Predictive models of long COVID

BACKGROUND

The cause and symptoms of long COVID are poorly understood. It is challenging to predict whether a given COVID-19 patient will develop long COVID in the future.

METHODS

We used electronic health record (EHR) data from the National COVID Cohort Collaborative to predict the incidence of long COVID. We trained two machine learning (ML) models - logistic regression (LR) and random forest (RF). Features used to train predictors included symptoms and drugs ordered during acute infection, measures of COVID-19 treatment, pre-COVID comorbidities, and demographic information. We assigned the 'long COVID' label to patients diagnosed with the U09.9 ICD10-CM code. The cohorts included patients with (a) EHRs reported from data partners using U09.9 ICD10-CM code and (b) at least one EHR in each feature category. We analysed three cohorts: all patients (n = 2,190,579; diagnosed with long COVID = 17,036), inpatients (149,319; 3,295), and outpatients (2,041,260; 13,741).

FINDINGS

LR and RF models yielded median AUROC of 0.76 and 0.75, respectively. Ablation study revealed that drugs had the highest influence on the prediction task. The SHAP method identified age, gender, cough, fatigue, albuterol, obesity, diabetes, and chronic lung disease as explanatory features. Models trained on data from one N3C partner and tested on data from the other partners had average AUROC of 0.75.

INTERPRETATION

ML-based classification using EHR information from the acute infection period is effective in predicting long COVID. SHAP methods identified important features for prediction. Cross-site analysis demonstrated the generalizability of the proposed methodology.

FUNDING

NCATS U24 TR002306, NCATS UL1 TR003015, Axle Informatics Subcontract: NCATS-P00438-B, NIH/NIDDK/OD, PSR2015-1720GVALE_01, G43C22001320007, and Director, Office of Science, Office of Basic Energy Sciences of the U.S. Department of Energy Contract No. DE-AC02-05CH11231.

A pilot randomized controlled trial evaluating outdoor community walking for knee osteoarthritis: walk

OBJECTIVES

To determine the feasibility of a randomized controlled trial (RCT) examining outdoor walking on knee osteoarthritis (KOA) clinical outcomes and magnetic resonance imaging (MRI) structural changes.

METHOD

This was a 24-week parallel two-arm pilot RCT in Tasmania, Australia. KOA participants were randomized to either a walking plus usual care group or a usual care control group. The walking group trained 3 days/week. The primary outcome was feasibility assessed by changes being required to the study design, recruitment, randomization, program adherence, safety, and retention. Exploratory outcomes were changes in symptoms, physical performance/activity, and MRI measures.

RESULTS

Forty participants (mean age 66 years (SD 1.4) and 60% female) were randomized to walking (n = 24) or usual care (n = 16). Simple randomization resulted in a difference in numbers randomized to the two groups. During the study, class sizes were reduced from 10 to 8 participants to improve supervision, and exclusion criteria were added to facilitate program adherence. In the walking group, total program adherence was 70.0% and retention 70.8% at 24 weeks. The walking group had a higher number of mild adverse events and experienced clinically important improvements in symptoms (e.g., visual analogue scale (VAS) knee pain change in the walking group: - 38.7 mm [95% CI - 47.1 to - 30.3] versus usual care group: 4.3 mm [- 4.9 to 13.4]).

CONCLUSIONS

This study supports the feasibility of a full-scale RCT given acceptable adherence, retention, randomization, and safety, and recruitment challenges have been identified. Large symptomatic benefits support the clinical usefulness of a subsequent trial.

TRIAL REGISTRATION NUMBER

12618001097235. Key Points • This pilot study is the first to investigate the effects of an outdoor walking program on knee osteoarthritis clinical outcomes and MRI joint structure, and it indicates that a full-scale RCT is feasible. • The outdoor walking program (plus usual care) resulted in large improvements in self-reported knee osteoarthritis symptoms compared to usual care alone. • The study identified recruitment challenges, and the manuscript explores these in more details and provides recommendations for future studies.

A time evolving online social network generation algorithm

The rapid growth of online social media usage in our daily lives has increased the importance of analyzing the dynamics of online social networks. However, the dynamic data of existing online social media platforms are not readily accessible. Hence, there is a necessity to synthesize networks emulating those of online social media for further study. In this work, we propose an epidemiology-inspired and community-based, time-evolving online social network generation algorithm (EpiCNet), to generate a time-evolving sequence of random networks that closely mirror the characteristics of real-world online social networks. Variants of the algorithm can produce both undirected and directed networks to accommodate different user interaction paradigms. EpiCNet utilizes compartmental models inspired by mathematical epidemiology to simulate the flow of individuals into and out of the online social network. It also employs an overlapping community structure to enable more realistic connections between individuals in the network. Furthermore, EpiCNet evolves the community structure and connections in the simulated online social network as a function of time and with an emphasis on the behavior of individuals. EpiCNet is capable of simulating a variety of online social networks by adjusting a set of tunable parameters that specify the individual behavior and the evolution of communities over time. The experimental results show that the network properties of the synthetic time-evolving online social network generated by EpiCNet, such as clustering coefficient, node degree, and diameter, match those of typical real-world online social networks such as Facebook and Twitter.

Prediction of knee pain improvement over two years for knee osteoarthritis using a dynamic nomogram based on MRI-derived radiomics: a proof-of-concept study

OBJECTIVES

To develop and validate a nomogram to detect improved knee pain in osteoarthritis (OA) by integrating magnetic resonance imaging (MRI) radiomics signature of subchondral bone and clinical characteristics.

METHODS

Participants were selected from the Vitamin D Effects on Osteoarthritis (VIDEO) study. The primary outcome was 20% improvement of knee pain score over 2 years in participants administrated either vitamin D or placebo. Radiomics features of subchondral bone and clinical characteristics from 216 participants were extracted and analyzed. The participants were randomly split into the training and validation cohorts at a ratio of 8:2. Least absolute shrinkage and selection operator (LASSO) regression was used to select features and generate radiomics signatures. The optimal radiomics signature and clinical indicators were fitted into a nomogram using multivariable logistic regression model.

RESULTS

The nomogram showed favorable discrimination performance [AUC_training, 0.79 (95% CI: 0.72-0.79), AUC_validation, 0.83 (95% CI: 0.70-0.96)] as well as a good calibration. Additional contributing value of fusion radiomics signature to the nomogram was statistically significant (NRI, 0.23; IDI, 0.14, P < 0.001 in training cohort and NRI, 0.29; IDI, 0.18, P < 0.05 in validating cohort). Decision curve analysis confirmed the clinical usefulness of nomogram.

CONCLUSION

The radiomics-based nomogram comprising the MR radiomics signature and clinical variables achieves a favorable predictive efficacy and accuracy in differentiating improvement in knee pain among OA patients. This proof-of-concept study provides a promising way to predict clinically meaningful outcomes.

Generalisable long COVID subtypes: findings from the NIH N3C and RECOVER programmes

BACKGROUND

Stratification of patients with post-acute sequelae of SARS-CoV-2 infection (PASC, or long COVID) would allow precision clinical management strategies. However, long COVID is incompletely understood and characterised by a wide range of manifestations that are difficult to analyse computationally. Additionally, the generalisability of machine learning classification of COVID-19 clinical outcomes has rarely been tested.

METHODS

We present a method for computationally modelling PASC phenotype data based on electronic healthcare records (EHRs) and for assessing pairwise phenotypic similarity between patients using semantic similarity. Our approach defines a nonlinear similarity function that maps from a feature space of phenotypic abnormalities to a matrix of pairwise patient similarity that can be clustered using unsupervised machine learning.

FINDINGS

We found six clusters of PASC patients, each with distinct profiles of phenotypic abnormalities, including clusters with distinct pulmonary, neuropsychiatric, and cardiovascular abnormalities, and a cluster associated with broad, severe manifestations and increased mortality. There was significant association of cluster membership with a range of pre-existing conditions and measures of severity during acute COVID-19. We assigned new patients from other healthcare centres to clusters by maximum semantic similarity to the original patients, and showed that the clusters were generalisable across different hospital systems. The increased mortality rate originally identified in one cluster was consistently observed in patients assigned to that cluster in other hospital systems.

INTERPRETATION

Semantic phenotypic clustering provides a foundation for assigning patients to stratified subgroups for natural history or therapy studies on PASC.

FUNDING

NIH (TR002306/OT2HL161847-01/OD011883/HG010860), U.S.D.O.E. (DE-AC02-05CH11231), Donald A. Roux Family Fund at Jackson Laboratory, Marsico Family at CU Anschutz.

Metformin is associated with reduced COVID-19 severity in patients with prediabetes

AIMS

Studies suggest that metformin is associated with reduced COVID-19 severity in individuals with diabetes compared to other antihyperglycemics. We assessed if metformin is associated with reduced incidence of severe COVID-19 for patients with prediabetes or polycystic ovary syndrome (PCOS), common diseases that increase the risk of severe COVID-19.

METHODS

This observational, retrospective study utilized EHR data from 52 hospitals for COVID-19 patients with PCOS or prediabetes treated with metformin or levothyroxine/ondansetron (controls). After balancing via inverse probability score weighting, associations with COVID-19 severity were assessed by logistic regression.

RESULTS

In the prediabetes cohort, when compared to levothyroxine, metformin was associated with a significantly lower incidence of COVID-19 with "mild-ED" or worse (OR [95% CI]: 0.636, [0.455-0.888]) and "moderate" or worse severity (0.493 [0.339-0.718]). Compared to ondansetron, metformin was associated with lower incidence of "mild-ED" or worse severity (0.039 [0.026-0.057]), "moderate" or worse (0.045 [0.03-0.069]), "severe" or worse (0.183 [0.077-0.431]), and "mortality/hospice" (0.223 [0.071-0.694]). For PCOS, metformin showed no significant differences in severity compared to levothyroxine, but was associated with a significantly lower incidence of "mild-ED" or worse (0.101 [0.061-0.166]), and "moderate" or worse (0.094 [0.049-0.18]) COVID-19 outcome compared to ondansetron.

