Pneumococcal vaccine uptake in patients with inflammatory arthritis: a single centre cohort study.

INTRODUCTION: Current guidelines recommend pneumococcal vaccination in individuals who are over the age of 65 or are immunosuppressed due to a disease or treatment. The objective of this study was to assess vaccine uptake rates in people with inflammatory arthritis for the pneumococcal, influenza and Covid-19 vaccines and factors determining uptake. METHODS: We conducted a retrospective single centre cohort study in the UK of individuals with rheumatoid arthritis, psoriatic arthritis and axial spondylarthritis between October and December 2023. Data were collected for age, gender, co-morbidities, immunosuppressive therapies, and dates of vaccines. Logistic regression was used to evaluate predictors of vaccine uptake, with adjustments for demographic and clinical factors. RESULTS: 906 individuals were identified. 46% were receiving treatment with csDMARD, 26% on biologic monotherapy, and 23% were on both biologic and csDMARDs. 316 individuals (35%) received a pneumococcal vaccine, lower than uptake for influenza (63%) and Covid-19 (87%) vaccines. Predictors of pneumococcal vaccine uptake included age, with older patients more likely to be vaccinated (odds ratio [OR] for age ≥ 65 years: 1.67, 95% CI 1.21-2.29). Those on biological therapy demonstrated higher likelihood of vaccination (OR for biologic therapy: 1.81, 95% CI 1.33-2.47). Additional Joint committee for immunisation and vaccination (JCVI) Green Book indicators also positively influenced vaccine uptake (OR: 1.67, 95% CI 1.19-2.33). CONCLUSION: Pneumococcal vaccine uptake in inflammatory rheumatic diseases is low, especially in younger patients and those not on biological therapy. The study highlights the need for a focused approach, distinct from strategies for other vaccines, to address this public health challenge.

Photoswitchable nonlinear optical properties of azobenzene-based supramolecular complexes: insights from density functional theory.

Density functional theory (DFT) calculations were performed for a series of supramolecular assemblies containing azobenzene (Azo-X where X = I, Br and H) and alkoxystilbazole subunits to evaluate their electronic, linear and nonlinear optical properties. These assemblies are derivatives of azobenzene, obtained by the substitution of electron-withdrawing and electron-donating groups onto the molecular skeleton. The interaction energies (Eint) of all the designed supramolecular complexes (IA-IF, IIA-IIF and IIIA-IIIF) range from -1.0 kcal mol-1 to -7.7 kcal mol-1. The electronic properties of these hydrogen/halogen bond driven supramolecular assemblies such as vertical ionization energies (VIE), HOMO-LUMO energy gap (GH-L), excitation energies, density of states (DOS) and natural population (NPA) analyses were also computed. The non-covalent interaction index (NCI) and quantum theory of atoms in molecules (QTAIM) analyses were also performed to validate the nature of inter- and intra-molecular interactions in these complexes. A substantial enhancement in the first hyperpolarizability (ß0) values of the designed supramolecular complexes was observed, which is driven by the charge transfer from the pyridyl moiety of alkoxystilbazole to Azo-X. The highest ß0 value of 1.3 × 104 au was observed for the supramolecular complex of p-nitro substituted azobenzene with alkoxystilbazole (ID complex). Moreover, the results show that the substitution of electron-withdrawing groups on Azo-X can also bring larger ß0 values for such complexes. It was confirmed on a purely theoretical basis that both the types of noncovalent interactions present and the substituent group incorporated influence the nonlinear optical (NLO) response of the systems. Furthermore, the ß0 values of the E (trans) and Z (cis) forms were compared to demonstrate the two-way photoinduced switching mechanism.

Enhancing CO2 separation from N2 mixtures using hydrophobic porous supports immobilized with tributyl-tetradecyl-phosphonium chloride [P44414][Cl].

The main obstacles in adopting solvent-based CO2 capture technology from power plant flue gases at the industrial scale are the energy requirements for solvent regeneration and their toxicity. These challenges can be overcome using new green and more stable ionic liquids (ILs) as solvents for post-combustion CO2 capture. In the current study, tributyl-tetradecyl-phosphonium chloride [P44414][Cl] as an IL, was immobilized on hydrophobic porous supports of polypropylene (PP), polyvinylidene fluoride (PVDF), and polytetrafluoroethylene (PTFE) at 298 ± 3 K and pressures up to 2 bar. The surface morphology indicated homogenous immobilization of the IL on the membrane support. Supported ionic liquid membranes (SILMs) were tested for CO2 permeability and CO2/N2 selectivity. None of the SILMs exhibited IL leaching up to 2 bar. The PTFE-based SILM performed better than other supports with minimum loss in water contact angle (WCA) and achieved good antiwetting with a maximum CO2 permeability and selectivity over N2 of 2300 ± 139 Barrer and 31.60 ± 2.4, respectively. This work achieves CO2 permeability about two-fold more than other works having CO2/N2 selectivity range of 25-35 in similar SILMs. The diffusivity of CO2 and N2 in [P44414][Cl] was measured as 3.64 ± 0.18 and 2.01 ± 0.09 [10-8 cm2 s-1] and CO2 and N2 solubility values were 9.79 ± 0.47 and 0.19 ± 0.001 [10-2 cm3(STP) cm-3 cmHg-1], respectively. The high values of Young's modulus and tensile strength of the PTFE support-based SILM (234 ± 12 MPa and 6.07 ± 0.31 MPa, respectively) indicated the long-term application of SILM in flue gas separation. The results indicated phosphonium chloride-based ILs could be better solvent candidates for CO2 removal from large volumes of flue gases than amine-based ILs.

