AB0570 MIXED CONNECTIVE TISSUE DISEASE: NOT THAT UNCOMMON, A SINGLE-CENTER EXPERIENCE FROM INDIA

Background:

Mixed connective tissue disease (MCTD) is considered to be uncommon; specifically there is sparse data on MCTD from developing countries like India.

Objectives:

This study examines the clinical and serological features of these patients in a single center in North-India.

Methods:

This was a retrospective single-center study of patients diagnosed as MCTD in last 20 years. The patients included fulfilled at least one of the diagnostic criteria namely Alarcón-Segovia, Kasukawa, and Kahns. Demographic details, clinical signs and symptoms, laboratory parameters, treatment and outcome were extracted from medical records and clinic files in a pre-designed proforma.

Results:

This study included 41 MCTD patients. There was a marked female preponderance (F: M=40:1), and mean age of disease onset and diagnosis was 33.8 ± 10.7 and 39.3 ± 10.2 years. 39 (92%) of the patients fulfilled both Kahn and Kasukawa criteria, while 31 (76%) fulfilled Alarcon-Segovia criteria. Initially patients had been (mis)diagnosed as rheumatoid arthritis, systemic lupus erythematosus (or UCTD) (in five patients each), overlap syndromes or myositis (in 4 patients). ANA was commonly high-titer and specked, U1RNP was positive in all. (Table 1) Other autoantibodies on immunoblot included SSA and Ro52 in half the patients. Raynaud’s was seen in three-fourth at presentation and all the patients over time. Digital gangrene and puffy fingers were seen in 8 (20%) and 18 (46%) patients. Other clinical features included arthritis in 33 (81%), sclerodactyly in 23 (56%) and proximal weakness in 20 patients (49%). Interstitial lung disease and pulmonary arterial hypertension were seen in 20 (57%) and 15 (44%) patients. All patients (except one) received prednisolone, and it was currently used in almost 90%. Intravenous cyclophosphamide was used in one-third, commonly for ILD.

Table 1.

Laboratory features of patients with MCTD

Labs n (%)Leucopenia9 (22)Thrombocytopenia10 (24)Raised globulinsb22 (69)Mean globulins, mean (SD)a5±3.4Elevated CPKb10 (31)CPK Levels U/L, median (IQR)256 (57.5-1036)ANA Speckled Pattern N (%)31d(82)U1RNP N (%)b32 (100%)U1RNP Blot Intensity1+8 (25%)2+1 (3.2%)3+7 (21.8%)4+16 (50%)U1RNP EIA, mean(SD), n=19141.3 ± 82.4Raised RF Titersh10 (35.7%)Low C3 mg/dlf8 (40%)Low C4 mg/dlf3 (15%)FVC, mean (SD) n=2082.4 ± 18.9 ILD on HRCTg20 (57) Dilated PA on CTf10 (50)PAHeon ECHO15 (44.1%)RA/RV Dilated5 (18)

SD-standard deviation, IQR- Interquartile range, CPK- Creatinine phosphokinase,, ILD- Interstitial lung disease, PAH- Pulmonary arterial hypertension, ANA- Anti nuclear antibody, IIF- Indirect Immunofluorescence, PA- pulmonary artery, RA/RV- Right atrium/Right Ventricle,a34b32d38e34f20g34h28

Conclusion:

MCTD was not uncommon in the single-center in North India. Kahn and Kasukawa criteria were found to be the most sensitive for its diagnosis. Digital gangrene was relatively common and sometimes the presenting feature; whereas puffy fingers was present in only half the patients.

Disclosure of Interests:

None declared

OP0108 RANDOMIZED CONTROLLED TRIAL OF ORAL CORTICOSTEROIDS IN AXIAL SPONDYLOARTHROPATHY: MODIFIED COBRA REGIME

Background:

There is an unmet need of anti-inflammatory agents in AxSpA after NSAID failure. This is especially true for patients with persisting high disease activity and not having access to anti-TNFα. In this regard, corticosteroids may be helpful as a short-term measure. However, current guidelines recommend against oral corticosteroids citing insufficient evidence of efficacy.1. Also, there is an assumption that the dose required for benefit is much higher than RA, and thus untenable. It is unclear whether starting with a high dose followed by rapid taper would be effective (like the COBRA regime in RA)2.

Objectives:

To study the efficacy of the COBRA regime of oral corticosteroids in axial SpA over 24 weeks.

