042611   DUNGA S K, SUNDARAM T G , KAVADICHANDA C G (Clinical Immunology Dep, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Email: doc.chengappa@gmail.com) : Pathogenesis of muscle weakness in inflammatory myositis. Indian J Rheumatol 2020, 15(6), S99-111.

Idiopathic inflammatory myositis (IIM) is a heterogeneous group of autoimmune diseases. These are characterized by muscle weakness and fatigue along with other systemic manifestations, ranging from pulmonary alveolitis to vasculopathic ulcers. Muscle weakness is encountered in a majority of individuals with IIM. Several hypotheses for muscle weakness have been proposed, but none have been convincingly proven. Understanding of the pathophysiology of muscle weakness is necessary to better delineate therapeutic options and tailor exercise regimens in patients with IIM. In this review, we have attempted to delineate the immune and nonimmune pathways implicated in muscle weakness and integrated them with the clinical, histopathological, and imaging findings in IIM.

illus, 2 tables, 118 ref

042610   HANNAH J, GUNAWARDENA H (Rheumatology Dep, Southmead Hospital, Bristol, BS10 5NB UK, Email: harsha.gunawardena@nbt. nhs.uk) : Picking interstitial lung disease out of the myositis haystack. Indian J Rheumatol 2020, 15(4), S91-8.

Interstitial lung disease (ILD) is a common manifestation of the connective tissue disease (CTD) associated idiopathic inflammatory myopathies (IIM). Although patients may be diagnosed as having polymyositis (PM) or dermatomyositis (DM) under the IIM spectrum, it is quite clear that risk, pattern of ILD and disease course between subgroups of patients is different. The natural history may be asymptomatic and slowly progressive or stable, chronically progressive or fulminant rapidly progressive depending on ILD subtype. ILD can be the initial presenting feature and this can make recognition of an underlying CTD‑IIM overlap more difficult with some patients initially misdiagnosed with idiopathic pulmonary fibrosis. Therefore, early recognition and characterization of patients can influence management and prognosis. It is clear than certain clinical and serological features phenotype patients into more specific CTD‑IIM ILD subgroups. A number of myositis‑CTD overlap associated antibodies and their clinical patterns have been described over the last few years. The hallmark CTD‑IIM ILD subgroup is antisynthetase syndrome, characterized by autoantibodies to tRNA synthetases. Muscle weakness is not universally present and parenchymal lung disease can predominate. Anti‑MDA5 DM has a distinct cutaneous pulmonary phenotype and is significantly associated with the development of ILD with different patterns seen in different ethnic groups. Other autoantibodies associated with ILD include those targeting nucleolar autoantigens such as anti‑PM‑SCL, again with characteristic syndromes. Picking ILD out of the “myositis haystack” can be complex. This heterogeneous disease group requires robust multidisciplinary collaboration between rheumatologists, pulmonologists, thoracic radiologists, and histopathologists to bring together clinical assessment to reach a diagnostic conclusion so optimal outcomes can be achieved.

3 illus, 67 ref

042609   PAULING J D, SKEOCH S, PAIK J J (Pharmacy and Pharmacology Dep, Bath Univ, Bath, UK, Email: jdp32@bath.ac.uk) : The clinicoserological spectrum of inflammatory myopathy in the context of systemic sclerosis and systemic lupus erythematosus. Indian J Rheumatol 2020, 15(6), S81-90.

Autoimmune rheumatic diseases (ARDs) are characterized by a pathological triad composed of autoimmunity/inflammation, microangiopathy, and aberrant tissue remodeling. Disease terms such as idiopathic inflammatory myopathy (IIM), scleroderma/systemic sclerosis (SSc), and systemic lupus erythematosus (SLE) are helpful clinically but disguise the considerable overlap that exists within these “distinct” disorders. This is perhaps best demonstrated by inflammatory myopathy, which can be present in SSc or SLE, but can itself be absent in clinically amyopathic IIM. Archetypal clinical manifestations of ARD (such as Raynaud’s phenomenon) are frequently present, albeit with varying prominence, within each of these diseases. This is certainly the case for inflammatory myositis, which has long been recognized as an important clinical feature of both SSc and SLE. Progress in elucidating the clinicoserological spectrum of ARDs has identified autoantibody specificities that are strongly associated with “overlap” disease and the presence of inflammatory myositis in SSc and SLE. In this review, we shall describe the prevalence, burden, prognostic value, and management considerations of IIM in the context of both SSc and SLE. A major emphasis on the value of autoantibodies shall highlight the value of these tools in predicting the future occurrence of inflammatory myositis in both SSc and SLE. Where applicable, unmet research needs shall be highlighted. The review emphasizes the importance of myopathy as a common feature across all the ARDs and highlights specific antibody specificities that are strongly associated with myopathy in the context of SLE and SSc.

4 illus, 1 table, 73 ref

040834   THAKOR J C, KUMAR P, DINESH M, VISHWA K V, QURESHI S, SINGH K P, SAHOO M (Pathology Dep, ICAR-Indian Veterinary Research Institute, Izatnagar - 243 122, Uttar Pradesh, Email: vety.lisa@gmail.com) : Sequential development of pathology and pathogenesis of capsular serotype D of Pasteurella multocida of porcine origin in mouse model. Indian J Vet Pathol 2020, 44(2), 69-80.

To understand the mechanism of host-pathogen interaction during the progression of Pasteurella multocida capsular serotype D of porcine origin causing pneumonia/septicemia, 36 adult Swiss albino mice were intranasally inoculated with 25 µl of P. multocida serotype D@10⁹ CFU/ml and sacrifi ced at 6, 12, 24, 48, 72 and 96 hours post inoculation. The infected mice showed varied clinical signs of depression, ruffl ed fur, ocular discharge, watery to mucoid nasal discharge with labored breathing pronounced during 24-48 HPI and declined thereafter. The leucocytosis, anaemia, low PCV, progressive neutrophilia with lymphocytopenia changes in these infected groups of mice paralleled with the clinical signs. The serum biochemical parameters such as total protein, blood urea nitrogen, creatinine, glucose, SGOT, SGPT and C-reactive protein were signifi cantly increased. The higher level of LPO, lower level of antioxidant enzymes (CAT, SOD and GSH) and higher values of proinfl ammatory cytokine genes (TNF-α, IL-1β and IL-6) in lungs and spleen of the inoculated mice as compared to control mice suggest towards the establishment of pneumonia and septicemia. The lesions of bronchopneumonia, splenitis, nephritis, hepatitis, enteritis and myocarditis along with the demonstration of bacterial antigens in lungs and spleen well correlated with severity of histopathological lesions at diff erent time points. Apoptotic nuclei were detected in infi ltrating leukocytes of the lungs and splenocytes on TUNEL staining. The infl ammatory lesions as well as the apoptosis were highest during 24-48 HPI followed by gradual decrease till the end of the experiment. This is the fi rst report on elucidating the pathogenesis of P. multocida capsular serotype D of porcine origin.

10 illus, 2 tables, 40 ref

042608   RIDDELL V, TANSLEY S L (Bath Univ, Bath, England, UK, Email: slt32@bath.ac.uk) : Bye bye muscle biopsy, we have autoantibodies with us now. Indian J Rheumatol 2020, 15(6), S74-80.

Muscle biopsy is generally considered the gold standard diagnostic tool for patients with presenting with features suggestive of idiopathic inflammatory myopathy. Muscle biopsy is however an invasive test, the histopathological findings can be influenced by previous treatment and not all patients with myositis spectrum disease have muscle involvement. Myositis specific and associated autoantibodies can now be identified in the majority of patients with myositis. When present they identify homogeneous patient subgroups and have the potential to be key tools in developing a personalised approach to disease management. Here we review the utility of myositis specific and associated autoantibodies as diagnostic and prognostic tools.

1 table, 55 ref

040833   KAPOOR J, BANGA H S, SINGH N D, DESHMUKH S (Veterinary Pathology Dep, Guru Angad Dev Veterinary and Animal Sciences Univ, Ludhiana - 141 004, Punjab, Email: hsbanga3@gmail.com) : Studies on pathology of ocular tumors in bovine. Indian J Vet Pathol 2020, 44(2), 65-8.

In the present study, eight cases of ocular tumor were diagnosed in the ocular tissue/biopsy samples received from Teaching Veterinary Clinical Complex Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana to the department of Veterinary Pathology to determine the type of ocular and peri-ocular lesions in bovine, using gross and histopathology approach. Amongst these eight tumor cases, fi ve were of squamous cell carcinoma (62.5 %), one malignant melanoma (12.5 %), one adenocarcinoma (12.5 %) and one occult tumor (12.5 %) in eye with primary tumor not known. The animals aff ected were of 1-11 years of age group. Caspase-3 was used to localize the apoptotic cells in area of degeneration in eye. Squamous cell carcinoma considered being the most common ocular tumor affl icting the bovine eye with secondary infl ammatory changes. In malignant melanoma case, staphyloma along with anterior synechia was observed. In case of occult tumor, with unknown origin; occult metastatic tumor cells in blood vessels were seen in iris. Considering the prevalence of ocular tumors, this study provides additional knowledge on ocular pathology in bovine.

5 illus, 14 ref

042607   DALAL A, RAJAK R (Rheumatology Dep, Wellness Clinic for Rheumatic and Musculoskeletal Medicine, Surat - 395 003, Gujarat, Email: dalal_ankur@ yahoo.co.in) : The impact of obesity on disease activity and other health outcome measures in rheumatoid arthritis. Indian J Rheumatol 2020, 15(4), 333-40.

Obesity is a common risk factor for noncommunicable diseases such as hypertension and diabetes. It is believed to be a state of low-grade inflammation. Rheumatoid arthritis (RA) is the most prevalent chronic inflammatory arthritis, and obesity is thought to influence its development through adipokines. However, the exact impact of obesity on the disease course of RA is not well understood. This nonsystematic literature review is, therefore, carried out in an effort to understand about how do the obesity affects disease activity (DA) and other health outcome measures in patients with RA. The reviewed evidences suggest that obesity if at all predispose than mostly to the sero-negative RA. Overall, the reviewed data show that obesity may increase DA, but not the radiological joint damage and mortality in patients with RA. However, few evidences also suggest that obesity by itself may actually increase the level of inflammatory markers rather than underlying disease process. These contradictory observations show a definite requirement of further research in this regard and until then weight reduction through reducing fat over lean body mass can be recommended in patients with RA to improve their DA, disability, quality of life, and general cardiovascular status.

1 illus, 1 tables, 45 ref

042606   RATH P D, PANDEY S, BISARALLI R (Rheumatology Dep, Max Super Speciality Hospital, Saket - 110 017, New Delhi, Email: drpdrath@gmail.com) : Role of neuroimmunomodulation by vagus nerve stimulation in rheumatoid arthritis: Are we heading towards a drug-free era?. Indian J Rheumatol 2020, 15(4), 323-32.

