This strategy complemented mutual limitations of techniques and corroborated common parameters to generate complete, self-consistent and precise parameters. Further, MRO domain size and inter-void separation were correlated to identify the presence of FV at MRO boundaries. This enabled the first experimental reconstruction of hierarchical subset: SRO → MRO → FV → bulk structure. The first ever image of intermediate region between MRO domains emerged from this link. We clarify that determination of all subsets is not our objective; the essence and novelty of this work lies in directing the pathway towards finite solution, in the most logical and unambiguous way.
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Sharma SK, Mandal TK. Correction to: Elemental Composition and Sources of Fine Particulate Matter (PM 2.5) in Delhi, India. BULLETIN OF ENVIRONMENTAL CONTAMINATION AND TOXICOLOGY 2023; 110:88. [PMID: 37131083 DOI: 10.1007/s00128-023-03727-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 04/15/2023] [Indexed: 05/04/2023]
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Shankar S, Gadi R, Sharma SK, Mandal TK. Short-Term Effects: Elemental and Morphological Assessment of Aerosols Over Old Delhi Region, India. MAPAN 2023; 38:745-757. [PMCID: PMC10115371 DOI: 10.1007/s12647-023-00646-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 04/05/2023] [Indexed: 06/16/2024]
Abstract
This study presents morphological and elemental characteristics of aerosols for the duration January-June, 2021, using Scanning Electron Microscope coupled with Energy Dispersive X-Ray (SEM–EDX). The results revealed that there were numerous spherical particles (D α ≤ 2.5 µm) but did not produced the expected EDX-spectra for elemental constituents. Limited deposited particles were observed which showed definite elemental constitutions. The results show that Cl, S, Al, Ca, K, Fe, Zn, Na, Mg, N, Tb, Ti, Ni, F, Cd, Cu, Mn, P and Cr were the overall determined elements, out of which Cl, S, Al, Ca, K, Fe, Zn, Na and Mg were the major constituents. Variation in particles’ shapes whether definite or irregular, columnar or spherical, flaky or aggregate or crystal-accumulation were attained on the basis of the major constituting element, majorly Ca-rich, S-rich, Cl-rich and Fe-rich. Interestingly, the physical characteristics of the particles varied with variation in elemental composition. All these indicate that there were specific sources contributing toward distinct particle-morphs. Ti, Tb and Cd need more analytical studies for their percent contribution. S, Cl and K contributed the most to the elemental composition as revealed by elemental relative proportion. Atomic weight percent curves for elements were slightly scattered during May. These probably played important role in defining the diversity indices, which was highest for April (2.17 ± 0.12). Particles containing six (P 6) to nine (P 9) elements dominated in this study, and particles containing seven elements (P 7) were generally observed.
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Singh SP, Singh H, Saini S, Mishra GK, Sharma SK. Studies on the breeding potential and entomological indices of dengue vector Aedes aegypti and Aedes albopictus in the district Ghaziabad of Uttar Pradesh, India. J Vector Borne Dis 2023; 60:187-192. [PMID: 37417168 DOI: 10.4103/0972-9062.353270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND & OBJECTIVES The female Aedes mosquito is a vector of many arboviruses-borne diseases. The evidence and information regarding their breeding habitats are vital for implementing appropriate control policies. METHODS An entomological survey was done at three sites in Ghaziabad district of Uttar Pradesh, India viz. Indirapuram, Vasundhara, and Vaishali to generate the first boundary line information of breeding sites of Aedes aegypti larvae for the early prevention and control interventions for dengue management. RESULTS A total of 2994 containers were checked in 1169 households at the time of the survey for breeding sites of Aedes mosquito during the pre-monsoon, monsoon, and post-monsoon period, out of which 667 containers were found positive in 518 positive households. The total HI, CI, and BI were 44.31, 22.27, and 57.05 respectively. The maximum and minimum breeding indices were found during monsoon and pre-monsoon respectively. The most preferred containers for Aedes breeding were cement tanks for lotus plants in nurseries, drums, and small and large size pots for storage of water and ornamental plants mostly in 8 plant nurseries. INTERPRETATION & CONCLUSION Breeding of Aedes was found in nurseries and desert coolers which were the primary breeding containers found during the survey. The containers found positive during surveys were emptied or destroyed with the help of the local community and the breeding status of nurseries was informed to the health authorities of Ghaziabad to take necessary action against the breeding sites of the Aedes mosquitoes.
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Sharma SK, Mandal TK. Elemental Composition and Sources of Fine Particulate Matter (PM 2.5) in Delhi, India. BULLETIN OF ENVIRONMENTAL CONTAMINATION AND TOXICOLOGY 2023; 110:60. [PMID: 36892662 PMCID: PMC9995727 DOI: 10.1007/s00128-023-03707-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/20/2023] [Indexed: 05/04/2023]
Abstract
In this study we have analysed the elemental composition of fine particulate matter (PM2.5) to examine the seasonal changes and sources of the elements in Delhi, India from January, 2017 to December, 2021. During the entire sampling period, 19 elements (Al, Fe, Ti, Cu, Zn, Cr, Ni, As, Mo, Cl, P, S, K, Pb, Na, Mg, Ca, Mn, and Br) of PM2.5 were identified by Wavelength Dispersive X-ray Fluorescence Spectrometer. The higher annual mean concentrations of S (2.29 µg m-3), Cl (2.26 µg m-3), K (2.05 µg m-3), Ca (0.96 µg m-3) and Fe (0.93 µg m-3) were recorded during post-monsoon season followed by Zn > Pb > Al > Na > Cu > Ti > As > Cr > Mo > Br > Mg > Ni > Mn > and P. The annual mean concentrations of elemental composition of PM2.5 accounted for 10% of PM2.5 (pooled estimate of 5 year). Principal Component Analysis (PCA) identified the five main sources [crustal/soil/road dust, combustion (BB + FFC), vehicular emissions (VE), industrial emissions (IE) and mixed source (Ti, Cr and Mo rich-source)] of PM2.5 in Delhi, India.