Methods:

This was a double blind placebo controlled randomized trial. Patients with active axial SpA (BASDAI ≥ 4) despite NSAIDs were randomized to either receive oral prednisolone or placebo as per COBRA regime, started on oral prednisolone at a dose of 60 mg, rapidly tapered weekly to reach a dose of 10 mg by 6 weeks and subsequently maintained on a low dose of 5 mg till 24 weeks. Primary end point was 50% improvement in BASDAI at week 24. Secondary end points were improvement in ASDAS and BASFI. Analysis was by intention-to-treat. Trial Registration# CTRI/2018/01/011342

Results:

This study enrolled 65 patients (62 males) who were randomized to corticosteroid (n=32) or placebo (n=33) with mean ± SD age 28.5 ± 8.4 years and BASDAI 5.4 ± 1.0. Primary end point was reached in 12 (37.5%) and 3 (9%) patients treated with steroids and placebo respectively (p=0.007). On repeated measures analysis by general linear model, there was a significant difference between the two-groups in BASDAI (p= 0.03) (Figure-1). Patients in the corticosteroid group had significant improvement in BASDAI, ESR, CRP, ASDAS ESR and ASDAS CRP at 24 weeks (Table-1). Clinically important improvement in ASDAS CRP was achieved by significantly higher number of patients in steroid group (17 (55%) vs 6 (18%), p= 0.002). Major improvement in ASDAS ESR and ASDAS CRP was also higher in the steroid group (Figure-2). At 24 weeks, patients in the steroid group had significant reduction in IL-6 levels compared to that in placebo group (p= 0.007, data for 41 patients). Patients in the steroid group had more weight gain and facial puffiness, however no serious adverse events were noted in both the groups.

Figure 1.

Change in mean BASDAI

Table 1.

Changes in disease indices and inflammatory markers at 24 weeks

Changes in Parameters (24 weeks-baseline)PlaceboCorticosteroidP valueESR, Median (IQR)0 (-11 to 21)-13 (-37 to 4)0.01CRP mg/LMedian (IQR)0 (-8.8 to 13)-9 (-22.7 to 0)0.03BASDAI (mean ± SD)- 0.51 ± 1.6- 1.88 ± 2.50.03BASMI (mean ± SD)-0.25 ± 0.8-0.56 ± 0.90.23BASFI (mean ± SD)-0.35 ± 2.3-1.48 ± 3.10.28BAS-G (mean ± SD)-1.02 ± 2.7-1.86 ± 2.50.32ASDAS-ESR (mean ± SD)-0.13 ± 1.0-1.11 ± 1.10.001ASDAS-CRP (mean ± SD)-0.24 ± 1.1-1.17 ± 1.30.006Figure 2.

Clinically important and Major improvement at 24 weeks

Conclusion:

Oral prednisolone given by COBRA regime was associated with significant improvement in disease activity scores in axial SpA at 24 weeks. This extends and supports results from a previous short term study.3Thus, corticosteroids may be an option for patients not having access to biologics, atleast for the short-term.

References:

[1]Ward M W, Deodhar A, Gensler L S et al 2019 Update of the American College of Rheumatology/ Spondylitis Association of America/Spondyloarthritis Research and Treatment Network Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis. Arthritis & Rheumatology; 71:1599-1613(2019).

[2]Landewé RB, Boers M, Verhoeven AC et al. COBRA combination therapy in patients with early rheumatoid arthritis: long-term structural benefits of a brief intervention. Arthritis Rheum.Feb;46(2):347-56 (2002).

[3]H Haibel, C Fendler,J Listing et al. Efficacy of oral prednisolone in active ankylosing spondylitis: results of a double-blind, randomised, placebo-controlled short-term trial. Ann Rheum Dis;73:243–6 (2014).

Disclosure of Interests:

None declared

AB0013 HLA ASSOCIATION WITH SYSTEMIC SCLEROSIS (SSc) IN NORTH INDIAN POPULATION AND FAMILIAL INHERITANCE PATTERNS

Background:

It is widely believed that SSc develops in an individual with a permissive genetic makeup.Genetic influences have long been suspected to impact SSc. In families with a history of SSc, the incidence of disease can range from 1.5 to 1.7% (1). There are several reports of familial occurrence and certain alleles of the HLA system have been associated with the disease (2).No Indian data pertaining to genetic basis of systemic sclerosis is present. Understanding the genetic basis of the disease will help us in defining the biomarkers of the disease in the population that can help in early diagnosis and prognosis.

Objectives:

To study HLA association with Systemic sclerosis (SSc) in North Indian Population and its genetic susceptibility to familial systemic sclerosis.

Methods:

A total of 150 SSc patients diagnosed by following ACR and EULAR criteria and 150 control subjects, were genotyped for HLA-A, B, DRB1, DQB1 loci by Luminex® 200 Instrument (USA). The association of alleles with disease susceptibility was tested by Chi-square test and Fisher’s exact test.

HLA Typing for HLA class I (A, B, C) and II(DR,DQ,DP) for familial study of systemic sclerosis in 2 families was performed by Next Generation Sequencing(NGS) with illumina MiniSeq using MIA FORA NGS Kits from IMMUCOR. Antinuclear patterns (ANA) and specific antibodies were detected by indirect Immunofluorescence and Immunoblot (Euroline, Germany).