CONCLUSIONS

Metformin use is associated with less severe COVID-19 in patients with prediabetes or PCOS.

Burden of osteoarthritis in India and its states, 1990-2019: findings from the Global Burden of disease study 2019

OBJECTIVE

To describe the burden of osteoarthritis (OA) in India from 1990 to 2019.

DESIGN

Data from Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 were used. The burden of OA -knee OA, hip OA, hand OA, and other OA- was estimated for India and its states from 1990 to 2019 through a systematic analysis of prevalence, incidence, years lived with disability (YLD), and disability-adjusted life years (DALY) using methods reported in GBD 2019 study.

RESULT

Around 23.46 million individuals in India had OA in 1990; this increased to 62.35 million in 2019. The age-standardised prevalence of OA increased from 4,895 (95% uncertainty interval (UI):4,420-5,447) in 1990-5313 (95%UI:4,799-5,898) in 2019, per 100,000 persons. Similarly, DALYs due to OA increased from 0.79 million (95%UI:0.40-1.55) to 2.12 million (95%UI:1.07-4.23); while age-standardised DALYs increased from 164 (95%UI:83-325) to 180 (95%UI:91-361) per 100,000 persons from 1990 to 2019. OA was the 20^th most common cause of YLDs in India in 2019, accounting for 1.48% (95%UI:0.88-2.78) of all YLDs; increasing from 23rd most common cause in 1990 (1.25%(95%UI:0.74-2.34)). Knee OA was the most common form of OA, followed by hand OA. The prevalence, incidence, and DALYs for OA and knee OA were consistently higher in females than males.

CONCLUSION

The burden and impact of OA in India are substantial and is increasing. Adopting suitable control and preventive community measures to reduce modifiable risk factors (obesity, injuries, occupational stress) are needed to reduce the current and future burden of OA in India.

Generalizable Long COVID Subtypes: Findings from the NIH N3C and RECOVER Programs

Accurate stratification of patients with post-acute sequelae of SARS-CoV-2 infection (PASC, or long COVID) would allow precision clinical management strategies. However, the natural history of long COVID is incompletely understood and characterized by an extremely wide range of manifestations that are difficult to analyze computationally. In addition, the generalizability of machine learning classification of COVID-19 clinical outcomes has rarely been tested. We present a method for computationally modeling PASC phenotype data based on electronic healthcare records (EHRs) and for assessing pairwise phenotypic similarity between patients using semantic similarity. Our approach defines a nonlinear similarity function that maps from a feature space of phenotypic abnormalities to a matrix of pairwise patient similarity that can be clustered using unsupervised machine learning procedures. Using k-means clustering of this similarity matrix, we found six distinct clusters of PASC patients, each with distinct profiles of phenotypic abnormalities. There was a significant association of cluster membership with a range of pre-existing conditions and with measures of severity during acute COVID-19. Two of the clusters were associated with severe manifestations and displayed increased mortality. We assigned new patients from other healthcare centers to one of the six clusters on the basis of maximum semantic similarity to the original patients. We show that the identified clusters were generalizable across different hospital systems and that the increased mortality rate was consistently observed in two of the clusters. Semantic phenotypic clustering can provide a foundation for assigning patients to stratified subgroups for natural history or therapy studies on PASC.

POS1105 EFFICACY AND SAFETY OF COLCHICINE FOR THE TREATMENT OF OSTEOARTHRITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF INTERVENTION TRIALS

Background

Colchicine, an approved treatment for gout, has been trialled in many diseases, including osteoarthritis (OA), due to its anti-inflammatory effects. However, its efficacy and safety remain unclear in OA.

Objectives

This systematic review and meta-analysis evaluated the efficacy and safety of colchicine for the treatment of OA.1

Methods

PubMed, Web of Science, Scopus, and Cochrane Central were searched from inception through November 2020. Two reviewers independently screened for randomised controlled trials (RCTs) comparing colchicine with placebo or other active-comparators for the treatment of OA (knee, hand, or hip OA), extracted data, and performed Cochrane risk of bias assessments.

Results

The search retrieved 391 articles after removing duplicates, and 16 full-text articles were reviewed for eligibility (Figure 1A). Ten RCTs, nine in knee OA, one in hand OA, consisting of 847 patients (429 in colchicine arm, 409 in control arm) were included. RCTs were conducted between 2002 and 2021; three in India, two in Iran and Turkey, and one each in Australia, Singapore, and Iraq; follow-up period ranged 2 to 12 months. Moderate-quality evidence showed no clinically important pain reduction with colchicine compared to placebo in knee/hand OA patients (standardised mean difference [SMD], -0.17; 95% confidence interval [CI], -0.55 to 0.22) (Figure 1B). Moderate-quality evidence showed no improvement in dysfunction with colchicine compared to placebo in knee OA patients (SMD, -0.37; 95% CI, -0.87 to 0.13). Colchicine showed an acceptable safety profile with AEs/SAEs comparable to placebo (Figure 1C)

Conclusion

Current evidence does not conclusively suggest a benefit of colchicine in reducing pain and improving physical function in hand/knee OA patients. Future trials should focus on the sub-groups of OA patients with local or systemic evidence of inflammation and/or mineralisation who may benefit from colchicine.

References

[1]Rheumatology (Oxford). 2018 Jan 1;57(suppl_1):i4-i11.

Disclosure of Interests

None declared

AB0994 Exploring knee osteoarthritis pain trajectories and movement-evoked pain changes during a 24-week outdoor walking program (WALK)

Background

Exercise therapy is recommended as first line treatment for knee osteoarthritis (OA), but it remains to be sub-optimally applied (1). Movement-evoked pain is a potential barrier to exercise adherence, but recent evidence suggests that such pain can be improved by training (2). Walking programs are low-cost, easily adopted and can be performed outdoors which can minimize the risk of SARS-CoV-2 transmission when in a group (3).

Objectives

To explore the acute pain trajectories of individuals with knee OA during a 24-week outdoor walking intervention. In addition, to explore the effect of pain trajectories and/or baseline characteristics on retention and adherence.

Methods

Individuals with clinical knee OA and bone marrow lesions (BMLs) on magnetic resonance imaging (MRI) were asked to follow a 24-week walking program. Every week consisted of two one hour supervised group sessions at various outdoor locations and one unsupervised session. At the start and end of every supervised group walk, knee pain was self-reported by participants to their trainer using a numerical rating scale (NRS) (0-10). The difference between the NRS pain values was considered as an acute pain change evoked by that walk. At baseline, the most affected knee of each participant was assessed using the Visual Analogue Scale (VAS) pain, the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC) pain, stiffness and function, wellbeing (3 questionnaires) and the Osteoarthritis Research Society International (OARSI) recommended strength and performance measures.

Results

In total, N = 24 participants started the program of whom N = 7 (29%) withdrew. Pain at the start of each walk decreased from NRS 2.5 (SD 1.6) at the first walk (N = 24) to NRS 0.9 (SD 0.8) at the final walk (N = 17). This pain was estimated to decrease on NRS by -0.04 (95% CI -0.05 to -0.02) per supervised session, p < 0.001 during the first 12 weeks and -0.01 (95% CI -0.02 to -0.004), p = 0.004 during the second twelve weeks of the program. The number (%) of participants who experienced an acute increase in pain decreased from 11 (45.8%) at the first walk to 4 (23.5%) at the last walk.

At baseline, non-adherent participants (<70% of group sessions) (N = 11) had lower physical performance scores, including the 30s Chair Stand Test (mean 10 (SD 1.7) stands versus mean 12.0 (SD 1.7) stands, p = 0.011), Fast Past Walk Test (1.23 (SD 0.14) meter per seconds (m/s) vs 1.50 (SD 0.20) m/s, p = 0.001), Six Minute Walk Test (418.8 (SD 75.9) m vs 529 (SD 72.6) m, p = 0.002), compared to adherent participants (N = 13). Non-adherent participants also had less severe self-reported symptoms including WOMAC stiffness (90.7 (SD 44.5) mm vs 121.5 (SD 17.0) mm, p = 0.031), compared to adherent participants. During the first two weeks of walking, acute increases in pain on average (mean ≥0.5 NRS) were reported by a greater number of non-adherent (N = 5 (45.5%)) than adherent participants (n = 4 (30.8%)).

Conclusion

This was an exploratory study and results need to be interpreted with caution due to the small sample size. The walking program resulted in clinically important improvements (MCIIs) (≥ 1 on NRS) (4) in start pain and acute pain changes. Improvements in start pain during the first 12-weeks were comparable to improvements measured in the NEMEX program (2) and may suggest that 12 weeks of exercise is sufficient to achieve MCIIs in pain. Improvements in acute changes in pain were smaller, which may have been related to a floor effect (5). Lower physical performance scores at baseline and more acute increases in pain during the first two weeks was associated with non-adherence. Participants with these characteristics may benefit from a lighter introduction to exercise.

References

[1]Bennell KL, et al. The Lancet Regional Health-Western Pacific. 2021;12:100187.

[2]Sandal LF, et al. Osteoarthritis and cartilage. 2016;24(4):589-92.

[3]Bulfone TC, et al. The Journal of infectious diseases. 2021;223(4):550-61.

[4]Perrot S, et al. Pain. 2013;154(2):248-56.

[5]McHorney CA, et al. Quality of life research. 1995;4(4):293-307.