Progressive clinical research in the field of neuroimmunomodulation has formed a base for the development of a new therapeutic paradigm for various inflammatory diseases, including rheumatoid arthritis (RA). One of the most common mechanisms is electrical vagus nerve stimulation of inflammation. The role of the vagal nerves in activation of various immune responses through preclinical and clinical evidence has established its role in assisting the control of inflammation and improving survival in the infectious and inflammatory disorders through efferent as well as afferent vagal pathways that regulate the peripheral inflammation via the central nervous system. Another mechanism is the neural inflammatory reflex that regulates innate and adaptive immune responses and also inhibits the production of a vital inflammatory therapeutic target molecule, known as tumor necrosis factor, for RA. This review discusses the multifactorial and multidimensional interactions between neurons and immune cells, the mechanisms of the nervous system which are responsible for the regulation of inflammation, the impact of cholinergic pathways on inflammation, and the evidence supporting the role of various bioelectronic devices in vagus nerve stimulation.

3 illus, 2 tables, 69 ref

042605   PRASAD R, CHOUDHARY R , SINGH A, AGARWAL S, KAUSHIK P, SINGH K , YADAV R R , YADAV A S, BHADAURIA D S , LAL H (Biochemistry Dep, Medanta – The Medicity, Gurugram - 122 001, Haryana, Email: reeta06@gmail.com) : Serum levels of neutrophil gelatinase associated lipocalin, kidney injury molecule 1, and cystatin c in renal artery stenosis: A pilot study. Indian J Rheumatol 2020, 15(4), 317-22.

The present pilot study evaluated the potential of newer renal biomarkers (neutrophil gelatinase‑associated lipocalin [NGAL], cystatin‑C [Cys‑c], and kidney injury molecule‑1 [KIM‑1]) in estimating subclinical renal injury due to renal artery stenosis (RAS). A total of 13 patients of magnetic resonance angiography confirmed RAS and 14 normotensive healthy controls were enrolled in the study after obtaining ethics approval and informed consent. Serum was collected from participants to check for serum levels of NGAL, KIM‑1, and Cys‑c by quantitative enzyme immunoassay. The data of RAS patients were compared and analyzed against the data of healthy controls. sNGAL, sKIM‑1, and sCys‑c values in RAS patients showed rising trend as compared to normal healthy control; however, the difference in their values was not statistically significant. This could be due to small and heterogeneous sample size. However, statistically significant difference was noted in the values of sNGAL and sCys‑c between healthy controls and RAS patients with abnormal serum creatinine. This difference in the values of these biomarkers was also statistically significant between RAS patients with normal and elevated serum creatinine. In RAS patients, sNGAL, sCys‑c, and sKIM‑1 seem to have potential as an early biomarker of kidney injury.

4 tables, 34 ref

040832   TAMULI S M, DUTTA J B, ISLOOR S, DUTTA K J, BURAGOHAIN M, ARIF S A, DEBBARMA B (Veterinary Pathology Dep, Assam Agricultural Univ, Guwahati - 781 009, Assam) : Rabies in stray dogs in Guwahati metro : Pathomorphology and diagnosis. Indian J Vet Pathol 2020, 44(1), 49-51.

A total of three adult stray dog carcasses from diff erent localities of Guwahati metro city were submiĴ ed to the Department of Pathology, C.V.Sc., A.A.U. Khanapara, Guwahati-22, in the month of April to May,2019 for necropsy. Clinically the dogs prior to death exhibited restlessness, excitement, aggression, drooling of saliva, and have biĴ en other street dogs and humans. The disease was diagnosed by LFA,Mann’s modifi ed stain, DFA and pathomorphological studies. Grossly brain, liver, kidneys, heart, intestine and salivary glands were highly congested. The lungs showed haemorrhages in the apical lobes while the intestines revealed haemorrhagic enteritis. Histopathological examination of the brain revealed perivascular cuffi ng, neuronophagia, satellitosis, gliosis and presence of intracytoplasmic eosinophilic inclusion bodies i.e. Negri bodies in the neurons.

5 illus, 11 ref

040831   DHARANESHA N K, KHORAJIYA J H, SHIVARAJ B M, SAMINATHAN M, BYREGOWDA S M (KVAFSU, Mysore, Karnataka - 570 001, Email: drdharanivet@gmail.com) : Clinicopathological and molecular investigation of sheep pox in southern districts of Karnataka, India. Indian J Vet Pathol 2020, 44(1), 43-8.

Sheep pox is a highly contagious viral disease that aff ects small ruminants and is caused by sheep pox virus from the Capripoxvirus genus belonging to the Poxviridae family. Outbreaks of this disease cause enormous economic losses to the sheep industry by reducing the quality of wool and hide followed by high morbidity and mortality rates. This communication pertains to the clinicopathological investigation of outbreak of sheep pox disease in Bandur crossbred sheep from diff erent villages in Mandya and Chamarajnagar districts of Southern Karnataka, India. Amid 607 sheep, 353 animals were aff ected clinically and 100 died in 15 households from 6 diff erent villages. The morbidity, mortality, and case fatality rates were 58.15 %, 16.47 % and, 28.33 %, respectively. The aff ected animals showed mucopurulent nasal discharge and typical skin lesions were spread all over the body. Gross lesions such as severe pneumonia with nodular lesions in all lobes of lungs were seen. The liver also had whitish multifocal discrete necrotic foci. The histopathological examination revealed interstitial pneumonia with the infi ltration of mononuclear cells in the interstitial area. The eosinophilic spherical intracytoplasmic inclusions were seen both in bronchial epithelium and in degenerating hepatocytes. The disease was diagnosed as sheep pox using polymerase chain reaction by targeting the ITRs gene. Based on clinical history, characteristic skin lesions, post-mortem, histopathological and molecular fi ndings, the outbreak was confi rmed as sheep pox.

2 illus, 1 table, 21 ref

042604   HEGDE A, ACHARYA S , SINGH K , KOVILAPU U B (Pediatrics Dep, AFMC, Pune - 411 040, Maharashtra, Email: suchi.acharya@yahoo.co.in) : Clinical profile of juvenile idiopathic arthritis from a tertiary care hospital in Northern India. Indian J Rheumatol 2020, 15(4), 310-6.

Juvenile idiopathic arthritis (JIA) is the most common rheumatological disorder in children with wide variation in its clinical profile. The aim is to study the clinical, laboratory, radiological, and treatment profile of children with JIA attending the rheumatology clinic of a tertiary care hospital in Northern India. In this prospective observational study, we analyzed the clinical, serological, radiological, and treatment profile of 56 consecutive JIA patients attending our hospital between January 2013 to December 2016. Out of 56 children, 38 (67.8 %) were boys and 18 (32.2 %) were girls. Five (8.9 %), 15 (26.8 %), 16 (28.5 %), and 20 (35.7 %) children had oligoarticular, systemic‑onset JIA (SOJIA), polyarticular JIA, and enthesitis‑related arthritis (ERA), respectively, with male: female ratios being 0.67:1. 6.5:1, 0.45:1 and 9:1, respectively. Mean age at disease onset was 6.7 ± 4.3 (mean ± standard deviation), 6.6 ± 4.5, 6.0 ± 2.6, and 10.4 ± 3.2 years in SOJIA, polyarticular, oligoarticular and ERA, respectively. Arthritis was present in all patients. Fever, lymphadenopathy, hepatosplenomegaly, and rash were exclusive to patients with SOJIA. Uveitis and anti‑nuclear antibody (ANA) positivity (3.5 % each) were rare findings. Knee was the most common joint involved in all subtypes except SOJIA, where the wrist was most commonly involved. All children with SOJIA and polyarticular JIA required conventional synthetic disease‑modifying anti‑rheumatic drugs. Seven children with SOJIA, six children with polyarticular JIA and six children with ERA received biological disease‑modifying anti‑rheumatic drugs, in view of refractory disease. JIA‑ERA, followed by polyarticular JIA, were most common subtypes of JIA in our study. The knee is the most common joint to be involved. Uveitis and ANA positivity are rare findings in our subsets of children.

2 illus, 4 tables, 32 ref

040830   LAL M, DUBEY A, SWAMY M, RAJPOOT N, SAHNI Y P (Veterinary Pathology Dep, NDVSU, Jabalpur, Madhya Pradesh, Email: amiabhishek@rediff mail.com) : Serum δ-aminolevulinic acid as a marker of lead toxicity in bovine. Indian J Vet Pathol 2020, 44(1), 40-2.

A study was conducted in 30 adult female bovine exposed to the lead pollutant to analyse the blood lead level and serum delta (δ)-aminolevulinic acid. Blood lead level was estimated by atomic absorption spectroscopy and (δ)-aminolevulinic acid by calorimetric method. Result of the study indicated that serum δ-aminolevulinicacid increased in correlation with mean blood lead level. Serum δ-aminolevulinic acid appeared as promising marker of lead exposure in absence of specifi c instrument like atomic absorption spectroscopy (AAS) and inductive coupled plasma spectroscopy (ICP).

1 table, 23 ref

042602   AHMED S, MAHAPATRA A , BEHERA B K , PADHAN P (Clinical Immunology and Rheumatology Dep, KIIT Univ, Bhubaneswar ? 751 024, Odisha, Email: prasanta.padhan@gmail.com) : Beliefs and outlook toward medications in indian patients with very early rheumatoid arthritis: Cross sectional survey. Indian J Rheumatol 2020, 15(4), 298-303.

Beliefs toward medicine influences drug compliance in rheumatoid arthritis (RA). Studies on attitudes toward medicine are available for established RA, where the disease itself could have altered the beliefs. Similar studies are not available for early RA. Thus, we surveyed patients with very early RA to determine their initial outlook toward medicines. Two hundred and fifty patients fulfilling the American College of Rheumatology/ European League against Rheumatism 2010 criteria for RA, who had developed arthritis within the past 3 months were surveyed using the Beliefs about Medicines Questionnaire (BMQ). For the BMQ subsets (specific necessity, specific concern, general overuse, and general harm), more than scale midpoint is considered high. Depending on these scores, patients were classified as indifferent, accepting, sceptical, or ambivalent. Correlations of these scores with age, sex, time to presentation, education, occupation, and income were calculated. Mean (±standard deviation) age of the cohort was 47.6 (±13.4) years with 88.4 % (221) being females. Twelve (4.8 %) had a high specific necessity, while 31 (12.4 %) had a high specific concern score. General overuse and general harm scores were high in 248 (99.2 %) and 246 (98.4 %) patients, respectively. Thus, 242 (96.8 %) patients were classified as indifferent, 4 (1.6 %) accepting, 4 (1.6 %) sceptical, and none as ambivalent. There was no statistically significant correlation between these scores and sex, age, educational status, occupation, or income. Multivariate analysis showed that persons with high specific concerns about medicines, educated to secondary level, being a student or having a desk job tended to present earlier. General harm and overuse scores were high, but patients had low scores on the scales specific for RA medication. Thus, most of them were classifiable as “indifferent” unlike as in previous studies on established RA. 