Results:

Strong disease associations were observed for haplotypes A*24(OR=1.7;< 0.02), A*32(OR=2.8;< 0.02), B*35(OR=1.7;< 0.03), DRB1*11(OR=2.1;< 0.007). The reduced frequencies of haplotypes A*68(P< 0.05), DRB1*10(P< 0.05), DRB1*12 (P<0.00) among patients suggested a protective association. There was no statistical association found with HLA DQB*1.

Through NGS we observed that in the 1stfamily haplotypes HLA –A*11, 32, 24; B* 51, 55, 35; C*-14, 04; DRB1*15, 04; DQB1*05, 03; DPB1*04, 26 appears in affected family members with serological abnormalities.In the 2ndfamily both mother and daughter had same set of haplotypes except DQB1 with serological abnormalities. The haplotypes DPB1*04 was present in all the diseased individuals of both the families (Fig. 1 and table 1).

Table 1.

NGS HLA typing report

ABCDRB1DQB1DPB1F111 2435 1504 0415 1505 0502 26F211 3251 5514 0415 0405 0304 04F311 2435 5504 0415 1505 0526 04F432 1151 1514 0415 0405 0302 04F524 3335 4404 0715 0705 0226 14F611 2435 5504 0415 1505 0504 26F711 2435 5504 0415 1505 0504 26F824 3251 3514 0404 1503 0526 04F911 3251 5514 0415 0405 0304 04F1011 3344 5207 1211 0702 0304 13F1111 3344 5207 1211 0703 0304 13

Fig. 1

Conclusion:

The risk alleles A*24, 32; B*35; DRB1*11 were found to be associated with North Indian cohort of SSc, while the protecting alleles were A*68; DRB1*10, 12.These risk alleles were present in the SSc affected family members and the protective alleles were absent in the same. Surprisingly, even healthy members carried the same risk alleles but did not manifest the disease or have serological evidence of the same. We have not excluded occurrence of disease at a later age, as presently the healthy siblings are young. Thus our study indicates that though HLA association are found with SSc but many other factors like HLA (HLA *C, DPB1*) or non HLA genes as wells as epigenetic factors might also play a role in disease manifestation and severity.

References:

[1]Luo Y, Wang Y, Wang Q,et al. Systemic sclerosis: genetics and epigenetics. J Autoimmun.2013; 41:161–67.

[2]de Juan MD1, Belzunegui J, Belmonte I, Barado J, Figueroa M, Cancio J, Vidal S, Cuadrado E. An immunogenetic study of familial scleroderma. Ann Rheum Dis. 1994 Sep; 53(9):614-7.

Acknowledgments:

The technical help of Mr.Manoj Kumar and Mr.Vinkesh are hereby gratefully acknowledged Indian Council of Medical Research(Funding of Fellowship)

Disclosure of Interests:

None declared

Prevalence of dengue vectors, larval breeding habitats, Stegomyia indices and their correlation with dengue cases in urban and rural areas of Punjab, India

BACKGROUND & OBJECTIVES

The state of Punjab, India is highly endemic for dengue fever as high number of confirmed dengue cases have been reported since 2013. A better understanding of vectors distribution and their seasonal variation is necessary to control the disease. Therefore, the present study was conducted in both rural and urban areas of 11 out of 22 districts of Punjab to highlight seasonal prevalence of Aedes vector mosquitoes.

METHODS

Entomological surveys were carried out in different seasons and all kinds of indoor and outdoor breeding habitats were examined and Aedes immatures were collected. The Stegomyia indices were calculated and compared from urban and rural areas in different seasons.

RESULTS

Both vectors of dengue, i.e. Aedes aegypti and Ae. albopictus were recorded to be prevalent. Ae. aegypti mosquitoes were observed in all districts surveyed while Ae. albopictus were found only in seven districts of Punjab. The Stegomyia indices were significantly high during monsoon as compared to pre- and post- monsoon periods. Occurrence of dengue cases were found to be correlated with the Stegomyia indices.

INTERPRETATION & CONCLUSION

This is the first detailed study of prevalence of dengue mosquito vectors in Punjab showing the presence of Ae. aegypti and Ae. albopictus in both urban and rural areas of the state, thereby demonstrating wide distribution of this vector. Different breeding habitats identified in the study should be subjected to targeted intervention such as source reduction in order to achieve effective control of dengue cases.

Identification and Characterization of a Large Effect QTL from Oryza glumaepatula Revealed Pi68(t) as Putative Candidate Gene for Rice Blast Resistance

BACKGROUND

Field resistance is often effective and durable as compared to vertical resistance. The introgression line (INGR15002) derived from O. glumaepatula has proven broad spectrum field resistance for both leaf and neck blast.