Acknowledgements

We thank the participants who made this study possible. We would like to acknowledge the research staff, Kate Probert, Lizzy Reid, Simone Fitzgerald, Claire Roberts, Jasmin Ritchie, Dawn Simpson, and Tim Albion. We also thank Hamish Newsham-West for his contribution to the study design.

Disclosure of Interests

Stan Drummen: None declared, Saliu Balogun: None declared, Lieke Scheepers Grant/research support from: Competitive Grant Program Inflammation ASPIRE 2020 Rheumatology International Developed Markets from Pfizer, Employee of: previously worked as an Associate Director Epidemiology at the Medical Evidence Observational Research Department at AstraZeneca., Ishanka Munugoda: None declared, aroub lahham: None declared, Kim Bennell: None declared, Rana Hinman: None declared, Michele Callisaya: None declared, Guoqi Cai: None declared, Petr Otahal: None declared, Tania Winzenberg Consultant of: received payment to create educational material by AMGEN, Zhiqiang Wang: None declared, Benny Antony: None declared, Johanne Martel-Pelletier Shareholder of: ArthroLab Inc., Jean-Pierre Pelletier Shareholder of: ArthroLab Inc., François Abram Consultant of: ArthroLab Inc., Employee of: Arthrolab Inc., Graeme Jones Speakers bureau: received payment for a speakers bureau from Novartis, Dawn Aitken: None declared

POS0178 ASSOCIATION BETWEEN KNEE MR IMAGING MARKERS AND KNEE SYMPTOMS OVER 7 YEARS IN YOUNG ADULTS

Background

Knee magnetic resonance imaging (MRI)-based morphological markers (quantitative biomarkers) and structural abnormalities (semi-quantitative biomarkers) are known to be associated with the progression of knee osteoarthritis (OA). However, there is conflicting evidence on the association between knee MRI-based morphological markers and knee symptoms. Besides, there is a lack of evidence on the clinical significance of MR imaging markers in the general population-based young adults. Hence, our aim was to investigate the associations between MR imaging biomarkers and knee symptoms in middle-aged adults followed over seven years.

Objectives

To describe the associations of cartilage volume, cartilage thickness, subchondral bone area, cartilage defects, and bone marrow lesions (BML) with knee symptoms in young adults followed up over 6-9 years.

Methods

Knee symptoms (pain, stiffness, and dysfunction) were assessed using the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scale during Childhood Determinants of Adult Health (CDAH)-knee study at baseline (year: 2008-10, age: 30–40 years) and 6-9 year follow-up (CDAH-3; year: 2014–2019, age: 36–49 years). Knee MRI scans were obtained at baseline and were assessed quantitatively for morphological markers such as cartilage volume, cartilage thickness, subchondral bone area using semi-automated segmentation (Chondrometrics, Germany). Cartilage defects and BMLs were assessed using semi-quantitative scoring systems. Univariable and multivariable (adjusted for age, sex, and body mass index (BMI)) zero-inflated Poisson (ZIP) regression model with random effects were used to describe the cross-sectional and longitudinal associations.

Results

The prevalence of knee pain at baseline (mean age (SD): 34 (2.7); female 49%) was 34% that increased to 50% over 6-9 year follow-up (mean age (SD): 43 (3.2)). Cross sectionally, there was a weak but statistically significant negative association between medial femorotibial compartment (MFTC) [Ratio of Mean (RoM)= 0.99971084; 95% CI: (0.9995525, 0.99986921; p<0.001], lateral femorotibial compartment (LFTC) [RoM=0.99982602; 95% CI: 0.99969915, 0.9999529; p=0.007], and patellar cartilage volume [RoM=0.99981722; 95% CI: 0.99965326, 0.9999811; p=0.029] with knee symptoms.

Similarly, there was a negative association between patellar cartilage volume (RoM=0.99975523; 95% CI: 0.99961427, 0.99989621; p=0.014), MFTC cartilage thickness (RoM= 0.72090775; 95% CI: 0.59481806, 0.87372596; p=0.001) and knee symptoms assessed after seven years.

The total bone area was consistently and negatively associated with knee symptoms at baseline [RoM= 0.9210485; 95%CI: 0.8939677, 0.9489496; p<0.001] and over seven years (RoM=0.9588811; 95% CI: 0.9313379, 0.9872388; p=0.005). Presence of any cartilage defect or BML was associated with higher knee symptoms at baseline and after seven years.

Conclusion

In the middle-aged adult population, BML and cartilage defects were positively associated with knee symptoms, whereas cartilage volume and thickness at MFTC and total bone area were weakly and negatively associated with knee symptoms. These results suggest that the quantitative and semi-quantitative MR imaging biomarkers can be explored as a marker of the clinical progression of OA in a young adult population.

Disclosure of Interests

Benny Antony: None declared, Alison Venn: None declared, Leigh Blizzard: None declared, Lyn March: None declared, Flavia Cicuttini: None declared, Felix Eckstein Shareholder of: Shareholder of Chondrometrics, image processing company, Graeme Jones: None declared, Changhai Ding: None declared, Ambrish Singh: None declared

POS1425 THE BURDEN OF OSTEOARTHRITIS ACROSS THE STATES OF INDIA, 1990–2019: FINDINGS FROM THE GLOBAL BURDEN OF DISEASE STUDY 2019

Background

Few studies have reported the burden of osteoarthritis (OA) in different parts of India. However, no study has reported the detailed estimates of incidence, prevalence, and years lived with disability (YLDs) and its trends for OA (and its various sites) across the states of India over a long period of time.

Objectives

We aim to describe the state-wise prevalence, incidence, and YLDs for osteoarthritis (OA) in India from 1990 to 2019 according to age and sex.

Methods

Data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 were used. The burden of OA –including knee OA, hip OA, hand OA, and other OA– was estimated for India and its states from 1990 to 2019 through a systematic analysis of prevalence, incidence, and YLDs modelled data using the methods reported in the GBD 2019 Study. All estimates are presented as counts and age-standardised rates per 100,000 population, with uncertainty intervals (UIs).

Results

Around 23.46 million individuals in India had OA in 1990; this increased to 62.35 million in 2019. The age-standardised prevalence of OA increased from 4,895 (95% uncertainty interval (UI): 4,420–5,447) in 1990 to 5313 (95%UI: 4,799–5,898) in 2019, per 100,000. OA was the 20th most common cause of YLDs in India in 2019, accounting for 1·48% (95%UI: 0·88–2·78) of all YLDs; increasing from 23rd most common cause in 1990 (1·25% (95%UI: 0·74–2·34)). Knee OA was the most common form of OA, followed by hand OA. The prevalence, incidence, and YLDs for OA and knee OA were consistently higher in females than males. Uttar Pradesh (8.53 million (95%UI: 7.63–9.53), Maharashtra (6.37 million (95%UI: 5.75–7.06), and West Bengal (4.90 million (95%UI: 4.39–5.46) had the three highest levels of OA prevalence. Goa (5689 (95%UI: 5,125–6,282)), Rajasthan (5667 (95%UI: 5,097–6,305)), and Kerala (5658 (95%UI: 5,107–6,263)) had the highest age-standardised prevalence of OA in 2019, per 100,000 (Figure 1 A and B).

Conclusion

The burden and impact of OA in India are substantial and is increasing; however, it varied among states. Females were affected more commonly than males. Knee OA was the most prevalent site. With improvement in life expectancy and population ageing, greater increases are expected. Adopting suitable control and preventive community measures to reduce modifiable risk factors (such as obesity, injuries, occupational stress) are needed now to reduce the current and future burden of OA in India.

Disclosure of Interests

None declared

Association between osteoarthritis-related serum biochemical markers over 11 years and knee MRI-based imaging biomarkers in middle-aged adults

OBJECTIVE

To describe the associations between osteoarthritis (OA)-related biochemical markers (COMP, MMP-3, HA) and MRI-based imaging biomarkers in middle-aged adults over 10-13 years.

METHODS

Blood serum samples collected during the Childhood Determinants of Adult Health (CDAH)-1 study (year:2004-06; n = 156) and 10-13 year follow-up at CDAH-3 (n = 167) were analysed for COMP, MMP-3, and HA using non-isotopic ELISA. Knee MRI scans obtained during the CDAH-knee study (year:2008-10; n = 313) were assessed for cartilage volume and thickness, subchondral bone area, cartilage defects, and BML.

RESULTS

In a multivariable linear regression model describing the association of baseline biochemical markers with MRI-markers (assessed after 4-years), we found a significant negative association of standardised COMP with medial femorotibial compartment cartilage thickness (β:-0.070; 95%CI:-0.138,-0.001), and standardised MMP-3 with patellar cartilage volume (β:-141.548; 95%CI:-254.917,-28.179) and total bone area (β:-0.729; 95%CI:-1.340,-0.118). In multivariable Tobit regression model, there was a significant association of MRI-markers with biochemical markers (assessed after 6-9 years); a significant negative association of patellar cartilage volume (β:-0.001; 95%CI:-0.002,-0.00004), and total bone area (β:-0.158; 95%CI-0.307,-0.010) with MMP-3, and total cartilage volume (β:-0.001; 95%CI:-0.001,-0.0001) and total bone area (β:-0.373; 95%CI:-0.636,-0.111) with COMP. No significant associations were observed between MRI-based imaging biomarkers and HA.

CONCLUSION

COMP and MMP-3 levels were negatively associated with knee cartilage thickness and volume assessed 4-years later, respectively. Knee cartilage volume and bone area were negatively associated with COMP and MMP-3 levels assessed 6-9 years later. These results suggest that OA-related biochemical markers and MRI-markers are interrelated in early OA.