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Utpalla P, Mor J, Sharma SK. On enhancing the Li-ion conductivity of quasi-solid-state electrolytes by suppressing the flexibility of zeolitic imidazolate framework-8 via a mixed ligand strategy. Phys Chem Chem Phys 2023; 25:3959-3968. [PMID: 36648501 DOI: 10.1039/d2cp05811a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Zeolitic imidazole frameworks (ZIFs) have emerged as potential conductive materials for Li ion-transport in polymer solid state electrolytes. However, developing ZIFs with high Li ionic conductivity is rather limited due to their flexible frameworks allowing dual ion conduction. Herein, we have used a mixed ligand strategy for fine-tuning the aperture and enhancing the rigidity of ZIF-8, which restricts the passage of large size anions. Poly(ethylene oxide)-based quasi-solid state electrolytes utilizing mixed ligand ZIF-7-8 frameworks as passive fillers show a continuous enhancement in Li ion-conductivity exclusively attributed to modifications in the flexibility and pore architecture of ZIF-8 as confirmed through broadband dielectric spectroscopy and positron annihilation spectroscopy. This study shows that polymer segmental relaxation and conductivity relaxation processes are decoupled in these electrolytes. Consequently, our proposed approach provides a new strategy for manufacturing a polymer-based electrolyte with enhanced ionic conductivity.
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Gupta N, Gupta SM, Sharma SK. Synthesis of in situ Generated Cu−CNT Hybrid Nanofluid and the Study of Their Thermo‐physical Properties. ChemistrySelect 2023. [DOI: 10.1002/slct.202203102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Verma R, Aravind JMVVS, Deb P, Rao JN, Dey P, Dubey AK, Shukla R, Majumder DB, Sharma SK, Mishra S, Meena M, Rongali L, Sethi B, Sagar K, Kumar GV, Babu NS, Sharma A. Modular electromagnetic railgun accelerator for high velocity impact studies. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2022; 93:124703. [PMID: 36586908 DOI: 10.1063/5.0104365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 11/03/2022] [Indexed: 06/17/2023]
Abstract
A modular electromagnetic railgun accelerator facility named "RAFTAR" (i.e., Railgun Accelerator Facility for Technology and Research) has been commissioned and its performance has been characterized for high velocity impact testing on materials in a single-shot mode. In the first tests, RAFTAR demonstrated an acceleration of more than 1000 m/s for an 8 g solid aluminum-7075 armature projectile. The current fed was 220 kA, having a muzzle time of about 1.75 ms. It is a single pulse breech-fed rectangular bore (14 × 13 mm2) railgun, and its 1.15 m long barrel assembly consists of two parallel copper bars with an inter-gap of 13 mm that are encased within 50 mm thick high strength reinforced fiberglass sheets (Garolite G10-FR4) and bolted from both the sides. RAFTAR is powered by two capacitor bank modules that have a maximum stored energy of 160 kJ each (containing eight 178 μF/15 kV capacitors), two high power ignitron switches, and a pulse shaping inductor. To obtain consistent acceleration of the armature inside the barrel, reversal of driving current is prevented, and its pulse duration is stretched by tactical integration of the crowbar switch and bitter coil inductor in the circuit. Armature projectile velocity measurement in-bore and outside in free space was performed by the time-of-flight technique using indigenously made miniature B-dot sensors and a novel shorting-foil arrangement, respectively. The time resolved measurement of the in-bore armature evidenced a velocity-skin-effect in the high acceleration phase. There is good agreement between the experimentally measured and theoretically predicted efficiency, confirming the optimal choice of operating parameters. The conclusion summarizes important experimental findings and analyzes the underlying causes that limit the performance of railguns.
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Johansson I, Balasubramanian K, Bangdiwala S, Mielniczuk L, Hage C, Sharma SK, Branch K, Yonga G, Kragholm K, Sliwa K, Roy A, Stork S, McMurray JJV, Conen D, Yusuf S. Factors associated with health-related quality of life in heart failure in 23,000 patients from 40 countries: results of the global congestive heart failure research program. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Poor health-related quality of life (HRQL) is common in heart failure (HF) and strongly predicts death and HF hospitalization in all regions of the world. Understanding facors associated with HRQL could therefore lead to improved prognosis in HF patients. Despite that the majority of HF occurs in low- and middle-income countries, there are limited data characterizing self-perceived health HRQL and its correlates in these settings.
Purpose
To examine clinical and social correlates of HRQL in patients with HF from high- (HIC), upper middle- (UMIC), lower middle-(LMIC) and low-income (LIC) countries.
Methods
Between 2017 and 2020, we enrolled 23,292 patients with HF (32% inpatients, 61% men) from 40 countries in the Global Congestive Heart Failure Study. We recorded HRQL at baseline using Kansas City Cardiomyopathy Questionnaire (KCCQ)-12. In a cross-sectional analysis, we compared age- and sex-adjusted mean KCCQ-12 summary scores (SS: 0–100, higher=better) between patients from different country income levels. We used multivariable linear regression examining correlations (estimates expressed as β-coefficients) of KCCQ-12-SS with sociodemographic-, comorbidity-, treatment- and symptom-covariates. The adjusted model (37 covariates) was informed by univariable findings, clinical importance and backward selection. We used partial R2-estimates to understand the contribution to the variability in KCCQ-12-SS of 4 different groups of covariates. (sociodemographic, comorbidities, treatments and signs and symptoms of congestion).