RESULTS

Quantitative Trait Loci (QTL) analysis of INGR15002, led to the identification of two major QTL - qBL3 contributing about 34% and 32% phenotypic variance towards leaf and neck blast resistance, respectively and qBL7 contributing about 25% of phenotypic variance for leaf blast. Further, qBL3 was fine mapped, narrowed down to 300 kb region and a linked SNP maker was identified. By combining mapping with microarray analysis, a candidate gene, Os03g0281466 (malectin-serine threonine kinase), was identified in the fine mapped region and named as Pi68(t). The nucleotide variations in the coding as well as upstream region of the gene was identified through cloning and sequence analysis of Pi68(t) alleles. These significant variations led to the non-synonymous changes in the protein as well as variations (presence/absence) in four important motifs (W-box element; MYC element; TCP element; BIHD1OS) at promoter region those are associated with resistance and susceptible reactions. The effect of qBL3 was validated by its introgression into BPT5204 (susceptible variety) through marker-assisted selection and progeny exhibiting resistance to both leaf and neck blast was identified. Further, the utility of linked markers of Pi68(t) in the blast breeding programs was demonstrated in elite germplasm lines.

CONCLUSIONS

This is the first report on the identification and characterization of major effect QTL from O. glumaepatula, which led to the identification of a putative candidate gene, Pi68(t), which confers field resistance to leaf as well as neck blast in rice.

Low Vitamin D Levels in Rheumatoid Arthritis Patient is Associated with Poor Disability Index and Increased Patient Global Disease Assessment Score

BACKGROUND

Rheumatoid arthritis (RA) is a chronic inflammatory connective tissue disorder with wide spectrum of presentation from polyarthritis to multisystem involvement. Apart from bones, muscles and other soft tissues, Vitamin D receptors have been found on many immune cells and tissues. The most vital function of Vitamin D is calcium and phosphorus absorption but it can also act as an immune-modulator hormone, which can affects both innate and adaptive immune responses leading to autoimmune diseases.

OBJECTIVES

To study the relationship of vitamin D insufficiency with disease activity and functional disability in patients of Rheumatoid Arthritis.

MATERIAL AND METHODS

The present study was an observational, cross sectional study done in a tertiary care hospital in New Delhi, India. The inclusion criteria comprised of patients attending the inpatient (IPD) and outpatient department (OPD), age above 18 years and fulfilling 1987 American college of Rheumatology (ACR) criteria for RA. The exclusion criteria was patients suffering from any other connective tissue disorder (CTD) and patients who were taking vitamin D supplements for past 6 months. Thirty patients were enrolled in the study after satisfying inclusion and exclusion criteria and appropriate clinical data and blood sample were collected after informed consent. Joint examination were performed and swollen joint count (SJC), tender joint count (TJC), patient global assessment (PGA) and evaluator global assessment (EGA) scores were recorded. Disease activity using DAS28ESR, DAS28CRP and CDAI were calculated and disability index was assessed using Short Fries Health Assessment Questionnaire.

RESULTS

In our study mean vitamin D level was 18.93 ng/ml (S.D. 6.64 ng/ml). Mean DAS28 ESR was 4.57±1.48. Mean Disability Index was 0.52±0.89. All the study population had low Vitamin D level (100%), while 50% patients had vitamin D level in deficiency range (<20ng/ml). On analysis by student t-test, statistically higher PGA (p value 0.024) and Disability Index (p value < 0.001) in vitamin D deficient patients, compared to vitamin D insufficient patient group was observed, however there was no significant difference in disease activity between the groups.

CONCLUSION

Low Vitamin D levels are common in Indian rheumatoid arthritis patients. Mean PGA significantly increased, and disability index significantly increased in Vitamin D deficient group compared to insufficient group suggesting vitamin D deficient patients poor wellbeing and more disability.

Fabrication of LaFeO3 and rGO-LaFeO3 microspheres based gas sensors for detection of NO2 and CO

In the present report, gas sensing devices based on LaFeO₃ and rGO-LaFeO₃ were fabricated by a photolithography technique. The X-ray diffraction, Raman spectra and FT-IR results confirm the formation of a perovskite phase and composite. XPS and TEM give the chemical compositions for both products. The higher roughness, greater surface area (62.1 m² g⁻¹), larger pore size (16.4 nm) and lower band gap (1.94 eV) of rGO-LaFeO₃ make it a suitable candidate to obtain high sensitivity. The gas sensing performance of the devices was investigated for various concentrations of NO₂ and CO gases at temperatures of 200 and 250 °C. It was observed that the rGO-LaFeO₃ based device exhibited a high relative response (183.4%) for a 3 ppm concentration of NO₂ at a 250 °C operating temperature. This higher response is attributed to the large surface area, greater surface roughness, and numerous active sites of rGO-LaFeO₃. The gas sensing properties investigated show that rGO-LaFeO₃ is an excellent candidate for an NO₂ sensor.