The interactions between MRI-detected osteophytes and bone marrow lesions or effusion-synovitis on knee symptom progression: an exploratory study

OBJECTIVES

To investigate the longitudinal association between MRI-detected osteophyte scores and progression of knee symptoms, and whether the association was modified in the presence of bone marrow lesions (BMLs) or effusion-synovitis.

METHODS

Data from Vitamin D Effects on Osteoarthritis (VIDEO) study, a randomized, double-blinded and placebo-controlled clinical trial in symptomatic knee osteoarthritis (OA) patients, were analyzed as an exploratory study. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to assess knee symptoms. Osteophytes, BMLs and effusion-synovitis were measured using MRI.

RESULTS

334 participants with MRI information and WOMAC score (baseline and follow-up) were included in the analyses, with 24.3% of them having knee pain increased 2 years later. Statistically significant interactions were found between MRI-detected osteophytes and BMLs or effusion-synovitis on increased knee symptoms. In participants with BMLs, higher baseline scores of MRI-detected osteophytes in most compartments were significantly associated with increased total knee pain, weight-bearing pain, stiffness, and physical dysfunction, after adjustment for age, sex, body mass index, intervention and effusion-synovitis. In participants with effusion-synovitis, higher baseline scores of MRI-detected osteophytes in almost all the compartments were significantly associated with increased total knee pain, weight-bearing pain, stiffness, and physical dysfunction, after adjustment for age, sex, body mass index, intervention and BMLs. In contrast, MRI-detected osteophyte scores were generally not associated with knee symptom progression in participants without baseline BMLs or effusion-synovitis.

CONCLUSIONS

MRI-detected OPs are associated with increased total knee pain, weight-bearing knee pain, stiffness and physical dysfunction in participants presenting BMLs or effusion-synovitis, but not in participants lacking BMLs or effusion-synovitis. This suggests they could interact with bone or synovial abnormalities to induce symptoms in knee OA.

POS0280 ASSOCIATION OF COMPLEMENTARY AND ALTERNATIVE MEDICINE USE WITH KNEE SYMPTOMS AND KNEE STRUCTURAL CHANGES OVER 2.6 YEARS: A POPULATION-BASED COHORT STUDY OF TASMANIAN OLDER ADULTS

Background:

There is increasing use of complementary and alternative medicines (CAMs) alone or as an adjuvant therapy to conventional palliative medicines.1 However, there remains clinical uncertainty about the benefit of CAMs in the management of osteoarthritis in older population.

Objectives:

To describe the association between CAM use (alone or in combination with conventional analgesics) with knee symptoms and structural changes amongst a representative sample of Tasmanian older adults.

Methods:

A total of 1,099 participants were selected from the Tasmania Older Adult Cohort Study (TASOAC), an ongoing prospective population-based study. Exposure to CAM and conventional medications was classified into four categories according to the national drug code directory: 2 CAM only, conventional analgesics only, both CAM and conventional analgesics, and neither CAMs nor conventional analgesics. Knee pain was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and a 1.5-T MRI of the right knee was performed at baseline and follow-up (around 2.6 years). Longitudinal associations were assessed using mixed effect linear models.

Results:

At baseline, participants‘ mean age was 63, 86.5% (n=951) reported any medication use. The prevalence of CAM use was 35.0% and of conventional analgesics was 58.6%. Over follow-up, the analgesic only group had a significant increase in WOMAC pain, function, and stiffness scores compared to those who took neither CAMs nor conventional analgesics. There was a statistically significant femoral cartilage volume loss across all four groups, and no statistical difference was found between participants who takes both CAMs and analgesics group and the reference group, but participant in the CAM only or the analgesics only groups loss statistically significant more femoral cartilage volume than the reference group (Table 1).

Table 1.

Association of change in clinical knee symptoms and knee structural changes over 2.6 years with different medications groups.

Mean change for reference group*Change for each category, coefficient (95% confident intervals)CAMsBothAnalgesicsReference group*No. of participants327128257387327WOMAC pain (5-50)-0.95 (-1.42, -0.48)0.04 (-0.85, 0.93)0.32 (-0.4, 1.04)0.78 (0.13, 1.43)RefWOMAC function (17-170)-3.09 (-4.52, -1.67)1.02 (-1.7, 3.73)1.39 (-0.81, 3.59)2.32 (0.33, 4.31)RefWOMAC stiffness (2-20)-0.39 (-0.62, -0.17)0.15 (-0.28, 0.58)0.35 (0, 0.7)0.40 (0.09, 0.72)RefFemoral cartilage volume (mL)-187.98 (-228.79, -147.18)-113.81 (-192.60, -35.03)-1.92 (-65.00, 61.17)-127.19 (-186.31, -68.06)Ref

*Reference group=participants taken neither CAMs nor conventional analgesics

Conclusion:

CAM use alone or in combination with conventional analgesics may associate with slower progression of knee pain. Conclusive evidence on the longitudinal benefits of CAM in the management of osteoarthritis among older adults warrants more studies.

References:

[1]Steel A, McIntyre E, Harnett J, et al. Complementary medicine use in the Australian population: Results of a nationally-representative cross-sectional survey. Sci Rep 2018;8:17325.

[2]National Center for Health Statistics. Long-term Care Drug Database System: Drugs by NDC Class Code, Drug Code and Name 2007 Available from: https://www.cdc.gov/nchs/data/nnhsd/DrugsbyNDCClass3.pdf [accessed date: 2020 23 December].

The data were fitted using mixed effect linear models, which were constructed by entering baseline medication group, phase, the interaction between medication group and phase, covariates (baseline age, sex, body mass index [BMI], baseline value of outcome), the interaction between the covariates and phase, random intercept, and random slope on phase (time).

Disclosure of Interests:

None declared

POS0276 EFFICACY OF KRILL OIL IN THE TREATMENT OF KNEE OSTEOARTHRITIS: A 24-WEEK MULTICENTRE RANDOMISED DOUBLE-BLIND CONTROLLED TRIAL

Background:

Elevated levels of systemic inflammation are common in people with osteoarthritis and predict both pain and structural outcomes. Krill oil has anti-inflammatory properties and reduces severity of inflammatory arthritis in mice by 50% compared to controls.1 In humans, krill oil reduced knee pain and function in two short, moderate quality randomised controlled trials (RCTs) in people with osteoarthritis. However, evidence from longer trials with imaging data is lacking.

Objectives:

The aim of this study was to compare the efficacy of krill oil (2g / day) vs. placebo for treating knee pain in patient with clinical knee osteoarthritis who have significant knee pain and effusion-synovitis.

Methods:

KARAOKE was a 24-week multicentre, randomised, double-blind, placebo-controlled trial conducted at five Australian sites. Participants aged ≥40 years with symptomatic knee OA (according to ACR criteria), significant knee pain (pain score ≥40mm on a 100mm visual analogue scale [VAS]), and effusion-synovitis present on MRI (grade ≥1 according to modified Whole-Organ Magnetic Resonance Imaging Score (WORMS) scoring) were eligible. The study protocol has been published previously.2

Participants were randomised to receive 2g/day of krill oil, (350 mg/g omega-3 content, 12 mg/g total omega-6 content) or inert placebo (vegetable oil, no EPA or DHA, <5 mg/g (0.05%) other omega-3s).

The primary outcome was absolute change in knee pain assessed using a VAS [0-100mm] after 24 weeks. Secondary outcomes were: change in knee pain and function assessed using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score [0-500mm]), change in back and hand pain assessed using a VAS [0-100mm], change in lower limb leg strength assessed using a dynamometer, and change in blood parameters (including CRP, triglycerides, fasting glucose and total, HDL, LDL cholesterol), after 24 weeks.

Linear mixed-models were used, using patient identification as random intercepts and trial centre and treatment month as random effect to adjust for correlated data within trial centres and repeated measures and to allow different treatment effects among patients over time, respectively.

Results:

262 participants were randomised (mean age 61.5 years, 53% females) to receive krill oil (n=130) or placebo (n=132). A total of 85% completed the trial.

Knee pain improved in both groups over 24 weeks, but with no between-group difference (krill oil, -20.1mm; placebo, -19.3mm, p=0.81). Secondary outcomes: knee pain and function score improved in both groups, but with no between-group difference (WOMAC pain: krill oil, -86.7; placebo, -82.5mm, p=0.81; WOMAC function: krill oil, -245.3; placebo, -184.3, p=0.14 at 24 weeks). The same applies for hand pain and back pain. No significant changes were seen in leg strength or any of the blood parameters at 24 weeks). Incidence of one or more adverse events was 50% in the krill oil group (n=66) and 55% in the placebo group (n=71). There were 8 serious adverse events in the krill oil group 6 in the placebo group, all considered unrelated to treatment.

Conclusion:

Krill oil was safe and well tolerated, but did not significantly reduce knee pain in patients with clinical knee osteoarthritis, significant knee pain and effusion-synovitis after 24 weeks compared to placebo. These findings do not support use of krill oil for alleviating knee pain in clinical knee osteoarthritis.

References:

[1]Ierna M, et al. BMC Musculoskelet Disord 2010;11:136.