A Review on SAPO-34 Zeolite Materials for CO2 Capture and Conversion.

Among several known zeolites, silicoaluminophosphate (SAPO)-34 zeolite exhibits a distinct chemical structure, unique pore size distribution, and chemical, thermal, and ion exchange capabilities, which have recently attracted considerable research attention. Global carbon dioxide (CO2 ) emissions are a serious environmental issue. Current atmospheric CO2 level exceeds 414 parts per million (ppm), which greatly influences humans, fauna, flora, and the ecosystem as a whole. Zeolites play a vital role in CO2 removal, recycling, and utilization. This review summarizes the properties of the SAPO-34 zeolite and its role in CO2 capture and separation from air and natural gas. In addition, due to their high thermal stability and catalytic nature, CO2 conversions into valuable products over single metal, bi-metallic, and tri-metallic catalysts and their oxides supported on SAPO-34 were also summarized. Considering these accomplishments, substantial problems related to SAPO-34 are discussed, and future recommendations are offered in detail to predict how SAPO-34 could be employed for greenhouse gas mitigation.

Blood and Blood Product Conservation: Results of Strategies to Improve Clinical Outcomes in Open Heart Surgery Patients at a Tertiary Hospital Are Maintained 4 Years after Initiation.

Blood product usage is an important outcome for patients undergoing cardiac surgery. In 2015, our center made a concerted effort with multiple departments to focus on reducing transfusion rates in surgical patients requiring cardiopulmonary bypass (CPB). Specific changes included an upgrade of the oxygenator in mid-2015 and, in early 2016, implementation of a hemostasis management system (HMS) that used heparin dose-response titration assays for heparin and protamine management. A retrospective chart review demonstrated significant decreases in the quarterly average of patients receiving packed red blood cells (PRBCs) from a baseline of 26.7% to 22.7% following the oxygenator upgrade (p = .021) and from 22.7% to 8.8% following implementation of the HMS (p = .0017). Platelet usage decreased from an average of 50.5% during the baseline and oxygenator upgrade periods to 22.2% following implementation of the HMS (p < .0001). Usage of fresh frozen plasma (FFP) decreased from an average of 28.2% of cases during the baseline and oxygenator upgrade periods to 10.4% during 2016, and cryoprecipitate usage decreased from 38.5% to 15.4%. Heparin usage averaged 56,903 units before implementation of the HMS, decreasing to an average of 43,796 units following HMS implementation (p < .0001). During the same time periods, protamine usage averaged 340.3 mg and 183.2 mg, respectively. Because improvements achieved during quality initiatives may revert back to their pre-intervention state once the assessment period is over, we performed a second retrospective analysis to determine whether the improvements achieved were maintained during the 48 months following the initial study. During 2017-2020, quarterly average usage of blood products was as follows: PRBCs, 11.9%; platelets, 14.7%; FFP, 6.2%; and cryoprecipitate, 11.5%. Quarterly, average use of heparin and protamine were 31,556 ± 2,757 units and 189 ± 113 mg, respectively. These findings indicate that the improvements achieved were not limited to the duration of the initial quality initiative.

Association of CRP Haplotypes in Rheumatoid Arthritis and their Correlation with Severity of the Disease.