Results
Mean age was 63 years and 40% were in NYHA class III–IV. Average HRQL was 55± SD 0.5. It was 62.5 (95% CI 62.0–63.1) in HIC, 56.8 (56.1–57.4) in UMIC, 48.6 (48.0–49.3) in LMIC, and 38.5 (37.3–39.7) in LICs (p<0.0001). Strong correlates (β-coefficient [95% CI]) of KCCQ-12-SS were NYHA class III vs class I/II (−12.1 [−12.8 to −11.4] and class IV vs. class I/II (−16.5 [−17.7 to −15.3]), effort dyspnea (−9.5 [−10.2 to −8.8]) and living in LIC vs. HIC (−5.8 [−7.1 to −4.4]). Symptoms explained most of the KCCQ-12-SS variability (partial R2=0.32 of total adjusted R2=0.51), followed by sociodemographic factors (R2=0.12). Results were consistent in populations across income levels.
Conclusion
The most important correlates of HRQL in HF patients relate to HF symptom severity, irrespective of country-income level. Improved symptom control may have a big impact on HRQL, especially in LICs.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Bayer AG
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Giustino G, Serrao GW, Melarcode-Krishnamoorty P, Vengrenyuk A, Kyaw H, Gidwani U, Sharma SK, Kini A. Development of an app-based bedside clinical decision-making tool for mechanical cardiocirculatory support in patients with cardiogenic shock: the MCS-Aid app. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Patients presenting with cardiogenic shock remain at high risk of morbidity and mortality. Several mechanical cardiocirculatory support (MCS) devices have been developed and their use is rapidly increase in clinical practice. However, there is significant heterogeneity in patient selection, timing of implantation, and post-implantation management across centers and operators.
Purpose
We sought to develop and smartphone app-based clinical decision-making tool to help bedside selection and post-implantation management of MCS devices in patients presenting with cardiogenic shock or cardiac arrest.
Methods
The MCS-Aid app will consistent of 3 major sections: (i) initial device selection based on clinical presentation (patients with cardiogenic shock or cardiac arrest post-ROSC); (ii) guide for escalation or addition of MCS based on the individual hemodynamic scenario; (iii) guide for weaning after implantation of MCS device. The app will have an interactive interface that will allow the user to select the most appropriate next step in management based on the clinical information being entered. A calculator to derive key hemodynamic parameters (e.g. cardiac power output or pulmonary artery pulsatility index) will be incorporated in the App to inform clinical decision-making when appropriate. An example of an algorithm that will be part of the MCS-Aid app is illustrated in the figure.
Conclusions
The MCS-Aid app is an user-friendly bedside clinical decision tool that could help fellows-in-training, early-career interventionalist and interventional cardiologist to select the appropriate MCS device according to the individual clinical and hemodynamic scenario.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Abiomed
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Mendieta Badimon G, Mehta S, Baber U, Collier T, Dangas G, Sharma SK, Cohen DJ, Angiolillo D, Briguori C, Escaned J, Gabriel Steg P, Huber K, Michael Gibson C, Pocock S, Mehran R. Effect of aspirin discontinuation according to individualised patient bleeding and ischemic risks after PCI: a TWILIGHT trial sub-analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The TWILIGHT trial demonstrated a reduction in BARC 2, 3 or 5 (BARC-235) bleeding without an increase in ischemic events at 1-year in high-risk PCI patients randomized to placebo or aspirin (ASA) on a background of ticagrelor 3-months after PCI. However, the effect of ASA discontinuation according to baseline risk of bleeding and ischemic events remain unclear.
Purpose
To a) develop separate models to predict the risk of bleeding and ischemic events, and b) to assess treatment effect of ASA discontinuation across the risk strata.
Methods
Using the TWILIGHT patient database (N=7,119), two multivariable models, one for BARC-235 bleeding and one for CV death, nonfatal MI or nonfatal ischemic stroke (ischemic endpoint) were developed, and their predictive capacity was assessed. The effect of randomized treatment on bleeding and ischemic events across different patient risk-group categories as determined by the risk scores was investigated.
Results
At 1-year, 350 (5.4%) patients experienced a BARC-235 bleeding event and 258 (3.6%) experienced an ischemic event. Independent predictors of BARC-235 included haemoglobin levels at index PCI, proton-pump inhibitor non-use at discharge, age, liver disease and active smoking (c-statistic 0.64). Independent predictors of the ischemic outcome included a positive troponin ACS, prior CABG, diabetes, age, peripheral artery disease, prior PCI, a history of congestive heart failure, active smoking, the level of index PCI complexity, and prior MI (c-statistic 0.71). The risk of a BARC-235 almost doubled between patients in lower versus higher bleeding risk categories (4.3% versus 7.9%) and ischemic risk more than tripled between patients in lower versus higher ischemic risk categories (2.0% versus 7.0%) (see Figure 1). There was no evidence of a differential treatment effect for dual antiplatelet therapy versus ticagrelor monotherapy across the different risk categories of bleeding (interaction P=0.54) and ischemic risk (interaction P=0.95) (Table 1).