[2]Laslett L, et al. Trials 2020;21:79

OutcomesAbsolute between group difference at 24 weeksP valuePrimaryKnee pain0.8 (-5.6 to 7.2)0.81SecondaryKnee pain (WOMAC)4.2 (-29.1 to 37.5)0.81Knee function (WOMAC)61 (-19.2 to 141.3)0.14Hand pain2.8 (-2.6 to 8.3)0.31Back pain1.9 (-3.9 to 7.8)0.46Leg strength-2.59 (-9.41 to 4.23)0.52Metabolic factorsTotal Cholesterol0.09 (-0.1 to 0.29)0.34HDL Cholesterol-0.03 (-0.1 to 0.03)0.35LDL Cholesterol0.05 (-0.12 to 0.22)0.57Triglycerides0.12 (-0.09 to 0.33)0.27Fasting glucose0.01 (-0.26 to 0.29)0.93hsCRP0.64 (-0.56 to 1.84)0.30

Disclosure of Interests:

Laura Laslett Speakers bureau: once, several years ago, and unrelated to this topic, Grant/research support from: Yes, received funding from Aker Biomarine to conduct this trial, Lieke Scheepers Shareholder of: AstraZeneca, Grant/research support from: Pfizer, unrelated to this topic, Employee of: Previously employed by AstraZeneca, Benny Antony Speakers bureau: Zydus, Grant/research support from: Grant support for investigator-initiated trial from NR Ltd for unrelated research, Anita Wluka: None declared, Catherine Hill: None declared, Lyn March Speakers bureau: Speaker fees from Pfizer Australia Ltd, Bristol Myer Squibb Australia, Abbvie Australia, Grant/research support from: Grant support for my institution from Janssen for unrelated research, Helen Keen: None declared, Petr Otahal: None declared, Flavia Cicuttini: None declared, Graeme Jones: None declared

POS0190 ASSOCIATION BETWEEN OSTEOARTHRITIS-RELATED SERUM BIOCHEMICAL MARKERS OVER 11 YEARS AND KNEE SYMPTOMS IN MIDDLE-AGED ADULTS

Background:

Serum levels of cartilage and joint-specific biochemical markers such as cartilage oligomeric matrix protein (COMP), matrix metalloproteinase (MMP)-3, and hyaluronan (HA) are associated with cartilage degradation, joint tissue degradation, and synovitis in patients with OA. Change in these biomarkers may precede the morphological and clinical manifestations of OA and therefore have been explored as predictive markers in OA. However, few studies have evaluated the association of OA-related biomarkers with knee symptoms in general population-based middle-aged adults

Objectives:

To describe the associations between OA-related biomarkers and knee symptoms in middle-aged adults followed up over 10-13 years

Methods:

Blood samples were collected during the Childhood Determinants of Adult Health (CDAH)-1 study at baseline (year: 2004-06, age: 26–36 years) and 10-13 year follow-up (CDAH-3; year: 2014–2019, age: 36–49 years). Serum samples from baseline (n=156) and follow-up (n= 167) were analyzed for three OA-related biomarkers – namely COMP, MMP-3, and HA– using ELISA. Knee symptoms (pain, stiffness, and dysfunction) were assessed using the WOMAC scale during the CDAH-3 phase. Univariable and multivariable (adjusted for age, sex, and body mass index (BMI)) zero-inflated Poisson regression models with random effects were used to describe the above associations

Results:

The prevalence of knee pain was 46%. In the multivariable model, adjusted for age, sex, and BMI, there was a significant positive association between COMP (ɞ=1.156, 95%CI: 0.989,1.324; p=0.04), MMP-3 (ɞ=1.013, 95%CI: 1.001,1.025; p=0.02), and HA (ɞ=1.008, 95%CI: 1.002,1.015, p=0.01) with knee pain and WOMAC-total score (Table 1) in middle-aged adults. The increase in knee pain per ng/ml increase in COMP, MMP-3, and HA was 15.7%, 1.3%, and 0.8%, respectively. The overall mean biomarker levels decreased over 10-13 years; however, the mean WOMAC-total scores were higher in participants whose COMP and HA levels increased (COMP: 24 (27.31), HA: 14.20 (22.60)) compared to those in whom it decreased or remained stable (COMP: 9.84 (16.83), and HA: 8.28 (13.22)) during this period. There was a significant positive association between COMP (ɞ=1.026, 95%CI: 1.002,1.050, p=0.03) and MMP-3 (ɞ=1.020, 95%CI: 1.009,1.030, p<0.01) measured at baseline and knee pain assessed after 10-13 year in the middle-aged adults (Table 1)

Table 1.

Cross-sectional and longitudinal association between WOMAC symptoms and OA-related biomarkers

VariablesLongitudinal Biomarker at CDAH-1, knee symptom at CDAH-3Cross-sectional Biomarker at CDAH-3, knee symptom at CDAH-3Adjusted. Coef. (95%CI) p-valueAdjusted. Coef. (95%CI) p-valueCOMP (Predictor)WOMAC-total1.047 (1.035, 1.060)1.088 (1.017, 1.159)p<0.01p=0.01Stiffness1.019 (0.988, 1.051)0.877 (0.708, 1.057)p=0.23p=0.12Dysfunction1.045 (1.030, 1.061)1.040 (0.949, 1.130)p<0.01p=0.38MMP3 (Predictor)WOMAC-total1.026 (1.020, 1.031)1.017 (1.010, 1.023)p<0.01p<0.01Pain1.020 (1.009, 1.030)1.013 (1.001, 1.025)p<0.01p=0.03Stiffness1.020 (1.004, 1.035)1.004 (.987, 1.021)p=0.01p=0.66Dysfunction1.029 (1.022, 1.037)1.019 (1.010, 1.026)p<0.01p<0.01HA (Predictor)WOMAC-total0.995 (0.991, 0.999)1.007 (1.003, 1.010)p=0.01p<0.01Pain0.999 (0.991, 1.006)1.008 (1.002, 1.015)p=0.75p=0.01Stiffness0.989 (0.980, 0.998)0.997 (0.989, 1.007)p=0.03p=0.65Dysfunction1.003 (0.998, 1.009)1.015 (1.010, 1.020)p= 0.22p<0.01

Bold denotes statistically significant. Model adjusted for age, sex, and BMI

Conclusion:

OA-related biochemical markers such as COMP and MMP-3 were positively associated with knee pain in population-based middle-aged adults. These results suggest biochemical markers measured in middle-aged adults may be used as a marker of joint pain

Acknowledgements:

AS is supported by International Graduate Research Scholarship, University of Tasmania.

Disclosure of Interests:

Ambrish Singh Employee of: Has worked in the past for Abbott and Eli Lilly and Company, Leigh Blizzard: None declared, Alison Venn: None declared, Graeme Jones: None declared, John Burgess: None declared, Venkat Parameswaran: None declared, Changhai Ding: None declared, Benny Antony: None declared

The cross-sectional and longitudinal associations of dietary patterns with knee symptoms and MRI detected structure in patients with knee osteoarthritis

OBJECTIVES

To examine the cross-sectional and longitudinal associations of dietary patterns with knee symptoms and structures in patients with knee osteoarthritis (OA).

METHODS

Participants with symptomatic knee OA were recruited from a randomised, placebo-controlled trial conducted in Tasmania (N = 259) and Victoria (N = 133). Diet was assessed by the Anti-Cancer Council of Victoria food frequency questionnaire. Factor analysis was used to identify dietary patterns. Knee symptoms were assessed using Western Ontario and McMaster Universities Arthritis Index (WOMAC) and structures using MRI. Multivariable linear regressions were used to examine associations.

RESULTS

Three dietary patterns ("high-fat", "healthy" and "mixed") were identified in whole sample. Participants with higher "healthy pattern" score had lower total WOMAC, pain, function and stiffness scores at baseline but the associations were not significant over 24 months. Three ("western", "vegetable and meat" and "mediterranean") and two ("processed" and "vegetable") patterns were identified in Tasmania and Victoria, respectively. Cross-sectionally, only "mediterranean pattern" and "vegetable pattern" scores were significantly and negatively associated with total WOMAC or function scores. Longitudinally, participants with higher "western pattern" had worsening function (β: 0.35, 95%CI: 0.03, 0.67) and total WOMAC (β: 0.40, 95%CI: 0.07, 0.72) scores; furthermore, "vegetable pattern" was associated with decreased WOMAC stiffness score (β: -0.47, 95%CI: -0.93, -0.02). In contrast, dietary patterns were largely not associated with structural changes.

CONCLUSION

Some healthy dietary patterns were associated with reduced joint symptoms but dietary patterns were not associated with joint structure in this sample with knee OA. Further studies are required to confirm these findings.

FRI0383 A RANDOMISED PLACEBO-CONTROLLED CLINICAL TRIAL OF CURCUMA LONGA EXTRACT FOR TREATING SYMPTOMS AND EFFUSION-SYNOVITIS OF KNEE OSTEOARTHRITIS (CURKOA TRIAL)

Background:

Pharmacological therapies are limited, associated with off-target effects, are frequently contraindicated, and only modestly effective for pain in osteoarthritis (OA). Effusion and synovitis are common in OA and are associated with symptomatic and structural progression of OA.Curcuma longa(Turmeric) extract has anti-inflammatory effects and is gaining popularity in the treatment of OA despite the lack of high-quality evidence.

Objectives:

The CurKOA trial aimed to determine the efficacy ofCurcuma longaextract for reducing knee symptoms and effusion-synovitis in patients with symptomatic knee OA and knee effusion-synovitis.

Methods:

In this randomised, double-blind, placebo-controlled trial, participants with significant knee pain (≥ 40 mm on a 100-mm visual analog scale [VAS]), symptomatic knee OA (by ACR criteria) and ultrasound defined effusion-synovitis were randomised to receiveCurcuma longaextract (80% aqueous based extract standardized to turmerosaccharides + 20% curcuminoids, 2 × 500 mg capsules/day) or identical placebo for 12 weeks. Knee MRI scans were obtained at baseline and 12 weeks. Coprimary outcomes were changes in knee pain assessed by VAS and change in knee effusion-synovitis volume assessed by MRI over 12 weeks.