5 tables, 26 ref

040829   SOHI H S, SANDHU B S, BRAR A P S, NARANG D (Veterinary Pathology Dep, Guru Angad Dev Veterinary and Animal Sciences Univ, Ludhiana, Punjab - 141 004, Email: bhupisandhu@rediff mail.com) : Intradermal rabies vaccination: An effi cient and economical method of rabies prevention in cattle. Indian J Vet Pathol 2020, 44(1), 35-9.

The present study was conducted to elucidate the comparison of rabies antibody titer in catt le vaccinated intramuscularly and intradermally with commercially available inactivated rabies vaccine. Twelve adult healthy cows divided into two groups of 6 animals each, were selected for the study and were vaccinated on day 0, 7 and 21. The animals in group I were vaccinated via IM route using 1ml of vaccine, while those of group-II were vaccinated via ID route using 0.1ml of vaccine on a single-site. Antibody titres against rabies were analyzed using the Enzyme-Linked Immunosorbent Assay (ELISA) on the day of vaccination i.e. day 0, and on 7^th, 14^th and 28^th days post-vaccination. No signifi cant statistical diff erence (p>0.05) was observed in the animals of the two groups vaccinated via IM and ID route during the entire period of study. All the animals vaccinated via ID and IM routes developed protective level of antibody titre of >0.5 IU/ml on day 14^th post-vaccination. ID route of vaccination was more economical as compared to IM route with 90 % cost savings att ained using ID route for pre-exposure rabies prophylaxis. From the study, it was concluded that intradermal route may be an alternative route for rabies prophylaxis.

2 illus, 5 tables, 28 ref

042601   SAHIN K, OZISLE CR, YESI N KL, DORTBAS F, OMMA A, ASLAR Z O, KARAASLAN Y (Rheumatology Dep, Health Sciences Univ, Ankara, Turkey, Email: drksahin@yahoo.com) : The effects of educational status and comorbidity on routine assessment of patient index data 3 and its correlation with disease activity score 28 and clinical disease activity index. Indian J Rheumatol 2020, 15(4), 292-7.

Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disease which leads to significant morbidity. Formal quantitative swollen and tender joint count and indices like disease activity score 28 (DAS28) and clinical disease activity index (CDAI) are very specific for measuring disease activity. Routine assessment of patient index data 3 (RAPID3) is a patient‑reported outcome measure used for the assessment and follow‑up of RA which can be completed in 10 s. We aimed to determine the effects of patient educational status and comorbidity on RAPID3 and its correlation with DAS28 and CDAI. A total of 246 RA patients (80.1 % female; mean age: 53.2 years) followed up for 3 years were asked to fill out RAPID3 questionnaires, and DAS28 and CDAI were calculated. Patients were subdivided according to disease severity as Group A (remission‑minimal disease activity) and Group B (moderate–severe disease activity). The duration of disease, medications, educational status, comorbidity, and medical history were recorded. The mean duration of disease was 8.44 years. Of the patients, 27.2 % were illiterate and the mean education time was 4.9 years. The 47.6 % of the patients had a comorbid disease. The correlation of RAPID3 with DAS28 and CDAI scores was statistically significant (P < 0.001). Similarly, educational status and the presence of comorbidity did not affect this correlation (P < 0.001). The kappa analysis showing compliance of RAPID3 with DAS28 and CDAI scores was also significant (P < 0.001). RAPID3 is an index which shows a perfect correlation with DAS28/CDAI and can be used routinely for follow‑up of RA patients and for decision‑making for treatment. It can provide quantitative data with DAS28/CDAI in busy outpatient clinics not only in patients with different educational levels but also in patients with comorbid diseases.

4 tables, 32 ref

040828   MADHWAL A, GHODASARA D J, JOSHI B P, BHANDERI B B, DAVE C J, JANI P B, CHAUDHARI S, CHOUDHARY K (Veterinary Pathology Dep, Veterinary Science and Animal Husbandry Coll, Anand - 388 001, Gujarat, Email: dinghodasara@gmail.com) : Etiopathology of femoral head necrosis with special reference to Escherichia coli in broilers. Indian J Vet Pathol 2020, 44(1), 29-34.

The present study was conducted to investigate the emerging pathology of femur head in colisepticemic broiler birds. A total of 75 broiler birds of age ranging 2-6 weeks from 15 diff erent commercial broiler farms from in and around Anand district were necropsied. Swab and tissue samples were collected from diff erent aff ected organs (liver, heart, spleen) including femur head surface and femur bone marrow for isolation and serotyping of Escherichia coli. The serotypes encountered in present study were O8, O88, O22, O11, O101, O119, O116, O20, O149, O1 and O87. Pathological fi ndings included gross and histopathology of femoral head. Gross examination of femur head revealed dull and debrided condition of epiphyseal cartilage. In certain cases, femur head was easily breakable, leaving the epiphyseal cartilage in the acetabulum, during post-mortem examination. Histopathological examination of femur head revealed degenerated epiphyseal cartilage characterized by damaged chondrocytes and loss of normal tissue architecture. Other lesions included fi brinous perihepatitis, fi brinous pericarditis, deposition in the abdominal cavity.

10 illus, 2 tables, 21 ref

042600   KUMAR A, BHAKUNI D S , SHANMUGANANDAN K , HEGDE A , VASDEV V , ARJUN MN , KISHORE K (Rheumatology Dep, Command Hospital (Southern Command), Pune - 411 040, Maharashtra, Email: drarunhegde@gmail.com) : Clinical efficacy and safety of tocilizumab in the treatment of seropositive rheumatoid arthritis patients in India. Indian J Rheumatol 2020, 15(4), 286-91.

Tocilizumab (TCZ) is a human interleukin (IL)‑6 receptor (IL‑6R) antibody which competitively inhibits IL‑6 signal transduction. Clinical efficacy and safety of TCZ in the treatment of rheumatoid arthritis (RA) and other autoimmune conditions have been established. However, there is a lack of data on its use in the Indian population. The objective was to study the clinical efficacy and safety of TCZ in Indian patients with seropositive RA. This was a prospective, observational single‑center study conducted at a tertiary care rheumatology center. All patients were more than 16 years of age, fulfilled the  American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria for RA, and had at least moderate disease activity as measured by disease activity score‑28 joints erythrocyte sedimentation rate (DAS28‑ESR) ≥3.2 at enrollment while on at least two disease‑modifying antirheumatic drugs. Patients with latent tuberculous infection were excluded from the study. Six doses of TCZ were administered at 8 mg/kg body weight dose at four weekly interval and clinical response was assessed at each visit. All 30 patients enrolled completed the study. Baseline DAS28‑ESR was 5.03 (SD0.39) which improved to 2.4 (∆‑2.6; 95 % confidence interval: 2.30–3.04; P < 0.005) after 24 weeks. A total of 19 (63.3 %) patients achieved remission (DAS‑28 ESR < 2.6) at 24 weeks, while 25 (83.3 %) patients showed a good EULAR response. No serious adverse effect was noted in any of the patients. TCZ is an effective and safe option for the treatment of seropositive RA.

3 illus, 2 tables, 32 ref

042603   THOMAS K N, ANUJA A K, GUPTA L (Clinical Immunology and Rheumatology Dep, Postgraduate Institute of Medical Sciences, Lucknow - 226 014, Uttar Pradesh, Email: drlatikagupta@gmail.com) : Clinical profile of adults and children with reactive arthritis in India – A cohort study. Indian J Rheumatol 2020, 15(4), 304-9.

An evolving clinicodemographic spectrum is reported in reactive arthritis (reA) with the changing microbial profile in recent times. Moreover, understanding of chronic disease patterns is limited due to widespread beliefs of a self‑limiting nature. We thus assessed the clinical profile of a cohort of acute reA and compare them with chronic reA. A hospital‑based study of prevalent triggers and demographic features, articular and extra‑articular manifestations, and radiological findings was undertaken in children and adults with reA at a tertiary care center in northern India. Sixty‑eight cases (8 juvenile, 41 acute, and 27 chronic) of age 26 years (18–34, M:F 5.8:1) and disease duration 36 (19–60) days were enrolled. Enteritis was the most common preceding trigger (37, 54 %), followed by genitourinary infection (25, 36 %), irrespective of gender. The clinical spectrum mirrored previous descriptions, with arthritis in most (95 %), enthesitis in 33 %, and conjunctivitis and circinate balanitis being the most common extra‑articular features (8 % each). Numerous cases (n = 7) did not fulfill the Braun’s criteria at the current visit though a high representation of sacroiliitis was noted (20 %, 12 %) in acute as well as chronic reA. Enthesitis was more common in the acute reA (P = 0.018) and mucocutaneous features occurred only at inception. Otherwise, the clinical profile was similar in cases triggered by urethritis and enteritis, and in children as compared with adults. These observations of varied spectrum of reA assume larger importance in light of the emerging concept of a unified clinic‑pathologic spectrum of spondyloarthritis.

2 illus, 1 table, 24 ref

042599   GANAPATI A, KABEERDOSS J, GOWRI M , ANTONISAMY B , DANDA D (Clinical Immunology and Rheumatology Dep, Christian Medical Coll and Hospital, Vellore - 632 004, Tamil Nadu, Email: debashisdandacmc@hotmail. com) : Myeloid related proteins 8/14 failed to act as theragnostic biomarker in axial spondyloarthritis patients on combination disease modifying anti rheumatic drugs therapy. Indian J Rheumatol 2020, 15(4), 282-5.

Reports signifying the utility of myeloid‑related proteins (MRP) 8/14 in axial spondyloarthritis (AxSpA) as a theragnostic biomarker are scarce. Evaluating the utility of serum MRP 8/14 (baseline levels and change from baseline to 3 months) in AxSpA as a predictor of Assessment of SpondyloArthritis International Society (ASAS) 20 response at 6 months post combination disease‑modifying anti‑rheumatic drugs (DMARD) therapy. Serum MRP 8/14 was assayed using enzyme‑linked immunosorbent assay platforms (R&D systems, USA) at baseline in 83 AxSpA patients satisfying ASAS 2009 criteria meeting the predefined eligibility criteria; treated with a combination of methotrexate, sulfasalazine at optimum tolerated doses with on‑demand nonsteroidal anti‑inflammatory agents and 30 healthy age‑matched controls. Repeat measurement was done at 3 months in 60 patients. Median MRP 8/14 levels in AxSpA patients was 3.00 (3.96) μg/ml compared to 2.3 (3.29) μg/ml in controls (P = 0.2). Median baseline MRP 8/14 levels in ASAS 20 responders at 6 months (n = 36) was 3.6 (4.1) μg/ml compared to 2.4 (4.8) μg/ml in nonresponders (n = 35) (P = 0.4). Median ∆ (baseline to 3 months) MRP 8/14 levels in ASAS 20 responders at 6 months (n = 33) was – 1 (−2.7) μg/ml compared to − 0.2 (−3.8) μg/ml for nonresponders (n = 27) (P = 0.5). Among the 83 patients with 138 disease activity assessments at baseline and 3 months post therapy, median MRP 8/14 in active disease (bath ankylosing spondylitis disease activity index [BASDAI] ≥4) (n = 112) was 2.2 (3.8) μg/ml, compared to 2 (2.3) μg/ml (P = 0.5) in inactive disease (BASDAI < 4) (n = 26). Serum MRP 8/14 did not serve as a theragnostic biomarker in our cohort of AxSpA patients treated with combination DMARDs and on‑demand NSAIDs. 