In the present report, gas sensing devices based on LaFeO₃ and rGO-LaFeO₃ were fabricated by a photolithography technique.

Emergence of Blue Sky Over Delhi Due to Coronavirus Disease (COVID-19) Lockdown Implications

Due to coronavirus pandemic (COVID-19) prevailing in more than 210 countries, out of them only few have promulgated lockdown and on March 24, 2020 India also implemented lockdown for 21 days to prevent the community spread of virus among people. Since then, lockdown heavily restricts travel movements of flights, rail, intercity bus services besides industrial activity halt throughout the country. The significant improvement in the air quality of Delhi region was observed due to strict implementation of lockdown. During the lockdown period, improvement in ambient air quality helped us in circumventing the coronavirus community spread. The preliminary results showing the decrease in horizontal advection of pollutants has given an opportunity to understand the background concentrations of air pollutants over Delhi. To analyse this peculiar situation, we have assessed the pollutants datasets collected by twelve different online ambient air quality monitoring stations (AQMS) of Central Pollution Control Board (CPCB), New Delhi, India and observed a colossal improvement in the ambient air quality. The analysis of data confirms the sharp decline in concentrations (nearly 200%) of PM_2.5 and PM₁₀. The concentration of nitrous oxides (NO_x), recorded its maximum (342 ppb) on 12 January 2020 in CRRI–Mathura Road, Delhi with the lowest value as 24 ppb on 30 March 2020 (reduced to nearly 14 times of the peak value). In the triad of this infectious disease, the role of environment is not linked better however, the ground reality cannot be ignored due to environment around us receives, maintains, protects and transports the aetiological agents to host prevailing in polluted environment which makes our lungs more susceptible to viral attacks. Therefore, a cleaner environment would prove to be an effective measure to halt and reduce the transmission of viral infections.

Binary activated iron oxide/SiO2/NaGdF4:RE (RE = Ce, and Eu; Yb, and Er) nanoparticles: synthesis, characterization and their potential for dual T1–T2 weighted imaging

Iron oxide/SiO₂/NaGdF₄:RE (RE = Ce, and Eu; Yb, and Er) NPs upon irradiation of (i) 254 nm UV light shows red lines in (Ce, and Eu) activated systems and (ii) a 980 nm NIR laser shows green lines and mid IR lines in (Yb, and Er) activated systems.

Influence of Vehicular Emissions (NO, NO2, CO and NMHCs) on the Mixing Ratio of Atmospheric Ammonia (NH3) in Delhi, India

Mixing ratios of atmospheric ammonia (NH₃), nitric oxide (NO), carbon monoxide (CO), nonmethane hydrocarbons (NMHCs), and methane (CH₄) were measured to investigate the vehicular emissions, which are a dominant source of atmospheric NH₃ in urban sites of Delhi, India from January 2013 to December 2014. The annual average mixing ratios of NH₃, NO, CO, NMHCs, and CH₄ were 21.2 ± 2.1 ppb, 21.2 ± 6.1 ppb, 1.89 ± 0.18 ppm, 0.67 ± 0.21 ppm and 3.11 ± 0.53 ppm, respectively. Considering NO as a tracer of vehicular plume, ambient NH₃ was correlated with NO during peak traffic hour in the morning (7:00-10:00 h) and evening (17:00-19:00 h) and observed significant positive correlation between them. Result reveals that the mixing ratio of atmospheric NH₃ significantly positive correlated with traffic related pollutants (NO, CO, and NHHCs) during all the seasons (winter, summer, and monsoon). During winter, the average mixing ratio of atmospheric NH₃ was increased by 1.2-3.5 ppb in the morning peak hour, whereas increased by 0.3-1.6 ppb in the evening peak hour. Similarly, an increase in NH₃ mixing ratio was observed during summer (morning: 1.2-2.7 ppb and evening: 1.5-1.6 ppb) and monsoon (morning: 0.4-3.6 ppb and evening: 0.9-1.4 ppb) seasons. The results emphasized that the traffic could be one of the dominant source of ambient NH₃ at the urban site of Delhi, as illustrated by positive relationships of NH₃ with traffic related co-pollutants (NO, CO and NMHCs).