Conclusion
Individual patient bleeding and ischemic risks after PCI can both be readily characterised with good discrimination. The effect of ASA discontinuation in preventing bleeding in ticagrelor-treated patients was consistent regardless of baseline bleeding risk. There was no evidence for increased ischemic events with ASA discontinuation according to baseline ischemic risk.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): AstraZenecaIcahn School of Medicine at Mount Sinai
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Tiwari V, Ali FB, Patra A, Dhiman A, Sharma SK. The conundrum of olecranon aperture and its relation to the distal end of the humerus in a modern Indian population: An anatomical and surgical perspective. Morphologie 2022; 107:199-206. [PMID: 36127255 DOI: 10.1016/j.morpho.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/24/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE We aimed to clarify the morphology of the olecranon aperture (OA) of the humerus with its relationship to the distal end of the humerus (epicondylar width) and the width of the medullary canal. METHODS In total, 156 dry adult humeri were examined for the presence of OA. When present, we reported their shape, measured transverse (TD) and vertical diameter (VD), the distance from its medial border to the tip of medial epicondyle (D1), lateral border to the tip of lateral epicondyle (D2) and lower border to the tip of trochlea (D3). The epicondylar width (EW) and the width of the medullary canal were also measured in all the humeri. RESULTS OA was reported in 32 humeri (20.6%) with left side predominance, translucent septum in 35.8%, and opaque septum in 43.6%. The most typical shape noted was oval. On right side, mean VD and TD was 4.30±0.54mm and 5.85±0.45mm, respectively, whereas on left, these value were 4.21±0.56mm and 5.64±0.43mm, respectively. The mean of D1, D2 and D3 was 25.86±0.43mm, 26.50±0.28mm and 15.07±0.53mm on right and 24.80±0.41mm, 26.84±0.21mm and 15.81±0.31mm on left with significant difference (P<0.05). The medullary canal was significantly smaller in humeri with OA. CONCLUSION Topographic location of OA may have possible role in determining safe zone for retrograde nailing in supracondylar humeral fractures. Since OA has a direct relation to the size of the intramedullary canal, it is crucial during preoperative planning and choosing an adequate surgical approach involving lower segment of humerus.
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Sharma SK, Mandal TK, Banoo R, Rai A, Rani M. Long-Term Variation in Carbonaceous Components of PM 2.5 from 2012 to 2021 in Delhi. BULLETIN OF ENVIRONMENTAL CONTAMINATION AND TOXICOLOGY 2022; 109:502-510. [PMID: 35322279 PMCID: PMC8942158 DOI: 10.1007/s00128-022-03506-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/07/2022] [Indexed: 05/20/2023]
Abstract
Carbonaceous species [organic carbon (OC), elemental carbon (EC), elemental matter (EM), primary organic carbon (POC), secondary organic carbon (SOC), total carbon (TC), and total carbonaceous matter (TCM)] of PM2.5 were analyzed to study the seasonal variability and long-term trend of carbonaceous aerosols (CAs) in megacity Delhi, India from January, 2012 to April, 2021. The average concentrations (± standard deviation) of PM2.5, OC, EC, TC, EM, TCM, POC and SOC were 127 ± 77, 15.7 ± 11.6, 7.4 ± 5.1, 23.1 ± 16.5, 8.2 ± 5.6, 33.3 ± 23.9, 9.3 ± 6.3 and 6.5 ± 5.3 µg m-3, respectively during the sampling period (10-year average). The average CAs accounted for 26% of PM2.5 concentration during the entire sampling period. In addition, the seasonal variations in PM2.5, OC, EC, POC, SOC, and TCM levels were recorded with maxima in post-monsoon and minima in monsoon seasons. The linear relationship of OC and EC, OC/EC and EC/TC ratios suggested that the vehicular emissions (VE), fossil fuel combustion (FFC) and biomass burning (BB) are the major sources of CAs at megacity Delhi, India.
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Sahoo P, Kundu S, Roy S, Sharma SK, Ghosh J, Mishra S, Mukherjee A, Ghosh CK. Fundamental understanding of the size and surface modification effects on r 1, the relaxivity of Prussian blue nanocube@ m-SiO 2: a novel targeted chemo-photodynamic theranostic agent to treat colon cancer. RSC Adv 2022; 12:24555-24570. [PMID: 36128364 PMCID: PMC9425834 DOI: 10.1039/d2ra03995h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/08/2022] [Indexed: 11/21/2022] Open
Abstract
A targeted multimodal strategy on a single nanoplatform is attractive in the field of nanotheranostics for the complete ablation of cancer. Herein, we have designed mesoporous silica (m-SiO2)-coated Prussian blue nanocubes (PBNCs), functionalized with hyaluronic acid (HA) to construct a multifunctional PBNC@m-SiO2@HA nanoplatform that exhibited good biocompatibility, excellent photodynamic activity, and in vitro T 1-weighted magnetic resonance imaging ability (r 1 ∼ 3.91 mM-1 s-1). After loading doxorubicin into the as-prepared PBNC@m-SiO2@HA, the developed PBNC@m-SiO2@HA@DOX displayed excellent pH-responsive drug release characteristics. Upon irradiation with 808 nm (1.0 W cm-2) laser light, PBNC@m-SiO2@HA@DOX exhibited synergistic photodynamic and chemotherapeutic efficacy (∼78% in 20 minutes) for human colorectal carcinoma (HCT 116) cell line compared to solo photodynamic or chemotherapy. Herein, the chemo-photodynamic therapeutic process was found to follow the apoptotic pathway via ROS-mediated mitochondrion-dependent DNA damage with a very low cellular uptake of PBNC@m-SiO2@HA@DOX for the human embryonic kidney (HEK 293) cell line, illustrating its safety. Hence, it may be stated that the developed nanoplatform can be a potential theranostic agent for future applications. Most interestingly, we have noted variation in r 1 at each step of the functionalization along with size variation that has been the first time modelled on the basis of the Solomon-Bloembergen-Morgan theory considering changes in the defect crystal structure, correlation time, water diffusion rate, etc., due to varied interactions between PBNC and water molecules.