1 illus, 15 ref

042598   WAKHLU A , GOEL A P, KUMAR P (Manipal Hospital, Jaipur - 302 013, Rajasthan, Email: holmes.akhil@gmail.com) : Prevalence of low bone mineral density in ankylosing spondylitis, correlation with disease activity, and serum sclerostin levels. Indian J Rheumatol 2020, 15(4), 275-81.

Ankylosing spondylitis (AS) involves pathological new bone formation in the cortical zone of vertebrae and excessive loss of trabecular bone in the center of the vertebral body causing osteoporosis (OP). OP expressed as reduced bone mineral density (BMD) is a common complication in AS. Tumor necrosis factor‑α (TNF‑α) causes induction of Dickkopf‑1 and sclerostin, which downregulates bone formation by inhibiting wingless proteins and bone morphogenic proteins. Fifty AS patients were compared with an equal number of age‑ and sex‑matched controls. Various biochemical and radiological parameters of disease activity were calculated. BMD was measured at antero‑posterior (AP) lumbar spine, neck of femur, and lateral lumbar spine using the dual‑energy X‑ray absorptiometry. Serum sclerostin, TNF‑α, interleukin‑17A (IL‑17A), and IL‑22 levels were measured using commercial enzyme‑linked immunosorbent assay kits. Mean BMD at various sites was significantly lower in patients. Patients with OP and low BMD at AP and lateral spine were 38 % and 72 %, respectively; at neck of femur, 20 % and 68 % of patients had OP and low BMD, respectively. Neck of femur BMD had significant positive correlation with Bath’s ankylosing spondylitis disease activity index. Serum sclerostin levels were significantly higher in patients and had significant negative correlation with modified Stoke’s ankylosing spondylitis spinal score. Low BMD is a significant complication in AS, and more prevalent in spine as compared to femur. Neck of femur BMD varies significantly with disease activity. Low sclerostin plays a significant role in the formation of syndesmophytes.

2 illus, 6 tables, 35 ref

042597   REDDY K N, RAUT A, PATIL P (Apex Center of Rheumatology, Pune - 411 004, Maharashtra, Email: drpravinpatil@gmail.com) : Axial spondyloarthritis in India: Determining the delay in diagnosis, impact on work productivity, and attitude of patients toward treatment. Indian J Rheumatol 2020, 15(4), 267-74.

Axial spondyloarthritis (axSpA) primarily affects young, working demographics, and impacts on work productivity. Here, we aimed to determine the delay in diagnosis of axSpA, assess the impact on work productivity, and explore patients’ perception of available treatment options. A cross‑sectional study was conducted on 100 axSpA patients who fulfilled the ASAS criteria. Ethical approval was obtained. Data regarding disease duration, delay in diagnosis, and other demographics were collected using an investigator‑designed questionnaire. Disease activity, quality of life, and loss in work productivity were determined using standardized scales. Median disease duration and delay in diagnosis were 5 years (interquartile range [IQR]: 2.0, 10.0) and 2 years (IQR: 0.5, 5.0), respectively. Median Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Function Index, Bath Ankylosing Spondylitis Global, and Ankylosing Spondylitis Quality of Life scores were 4.15, 3.00, 4.00, and 8.00 respectively. Three different specialists were visited by 58 % of the patients before reaching a rheumatologist. An incorrect clinical impression was made in 69 % of the patients before consultation with the rheumatologist. Median presenteeism and impact on work productivity reported were 20 % and 20.34 %, respectively. Eight percent of the patients had to cease employment due to debilitating consequences of axSpA. Daily activities were affected up to 40 %. A misconception that “allopathic medications cause side effects in all axSpA patients” was held by 58 % of the patients and 25 % of the patients believed that doctors deliberately conceal side effects of medications. A patient referral pathway for axSpA should be established to avoid the visits to multiple specialists. AxSpA not only reduces work productivity but also leads to work disability. There is a need to address the patient’s concerns regarding modern medicine so that their health‑seeking behavior is improved.

2 illus, 3 tables, 39 ref

042596   SANTHANAM S, MURUGESAN H , NAMBI T, NATARAJAN R , MOHANASUNDARAM K (Rheumatology Dep, Saveetha Medical Coll and Hospital, Thandalam, Kancheepuram, Tamilnadu, Email: mmkavitha. 98@gmail.com) : Effectiveness and safety of secukinumab in axial spondyloarthritis and psoriatic arthritis: A retrospective analysis of its real world usage from India. Indian J Rheumatol 2020, 15(4), 261-6.

Although secukinumab has become available in India since mid‑2016, there is no published data on its usage in axial spondyloarthritis (axial SpA) and psoriatic arthritis (PsA). In this study, we analyzed the real‑world usage of this drug to assess the effectiveness and safety in axial SpA and PsA. All patients with active axial SpA or PsA who had received secukinumab as a biological disease‑modifying antirheumatic therapy either as a primary or as a secondary biological therapy covering the period between August 2017 and February 2020 from five Indian centers were included in the study. Whereas Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) 50 and Ankylosing Spondylitis Disease Activity Score (ASDAS) C‑reactive protein (CRP) improvement were used to assess the treatment response in axial SpA, DAS 28ESR was used for PsA. The data were retrospectively analyzed. Out of 45 patients included in the study, 27 had axial SpA and 18 had PsA. Disease duration (median [interquartile range]) was 60 (96) months in axial SpA and 54 (108) in PsA. In axial SpA, out of 21 patients who had completed at least 6 months of therapy, 19 demonstrated a BASDAI 50 response and 20 reported good response as per ASDAS CRP (15, low disease activity and 5, inactive disease). In PsA, 14 patients had completed at least 6 months of therapy and 8 of them went in remission and another 4 achieved low disease activity. Adverse events were few (2, upper respiratory tract infection; 1 pneumonia; 3, uveitis; and leukocytoclastic vasculitis in 1) with no tuberculosis reported. In its real‑life usage to treat both active axial SpA and PsA, secukinumab was found to be effective and safe. 

1 illus, 3 tables, 16 ref

040824   PRABHAKARAN K P, BALASUBRAMANIAM G A, MADHESWARAN R, RAJA A (Tamil Nadu Animal Husbandry Dep, Veterinary Coll and Research Institute, Namakkal – 637 002, Tamil Nadu, Email: dr.prabhakaran2010@gmail.com) : Cytopathological and immunohistochemical assessment of mammary tumors in male dogs. Indian J Vet Pathol 2020, 44(1), 7-10.

Three male dogs aff ected with mammary tumors brought for treatment were aged 7 to 10 years. Tumor was noted at right caudal thoracic in one dog and left caudal thoracic region in two dogs. The mean haemato-biochemical parameters revealed no alterations except leucocytosis associated neutrophilia and elevated blood urea nitrogen and creatinine. The serum sex hormones estradiol and progesterone were increased, whereas, testosterone values were unaltered. Grossly, cut surface of the tumor mass from one dog revealed greyish white, blood tinged and caulifl ower like growth. Fine needle aspiration smears revealed neoplastic cells mixed with infl ammatory cells. Histopathologically the tumor mass revealed extensive proliferation of dense fi brous tissue, area of chondroid diff erentiation and transformation of fi broblast into cartilage. Proliferating neoplastic cells showed degeneration, necrosis and infi ltration of infl ammatory cells. Immunohistochemical analysis of tumor tissues revealed triple negative phenotype for estrogen and progesterone receptors and Human Epidermal Growth Factor-2, but positive reaction for cytokeratin. Clinico-pathological investigations and immunohistochemical features were consistent in diagnosis of mammary tumors in male dogs.

10 illus, 1 table, 19 ref

042595   SAHOO R R, HAZARIKA K, BAFNA P, MANOJ M, WAKHLU A (Clinical Immunology and Rheumatology Dep, King George’s Medical Univ, Lucknow - 226 018, Uttar Pradesh, Email: anupamwakhlu@gmail.com) : Convalescent plasma therapy in severe coronavirus disease-2019: A narrative review. Indian J Rheumatol 2020, 15(3), 217-22.

Passive immunotherapy using whole blood or plasma from recovered patients is a potential therapeutic strategy for infections with no known drug therapy or prophylactic vaccines. Much before, the concept of transfusing neutralizing antibodies through convalescent blood or plasma was established; this modality demonstrated its effectiveness in containing the havoc caused by diphtheria and tetanus during the early 20th century. Convalescent blood products were effective in reducing the mortality risk when administered early in the disease course during the deadliest pandemic of Spanish flu in 1918. Even in the antibiotic era, the use of passive immunization strategy continued to expand with promising results against measles, Ebola, Argentine hemorrhagic fever, and Zika viruses. It was also effective in reducing the mortality and viral load in severe acute respiratory syndrome, H5N1, H1N1, and Middle East Respiratory Syndrome. Convalescent plasma administration carries the risk of anaphylactic reactions, transfusion‑related acute lung injury, and transfusion‑associated circulatory overload, but these are extremely rare. The impact of the recent coronavirus disease 2019 is enormous with significant morbidity and mortality. Until, a specific antiviral therapy or an effective vaccine is made available, the consideration for use of convalescent blood products, especially plasma, is warranted. Conceptual and observational wisdom often blossoms among therapeutic penury.

3 tables, 38 ref

042594   ANJANI G, SINGH S , RAWAT A (Paediatrics Dep, Postgraduate Institute of Medical Education and Research, Chandigarh,, Email: rawatamit@yahoo.com) : Autoinflammatory diseases: Emerging phenotypes. Indian J Rheumatol 2020, 15(3), 207-16.

Autoinflammatory diseases (AIDs) are a heterogeneous group of genetically inherited disorders involving genes regulating innate immune response. The genetic basis of several AIDs has been characterized and many new syndromes have been identified in the past few years. This review focuses on some of the common AIDs encountered in clinical practice.

1 illus, 4 tables, 45 ref

042593   MOROWATISHARIFABAD M A, GERAYLLO S, KARIMIANKAKOLAKI Z , DEHGHAN A, SALEHABADI H S, FALLAHZADEH H (Shahid Sadoughi Univ of Medical Sciences, Yazd, Iran, Email: gerayllo65@yahoo.com) : Determinants of self-care behaviors in patients with knee osteoarthritis based on the theory of planned behavior in Iran. Indian J Rheumatol 2020, 15(3), 201-6.