The burden of submicroscopic and asymptomatic malaria in India revealed from epidemiology studies at three varied transmission sites in India

Malaria in India, while decreasing, remains a serious public health problem, and the contribution of submicroscopic and asymptomatic infections to its persistence is poorly understood. We conducted community surveys and clinic studies at three sites in India differing in their eco-epidemiologies: Chennai (Tamil Nadu), Nadiad (Gujarat), and Rourkela (Odisha), during 2012-2015. A total of 6,645 subject blood samples were collected for Plasmodium diagnosis by microscopy and PCR, and an extensive clinical questionnaire completed. Malaria prevalence ranged from 3-8% by PCR in community surveys (24 infections in Chennai, 56 in Nadiad, 101 in Rourkela), with Plasmodium vivax dominating in Chennai (70.8%) and Nadiad (67.9%), and Plasmodium falciparum in Rourkela (77.3%). A proportional high burden of asymptomatic and submicroscopic infections was detected in community surveys in Chennai (71% and 71%, respectively, 17 infections for both) and Rourkela (64% and 31%, 65 and 31 infections, respectively). In clinic studies, a proportional high burden of infections was identified as submicroscopic in Rourkela (45%, 42 infections) and Chennai (19%, 42 infections). In the community surveys, anemia and fever were significantly more common among microscopic than submicroscopic infections. Exploratory spatial analysis identified a number of potential malaria hotspots at all three sites. There is a considerable burden of submicroscopic and asymptomatic malaria in malarious regions in India, which may act as a reservoir with implications for malaria elimination strategies.

Status of vitamin D and the associated host factors in pulmonary tuberculosis patients and their household contacts: A cross sectional study

Innate immunity plays an important role in pathophysiology of tuberculosis which is influenced by various host factors. One such factor is vitamin D which, along with its associated molecule, can alter the host defense against Mycobacterium Tuberculosis (M.Tb.) via altered production of cathelicidin and nitric oxide, both having bactericidal effect. Therefore, assessment of vitamin D and its associated molecules in tuberculosis patients and household contacts as compared to healthy controls were done and the implication of these findings in susceptibility to tuberculosis (TB) was studied. 80 active TB patients, 75 household contacts and 70 healthy controls were included. Vitamin D receptor (VDR), vitamin D binding protein (VDBP) and inducible nitric oxide synthase (iNOS) mRNA levels were studied using quantitative PCR. Serum VDR, cathelicidin, and iNOS levels were measured using ELISA. Vitamin D and NO levels were measured in serum using chemiluminescence based immunoassay and greiss reaction based colorimetry kit respectively. Decreased serum levels of vitamin D were observed in active TB patients as compared to healthy controls (p < 0.001). VDR and iNOS mRNA levels were found to be significantly lower in active TB patients compared to household contacts and healthy controls (p < 0.0001 and 0.005 respectively). VDBP mRNA expression was found to be lower in active TB group as compared to household contacts and healthy controls however the difference was not found to be significant (p > 0.21). Although, mRNA expression of VDR, VDR protein and iNOS along with vitamin D levels were significantly (p < 0.05) higher in household contacts compared to active TB group. However, levels of iNOS, NO and cathelicidin were found to be higher in TB patients as compared to household contacts and healthy controls (p < 0.01, 0.05 and 0.01 respectively). Higher levels of Vitamin D along with VDR and iNOS expression in household contacts as compared to active TB patients suggest vitamin D might have a protective role against TB plausibly decreasing disease susceptibility. Low vitamin D levels in active TB patients warrants further studies to determine the role of vitamin D supplementation in prevention and treatment of TB.

Synthesis of Broad Band Violet-Blue Light-Emitting Core-Shell Cr3+:C-CaIn₂O₄ Nanowires

We developed a simple, effective and green method for synthesis of broad band violet-blue lightemitting core-shell Cr³⁺:C-CaIn²O⁴ nanowires (1-10 mol% of Cr³⁺) using aloe vera nectar. Calcium indate (CaIn²O⁴) is an important wideband gap semiconductor that could be explored for optical doping such as transition metals and/or rare-earths useful to make light-emitters, optical data storage, and other devices. The nectar embeds the cations in a gel so as it controls an ionic conversion Cr⁶⁺ to Cr³⁺ in ambient air. When grafting a carbon layer on surface of Cr³⁺:CaIn²O⁴ crystallites it yields a core-shell structure of tailored dielectric, optical and other properties. Asprepared Cr³⁺:CaIn²O⁴-C exhibits two bands at 270 nm and 360 nm, which got shifted-to at 265 and 370 nm when annealed at higher dosage of Cr³⁺ ions. These are the ligand-to-metal O^2- to Cr³⁺ charge transfer bands. We studied the light-emission properties in analyzing migration, transfer and recombination processes of light-induced e^--h⁺ pairs in detail in correlation to a Cr³⁺:CaIn²O⁴-C core-shell nanostructure.

Urinary EPCR and dermcidin as potential novel biomarkers for severe adult OSA patients

BACKGROUND

Due to low predictive values of obstructive sleep apnea (OSA) screening tools, there is a need for biomarker for screening of OSA patients at an early stage. The aim of the study was to evaluate differentially expressed proteins in blood and urine samples of OSA patients.