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Farley KA, Stack KM, Shuster DL, Horgan BHN, Hurowitz JA, Tarnas JD, Simon JI, Sun VZ, Scheller EL, Moore KR, McLennan SM, Vasconcelos PM, Wiens RC, Treiman AH, Mayhew LE, Beyssac O, Kizovski TV, Tosca NJ, Williford KH, Crumpler LS, Beegle LW, Bell JF, Ehlmann BL, Liu Y, Maki JN, Schmidt ME, Allwood AC, Amundsen HEF, Bhartia R, Bosak T, Brown AJ, Clark BC, Cousin A, Forni O, Gabriel TSJ, Goreva Y, Gupta S, Hamran SE, Herd CDK, Hickman-Lewis K, Johnson JR, Kah LC, Kelemen PB, Kinch KB, Mandon L, Mangold N, Quantin-Nataf C, Rice MS, Russell PS, Sharma S, Siljeström S, Steele A, Sullivan R, Wadhwa M, Weiss BP, Williams AJ, Wogsland BV, Willis PA, Acosta-Maeda TA, Beck P, Benzerara K, Bernard S, Burton AS, Cardarelli EL, Chide B, Clavé E, Cloutis EA, Cohen BA, Czaja AD, Debaille V, Dehouck E, Fairén AG, Flannery DT, Fleron SZ, Fouchet T, Frydenvang J, Garczynski BJ, Gibbons EF, Hausrath EM, Hayes AG, Henneke J, Jørgensen JL, Kelly EM, Lasue J, Le Mouélic S, Madariaga JM, Maurice S, Merusi M, Meslin PY, Milkovich SM, Million CC, Moeller RC, Núñez JI, Ollila AM, Paar G, Paige DA, Pedersen DAK, Pilleri P, Pilorget C, Pinet PC, Rice JW, Royer C, Sautter V, Schulte M, Sephton MA, Sharma SK, Sholes SF, Spanovich N, St Clair M, Tate CD, Uckert K, VanBommel SJ, Yanchilina AG, Zorzano MP. Aqueously altered igneous rocks sampled on the floor of Jezero crater, Mars. Science 2022; 377:eabo2196. [PMID: 36007009 DOI: 10.1126/science.abo2196] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The Perseverance rover landed in Jezero crater, Mars, to investigate ancient lake and river deposits. We report observations of the crater floor, below the crater's sedimentary delta, finding the floor consists of igneous rocks altered by water. The lowest exposed unit, informally named Séítah, is a coarsely crystalline olivine-rich rock, which accumulated at the base of a magma body. Fe-Mg carbonates along grain boundaries indicate reactions with CO2-rich water, under water-poor conditions. Overlying Séítah is a unit informally named Máaz, which we interpret as lava flows or the chemical complement to Séítah in a layered igneous body. Voids in these rocks contain sulfates and perchlorates, likely introduced by later near-surface brine evaporation. Core samples of these rocks were stored aboard Perseverance for potential return to Earth.
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Yadav S, Kalal N, Sharma SK, Deora S. Effect of nurse-led lifestyle modification follow up program on health outcomes and quality of life among post myocardial infarction patients: a randomized controlled trial. Eur J Cardiovasc Nurs 2022. [DOI: 10.1093/eurjcn/zvac060.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
India has among the world's highest burden of cardiovascular disease, potentially contributed by myocardial infarction. Despite growing trouble, there are no known post-discharge programs & randomized trials reporting health status outcomes & quality of life among post-myocardial infarction patients. Cardiac rehabilitation programs reduce mortality, therefore, it is crucial to understand the local burden of the disease, common challenges, public perceptions, develop timely & effective interventional programs.
Purpose
This study aimed to evaluate the effect of a nurse-led lifestyle modification follow-up program on health outcomes & quality of life among post-myocardial infarction patients.
Methods
A two-arm randomized controlled trial was adopted & 104 post-myocardial infarction patients were recruited from August to December 2021. An equal number of participants were randomly assigned to intervention & control group by random number table generator. The control group patients received routine care, while the intervention group was provided routine care along with a nurse-led lifestyle modification follow-up program(health education, educational booklet, & telephone follow- up). A low-cost intervention based on information-motivation-behavioural skill model was developed. It was designed according to the needs of patients to know their risk factors, help patients establish a knowledge base, & adapt to the post-illness lifestyle changes. Data were assessed & compared by using the demographic datasheet, health outcomes datasheet, & MacNew heart disease quality of life questionnaire. All evaluations were conducted at baseline after 12 weeks post-discharge, by face-to-face interview & biophysiological measurements.
Results
The nurse-led lifestyle modification follow-up program was convenient for clinical application. The intervention group showed a appreciable improvement in low density lipoprotein(p=0.045), systolic blood pressure(p=0.009), diastolic blood pressure(p=0.044), body mass index(p=0.043), and NT ProBNP(p=0.007). The program effectively improved the lifestyle behaviours thereby considerably improving the quality of life in all the subscales-physical, emotional & social (p<0.001) after 12 weeks of discharge.
Conclusion
In the Indian context, it is a novel & extensive approach to improve access to health care and emphasizes post-discharge self-management. The greatest benefit of this program was allowing the intervention group participants to consult with us immediately. Since lifestyles vary among different individuals, we considered individuality when providing education & involving them in implementation of an intervention to enhance their confidence & ultimately achieve optimal health outcomes & quality of life. The findings of this study are important for health care professionals caring for post-myocardial infarction patients & direct incorporation of such programs into routine practice to reduce morbidity & mortality.