Knee osteoarthritis (OA) is one of the most prevailing causes of knee joint pains depending on age and one of the main reasons for functional deficiency. As patients are in need of effective self-care plans in promoting health, so that, this study was conducted with an aim to study the determinants of self‑care behaviors in the patients with knee OA referring to clinical centers of Yazd city based on theory of planned behavior (TPB). The cross‑sectional study was performed on 235 patients who referred to the health‑care centers of Yazd city. A questionnaire was developed and used to collect the data based on TPB constructs. Data were analyzed using SPSS 18 software and by the statistical tests of correlative coefficient, Chi‑square, and linear regression at 0.05 significance level. This study was conducted on 235 patients. Based on the results of Pearson correlation test, the self‑care behaviors of knee OA had a statistically significant positive correlation with all constructs of the TPB (P < 0.05). Following data analysis, the constructs of the TPB predicted 8 % of the variance of intention and 16.2 % of the variance of OA self‑care behaviors. According to the results, the TPB can be suitable for explaining knee OA self‑care behavior. Furthermore, recurrent training can be effective in promoting behavioral intervention of patients in self‑care.

1 illus, 5 tables, 36 ref

042592   KAYMAZ S, ALKAN H, KARASU U, ÇOBANKARA V (Pamukkale Univ, Denizli, Turkey, Email: dr.serdarkymaz@gmail.com) : Ultrasonographic measurement of the peroneal and tibial nerves in patients with rheumatoid arthritis with symptoms or signs of polyneuropathy: A cross-sectional study. Indian J Rheumatol 2020, 15(3), 192-200.

Drug toxicity, vasculitis, entrapment neuropathy, and amyloidosis are among the various different reasons of peripheral neuropathy in rheumatoid arthritis (RA). We aimed to determine the cross‑sectional areas (CSA) of the peroneal and tibial nerves in patients with RA who had neuropathic symptoms, and to determine a cutoff value for peroneal and tibial nerves CSA by ultrasonography (USG) to diagnose polyneuropathy (PN) in patients with RA. Sixty‑nine patients with RA and thirty healthy controls were included in this cross‑sectional study. According to nerve conduction study (NCS) test, patients with RA were divided into two groups, diagnosed as having PN or not. Demographic data, laboratory findings, CSA of bilateral peroneal and tibial nerves, NCS values, and painDETECT (PD‑Q) scores of all patients were assessed. Disease duration, disease activity score 28, duration of neuropathic symptoms, and Health Assessment Questionnaire of patients with RA were also determined. No statistically significant difference was found among the groups in terms of age, gender, and laboratory findings. However, a statistically significant difference was found among these three groups in comparison with PD‑Q, NCS values, and nerve CSA (P < 0.05). Seropositivity was statistically higher in the group with PN. When peroneal nerve CSA cutoff value was taken as 20 mm2 , sensitivity and specificity values were 96.6 % and 79.6 %, respectively, for the diagnosis of PN (area under the curve [AUC] = 0.962). When tibial nerve CSA cutoff value was taken as 8.5 mm2 , the sensitivity and specificity values were 93.1 % and 71.6 %, respectively, for the diagnosis of PN (AUC = 0.897). USG can be used as a noninvasive diagnostic modality in the assessment of RA‑associated PN.

4 illus, 3 tables, 38 ref

042591   GEORGE R M, INAMADAR A C, JANAGOND A B (Dermatology Dep, Shri B M Patil Medical Coll and Research Centre, Vijayapura - 586 103, Karnataka, Email: aruninamadar@gmail.com) : Neutrophil-to-lymphocyte ratio: A biomarker for predicting systemic involvement in igA vasculitis. Indian J Rheumatol 2020, 15(3), 187-91.

“IgA vasculitis, is an immune complex mediated, self limited cutaneous small vessel vasculitis, characterized by palpable purpurae, arthralgia or arthritis, gastrointestinal and/or renal involvement.” Systemic involvement is considered to be the presence of gastrointestinal (GI) and/or renal involvement in IgA vasculitis patients. Neutrophil‑to‑lymphocyte ratio (NLR) is a relatively cost‑effective and easily obtainable laboratory parameter integrating information on two immune pathways to provide a superior predictive ability over other inflammatory parameters regarding systemic involvement. The aim of the study was to assess the predictive value of NLR with regard to the systemic involvement in IgA vasculitis. This was a hospital‑based cross‑sectional study of patients diagnosed with IgA vasculitis, irrespective of age, between 2017 and 2019. The study consisted of 33 patients with a mean age of 33.52 ± 19.78 years. Joint involvement was observed in 52 % (17), whereas systemic manifestations in the form of renal involvement were present in 7 (21 %), GI in 19 (57.6 %), and renal and/or GI in 22 (66.7 %) patients. NLR was found to be significantly associated with GI manifestations (P < 0.001). Optimal cutoff value of NLR for predicting systemic involvement was 3.25, with a specificity of 100% and sensitivity of 59 %. NLR can be considered as a biomarker for predicting systemic involvement in IgA vasculitis, presenting with only cutaneous with/without joint manifestations. 

2 illus, 3 tables, 15 ref

042590   TALUKDAR D, GOGOI A P, DOLEY D, MARAK R R , KAKATI S , PRADHAN V , NADKARNI A H , BARUAH S (Molecular Biology and Biotechnology Dep, Tezpur Univ, Tezpur - 784 028, Assam, Email: sbaruah@tezu.ernet.in) : The clinical and immunological profiles of systemic lupus erythematosus patients from Assam, North-East India. Indian J Rheumatol 2020, 15(3), 181-6.

The objective of this study is to document the clinical and immunological profiles of systemic lupus erythematosus (SLE) patients from the Upper Assam region and to evaluate the relevance of autoantibody combinations on the clinical presentation of SLE. One hundred and forty-five SLE patients were enrolled in the study. Anti-nuclear antibody (ANA) profiles and titers of autoantibodies were determined using the ANA blot and enzyme-linked immunosorbent assay, respectively. The patients were clustered based on autoantibody titers and clinical features among the clusters were compared. Mucocutaneous (87.59 %), hematological (69.65 %), renal (58.03 %), and musculoskeletal (50.34 %) manifestations were the common clinical complications, whereas anti-double stranded deoxyribonucleic acid (dsDNA) antibody was noted in 62.76 % of the patients. Patient clustering using autoantibody titers revealed that the cluster with a combination of high titers of anti-dsDNA, anti-nucleosome (Nuc), and anti-ribosomal P (Rib-P) antibody had complex disease presentation with higher frequencies of oral/nasal ulcer, serositis, musculoskeletal, hematological, and central nervous system manifestations. The most common clinical features of the SLE patients were mucocutaneous, hematological, renal and musculoskeletal manifestations, and anti-dsDNA antibody was the most frequent autoantibody. A combination of high titers of anti-dsDNA, anti-Nuc, and antiRib-P antibodies showed association with disease complexity but not the combinations of autoantibodies against extractable nuclear antigens.

3 tables, 29 ref

042589   YARLAGADDA L D, JACOB R, RAJASEKHAR D L , IYYAPU K M, KOMPELLA S B S S, MADROL V B, SREEDEVI N N, KHAN S A, MOHAMMED N (Biochemistry Dep, Nizam’s Institute of Medical Sciences, Hyderabad ? 500 082, Telangana, Email: m_noorjahan@yahoo.co.in) : Evaluation of a new biomarker 14-3-3 eta protein in diagnosis of rheumatoid arthritis. Indian J Rheumatol 2020, 15(1), 175-80.

The lack of sensitivity and specificity of the existing diagnostic markers in Rheumatoid arthritis(RA) stimulates the search for new biomarkers to improve diagnostic sensitivity especially in seronegative cases. To estimate the levels of 14‑3‑3 η in RA cases, to assess the positivity of 14‑3‑3 η in seronegative RA and to correlate rheumatoid factor (RF) positivity with 14‑3‑3 η positivity in seropositive RA. This was cross sectional case control study by the Departments of Biochemistry and Rheumatology and clinical immunology. A total of 61 RA cases and 20 healthy controls were included. Erythrocyte sedimentation rate, high sensitivity C reactive protein, RF, anti‑citrullinated peptide antibodies (CCP) and 14‑3‑3 η protein were estimated. RA cases were further classified as seropositive (n = 23) and seronegative (n = 38) based on the positivity of either RF or anti‑CCP result. Prism 7 (GraphPad Software Inc.). The median levels of 14‑3‑3 η (ng/ml) in cases (0.66 [0.2–1.1]) were significantly high compared to controls (0.1 [0.07–0.28]), P < 0.0001. It had a sensitivity of 74 % and specificity of 90 % at >0.3 ng/ml. 14‑3‑3 η showed statistically significant difference between seronegative cases and controls (P = 0.0003). The sensitivity and specificity of RF and anti‑CCP were 33 % and 85 % and 37 % and 90 % respectively. The combination of 14‑3‑3 η, RF and anti‑CCP showed sensitivity and specificity of 85.4 % and 100 % respectively with area under the curve 0.927. Our study demonstrated that serum levels of 14‑3‑3 η were significantly higher in cases compared to controls. Seronegative RA cases showed 14‑3‑3 η positivity in 71 % of cases. 14‑3‑3 η appears to be a useful and highly specific marker in RA.

4 illus, 5 tables, 19 ref

040822   PALAKKAL S, SOBHANAKUMARI K A K, CELINE M I, VINEETHA M (Dermatology Dep, Government Medical Coll, Kottayam - 686 006, Kerala, Email: ammuseangel@gmail.com) : Viewing the resurgence of early syphilis in light of increasing male homosexuality and childhood sexual abuse. Indian J Sex Transm Dis AIDS 2020, 41(2), 188-91.

A rising trend of syphilis has been documented worldwide recently. After decriminalization of homosexuality in India more and more males having sex with males (MSMs) have come out to seek medical advice. We evaluated sexual behavior of patients with syphilis attending our sexually transmitted infections (STIs) clinic focusing on the factors associated with the increasing MSM practices and rising trend of syphilis among MSM. This is a 10-year (2006–2015) descriptive study from among STI patients attending the dermatology outpatient department in a tertiary care center. Recognizing the rising homosexuality, from 2011 onward, we had given a questionnaire to assess their sexual behavior and sexual practices. Analysis of data from 560 cases diagnosed as having STI revealed a rising trend of all STIs including syphilis from 2011 onward. The MSM cases reporting to our STI clinic showed a sustained rise from 2011 onward. The most common STI in MSM was syphilis that too early acquired. More than half of the MSM indulged in bisexual activities and the predominant mode was anoreceptive. Nearly 70 % had unprotected contact and most had early sexual debut (<20 years). Thirty-six percent gave a history of childhood sexual abuse (CSA) by a close male acquaintance. After 2011, we have observed a resurgence of early acquired syphilis which coincided with an increase in promiscuous homosexuality. Many of the MSMs were bisexuals and homosexuality was an acquired behavior. An alarming increase in the incidence of CSA was observed in MSMs.