BACKGROUND: Rheumatoid arthritis is a heterogenous autoimmune disorder of unknown cause with variable clinical expression. Genetic factors play an important role and likely account for about 60% of disease susceptibility and expression. The aim of this study to find out the association of CRP haplotypes in rheumatoid arthritis and their correlation with severity of the disease. MATERIAL AND METHODS: This was case control study where in all available patients and volunteers (only for blood samples) were recruited. Peripheral blood samples of patients were collected at Rheumatology Clinic and Medicine Department of S.P. Medical College, Bikaner in collaboration with Department of Biological Sciences, BITS, Pilani-Hyderabad during July 2009 to January 2012. 100 control subjects with no known history of disease and 135 cases were recruited as per pre-decided inclusion and exclusion criteria. A tag SNP approach captured common variation at the CRP locus and the relationship between genotype and serum CRP was explored by linear modelling. RESULTS: Cases comprised of 98 females (Mean age 43.01+13.23 yrs) and 37 (mean age 47.4+14.9 years) males. The Control group comprised of 100 unrelated healthy controls. The cases and controls did not differ significantly for any of the clinical parameters, except for serum CRP levels. The allele distribution of rs1205 polymorphism among the studied cases and controls, which was statistical non-significant. The rs3093066 polymorphism located at the 3` position of the gene in the UTR at position number 157949723. The rs3116640 polymorphism located at 157948938 position on chromosome1 and the allele distribution of rs3116637 polymorphism among cases and controls which was also found to be monomorphic respectively. CONCLUSION: Extending the studies to a larger cohort will also allow genetic analyses of clinically defined endophenotypes observed in the patients of this chronic metabolic disease with attributes of autoimmune disorder and multiple symptoms in patients. Genetic studies can also impact strategies adopted for effective personalized treatment for this progressively debilitating disease.

Removal of levofloxacin from aqueous solution by green synthesized magnetite (Fe3O4) nanoparticles using Moringa olifera: Kinetics and reaction mechanism analysis.

Levofloxacin antibiotic is frequently being detected in the environment and regarded as an emerging contaminant. The present study was focused on the green synthesis of magnetite (Fe3O4 - gINPs) nanoparticles from Moringa olifera and its efficiency for removal of levofloxacin from aqueous solution. The adsorbent magnetite nanoparticles (Fe3O4) were prepared by green synthesis using Moringa olifera and coprecipitation method. Characterizations analyses of both chemically and green synthesized nanoparticles were performed by SEM, XRD, and FTIR. The average crystallite size of gINPs was 14.34 nm and chemically synthesized was 18.93 nm. The performance of the synthesized product was evaluated by adsorption capacity and removal efficiency. The parameters considered included adsorbent (gINPs) dosage, initial concentration of adsorbate, pH, contact time, and temperature. The obtained data were fitted to kinetic and isotherm models to determine the mechanism. Adsorption batch experiments were conducted to determine the reaction mechanism by studying kinetics while fitting isotherm models for samples analyzed using HPLC at 280 nm. Results showed that 86.15% removal efficiency of 4 mg L-1 levofloxacin was achieved by 100 mg L-1 gINPs in 24 h contact time when all other parameters (pH 7, temperature 25 °C) were kept constant. The maximum adsorption capacity achieved at equilibrium was 22.47 mg/g. Further, it was identified as a pseudo-second-order model with R2 = 0.965 for adsorption kinetics while isotherm data better fitted to the Freundlich model compared to Langmuir isotherm with R2 = 0.994. The potential pathway determined for levofloxacin removal was chemisorption with minor diffusion, multilayer, spontaneous and exothermic processes on the gINPs (Fe3O4). Reusability experiments were conducted in four cycles and removal efficiency varied from 85.35% to 80.47%, indicating very high potential of the adsorbent for re-use.

Recent progress in integrated fixed-film activated sludge process for wastewater treatment: A review.

Integrated fixed-film activated sludge (IFAS) process is considered as one of the leading-edge processes that provides a sustainable solution for wastewater treatment. IFAS was introduced as an advancement of the moving bed biofilm reactor by integrating the attached and the suspended growth systems. IFAS offers advantages over the conventional activated sludge process such as reduced footprint, enhanced nutrient removal, complete nitrification, longer solids retention time and better removal of anthropogenic composites. IFAS has been recognized as an attractive option as stated from the results of many pilot and full scales studies. Generally, IFAS achieves >90% removals for combined chemical oxygen demand and ammonia, improves sludge settling properties and enhances operational stability. Recently developed IFAS reactors incorporate frameworks for either methane production, energy generation through algae, or microbial fuel cells. This review details the recent development in IFAS with the focus on the pilot and full-scale applications. The microbial community analyses of IFAS biofilm and floc are underlined along with the special emphasis on organics and nitrogen removals, as well as the future research perspectives.

Photocatalytic Decolorization and Biocidal Applications of Nonmetal Doped TiO2: Isotherm, Kinetic Modeling and In Silico Molecular Docking Studies.