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Kasaudhan SM, Ghimire A, Sharma SK, Baral D, Jha N, Singh SB. Undiagnosed and Uncontrolled Hypertension and Access to Health Care among Residents of an Urban Area of Eastern Nepal: a Cross-sectional Study. Kathmandu Univ Med J (KUMJ) 2022; 20:273-279. [PMID: 37042365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Background The burden and complication of hypertension is increasing as most of the people living with hypertension are unaware of their condition and those who are already diagnosed with it do not have their blood pressure under control. Objective To assess the prevalence of undiagnosed and uncontrolled hypertension among residents of Itahari sub metropolitan city of eastern Nepal, along with its associated socio demographic and behavioral risk factors and access to health care services. Method Cross sectional study was conducted in five wards of Itahari, among 1161 participants, using population proportionate to sample size sampling technique. Face to face interview was conducted with participants for data collection applying semi- structured questionnaire and physical measurement like blood pressure, weight and height. Result Prevalence of hypertension was 26.5% includingundiagnosed 11.0% and previously diagnosed 15.5%. Among diagnosed, 76.6% had uncontrolled blood pressure and 56.70% were taking anti-hypertensive medicine, and 7.8% were under Ayurvedic medicine. More than 70% participants preferred private health facility for treatment and 22.7% had faced financial barrier to seek healthcare. About 64% of participants did not visit health services or had visited only once in past six months. Increasing age, Body Mass Index (BMI), smoking status and positive family history were found to be significantly associated with hypertension at < 0.05 level. Conclusion Prevalence of hypertension is high and awareness regarding available health services in local primary health center and its utilization is lacking among participants. Regular screening program for hypertension and awareness program to disseminate the knowledge of availability of primary health center should be conducted.
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Koirala B, Adhikari SR, Shrestha A, Vaidya A, Aryal KK, Kalaunee SP, Shrestha A, Mishra SR, Sharma SK, Karki A, Maharjan B, Singh S, Schwarz D, Gupta N, Bukhman G, Karmacharya BM. A National Equity Initiative to Address Noncommunicable Diseases and Injuries: Findings and Recommendation from the Nepal NCDI Poverty Commission. Kathmandu Univ Med J (KUMJ) 2022; 20:376-383. [PMID: 37042383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
We aimed to assess the burden of NCDIs across socioeconomic groups, their economic impact, existing health service readiness and availability, current policy frameworks and national investment, and planned programmatic initiatives in Nepal through a comprehensive literature review. Secondary data from Global Burden of Disease estimates from GBD 2015 and National Living Standard Survey 2011 were used to estimate the burden of NCDI and present the relationship of NCDI burden with socioeconomic status. The Commission used these data to define priority NCDI conditions and recommend potential cost-effective, poverty-averting, and equity-promoting health system interventions. NCDIs disproportionately affect the health and well-being of poorer populations in Nepal and cause significant impoverishment. The Commission found a high diversity of NCDIs in Nepal, with approximately 60% of the morbidity and mortality caused by NCDIs without primary quantified behavioral or metabolic risk factors, and nearly half of all NCDI-related DALYs occurring in Nepalese younger than 40 years. The Commission prioritized an expanded set of twenty-five NCDI conditions and recommended introduction or scale-up of twenty-three evidence-based health sector interventions. Implementation of these interventions would avert an estimated 9680 premature deaths per annum by 2030 and would cost approximately $8.76 per capita. The Commission modelled potential financing mechanisms, including increased excise taxation on tobacco, alcohol, and sugar-sweetened beverages, which would provide significant revenue for NCDI-related expenditures. Overall, the Commission's conclusions are expected to be a valuable contribution to equitable NCDI planning in Nepal and similar resource-constrained settings globally.
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Kalra S, Dhar M, Afsana F, Aggarwal P, Aye TT, Bantwal G, Barua M, Bhattacharya S, Das AK, Das S, Dasgupta A, Dhakal G, Dhingra A, Esfahanian F, Gadve S, Jacob J, Kapoor N, Latheef A, Mahadeb Y, Maskey R, Naseri W, Ratnasingam J, Raza A, Saboo B, Sahay R, Shah M, Shaikh S, Sharma SK, Shrestha D, Somasundaram N, Tiwaskar M, Jawdekar A. Asian Best Practices for Care of Diabetes in Elderly (ABCDE). Rev Diabet Stud 2022; 18:100-134. [PMID: 35831938 PMCID: PMC10044048 DOI: 10.1900/rds.2022.18.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The elderly population with diabetes is diverse with the majority experiencing a decline in physical and mental capabilities, impacting the entire diabetes management process. Therefore, a need for geriatric-specific guidelines, especially for the Asian population, was identified and
subsequently developed by an expert panel across government and private institutions from several Asian countries. The panel considered clinical evidence (landmark trials, position papers, expert opinions), recommendations from several important societies along with their decades of clinical
experience and expertise, while meticulously devising thorough geriatric-specific tailored management strategies. The creation of the ABCDE best practices document underscores and explores the gaps and challenges and determines optimal methods for diabetes management of the elderly population
in the Asian region.