3 illus, 2 tables, 13 ref

040821   VERMA D, BACHANI D, ACHARYA A S, SETH A, HEMAL A (Community Medicine Dep, Maulana Azad Medical Coll, New Delhi - 110 045, Email: dr.deepshikha.vrma@gmail.com) : Factors affecting adherence to treatment in children living with HIV. Indian J Sex Transm Dis AIDS 2020, 41(2), 181-7.

With the successful introduction of ART, the life expectancy of children living with HIV (CLHIV) is substantially increased. However, strict compliance is a necessary step to begin with as noncompliance is again associated with its own demerits of incomplete suppression and decreasing the overall survival of the patients. The aim of this study was to measure factors associated with adherence to ART among CLHIV. Materials and This is a 1-year follow-up study conducted from November 2012 to December 2013. A total of 171 children between 18 months and 15 years living with HIV and on ART attending the two ART centers of Delhi were enrolled in the study. Adherence and factors affecting adherence were obtained from the study participants using a semi-structured interview schedule. Collected data were transformed into variables and analyzed into SPSS. All observations were in terms of mean, median, standard deviations, percentages, and proportions. Tests of significance such as Chi‑square test and t-test were applied wherever required. In nearly 89 % of the study participants, adherence to ART was ≥ 95 % at the end of the study. The most common reason for nonadherence was forgetfulness (59 %), and 57 % of the parents/ caretakers were facing monetary problems. Long distance, greater duration to reach center, and unavailability of the parents/caretakers were also quoted as problems. Adherence is genesis to successful treatment outcome and is strongly associated with availability of support by their parents/caretakers. Professional help along with guidance and encouragement is required not only at the caretaker level but also to the family as a whole.

1 illus, 5 tables, 37 ref

042588   AHMED S, GUPTA L (Clinical Immunology Dep, Institute of Medical Sciences, Lucknow - 226 014, Uttar Pradesh, Email: drlatikagupta@gmail.com) : Perception about social media use by rheumatology journals: Survey among the attendees of IRACON 2019. Indian J Rheumatol 2020, 15(1), 171-4.

Rheumatology journals are exploring social media presence, though currently less than a third have dedicated social media editors. A survey was conducted among the attendees of the Indian Rheumatology Association annual meet 2019 held at Puducherry, to assess the attitudes and perceptions of a target audience. There were 111 respondents, 90 practicing rheumatology and 21 from allied fields. Around threequarters (76.6 %) have never subscribed to hard copies of any journal and 65 % followed at least one medical journal on at least one social media platform; 87 % preferred visual cues for learning and 95 % felt the need for visual abstracts to promote articles on social media. Two-thirds (64 %) felt that Altmetrics® might reflect the impact of an article better than the number of times it is cited. Thus, the survey strengthened the felt need of rheumatology journals to have a presence on the social media. This presence ought to be supported by a strategy, including the active use of visual abstracts.

1 illus, 18 ref

042587   ARJUN MN, VASDEV V , KISHORE K , HEGDE A , SHANMUGANANDAN K, KUMAR A , KOVILAPU U B , SHIVASHANKAR R (Rheumatolgy and Clinical Immunology Dep, Command Hospital (Central Command), Lucknow-226 002, Uttar Pradesh, Email: arjunmn023@gmail.com) : Comparison of intra articular autologous platelet-rich plasma with steroids in osteoarthritis knee: Experience from a north Indian tertiary care center. Indian J Rheumatol 2020, 15(1), 165-70.

Intra‑articular (IA) platelet‑rich plasma (PRP) is a promising treatment option for knee osteoarthritis (OA). It accelerates the process of healing, ligament repair, cartilage regeneration, and bone formation when given in supraphysiological doses. The aim of this study was to compare the efficacy of IA PRP versus IA methylprednisolone acetate (MPA) in patients with knee OA. Open labeled prospective observational study was conducted on 60 patients with Kellgren‑Lawrence Grade 2 and 3 OA knee, who fulfilled the ACR classification criteria for knee OA. Thirty patients were given IA PRP (6 ml) and 30 received IA methyl prednisolone (80 mg) at baseline line, which was repeated at 12 weeks. The primary endpoint was an improvement in Western Ontario and McMaster Universities Index (WOMAC) and 100 mm Visual Analog Scale (VAS) pain at 24 weeks postinjections. The mean change in VAS pain and total WOMAC score from baseline to 24 weeks was 32.9 ± 12.1, 31.8 ± 14.7 for PRP group, and 12.9 ± 5.9, 7.5 ± 5.5 for MPA group, which was statistically significant (P < 0.0001). Treatment with IA PRP showed sustained improvements in WOMAC and VAS scores compared to IA steroids. PRP is an effective treatment for functional status and pain in moderate knee osteoarthritis.

1 illus, 4 tables, 22 ref

040820   GOEL S, CHOPRA D, CHOUDHARY V, RIYAT A, CHOPRA S (Dermatology Venereology and Leprology Dep, Government Medical Coll, Patiala - 147 001, Punjab, Email: drdimplechopra@gmail.com) : Changing trends of sexually transmitted infections and estimation of partner notification at a tertiary care center in North India. Indian J Sex Transm Dis AIDS 2020, 41(2), 176-80.

Sexually transmitted infections (STIs) are dynamic and show a variable prevalence in different parts of the country. Moreover, the prevalence changes with time in the same geographical area. It is important to have the knowledge of current trend of STIs and partner notification (PN) rate in a particular area for the effective implementation of preventive and control measures. This study aimed to assess the changing demographic and clinical trends of STIs in the patients attending a tertiary care center in North India. This study was conducted at STI clinic located at a tertiary care center in North India. All the patients visiting STI clinic over a 5-year period from January 1, 2013, to December 31, 2017, were included in our study. Diseases were diagnosed on the basis of detailed history, clinical examination, and relevant investigations, and PN was done using the patient‑oriented notification method. The most common STI affected age group was 25–44 years (45.11 %), and the most common STI noted was candidal balanoposthitis in males (19.49 %) and candidal vaginal discharge in females (20.54 %), followed by herpes genitalis (15.04 %) and condylomata acuminata (14.66 %) in both the genders. Bacterial STIs such as syphilis (1.58 %), lymphogranuloma venereum (0.45 %), and chancroid (0.39 %) were less common. The average PN rate was 42.48 %. In the present study, fungal and viral STIs showed an upward trend, whereas bacterial STIs such as syphilis and chancroid demonstrated a declining trend. The measures to improve PN are urgently required for both cure and the prevention of STIs.

1 illus, 5 tables, 22 ref

042586   AHMED S, DHOORIA A (Clinical Immunology and Rheumatology Dep, KIIT Univ, Bhubaneswar - 751 024, Odisha, Email: sakir005@gmail.com) : Pitfalls in statistical analysis – A reviewers’ perspective. Indian J Rheumatol 2020, 15(1), 39-45.

Statistics are a quintessential part of scientific manuscripts. Few journals are free of statistics‑related errors. Errors can occur in data reporting and presentation, choosing the appropriate or the most powerful statistical test, misinterpretation or overinterpretations of statistics, and ignoring tests of normality. Statistical software used, one‑tailed versus two‑tailed tests, and exclusion or inclusion of outliers can all influence outcomes and should be explicitly mentioned. This review presents the corresponding nonparametric tests for common parametric tests, popular misinterpretations of the P value, and usual nuances in data reporting. The importance of distinguishing clinical significance from statistical significance using confidence intervals, number needed to treat, and minimal clinically important difference is highlighted. The problem of multiple comparisons may lead to false interpretations, especially in p‑hacking when nonsignificant comparisons are concealed. The review also touches upon a few advanced topics such as heteroscedasticity and multicollinearity in multivariate analyses. Journals have various strategies to minimize inaccuracies, but it is invaluable for authors and reviewers to have good concepts of statistics. Furthermore, it is imperative for the reader to understand these concepts to properly interpret studies and judge the validity of the conclusions independently.

1 illus, 3 tables, 35 ref

042585   ZAGHLOL R S , KHALIL S S, ALMOLLA R M , EL MAGHRABY A M , MAKARM W K (Physical Medicine and Rehabilitation Dep, Dubai Hospital, P. O. 7272, Al-Baraha Area, Dubai, UAE, Email: drsaharkhalil@yahoo.com) : Acro Osteolysis and its relationship with bone mineral density and peripheral vascularity in premenopausal females with systemic sclerosis. Indian J Rheumatol 2020, 15(1), 32-8.

To investigate the relationship between acro-osteolysis (AO), bone mineral density (BMD) and peripheral vascularity in premenopausal female patients with diffuse systemic sclerosis (dcSSc). An observational cohort study that included thirty premenopausal female patients with dcSSc. The recruited patients were categorized into two groups according to the presence of radiological signs of AO. Patients were assessed clinically, laboratory and radiologically by X-ray imaging of both hands and wrists, dual-energy X-ray absorptiometry for measuring BMD and Doppler ultrasonography for evaluation of upper limbs peripheral vascularity. Overall, 80% patients had AO; comparing patients with and without AO, the former had significant increase in the frequencies of Raynaud's phenomenon, calcinosis and digital pits (88.5, 94.7, 91.7) versus (11.5, 5.3, 8.3) in the latter, respectively. Additionally, they had significantly lower distal radius BMD and higher macrovascular abnormalities at both radial and ulnar arteries (P < 0.05). On regression analysis, the most important factors associated with AO were calcinosis (OR= 1.7; 95 % CI: 1.01- 3.02; P = 0.02), Raynaud’s phenomenon (OR= 3.5; 95 % CI: 0.6-19.4; P = 0.003), digital pits (OR= 2.8; 95 % CI: 0.9-8.8; P = 0.001), low BMD at the distal radius (OR= 1.9; 95 % CI: 1.1-3.0; P = 0.002), and macrovascular changes at radial and ulnar arteries (OR = 2.2; 95 % CI: 0.7-6.5; P = 0.04 and OR =1.6; 95 % CI: 0.9-3.0; P = 0.05) respectively. Calcinosis, Raynaud’s phenomenon, digital pits, vascular alterations at radial and ulnar arteries, and low BMD at the distal radius are the most important factors associated with AO in dcSSc patients.

1 illus, 5 tables, 39 ref

040818   RATHOD S P, PADHIAR B, SHAH B (Dermatology Dep, Smt. NHL Municipal Medical Coll, Ahmedabad - 382 470, Gujarat, Email: santosh_rathod85@yahoo.com) : Sexually transmitted infections and human immunodeficiency virus coinfection: Scenario in Western India. Indian J Sex Transm Dis AIDS 2020, 41(2), 162-8.