Results:

Among 70 participants (36 receivedCurcuma longa, 34 received placebo, age 61.8±8.6 years, 56% female),Curcuma longasignificantly improved VAS knee pain compared to placebo (-9.11mm, 95% confidence interval [CI] [- 17.79 to -0.44]) over 12 weeks, equivalent to a standardised effect size of 0.50. There was no significant between group difference in change in effusion-synovitis volume (3.24 mL [-0.33, 6.82]). There were significantly greater reductions in WOMAC knee pain (-47.22mm [-81.22, -13.22]), WOMAC function (-112.26mm [-222.79 to -1.74]) and significantly more OARSI-OMERACT treatment responders (63% treatment vs. 38% placebo [Risk Ratio=1.64 (1.00 to 2.70)]) in theCurcuma longagroup compared to the placebo group. There was no significant between-group difference in lateral femoral cartilage T2 relaxation time (-0.38 ms [- 1.10 to 0.34]) assessed from compositional MRI. The incidence of adverse events was similar in theCurcuma longa(n=14 (39%)) and placebo (n=18 (53%)) groups over 12 weeks (P=0.24).

Conclusion:

An extract ofCurcuma longasignificantly improved knee pain in an inflammatory phenotype of knee OA patients over 12 weeks compared to placebo but had no effect on knee effusion-synovitis and cartilage composition assessed using MRI. The moderate effect size of the treatment supports the use ofCurcuma longaextract for the symptomatic management of knee OA.

Figure 1.

Disclosure of Interests:

None declared

KARAOKE: Krill oil versus placebo in the treatment of knee osteoarthritis: protocol for a randomised controlled trial

BACKGROUND

Knee osteoarthritis (OA) is a common and important cause of pain and disability, but interventions aimed at modifying structures visible on imaging have been disappointing. While OA affects the whole joint, synovitis and effusion have been recognised as having a role in the pathogenesis of OA. Krill oil reduces knee pain and systemic inflammation and could be used for targeting inflammatory mechanisms of OA.

METHODS/DESIGN

We will recruit 260 patients with clinical knee OA, significant knee pain and effusion-synovitis present on MRI in five Australian cities (Hobart, Melbourne, Sydney, Adelaide and Perth). These patients will be randomly allocated to the two arms of the study, receiving 2 g/day krill oil or inert placebo daily for 6 months. MRI of the study knee will be performed at screening and after 6 months. Knee symptoms, function and MRI structural abnormalities will be assessed using validated methods. Safety data will be recorded. Primary outcomes are absolute change in knee pain (assessed by visual analog score) and change in size of knee effusion-synovitis over 24 weeks. Secondary outcomes include improvement in knee pain over 4, 8, 12, 16 and 20 weeks. The primary analyses will be intention-to-treat analyses of primary and secondary outcomes. Per protocol analyses adjusting for missing data and for treatment compliance will be performed as the secondary analyses.

DISCUSSION

This study will provide high-quality evidence to assess whether krill oil 2 g/day reduces pain and effusion-synovitis size in older adults with clinical knee OA and knee effusion-synovitis. If krill oil is effective and confirmed to be safe, we will provide compelling evidence that krill oil improves pain and function, changes disease trajectory and slows disease progression in OA. Given the lack of approved therapies for slowing disease progression in OA, and moderate cost of krill oil, these findings will be readily translated into clinical practice.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry, ACTRN12616000726459. Registered on 02 June 2016. Universal Trial Number (UTN) U1111-1181-7087.

Associations between MRI-detected early osteophytes and knee structure in older adults: a population-based cohort study

OBJECTIVES

To describe prevalence of osteophytes (OPs) detected only by magnetic resonance imaging (MRI) but not by standard X-ray in older adults and to evaluate longitudinal associations with knee structural changes.

METHODS

837 participants were randomly selected from the local community and had MRI scans to assess knee OPs and other structures. OPs detected only by MRI but not by standard X-ray were defined as MRI-detected early OPs (MRI-OPs for short). OPs detected by both MRI and X-ray were defined as established-OPs.

RESULTS

The prevalence of MRI-OPs was 50% while the prevalence of established-OPs was 10% and no-OPs was 40% at total tibiofemoral (TF) compartment at baseline. Compared with no-OPs, participants with MRI-OPs had greater risks of increased cartilage defects in all TF compartments (RR 1.37, 95%CI 1.07-1.74) and bone marrow lesions (BMLs) only in medial TF compartment (RR 1.49, 95%CI 1.06-2.11), after adjustment for age, sex, BMI, cartilage defects, BMLs and/or joint space narrowing; participants with established-OPs had greater cartilage volume loss at total (β -2.02, 95%CI -3.86, -0.17) and lateral tibial sites (β -5.63, 95%CI -9.93, -1.32), greater risks of increased cartilage defects in total (RR 1.66, 95%CI 1.15-2.40) and medial TF compartments (RR 1.49, 95%CI 1.20-1.69) and BMLs in all TF compartments (RR 1.88, 95%CI 1.22-2.89), after adjustment for covariates.

CONCLUSION

MRI-OPs were associated with changes in knee structures, and the associations were similar but not as prominent as those for established-OPs. These suggest MRI-OPs may have a role to play in knee early-stage osteoarthritic progression.

Associations between proximal tibiofibular joint (PTFJ) types and knee osteoarthritic changes in older adults

PURPOSE

To describe the cross-sectional associations between proximal tibiofibular joint (PTFJ) type configurations and knee joint structural abnormalities in older adults.

METHODS

A total of 967 community-based participants were studied. T1-weighted fat-suppressed magnetic resonance image (MRI) with spoiled gradient recalled echo sequence was utilized to assess the PTFJ type configurations. Knee cartilage volume, cartilage defects, bone marrow lesions and osteophytes were measured. Linear regression and binary logistic regression analyses were used to examine the associations between PTFJ type configurations and knee joint cartilage volume as well as knee structural abnormalities, respectively, after adjustment for potential confounders.

RESULTS

Seven PTFJ types including plane (49.4%), trochoid (31.9%), double trochoid (4.3%), saddle (5.4%), condylar (5.3%), trochlear (3.5%) and ball & socket (0.2%) were observed. Plane type was used as the comparator. In multivariable analyses, irregular joint types (comprising the five uncommon joint types) were associated negatively with cartilage volume, and positively with knee cartilage defects, bone marrow lesions and osteophytes in the lateral (but not medial) compartments. In contrast, trochoid type was only associated with reduced femoral cartilage volume, but not with knee cartilage defects, bone marrow lesions and osteophytes.

CONCLUSIONS

Irregular PTFJ joint shapes are associated with osteoarthritic changes in the lateral, but not medial, tibiofemoral compartment in older adults. The causal relationship needs to be examined in future longitudinal studies.

Identification and expression profiling of novel plant cell wall degrading enzymes from a destructive pest of palm trees, Rhynchophorus ferrugineus

Plant cell wall degrading enzymes (PCWDEs) from insects were recently identified as a multigene family of proteins that consist primarily of glycoside hydrolases (GHs) and carbohydrate esterases (CEs) and play essential roles in the degradation of the cellulose/hemicellulose/pectin network in the invaded host plant. Here we applied transcriptomic and degenerate PCR approaches to identify the PCWDEs from a destructive pest of palm trees, Rhynchophorus ferrugineus, followed by a gut-specific and stage-specific differential expression analysis. We identified a total of 27 transcripts encoding GH family members and three transcripts of the CE family with cellulase, hemicellulase and pectinase activities. We also identified two GH9 candidates, which have not previously been reported from Curculionidae. The gut-specific quantitative expression analysis identified key cellulases, hemicellulases and pectinases from R. ferrugineus. The expression analysis revealed a pectin methylesterase, RferCE8u02, and a cellulase, GH45c34485, which showed the highest gut enriched expression. Comparison of PCWDE expression patterns revealed that cellulases and pectinases are significantly upregulated in the adult stages, and we observed specific high expression of the hemicellulase RferGH16c4170. Overall, our study revealed the potential of PCWDEs from R. ferrugineus, which may be useful in biotechnological applications and may represent new tools in R. ferrugineus pest management strategies.

Knee effusion-synovitis volume measurement and effects of vitamin D supplementation in patients with knee osteoarthritis

OBJECTIVE

To develop a measure of knee joint effusion-synovitis volume and to examine the effect of vitamin D supplementation on effusion-synovitis in people with knee osteoarthritis (OA) and low vitamin D levels over 24 months.

METHOD

Symptomatic knee OA patients with low 25-(OH)D levels (12.5-60 nmol/l) were recruited for a multi-centre, randomised, placebo-controlled and double-blind trial. Participants (age 63 ± 7 years, 208 females) were allocated to either 50,000 IU monthly vitamin D₃ (n = 209) or placebo (n = 204) for 24 months. Knee effusion-synovitis volume in suprapatellar and other regions was measured on magnetic resonance imaging (MRI) using OsiriX software. The intra-class correlation coefficients (ICCs) were used to test inter- and intra-rater reliabilities. The least significant change criterion was used to define the increase/decrease in effusion-synovitis volume.

RESULT

The reproducibilities of effusion-synovitis volume measurement were high with ICCs ranging from 0.93 to 0.99. Over 24 months, effusion-synovitis volume remained stable in the vitamin D group but increased in placebos with a significant between-group difference (-1.94 ml, 95% confidence interval (CI): -3.54, -0.33). This effect was evident in those with baseline effusion-synovitis and with suprapatellar effusion-synovitis. The proportion with an increase in effusion-synovitis volume was lower in the vitamin D group than placebo (risk ratio (RR): 0.87, 95% CI: 0.77, 0.97).

CONCLUSION

This highly reproducible effusion-synovitis volume measurement could be a promising outcome measure in OA trials. Vitamin D supplementation could retard the progression of effusion-synovitis which can potentially benefit people with an inflammatory OA phenotype.