METHODS

In this study, we used isobaric tagging for relative and absolute quantification (iTRAQ) based proteomics approach to identify differentially expressed proteins, which were subsequently verified and validated using enzyme-linked immunosorbent assay (ELISA) technique in adult OSA patients.

RESULTS

Seventeen differentially expressed proteins were selected from iTRAQ data for verification, based on their clinical significance and reproducibility among different iTRAQ experiment sets. Five of these proteins (plasma = 2; urine = 3) were further validated in plasma (non-OSA- = 42; OSA = 198) and urine samples (non-OSA = 46; OSA = 197). ROC curve analysis for all OSA vs. non-OSA subjects ensured optimal diagnostic utility of two urinary proteins: Endothelial protein c receptor (EPCR) (AUC = 73%, cut-off: 35 pg/ml) and dermcidin (AUC = 74%, cut-off: 4.6 pg/ml). For severe OSA, diagnostic accuracy significantly improved with AUC as 88% and 82% for EPCR (cut-off: 46 pg/ml) and dermcidin (cut-off: 5.2 pg/ml) respectively. Sensitivity and specificity of combined performance of both urinary proteins for severe OSA were 94% and 91% respectively.

CONCLUSION

In this study, urinary EPCR and dermcidin emerged as novel biomarkers for screening severe OSA patients.

The impact of O2/Ar ratio on morphology and functional properties in reactive sputtering of metal oxide thin films

Morphology is a critical parameter for various thin film applications, influencing properties like wetting, catalytic performance and sensing efficiency. In this work, we report on the impact of oxygen partial flow on the morphology of ceramic thin films deposited by pulsed DC reactive magnetron sputtering. The influence of O₂/Ar ratio was studied on three different model systems, namely Al₂O₃, CuO and TiO₂. The availability of oxygen during reactive sputtering is a key parameter for a versatile tailoring of thin film morphology over a broad range of nanostructures. TiO₂ thin films with high photocatalytic performance (up to 95% conversion in 7 h) were prepared, exhibiting a network of nanoscopic cracks between columnar anatase structures. In contrast, amorphous thin films without such crack networks and with high resiliency to crystallization even up to 950 °C were obtained for Al₂O₃. Finally, we report on CuO thin films with well aligned crystalline nanocolumns and outstanding gas sensing performance for volatile organic compounds as well as hydrogen gas, showing gas responses up to 35% and fast response in the range of a few seconds.

Corticosteroid-associated lupus pancreatitis: a case series and systematic review of the literature

BACKGROUND

Acute pancreatitis is an uncommon complication that occurs in 0.85% to 4% of patients with systemic lupus erythematosus (SLE). In some patients, it occurs within days to weeks of starting medium-to-high dose corticosteroids. The authors have used the term 'corticosteroid-associated lupus pancreatitis' for these patients, and they report a case series and perform a systematic review of previously published reports.

METHODS

For the purpose of this study, corticosteroid-associated lupus pancreatitis was defined as occurrence of acute pancreatitis in patients with SLE (fulfilling the 1997 ACR), within 3 weeks of starting therapy with medium-to-high dose corticosteroids - either newly initiated or escalated from a lower dose. All patients with SLE admitted in the last 2.5 years in a North Indian university hospital were reviewed, and those with pancreatitis who fulfilled the above criteria were included in the case series. For the systematic review, a PUBMED search using the keywords 'lupus' and 'pancreatitis' was performed, and reports in English were reviewed for an association with corticosteroids.

RESULTS

Among 420 admissions of SLE patients, six patients (1.4%) fulfilled criteria for corticosteroid-associated lupus pancreatitis. All were female, with mean age and disease duration of 19.7 ± 3.3 and 3.8 ± 2.5 years respectively. All had active disease and developed acute pancreatitis within 48-72 hours of newly initiating medium-to-high dose corticosteroids (in three patients) or escalating them to medium-high dose (in three patients). After the development of pancreatitis, corticosteroids were continued in all except one patient. In addition, two patients received pulse methylprednisolone, two received pulse cyclophosphamide and one was started on azathioprine. Three patients died during hospitalization, all with severe pancreatitis. On systematic review, among 451 cases of lupus pancreatitis reported, 23 (5%) fulfilled criteria for 'corticosteroid-associated lupus pancreatitis'. A majority of them had pancreatitis within 3 days of starting treatment with medium-to-high dose corticosteroids. The mortality in these patients was 37.5%.

CONCLUSION

In a small but substantial proportion of patients with lupus who develop pancreatitis, it occurs within days to weeks of starting medium-to-high dose corticosteroids. Many of these patients continue to receive corticosteroids, and some receive more aggressive immunosuppression. However, they have significant mortality, and further studies are required to identify appropriate treatment in this subgroup of patients.