Sexually transmitted infections (STIs) have a well-established synergistic relationship with human immunodeficiency virus (HIV) infection. Coinfection with HIV and STI can increase the probability of HIV transmission to an uninfected partner by increasing HIV concentrations in genital lesions, genital secretions, or both. Concurrent HIV infection alters the natural history of the classic STIs. The aim was to study the current scenario of STIs with HIV co-infection, and to recognize different manifestations of STIs than the classical presentation in people living with HIV/ AIDS (PLHIV). It was an open, cross-sectional, descriptive study carried out in the setting of state government hospital with attached antiretroviral therapy referral center. The sample size of the study was duration based (30 months). All PLHIV presenting to the department of dermatology with STIs were included in the study. Non-STI causes of genital ulceration were excluded in the study. The study includes total (n = 484) patients living with HIV/AIDS, prevalence of different STIs was in the following order, herpes simplex virus infections 24.17 %, human papillomavirus infections 8.88 %, molluscum contagiosum 7.43 %, secondary syphilis 4.33 %, gonorrhea 1.85 %, chancroid 1.44 %, and granuloma inguinale 0.41 %. Of all the patients with herpes simplex virus infections, 45.6 % (n = 57) had multiple recurrences (>6/year). The incidence of mixed STI was 17.29 % in the present study. The study represents decreasing trends in bacterial STIs and the rise of viral STIs. Atypical presentations of classic STIs were more frequent than non-HIV-infected individuals.

9 illus, 4 tables, 29 ref

042584   DHAON P, KHAN H , SINGH R R, SHUKLA M (Medicine Dep, Institute of Medical Sciences, Barabanki, Uttar Pradesh, Email: poojadhaon@gmail.com) : Depression in patients of primary knee osteoarthritis: A cross sectional study. Indian J Rheumatol 2020, 15(1), 27-31.

The aim and objective are to find the prevalence of depression and its relationship with functional status in patients with primary knee osteoarthritis (OA). The present study included 100 patients (33 males and 67 females) of primary knee OA fulfilling the American College of Rheumatology criteria. Demographic and diseases variables were recorded for all patients. Functional status was assessed using the Western Ontario and McMaster Universities Index (WOMAC), and depression was assessed using the Hamilton Depression Rating Scale (HAM‑D). Significant depression (HAM‑D >13) was present in 19 % of patients. Depression was associated with female sex and associated comorbid conditions. There was a significant positive correlation between WOMAC score and HAM‑D score in all patients. Female patients with knee OA have associated depression, which is associated with poor functional status. 

1 illus, 3 tables, 29 ref

040817   SUJA S, SARAVANAN T, KARTHIKEYAN S (General Medicine Dep, PSG Institute of Medical Sciences and Research, Coimbatore - 641 004, Tamil Nadu, Email: sujasadhasivam@gmail.com) : Profile of hematological abnormalities and its correlation with absolute CD4 count and human immunodeficiency virus viral load in human immunodeficiency virus‑infected patients in a tertiary care hospital. Indian J Sex Transm Dis AIDS 2020, 41(2), 156-61.

A variety of hematological manifestations are seen at every stage of human immunodeficiency virus (HIV) infection, and they often pose a great challenge in the comprehensive management of acquired immunodeficiency syndrome. Anemia is the most common hematological abnormality associated with HIV infection. The severity and the incidence of cytopenia are usually correlated with the stage of the disease and underlying immune status if interpreted cautiously, especially if the patient is on regular follow-up. The primary objective of the present study was to understand the spectrum of hematological abnormalities in HIV-infected patients, whereas the secondary objective was to evaluate the correlation of hematological abnormalities with absolute CD4 count and HIV viral load. The present cross-sectional descriptive study was conducted on 100 patients, aged 18 years and above, diagnosed with HIV infection and confirmed by Western blot or ELISA method. Both inpatients and outpatients at our tertiary care hospital were included in the study. Individuals with high viral load and low CD4 count had a higher prevalence of anemia. There was a statistically significant and directly proportionate decrease in the absolute CD4 count as the hemoglobin levels decreased (P = 0.004). In the present study, normocytic normochromic blood picture and anemia of chronic disease blood picture were more prevalent among the study participants. Individuals with high viral load and CD4 count <200 cells/mm³ had a higher rate of occurrence of coinfections. The correlation of absolute neutrophil count and thrombocytopenia with absolute CD4 count and HIV viral load was not statistically significant. Complete blood counts and peripheral smear observations were significantly correlated with high HIV viral load and lower absolute CD4 cell counts and therefore can be suggested as economical alternatives for the evaluation of the status of HIV disease stage and its progression.

3 tables, 19 ref

040816   MOHAPATRA D, BHATIA V, SINGH A K (Community and Family Medicine Dep, AIIMS, Bhubaneswar, Odisha, Email: arvind28aug@gmail.com) : Assessment of clinical and behavioral profile of clients attending integrated counseling and testing centers of a tertiary care institute in Eastern India: A secondary data analysis. Indian J Sex Transm Dis AIDS 2020, 41(2), 149-55.

Integrated counseling and testing center (ICTC) forms the major forum under the National AIDS Control Organization (NACO) for counseling and testing of HIV-suspected patients. ICTC setup in a tertiary care institute also provides a chance for opportunistic screening of large number of individuals. The study was done to assess and to profile the ICTC clients with respect to their seropositivity rate, their biological and behavioral risk factors, and seroconcordance rate. We did a secondary analysis of routine health data collected in the ICTC in the formats prescribed by the NACO. The data were entered into MS Excel and analyzed using SPSS version 22. Majority of the clients of ICTC were in the age group of 35–49 years. Seropositivity among client-initiated group (11.9 %) was much higher compared to provider-initiated group (0.3 %). None of the pregnant women were found to be positive. Heterosexual route was most common form of transmission in both provider-initiated and client-initiated groups. Seroconcordance rate was 43.4 % in our study. The ICTC of a tertiary care center attracted a huge number of patients. The seropositivity in our study was greater than those generated by sentinel surveillance system. A well-functioning ICTC can help in detecting a large number of cases and also provide a forum for counseling and education about risk factors of HIV.

2 illus, 3 tables, 20 ref

042583   SINGHA AL, SUBRAMANIAN S, SINGH S, YADAV A K , HALLAPANAVAR A, ANJALI B (Internal Medicine Dep, Armed Forces Medical Coll, Pune - 411 040, Maharashtra, Email: 384sonal@gmail.com) : Introduction of mini clinical evaluation exercise as a mode of assessment for postgraduate students in medicine for examination of sacroiliac joints. Indian J Rheumatol 2020, 15(1), 23-6.

Formative and subjective assessment of medical education is the need of the hour today. Mini‑Clinical Evaluation Exercise (mini‑CEX) and Directly Observed Procedural Skills (DOPS) are the commonly used workplace‑based assessment (WPBA) tools which have been extensively studied in both undergraduate and postgraduate (PG) settings. In this study, we tried to assess the feasibility of mini‑CEX and also its acceptability among PG students of internal medicine and teaching faculty for the examination of sacroiliac joints. This is an interventional study which was carried out in a government medical college in Pune, Maharashtra, India, from January to June 2019. A total of 18 1^st‑ and 2^nd‑year PG students and 9 teaching faculty from the department of internal medicine participated in this study. Each student underwent five mini‑CEX evaluations over a period of 6 months under different teaching faculty. Feedback was taken from both the teaching faculty and students regarding the feasibility of mini‑CEX as an assessment tool. A total of ninety mini‑CEX exposures involving 18 PG students and nine faculty were analyzed. We found a statistically significant improvement in the domain of medical interviewing (P < 0.001), physical examination (P = 0.003), professionalism (P = 0.001), clinical judgment (P = 0.003), counseling skills (P < 0.001), and organizing efficiency (P < 0.001). Overall clinical competence improved from a scale of 5 (1.7) to 6.7 (0.8). The results of this study show that overall mini‑CEX is an acceptable and effective assessment tool. However, regular training of assessors through workshops on the provision of effective feedback is required. Modification of the assessment form based on the feedbacks provided by teachers and students will further facilitate the implementation of this teaching tool in the curriculum.

2 illus, 1 table, 14 ref

042582   KARAMI M, MOHAMMADZADEH Z, EBRAHIMIAN S, MORADI M, SAYEDBONAKDAR Z (Radiology Dep, Isfahan Univ of Medical Sciences, Isfahan, Iran, Email: shadiebr2005@yahoo.com) : Ultrasonography of articular and periarticular structures as a relapse predictor in patients with clinically remitted rheumatoid arthritis. Indian J Rheumatol 2020, 15(1), 17-22.

Rheumatoid arthritis (RA) is an autoimmune disease causing mortality and morbidity among patients. The goal of RA treatment is remission and prevention of joint degeneration. Remission is diagnosed by physical examinations and laboratory markers. Due to the high rate of relapse, it appears that physical examination is not a sensitive method in detecting active and remitted RA patients. The aim of this study is to find whether ultrasonography (US) is an appropriate method in detecting active RA patients and estimating the relapse rate. Seventy clinically remitted RA patients were enrolled based on the Disease Activity Score in 28 joints. They underwent US to examine the presence of synovitis, tendinitis, tenosynovitis, and bursitis and were followed for 6 months regarding the relapse rate. Moreover, the predictive value of US was measured. SPSS was used for analyzing data. According to the US findings, 27.1 % of the clinically remitted patients had signs of active synovitis, whereas 15.7 % of them showed signs of tenosynovitis, tendinitis, or bursitis. In addition, relapse was observed in 12.9 % of the patients with clinical remission and was significantly higher in patients with signs of active synovitis (P < 0.05). The results also revealed that the prognostic values of US for estimating the relapse rate were 77.7 % and 70.0% in terms of sensitivity and specificity, respectively. US is capable of detecting active synovitis among patients with clinically remitted RA and also predicts those with a higher risk of relapse within 6 months. It is also useful in identifying people with active RA, whose clinical symptoms indicate remission of the disease. Involvement of periarticular structures including tenosynovitis, tendinitis, or bursitis cannot independently predict relapse in patients with RA.

2 tables, 29 ref

042581   GÜNGÖRER V, YORULMAZ A, VATANSEV H , ARSLAN S (Pediatric Rheumatology Dep, Selçuk Univ Medical School, Konya, Turkey, Email: vildan_61183@hotmail.com) : The effect of neutrophil lymphocyte ratio and thrombocyte index on inflammation in patients with periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome. Indian J Rheumatol 2020, 15(1), 11-6.

The periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome is the most common periodic fever syndrome in childhood. Its pathogenesis and etiology remain unknown. This study aimed to determine whether or not the neutrophil‑to‑absolute lymphocyte ratio (NLR) and thrombocyte indices could be used as subclinical inflammation markers in healthy control group children and children with PFAPA syndrome during the attacks and attack‑free periods. Twenty‑eight children with PFAPA syndrome that presented to our clinic were enrolled in this study. As a control group, healthy children that presented to the general pediatrics polyclinic with the exact same age and sex as the patient group were recruited. The medical records of all participants were evaluated retrospectively. The leukocyte and neutrophil counts, NLRs, platelet count‑to‑absolute lymphocyte ratios (PLRs), and C‑reactive protein levels of the patients with PFAPA syndrome during the attack period were found to be significantly higher than during the attack‑free period. Similarly, during the attack period, the leukocyte and neutrophil counts, NLRs, and PLRs were significantly higher compared to the healthy control group. Patients with PFAPA syndrome during the attack‑free periods were compared with the control group, and their mean platelet volume (MPV) values were significantly lower than the control group. MPV in PFAPA syndrome patients was significantly lower during the inflammation. We observed a significant decrease in MPV values during the attack‑free period compared to the control group, suggesting that subclinical inflammation continues in the attack‑free period in PFAPA syndrome. 