Associations between endogenous sex hormones and MRI structural changes in patients with symptomatic knee osteoarthritis

OBJECTIVE

To investigate the longitudinal association between endogenous sex hormones and knee osteoarthritis (OA) structures and pain.

METHOD

We examined 200 participants (mean age 63.0 ± 7.3 years) from a clinical trial of vitamin D supplement for symptomatic knee OA. Serum levels of estradiol, progesterone, testosterone and sex hormone binding globulin (SHBG) were analyzed at baseline and 24 months later. Magnetic resonance imaging (MRI) scans of selected knee were obtained at both baseline and follow-up for the measurement of cartilage volume, cartilage defects, bone marrow lesions (BMLs) and effusion-synovitis volume. Knee pain was assessed using a 100 mm visual analogue scale (VAS). Longitudinal data were analyzed using linear mixed-effects model.

RESULTS

One hundred and seven males and 93 females were included in this study. For females, after adjustment for age, body mass index (BMI), and vitamin D level, progesterone was positively associated with cartilage volume (β = 0.12 mm³ per quartile, P < 0.01). Estradiol levels were associated with lower grades of BMLs (β = -0.46 per quartile, P = 0.03), while estradiol (β = -1.28 per quartile, P = 0.04), progesterone (β = -1.56 per quartile, P < 0.01) and testosterone (β = -1.51 per quartile, P = 0.01) were inversely associated with effusion-synovitis volume. Testosterone was inversely associated with knee pain. No consistent associations were observed for males.

CONCLUSION

In women but not men, low serum levels of endogenous estradiol, progesterone and testosterone are associated with increased knee effusion-synovitis and possibly other OA-related structural changes. This may contribute to observed sex differences in knee OA.

Association between MRI-detected osteophytes and changes in knee structures and pain in older adults: a cohort study

OBJECTIVE

To describe cross-sectional and longitudinal associations between magnetic resonance imaging (MRI)-detected osteophytes (OPs) and knee structural abnormalities and knee pain in older adults.

METHOD

A prospective population-based cohort study of 895 participants aged 50-80 years (mean age 62 years, 50% female) was performed. T1-or T2-weighted fat suppressed MRI was used to assess knee OPs, cartilage volume, cartilage defects and bone marrow lesions (BMLs) at baseline and after 2.6 years. Radiographically-detected OPs were scored according to the Osteoarthritis Research Society International (OARSI) atlas. Knee pain was assessed using a self-administered questionnaire at baseline, 2.6 and 5 years later.

RESULTS

85% of participants had MRI-detected OPs at baseline, while 10% of participants had radiographically-detected OPs. Cross-sectionally, higher gardes of MRI-detected OPs in all compartments were significantly, independently and site-specifically associated with higher prevalences of cartilage defects and BMLs, lower cartilage volume and higher prevalence of knee pain. Longitudinally, higher gardes of baseline MRI-detected OPs site-specifically predicted greater risks of any increase in cartilage defects or BMLs, and loss of cartilage volume in medial and lateral tibiofemoral (LTF) and total compartments over 2.6 years in multivariable analyses. These significant associations were similar in those without radiographically-detected OPs. MTF and total OP scores were significantly associated with change in total knee pain over 2.6 and 5 years but these became non-significant after adjustment for cartilage defects and BMLs.

CONCLUSION

MRI-detected knee OPs are common and appear to be clinically relevant to knee structural changes in older adults.

Cross-sectional and longitudinal associations between serum inflammatory cytokines and knee bone marrow lesions in patients with knee osteoarthritis

OBJECTIVE

To describe cross-sectional and longitudinal associations between serum levels of interleukin (IL) - 6, IL-17A, IL-17F, IL-23 and knee bone marrow lesions (BMLs) in patients with knee osteoarthritis (OA).

DESIGN

Patients (n = 192) with symptomatic knee OA (mean 63 years, range 50-79, female 53%) were assessed at baseline and after 24 months. At each time point, serum IL-6, IL-17A, IL-17F and IL-23 were measured using Bio-Plex^® Multiplex Immunoassays with Luminex xMAP technology. Knee BMLs were scored using the modified whole organ MRI score (WORMS) from T2 weighted fat-suppressed fast spin echo magnetic resonance imaging (MRI). Multivariable linear regression and log binominal regression were used to determine the associations between cytokines and BMLs.

RESULTS

Baseline IL-6 (quarters) were significantly associated with total knee BMLs (P < 0.01 for the trend) as well as associated with an increase in BML score (P = 0.05 for the trend), after adjustment for confounders. Baseline IL-17F and IL-23 (highest quarters vs others) was associated with an increase in BML score in females (P = 0.04 for IL-17F; P = 0.01 for IL-23), but not in males, in multivariable analyses. In contrast, IL-17A was not significantly associated with BMLs in either females or males.

CONCLUSION

IL-6 is associated with increased knee BMLs in both females and males with OA. Serum IL-17F and IL-23 predicted increased knee BML scores in females only, suggesting that inflammation is involved in BML pathogenesis in knee OA, especially in women.

TRAIL REGISTRATION

ClinicalTrials.gov identifier: NCT01176344; Australian New Zealand Clinical Trials Registry: ACTRN12610000495022.

Association of patellar bone marrow lesions with knee pain, patellar cartilage defect and patellar cartilage volume loss in older adults: a cohort study

AIM

To examine the cross-sectional and longitudinal associations of patellar bone marrow lesion (BMLs) with knee pain, cartilage defects and cartilage volume in older adults.

METHODS

A total of 904 randomly selected subjects (mean 62.4 years, 49.9% female) were studied. Fat suppressed T1-weighted spoiled gradient recall and T2-weighted fast spin echo magnetic resonance imaging (MRI) sequences were used to assess cartilage volume, cartilage defects and/or BMLs at baseline (n = 904) and 2.6 (range: 1.4-4.8) years' follow-up (n = 414). Knee pain was assessed by self-administered Western Ontario McMaster Osteoarthritis Index (WOMAC) questionnaire at baseline (n = 904) and follow-up (n = 790).

RESULTS

The prevalence of any patellar BMLs was 19% and was higher in those with tibiofemoral BMLs. In multivariable analyses, patellar BMLs were positively associated with any knee pain at baseline and an increase in knee pain when going up/down stairs (odds ratio (OR): 1.67, 95% confidence interval (CI): 1.08, 2.59) but not with other knee pain subscales. Patella BMLs were also associated with patellar cartilage defects both at baseline and change over time (OR: 1.76, 95% CI: 1.00, 3.70) but not tibiofemoral defects. Patellar BMLs were negatively associated with baseline and change in patella cartilage volume (β: -2.10%, 95% CI: -3.39%, -0.80%). These associations remained significant after further adjustment for tibiofemoral BMLs.

CONCLUSIONS

Patellar BMLs were consistently associated with increased knee pain especially going up/down stairs, increased patellar cartilage defects, and decreased patellar cartilage volume cross-sectionally and longitudinally, suggesting a predominantly compartment specific role for patellar BMLs.

Mass effect and signal intensity alteration in the suprapatellar fat pad: associations with knee symptoms and structure

OBJECTIVE

To describe cross-sectional associations between mass effect or signal intensity alteration of the suprapatellar fat pad (SPFP) with knee symptoms and structure in older adults.

METHODS

A cross-sectional sample of 904 randomly selected subjects (mean 62.4 years, 49.9% female) was studied. T1- or T2-weighted fat suppressed magnetic resonance imaging (MRI) was used to assess mass effect or signal intensity alteration of SPFP, cartilage volume, cartilage defects, and bone marrow lesions (BMLs). Knee pain was assessed by self-administered Western Ontario McMaster Osteoarthritis Index (WOMAC) questionnaire. The Osteoarthritis Research Society International (OARSI) atlas was used to assess knee osteophyte, joint space narrowing (JSN) and radiographic osteoarthritis (ROA). Univariable and multivariable linear or logistic regression analyses were used to examine the associations.

RESULTS

After adjustment for confounders including age, sex, body mass index (BMI), disease status, tibial bone area and/or ROA, the presence of SPFP mass effect was significantly associated with any knee pain (OR: 2.39; 95% confidence interval (CI): 1.54, 3.70) and ROA (OR: 2.10; 95% CI: 1.33, 3.31) but not with cartilage volume, cartilage defects or BMLs. The presence of SPFP signal intensity alteration was significantly associated with any knee pain (OR: 1.90; 95% CI: 1.43, 2.53), ROA (OR: 1.83; 95% CI: 1.37, 2.45), any BMLs (OR: 1.55; 95% CI: 1.17, 2.06) but not with cartilage volume and cartilage defects. Significant associations with knee pain and BMLs were more evident in subjects with ROA. Presence of SPFP mass effect and/or signal intensity alteration combined was associated with any tibial cartilage defects (OR: 1.45; 95% CI: 1.04, 2.04).

CONCLUSIONS

SPFP mass effect and/or signal intensity alterations are deleteriously associated with knee pain, radiographic OA and BMLs in this cross-sectional study, suggesting that SPFP abnormalities may contribute to pain and structural abnormalities in the knee.

Body fat is associated with increased and lean mass with decreased knee cartilage loss in older adults: a prospective cohort study

OBJECTIVE

To determine the associations between body composition at baseline and knee cartilage loss over 2.9 years in older adults.

METHODS

A total of 395 randomly selected subjects (mean 62 years, range 51-81, 50% female) were studied at baseline and 2.9 years later. T1-weighted fat-suppressed magnetic resonance imaging of the right knee was performed to determine knee cartilage volume and tibial bone area at baseline and follow-up. Height, weight and radiographic osteoarthritis were measured by standard protocols at baseline. Fat mass and lean mass were measured by dual-energy X-ray absorptiometry at baseline.