Improved access to early diagnosis and complete treatment of malaria in Odisha, India

Background

In 2013, the Comprehensive Case Management Programme (CCMP) was initiated to assess the impact of universal access to diagnosis and treatment and improved surveillance on malaria transmission in different settings in Odisha state, India.

Methods

Pairs of intervention and control sub-districts (blocks), matched on malaria incidence were selected in four districts with different transmission intensities. CCMP activities included training and supervision, ensuring no stock-outs of malaria tests and drugs, analysing verified surveillance data, stratifying areas based on risk factors, and appointing alternative providers to underserved areas. Composite risk scores were calculated for each sub-centre using principal component analysis. Post−pre changes (2013–2015 versus 2011–2012) for annual blood examination rates (ABER) and annual parasite incidence (API) across intervention and control groups were assessed using difference-in-difference (DID) estimates, adjusted for malaria transmission risk.

Results

In the intervention sub-centres, the mean increase in ABER was 6.41 tests/sub-centre (95%CI 4.69, 8.14; p<0.01) and in API was 9.2 cases diagnosed/sub-centre (95%CI 5.18, 13.21; p<0.01). The control sub-centres reported lower increases in ABER (2.84 [95%CI 0.35, 5.34]; p<0.05) and API (3.68 [95%CI 0.45, 6.90]; p<0.05). The control-adjusted post–pre changes in API showed that 5.52 more cases (95%CI 0.34, 10.70; p<0.05) were diagnosed, and a 3.6 more cases (95%CI 0.58, 6.56; p<0.05) were tested per sub-centre in the intervention versus control areas. Larger differences in post–pre changes in API between intervention and control sub-centres were registered in the higher transmission-risk areas compared with the lower risk areas. All the changes were statistically significant.

Conclusions

Intensive intervention activities targeted at improved access to malaria diagnosis and treatment produced a substantial increase in blood examination and case notification, especially in inaccessible, hard-to-reach pockets. CCMP provides insights into how to achieve universal coverage of malaria services through a routine, state-run programme.

Patient’s Utility for Various Attributes of Diabetes Care Services

Diabetes is rising like an epidemic in India. The prevalence of diabetes in India has reached an alarming level of 72.95 millions. The purpose of this article is to assess the relative importance of various health care service attributes in diabetes care. Our study uses secondary research and focus group discussion to identify the attributes of a diabetes specialty clinic. The attributes included in the questionnaire were the quality of the care provide by the health care givers, spend per visit, hospitalization expense, waiting time and the distance to the hospital. Conjoint analysis was used to assess the relative importance of the attributes. It was found that the hospital’s quality was the most important attribute while the distance to the hospital was the attribute with the least importance. Although the quality of the hospital is the most important criterion in selecting a hospital in diabetes care, factors like waiting time, spend per visit, and hospitalization expense play an important role in the selection. We assess the relative importance of these factors for the diabetic patients in India. The study is first of its kind and could help policy makers in designing better health care services in diabetes care.

Joint Indian Chest Society-National College of Chest Physicians (India) guidelines for spirometry

Although a simple and useful pulmonary function test, spirometry remains underutilized in India. The Indian Chest Society and National College of Chest Physicians (India) jointly supported an expert group to provide recommendations for spirometry in India. Based on a scientific grading of available published evidence, as well as other international recommendations, we propose a consensus statement for planning, performing and interpreting spirometry in a systematic manner across all levels of healthcare in India. We stress the use of standard equipment, and the need for quality control, to optimize testing. Important technical requirements for patient selection, and proper conduct of the vital capacity maneuver, are outlined. A brief algorithm to interpret and report spirometric data using minimal and most important variables is presented. The use of statistically valid lower limits of normality during interpretation is emphasized, and a listing of Indian reference equations is provided for this purpose. Other important issues such as peak expiratory flow, bronchodilator reversibility testing, and technician training are also discussed. We hope that this document will improve use of spirometry in a standardized fashion across diverse settings in India.

Liquid Type Nontoxic Photoluminescent Nanomaterials for High Color Quality White-Light-Emitting Diode

High-brightness white-light-emitting diodes (w-LEDs) with excellent color quality is demonstrated by using nontoxic nanomaterials. Previously, we have reported the high color quality w-LEDs with heavy-metal phosphor and quantum dots (QDs), which may cause environmental hazards. In the present work, liquid-type white LEDs composed of nontoxic materials, named as graphene and porous silicon quantum dots are fabricated with a high color rendering index (CRI) value gain up to 95. The liquid-typed device structure possesses minimized surface temperature and 25% higher value of luminous efficiency as compare to dispensing-typed structure. Further, the as-prepared device is environment friendly and attributed to low toxicity. The low toxicity and high R9 (87) component values were conjectured to produce new or improve current methods toward bioimaging application.