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Jain S, Dhir V, Leishangthem B, Kalyan M, Verma I, Naidu G, Sharma SK, Sharma A, Jain S. AB0417 SHORT-TERM EFFECT OF METHOTREXATE ON APOLIPOPROTEINS AND LIPID PROFILE IN PATIENTS WITH ACTIVE RHEUMATOID ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundMethotrexate (MTX) forms the first line therapy for rheumatoid arthritis (RA). The cardioprotective effect of MTX is well established, but whether this is just due to control of inflammation, or is also via an effect on serum lipoproteins, is unclear. Although a few studies have studied the effect of the MTX on the traditional lipid profile in RA1, there is no data on the effect of MTX on apolipoproteins (Apo A1, Apo B, ApoB/ApoA1), which are considered better cardiovascular risk predictors than the traditional lipid profile.ObjectivesTo determine the short-term effect of MTX on apolipoproteins and traditional lipid profile in patients with active RA.MethodsDMARD-naïve patients with active RA (SJC≥2 and TJC≥4) who had been enrolled in the multicentre, RCT comparing two different MTX escalation strategies in RA (MEIRA)2 and for whom paired serum samples were available before and after MTX treatment were included. All these patients received MTX monotherapy started at 15 mg/week and escalated to 25 mg/week by 4-8 weeks. Serum levels of apolipoprotein A1 (Apo A1), apolipoprotein B (Apo B), total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides (TG) were measured before starting MTX and after 16 weeks of MTX monotherapy. Proatherosclerotic indices (TC/HDL and ApoB/ApoA1) were also calculated.ResultsA total of 103 patients [mean age 40 (8) years, 93 (90%) females, mean BMI 25.1 (4.8) kg/m2, all non-smokers and non-alcoholics] were included. No study participant had comorbid diabetes mellitus or coronary artery disease; none of them were taking glucocorticoids or hypolipidemic drugs. An increase in Apo A1 levels [by a mean of 5.6 mg/dL (p=0.02)], and HDL levels [by a mean of 1.6 mg/dL (p=0.04)] was seen after 16 weeks of MTX monotherapy. Although a numerical increase in levels of TC (mean 4.6 mg/dL, p=0.07), LDL (mean 2 mg/dL, p=0.34) and TG (mean 6.6 mg/dL, p=0.35) was also noted, none of these were statistically significant. No obvious change in Apo B levels and TC/HDL ratio occurred due to MTX therapy. However, the ApoB/ApoA1 ratio decreased significantly from 0.8 to 0.7 (p=0.002) with 16 weeks of MTX therapy (Table 1).Table 1.Baseline and end of treatment values of apolipoprotein A1 (Apo A1), apolipoprotein B (Apo B), total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TG), and proatherosclerotic indices (TC/HDL and ApoB/ApoA1).Parameter (mg/dL)BaselineAfter 16 weeks of MTX therapyp-valueApo A1126.0 (25.1)131.6 (23.4)0.02Apo B92.3 (18.9)92.0 (20.9)0.84ApoB/ApoA10.8 (0.2)0.7 (0.2)0.002TC164.5 (32.4)169.1 (36.8)0.07HDL40.9 (9.8)42.5 (9.7)0.04TC/HDL4.2 (1.1)4.1 (1.1)0.34LDL88.8 (25.2)90.8 (29.8)0.34TG139.8 (69.6)146.4 (91.3)0.35All values represented as mean (SD).Apo A1=apolipoprotein A1, ApoB=apolipoprotein B, TC=total cholesterol, LDL=low-density lipoprotein, HDL=high-density lipoprotein, TG=triglyceridesConclusionMTX therapy led to a mild but significant increase in HDL, ApoA1 and a reduction in ApoB/ApoA1 over short-term. This could potentially represent one of the mechanisms by which MTX exerts its cardioprotective effect; however, these changes need to be carefully interpreted over longer term and in context of the lipid paradox operating in RA.References[1]Navarro-Millán I, Charles-Schoeman C, Yang S, et al. Changes in lipoproteins associated with methotrexate or combination therapy in early rheumatoid arthritis: results from the treatment of early rheumatoid arthritis trial. Arthritis Rheum. 2013;65(6):1430-1438.[2]Jain S, Dhir V, Aggarwal A, et al. Comparison of two dose escalation strategies of methotrexate in active rheumatoid arthritis: a multicentre, parallel group, randomised controlled trial. Ann Rheum Dis. 2021;80(11):1376-1384.Disclosure of InterestsNone declared
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Jain S, Dhir V, Aggarwal A, Gupta R, Leishangthem B, Naidu G, Khullar A, Dhawan V, Sharma SK, Sharma A, Jain S. POS0566 PREDICTORS OF RESPONSE TO METHOTREXATE MONOTHERAPY IN ACTIVE RHEUMATOID ARTHRITIS: RESULTS FROM A MULTICENTRE, RANDOMIZED CONTROLLED TRIAL (MEIRA). Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundMethotrexate (MTX) is the gold standard, first-line therapy for rheumatoid arthritis (RA). However, not all patients respond to MTX, and the predictors of its response or non-response have not yet been reliably identified. Identification of these predictors will facilitate personalized therapeutic choices, and improve patient outcomes.ObjectivesTo identify the clinico-laboratory predictors of response to MTX monotherapy in active RA.MethodsThis study included patients with active RA (SJC≥2 and TJC≥4) aged 18-55 years, with disease duration <5 years, who were not receiving DMARDs (except HCQ and low-dose prednisolone) and had been enrolled in the multicentre, parallel group RCT comparing two different MTX escalation strategies in RA (MEIRA)1. All these patients received MTX monotherapy which was started at 15 mg/week, escalated to 25 mg/week by 4-8 weeks, and continued till 16 weeks. MTX response was defined as EULAR good or moderate response (based on DAS28-CRP-3v) at 16 weeks. Stepwise, multivariable logistic regression was done using key demographic (age, gender, BMI, comorbidities), clinical (disease duration, DAS28, HAQ), and laboratory parameters (RF, anti-CCP, ESR, CRP, RBC MTX-polyglutamates 1-4, IL-6, MMP-3) as independent variables to