RESULTS

Tibial cartilage volume decreased by 2.0-2.7% per annum. In multivariable analysis, annual change in medial cartilage volume was negatively and significantly associated with body mass index (β: -0.14% per kg m(-2), 95% confidence interval (CI): -0.25%, -0.02%), percentage total body fat (β: -0.19% per %, 95% CI: -0.30%, -0.07%) and percentage trunk fat (β: -0.10% per %, 95% CI: -0.19%, -0.02%), and positively associated with percentage lean mass (β: 0.20% per %, 95% CI: 0.08%, 0.32%). Change in lateral tibial cartilage volume was also significantly associated with percentage total body fat (β: -0.11% per %, 95% CI: -0.21%, -0.001%) and total lean mass (β: 0.13% per kg, 95% CI: 0.04%, 0.22%). These were independent of sex and age even though both were also significant predictors.

CONCLUSIONS

Body fat adversely affects tibial cartilage loss over time, whereas lean mass is protective. Strategies aimed at reducing body fat but increasing lean mass may reduce knee cartilage loss in older people.

Vitamin B12 supplementation improves heart rate variability in healthy elderly Indian subjects

While vitamin B(12) deficiency is global, data in elderly Indians are lacking. The problem in India is likely to be higher because of vegetarianism and malabsorption related to gastro-intestinal parasites. Autonomic dysfunction is known to occur much earlier in pernicious anemia. However, what is not known is whether these changes are reflected in healthy elderly individuals. This study assessed cardiac sympathetic and parasympathetic activity using heart rate variability (HRV) in healthy elderly individuals of low and high vitamin B(12) status and evaluated the effect of vitamin B(12) supplementation in those with low vitamin B(12) status. 140 elderly subjects aged ≥60 years were screened; 47 healthy subjects were assessed. They underwent blood sampling, anthropometry, HRV and nerve conduction assessment. Subjects were classified based on vitamin B(12) level (148 pmol/L) into deplete vitamin B(12) and replete vitamin B(12) groups. Elderly subjects with low vitamin B(12) status underwent cyanocobalamin supplementation (100 μg) for 3 months. Low frequency (LF) HRV in absolute units was significantly lower in the low vitamin B(12) group. Following supplementation, LF HRV in absolute units and total power rose significantly as compared to pre-supplementation values for the entire supplemented group. In conclusion, elderly with lower vitamin B(12) status have reduced low frequency HRV suggestive of sympathetic involvement. Supplementation with vitamin B(12) for 3 months results in a significant increase in low frequency HRV to values comparable with unsupplemented, but vitamin B(12) replete elderly.

Amlamax in the management of dyslipidemia in humans

Hypercholesterolemia is the major cause of cardiovascular diseases leading to myocardial infarctions leading to considerable morbidity and mortality. During the past decade a group of molecules referred to as statins such as simvastatin, atrovastatin have been tried with great success in reducing total cholesterol. These molecules act by inhibiting the HMG CoA reductase enzyme thereby interfering with the synthesis of cholesterol. But statins reduce all the cholesterol including HDL cholesterol. Long term drug vigilance activity has revealed serious side effects of tendinopathy and related musculoskeletal disorders in some of the subjects. In an effort to manage hypercholesterolemia without serious side effects in a natural way we had tried the use of Amlamax a reconstituted, purified, standardized dried extract of amla (Emblica officinalis) containing 30% ellagitannins with other hydrolysable tannins on humans. We report the hitherto unobserved significant elevation of HDL cholesterol by the administration of Amlamax.

A Pilot Cross-Over Study to Evaluate Human Oral Bioavailability of BCM-95CG (Biocurcumax), A Novel Bioenhanced Preparation of Curcumin

Curcumin, the bioactive component of turmeric, Curcuma longa has an exceptionally wide spectrum of activities including antioxidant, anti-inflammatory and anti-cancer properties, and is currently under different phases of clinical trials for various types of soft tissue cancers. However, although in vitro and animal studies have shown anticancer activities of curcumin for virtually all types of human cancers, its poor bioavailability in the human body has severely limited its application to these diseases. Methods to increase its oral bioavailability are a subject of intense current research. Reconstituting curcumin with the non-curcuminoid components of turmeric has been found to increase the bioavailability substantially. In the present clinical study to determine the bioavailability of curcuminoids, a patented formulation, BCM-95^®CG was tested on human volunteer group. Normal curcumin was used in the control group. Curcumin content in blood was estimated at periodical intervals. After a washout period of two weeks the control group and drug group were crossed over BCM-95^®CG and curcumin, respectively. It was also compared with a combination of curcumin-lecithin-piperine which was earlier shown to provide enhanced bioavailability. The results of the study indicate that the relative bioavailability of BCM-95^®CG (Biocurcumax™) was about 6.93-fold compared to normal curcumin and about 6.3-fold compared to curcumin-lecithin-piperine formula. BCM-95^®CG thus, has potential for widespread application for various chronic diseases.

Salmonella enterica serotype Dublin bacteraemia mimicking enteric fever

Salmonella enterica serotype Dublin, a bovine adapted serotype, is the commonest cause of salmonellosis in cattle. Salmonellosis in animals always presents a potential zoonotic threat. Infected cattles serves as a source of infection to humans. We present here Salmonella Dublin Bacteraemia in an elderly patient, with all the clinical details, due to the rarity of its occurrence. He was treated successfully with ciprofloxacin and his follow up period was uneventful.

A Pilot clinical study to evaluate the effect of Emblica officinalis extract (Amlamax™) on markers of systemic inflammation and dyslipidemia

Emblica officinalis Gaertn., commonly known as the Indian gooseberry or "Amla", has been used as health food for centuries in India and other Asian countries. The biological effects of amla have been attributed to the antioxidant properties of the low-molecular weight hydrolysable tannins present in the fruit. Amlamax™ is a purified, standardized, dried extract of amla containing about 35% galloellagi tannins along with other hydrolysable tannins. Our earlier studies on rabbits showed significant reduction in total cholesterol and triglycerides as well as increase in HDL. The present study extends these results to human volunteers. Two doses of the extract were evaluated - 500 mg and 1000 mg per day for 6 months. Blood samples were collected at the 3rd and 6th months showed reduction in total and LDL cholesterols and enhancement of beneficial HDL cholesterol. In addition, blood CRP levels, a marker for inflammation, were also significantly reduced. Since dyslipidemia and inflammation are the two major components of cardiovascular diseases, the present results must be considered encouraging and indicate the potential of Amlamax™ in the management of heart diseases.

Burkholderia pseudomallei septicaemia - a case report

Burkholderia pseudomallei, a natural saprophyte widely distributed in soil, stagnant waters of endemic areas, is said to infect humans through breaks in the skin or through inhalation causing protean clinical manifestations including fatal septicaemia. A case of septicaemia in a elderly female diabetic due to B. pseudomallei following a history of fall is being reported with complete details.

Bemisia tabaci (Homoptera: Aleyrodidae) biotypes in India

Host plant performance, esterase, and virus transmission tests revealed cassava-strain and sweetpotato-strain populations of whitefly Bemisia tabaci (Gennadius) biotypes in India. Individuals from the sweetpotato-reared population did not breed on cassava, Manihot esculenta Crantz, and the cassava-strain-reared individuals failed to develop on sweetpotato, Ipomoea batatus (L.) Lam. Eggplant, Solanum melongena L., and tobacco, Nicotiana tabacum L., were common hosts for both biotypes. The cassava-strain whiteflies but not the sweetpotato-reared whiteflies successfully transmitted cassava mosaic virus from disease-infected cassava seedlings to healthy cassava seedlings. Presence of biotypes in B. tabaci is reported for the first time from India.

Bacteriological spectrum of cholecystitis and its antibiogram

Bile Cultures for aerobic and anaerobic bacteria were carried out on 125 samples from patients with chronic cholecystitis with cholelithiasis. Cultures grew 71(56.8%) aerobes and 17(13.6%) anaerobic microorganisms. Polymicrobial infection was seen in 7(16.2%) cases. E. coli (45.07%) and Klebsiella (25.35%) were predominant among the aerobes and Bacteroides fragilis (58.82%) was predominant among the anaerobes. Highest incidence of the disease was observed in the fourth decade of life and females predominated in this study.

Plica neuropathica (polonica) in schizophrenia - a case report and review of literature

Plica neuropathica also known as plica polonica is an uncommon condition in which the hairs of the scalp in a localised area is compacted into irregularly twisted, irreversibly entangled plaits. A review of literature shows several predisposing factors figuring in plica neuropathica like kinky hair, use of shampoos, febrile illness and psychological disturbances. The authors describe a case of plica neuropathica in a paranoid schizophrenic patient who developed irreversible tangling of scalp hair.

Intraperitoneal abscess in a new born secondary to Klebsiella septicaemia--a case report

A five day old female baby was admitted with distension of abdomen since birth and nonbilious vomiting, fever of one day duration. Blood culture grew Klebsiella pneumoniae. Abdominal exploration revealed thick walled cavity containing purulent fluid grew klebsiella pneumoniae which was sensitive to various antibiotics including gentamycin. The child was treated with injection gentamycin and ceftazidime. The child had uneventful recovery and is doing well 3 years post operatively.

Meningitis due to Xanthomonas maltophilia

During 1st week of post-operative period, a 28 year old female patient operated for left cerebellopontine angle tumor, continued to get fever. Lumbar puncture did not reveal any organisms. She responded to ciprofloxacin. Two months later, she was readmitted with signs and symptoms of meningitis. The CSF tapped on lumbar puncture grew Xanthomonas maltophilia, Gram negative bacilli, sensitive to various antibiotics, ciprofloxacin being one of them. The patient was given ciprofloxacin for 3 weeks. On follow up, a year later she was found to be asymptomatic.