4 tables, 40 ref

042580   SINGH H, PRASAD N, MISRA D P, JAISWAL A K , AGARWAL V (Clinical Immunology Dep, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow - 226 014, Uttar Pradesh, Email: vikasagr@yahoo.com) : P glycoprotein and/or histone Deacetylase 2 regulates steroid responsiveness in childhood nephrotic syndrome. Indian J Rheumatol 2020, 15(1), 5-10.

P‑glycoprotein (P‑gp) overexpression in peripheral blood mononuclear cells (PBMCs) has been reported in patients with steroid‑resistant nephrotic syndrome (SRNS). Glucocorticoids suppress NFκB‑associated coactivator activity by deacetylation of histone by enzyme histone deacetylase  (HDAC)‑2. Interaction between HDAC2 activity and P‑gp expression in childhood NS patients is not clear. This study aims to evaluate the role of HDAC2 and P‑gp expression on PBMCs and steroid responsiveness in patients with childhood NS. Thirty‑one patients were recruited at baseline  (n  =  31)  (before initiating steroid therapy); after 6  weeks of steroid therapy, 24  patients achieved remission  (steroid‑sensitive NS  [SSNS] n = 24 mean age, 7.96 ± 3.90), whereas seven patients were resistant to steroids  (SRNS, n =  7, mean age 10.00 ±  3.55). mRNA expression of HDAC2 and P‑gp and functional analysis of P‑gp and enzymatic activity of HDAC2 were analyzed at baseline, and at 6 weeks of steroid treatment and at the time of relapse. The expression of P‑gp mRNA was significantly lower in individuals  (n  =  24) who achieved remission at 6‑week steroid therapy as compared to baseline and those who were resistant  (n  =  7) to steroids  (P  <  0.005). Similarly, the expression of HDAC2 mRNA was significantly higher at baseline and at remission following 6‑week steroid therapy as compared to their expression in those who were resistant to steroids  (P  <  0.005). The function of P‑gp was significantly lower in NS patients who achieved remission after 6‑week steroid therapy compared to baseline (P < 0.005), whereas it was not significant in resistant patients (P = 0.37). The enzymatic activity of HDAC2 was significantly higher in SSNS patients as compared SRNS patients at 6‑week steroid therapy (P < 0.005). The expression and function of P‑gp and HDAC2 may affect steroid response in NS patients. Combined therapy of steroids with P‑gp inhibitor and/or HDAC2 inducers may have a rationale in management of SRNS patients.

4 illus, 40 ref

042579   PATEL S, BISWAS B, RAMBABU K, SUNDARAM E N , ARYA R (Drug Standardisation Unit (H), Hyderabad - 500 007, Telangana, Email: satishpatel05nov@gmail.com) : Pharmacognostical studies of Smilax aspera Linn. – A herbal drug. Indian J Res Homoeopathy 2020, 14(4), 260-6.

Smilax aspera L. (sarsaparilla or prickly ivy) is a perennial climber from the family Smilacaceae. Its root and rhizome are used as alterative, demulcent, depurative, diaphoretic, diuretic, stimulant and tonic. To perform standardization of root and rhizome of S. aspera for authentication and identification of raw drug by pharmacognostical, physiochemical, powder and finish product evaluation. Air‑dried rhizome and roots were boiled, sectioned and stained for macroscopical and microscopical analysis. For physicochemical studies, rhizome and roots were coarsely powdered and subjected for determination of extractive values, ash values, chemical constituents, weight per millilitre, alcohol content, total solids and loss on drying. Finished product analyses(chromatographic studies, sediments, pH and total solid) were also undertaken. The root was longitudinally wrinkled, about 3 mm in diameter with numerous branching, rootless, tough and flexible. Cortex consisted of 18–20 rows of parenchymatous cells; xylem and phloem were arranged in a radiate manner. Rhizome was wrinkled, hard and brown externally and white or light‑yellow internally. The outer cortex consisted of polygonal parenchymatous cells. The findings of physicochemical determination of raw drugs including maximum extractive values in alcohol were 5.67 % w/w, 0.1 % w/w foreign matter, 8.90 % w/w moisture content, 10.60 % w/w total ash, etc., and finished product parameter showed pH near to 7, total solid 1.07 % w/v and 50 % v/v alcohol content. The data represented in this article may be used as distinctive diagnostic characters for proper identification, authentication of raw drug to ensure purity, quality and efficacy of drug S. aspera. 

3 illus, 3 tables, 27 ref

042578   TAMILARASAN B, KARTHIKEYAN P , KANNAN P , PERIANDAVAN K, MANCHANDA R K, KHURANA A, NAYAK D , PALAINIVELU S (Medical Biochemistry Dep, Madras Univ, Chennai, Tamil Nadu, Email: pkalaiselvi2011@gmail.com) : Understanding the role of homoeopathic preparation of Berberis vulgaris in mitigation of sodium oxalate‑ induced hyperoxaluria: An experimental approach. Indian J Res Homoeopathy 2020, 14(4), 251-9.

Hyperoxaluria and calcium oxalate crystal deposition in the kidneys lead to overproduction of reactive oxygen species, resulting in the development of oxidative stress and renal injury. At the cellular levels, mitochondria and NADPH oxidase involved in reactive oxygen species production play a crucial role in the pathogenesis of hyperoxaluria‑induced renal injury. The objective was to investigate the therapeutical effect of homoeopathic drug Berberis vulgaris, a potent antioxidant, upon regulation of NADPH oxidase against acute high‑grade sodium oxalate‑induced hyperoxaluria in rats. Hyperoxaluria was induced in male Wistar rats by administering a single dose of sodium oxalate (70 mg/kg body weight) intraperitoneally, and the treatment groups were pre‑treated with homoeopathic drug Berberis vulgaris 6c (20 μl/100 g of body weight) ultra low dose for 7 days. Berberis vulgaris significantly reduces hyperoxaluria‑induced oxidative stress and restores antioxidant enzyme activities in kidney tissue. Histological analysis depicted that Berberis vulgaris treatment decreases renal epithelial damage and inflammation and restored normal glomerular morphology. Furthermore, immunoblotting analyses of NADPH oxidase revealed significant increased activity in the renal tissue of hyperoxaluric rats when compared to that of control rats. This has been brought back to normal by Berberis vulgaris treatment. Thus, our results emphasised that the Homoeopathy drug Berberis vulgaris has been effective in ameliorating sodium oxalate‑induced acute hyperoxaluria in Wistar rats by modulating mitochondrial oxidative stress through the inhibition of NADPH oxidase.

4 illus, 2 tables, 27 ref

042577   GUPTA J, BAWASKAR R, RAO P , SHIVADIKAR A , SUMITHRAN P , PAL R, ALI S , BINDU H, ARYA M D , LAMBA C D (Central Council for Research in Homoeopathy, New Delhi, Email: jgupta21@gmail.com) : Homoeopathic therapy in cervical spondylosis pain management: A randomised, double-blind, placebo-controlled trial. Indian J Res Homoeopathy 2020, 14(4), 242-50.

Homoeopathic medicines are known to be effective in alleviating pain and other troublesome symptoms of patients suffering from cervical spondylosis. The primary objective was to evaluate the effectiveness of predefined homoeopathic medicines in the pain management of cervical spondylosis using the Cervical Spondylosis Pain Management Scale (CSPMS). A prospective, doubleblind randomised placebo-controlled multicentric clinical trial was conducted from April 2012 to May 2013. Sixty-seven cases were enrolled in the Homoeopathy group and 69 in the placebo group. One hundred and thirty-four cases that completed the follow-ups were analysed. The improvement in pain was 56.18 % in the Homoeopathy group and 46.45 % in the placebo group, as per CSPMS. The mean improvement between the groups was not significant: 60.36 % in the Homoeopathy group and 48.66 % in the placebo group. The mean score of quality of life, assessed using the ‘Patient’s Global Impression of Change Scale,’ was 2.29 ± 1.90 quality of life in the Homoeopathy group and 2.93 ± 2.28 in the placebo group. There was 27.95 % more improvement in the Homoeopathy group, as compared to the placebo group. Among the most used medicines were Rhus toxicodendron (n = 19) 28.8 %, Calcarea carbonica (n = 7) 10.6 %, Kalmia latifolia (n = 7) 10.6 % and Paris quadrifolia (n = 8) 12.1 %. Homoeopathic medicines are effective in management of acute pain due to cervical spondylosis. 

6 illus, 3 tables, 17 ref

042576   PONNAM H B, LAMBA C D, OBERAI P , MASOOD S V , YANDAMURI S , RAO M N , MANCHANDA R K (Central Council for Research in Homoeopathy, New Delhi, Email: drchetnalamba@gmail.com) : Calendula mother tincture vs normal saline for ulcer dressing as an add-on to individualized homoeopathic intervention in the management of diabetic foot ulcer: A randomized controlled pilot study. Indian J Res Homoeopathy 2020, 14(4), 233-41.

Despite standard management, healing rate of Diabetic Foot Ulcers (DFUs) remains low, posing risk of lower extremity amputation. This study was undertaken to evaluate if Calendula Q has added benefit over individualized homoeopathic intervention (IHI). The primary objective was to achieve complete epithelialisation within 20 weeks and secondary objective was to assess the changes in quality of life using DFU Scale-short form (DFU-SF) questionnaire. A randomised controlled pilot study with a 20-week intervention was conducted from 2014-2017. 277 cases were screened and 60 cases were enrolled and randomised to Group I: IHI + Calendula Q dressing (n= 30) and Group II: IHI + normal saline (NS) dressing (n = 30), along with standard conventional medication for glycaemic control. The mean time (Group I= 12 weeks, Group II= 11 weeks) of ulcer healing in both groups showed no statistically significant difference, thus calendula Q used for dressing did not have any added benefits (p= 0.0521). Arsenicum album (n= 14, 23.3 %), Lycopodium (n= 8, 13.3 %), Silicea (n= 7, 11.7 %), Sulphur (n= 6, 10 %), Phosphorus (n= 5, 10%) and Sepia (n=5, 10 %) were found to be effective medicines. IHI, along with wound hygiene and conventional diabetic management, proved to be effective, irrespective of whether Calendula Q or normal saline was used for wound hygiene, thus leading to early, complete epithelialisation of Wagner’s first and second stages of DFUs. Further studies comparing IHI with standard care are warranted. 

5 illus, 5 tables, 24 ref