identify predictors of MTX response. A two-tailed p-value <0.05 was used for defining statistical significance. (Trial Reg: CTRI/2018/12/016549)ResultsOut of a total of 178 included patients [84% females, mean age 40 (9) years, mean DAS28-CRP=5.4 (1.1)], 113 (63.5%) were classified as MTX responders at 16 weeks. Age (OR=0.95, p=0.01), BMI (OR=1.12, p=0.006), and RF (OR=0.34, p=0.045) were found to be independent predictors of MTX response on multivariable analysis (Table 1). On sensitivity analysis with DAS28-ESR-based EULAR response, age (OR=0.94, p=0.003) and RF (OR=0.42, p=0.059) were replicated as independent predictors of MTX response, in addition to pre-treatment swollen joint count (OR=0.94, p=0.05).Table 1.Results of multivariable logistic regression analysis for prediction of response (as defined by DAS28-CRP-based EULAR good or moderate response) to methotrexate monotherapy in RAVariableOR (unadjusted)Unadjusted p-valueOR (adjusted)Adjusted p-valueAge0.97 (0.93-1.002)0.060.95 (0.91-0.99)0.01Male sex0.78 (0.35-1.76)0.55-BMI1.1 (1.02-1.19)0.011.12 (1.03-1.22)0.006Presence of comorbidities0.67 (0.31-1.44)0.31-Disease duration0.98 (0.79-1.22)0.87-Baseline DAS281.1 (0.81-1.49)0.54-Baseline HAQ1.04 (0.66-1.64)0.86-Baseline TJC1.01 (0.96-1.05)0.72-Baseline SJC0.97 (0.91-1.02)0.24-Baseline ESR1.01 (1.00-1.02)0.27-Baseline CRP1.00 (0.99-1.01)0.85-RF positive0.31 (0.11-0.85)0.020.34 (0.12-0.98)0.045Anti-CCP positive0.73 (0.27-1.99)0.54-MTX PG1 (16 weeks)0.99 (0.94-1.04)0.69-MTX PG2 (16 weeks)0.98 (0.95-1.02)0.37-MTX PG3 (16 weeks)0.99 (0.96-1.02)0.43-MTX PG4 (16 weeks)0.99 (0.95-1.03)0.62-Serum IL-6 (baseline)0.98 (0.95-1.02)0.33-Serum MMP-3 (baseline)1.00 (1.00-1.00)0.48-BMI= Body Mass Index, CCP= Cyclic Citrullinated Peptides, CRP= C-reactive protein, DAS= Disease Activity Score, ESR= Erythrocyte Sedimentation Rate, HAQ= Health Assessment Questionnaire, MTX= Methotrexate, PG= polyglutamate, OR=Odds Ratio, RF=Rheumatoid Factor, SJC= Swollen Joint Count, TJC= Tender Joint CountNote: Only variables with p-value <0.2 on univariable analysis were included in the multivariable analysis.ConclusionYounger age, RF negativity, higher BMI, and lower pre-treatment swollen joint count are potential predictors of response to MTX monotherapy in RA.References[1]Jain S, Dhir V, Aggarwal A, et al. Comparison of two dose escalation strategies of methotrexate in active rheumatoid arthritis: a multicentre, parallel group, randomised controlled trial. Ann Rheum Dis. 2021;80(11):1376-1384.Disclosure of InterestsNone declared.
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Sharma SK, Adhikari S, Shah N, Aebischer Perone S, Lab B, Heller O, Chappuis F. Familial hypercholesterolemia in community-based KHDC Nepal program-baseline data. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): HUG and Republic and Canton of Geneva – Service de solidarité internationaleBP Koirala Institute of Health Sciences
Familial hypercholesterolemia (FH) is either underdiagnosed or diagnosed after primary coronary events. Although homozygous variant of FH is considered rare, heterozygous FH is estimated to occur in about 1 in 200 to 300 individuals. There is no study pertaining to prevalence of FH in Nepal which could be a factor influencing cardiovascular morbidity and mortality.
We present a baseline data of FH in an ongoing in participants of community-based cardiovascular and kidney diseases preventive (KHDC Nepal) program in Mechinagar municipality in Eastern Nepal.
KHDC is a program to collaborate among health post, primary health center or equivalent, and local government along with community representatives created to educate, screen, and intervene for selective NCDs. This program is in alignment with the World Health Organization’s Package of Essential Noncommunicable (WHO PEN) disease interventions for primary health care in low-resource settings. General health status and lifestyle habits, physical examination, and blood pressure were assessed. Blood tests done included fasting lipid profile, serum creatinine, FBS, and HbA1c. A mechanism was developed to follow-up screened positive persons in the primary health centers. Referrals were made to the tertiary care center as needed.
We analyzed initial 7289 participants, 20 years or above, who were enrolled in KHDC program in the year 2020. We assessed for FH using Dutch Lipid Clinic Network(DLCN), Simon Broome and AHA criteria. Participants were categorized as definite, probable, possible, or no FH based on the scores of DLCN criteria; as definite and probable based on Simon Broome criteria and as clinically diagnosed FH based on AHA criteria.
The median age of the patient was 54 years, the majority being females (62.7%). A total of 70(0.96%) of the participants had elevated LDL-C levels of more than 190mg/dl detected during the screening and had no secondary cause for hyperlipidemia. According to DLCN criteria, 65(0.89%) participants were grouped under possible FH, 5(0.06%) were grouped under probable FH while none of them could be delineated as definite FH. According to Simon Broome criteria, 14(0.2%) participants were grouped under probable and none of them could be delineated as definite. According to AHA criteria, 10 (0.13%) participants were categorized as clinically diagnosed FH. DNA analysis was not available in our setup. Clinically manifested atherosclerotic disease was recorded in 5 participants. None of the participants were aware of the FH.
This community-based program of the adult population help create baseline data of FH in Nepal. Larger study with genetic analysis is likely to reveal true prevalence of FH in Nepal.
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