Textile dyes and microbial contamination of surface water bodies have been recognized as emerging quality concerns around the globe. The simultaneous resolve of such impurities can pave the route for an amicable technological solution. This study reports the photocatalytic performance and the biocidal potential of nitrogen-doped TiO2 against reactive black 5 (RB5), a double azo dye and E. coli. Molecular docking was performed to identify and quantify the interactions of the TiO2 with ß-lactamase enzyme and to predict the biocidal mechanism. The sol-gel technique was employed for the synthesis of different mol% nitrogen-doped TiO2. The synthesized photocatalysts were characterized using thermal gravimetric analysis (TGA), scanning electron microscopy (SEM), X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), Brunauer-Emmett-Teller (BET) and diffuse reflectance spectroscopy (DRS). The effects of different synthesis and reaction parameters were studied. RB5 dye degradation was monitored by tracking shifts in the absorption spectrum and percent chemical oxygen demand (COD) removal. The best nanomaterial depicted 5.57 nm crystallite size, 49.54 m2 g-1 specific surface area, 11-40 nm particle size with spherical morphologies, and uniform distribution. The RB5 decolorization data fits well with the pseudo-first-order kinetic model, and the maximum monolayer coverage capacity for the Langmuir adsorption model was found to be 40 mg g-1 with Kads of 0.113 mg-1. The LH model yielded a higher coefficient KC (1.15 mg L-1 h-1) compared to the adsorption constant KLH (0.3084 L mg-1). 90% COD removal was achieved in 60 min of irradiation, confirmed by the disappearance of spectral peaks. The best-optimized photocatalysts showed a noticeable biocidal potential against human pathogenic strain E. coli in 150 min. The biocidal mechanism of best-optimized photocatalyst was predicted by molecular docking simulation against E. coli ß-lactamase enzyme. The docking score (-7.6 kcal mol-1) and the binding interaction with the active site residues (Lys315, Thr316, and Glu272) of ß-lactamase further confirmed that inhibition of ß-lactamase could be a most probable mechanism of biocidal activity.

Hybrid Membrane Distillation and Wet Scrubber for Simultaneous Recovery of Heat and Water from Flue Gas.

Flue gas contains high amount of low-grade heat and water vapor that are attractive for recovery. This study assesses performance of a hybrid of water scrubber and membrane distillation (MD) to recover both heat and water from a simulated flue gas. The former help to condense the water vapor to form a hot liquid flow which later used as the feed for the MD unit. The system simultaneously recovers water and heat through the MD permeate. Results show that the system performance is dictated by the MD performance since most heat and water can be recovered by the scrubber unit. The scrubber achieved nearly complete water and heat recovery because the flue gas flows were supersaturated with steam condensed in the water scrubber unit. The recovered water and heat in the scrubber contains in the hot liquid used as the feed for the MD unit. The MD performance is affected by both the temperature and the flow rate of the flue gas. The MD fluxes increases at higher flue gas temperatures and higher flow rates because of higher enthalpy of the flue gas inputs. The maximum obtained water and heat fluxes of 12 kg m-2 h-1 and 2505 kJm-2 h-1 respectively, obtained at flue gas temperature of 99 °C and at flow rate of 5.56 L min-1. The MD flux was also found stable over the testing period at this optimum condition. Further study on assessing a more realistic flue gas composition is required to capture complexity of the process, particularly to address the impacts of particulates and acid gases.

Development of novel hydrophilic ionic liquid membranes for the recovery of biobutanol through pervaporation.

This paper aims to develop novel hydrophilic ionic liquid membranes using pervaporation for the recovery of biobutanol. Multiple polyvinyl alcohol (PVA) membranes based on three commercial ionic liquids with different loading were prepared for various experimental trials. The ionic liquids selected for the study include tributyl (tetradecyl) phosphonium chloride ([TBTDP][Cl]), tetrabutyl phosphonium bromide ([TBP][Br]) and tributyl methyl phosphonium methylsulphate ([TBMP][MS]). The synthesized membranes were characterized and tested in a custom-built pervaporation set-up. All ionic liquid membranes showed better results with total flux of 1.58 kg/m2h, 1.43 kg/m2h, 1.38 kg/m2h at 30% loading of [TBP][Br], [TBMP][MS] and [TBTDP][Cl] respectively. The comparison of ionic liquid membranes revealed that by incorporating [TBMP]MS to PVA matrix resulted in a maximum separation factor of 147 at 30 wt% loading combined with a relatively higher total flux of 1.43 kg/m2h. Density functional theory (DFT) calculations were also carried out to evaluate the experimental observations along with theoretical studies. The improved permeation properties make these phosphonium based ionic liquid a promising additive in PVA matrix for butanol-water separation under varying temperature conditions.

Role of µ-Opioid Receptor Polymorphism in Patients of Rheumatoid Arthritis and their Correlation with Severity of Disease.

INTRODUCTION: With 1 billion tobacco users worldwide, nicotine dependence has a major impact on global health. Advances in medication development for nicotine dependence require an improved understanding of the neurobiology of this complex, relapsing brain disorder. AIMS: To study association of µ Opioid Receptor polymorphism in patients of rheumatoid arthritis and its correlation with severity of disease and prevalent alleles of the OPRM1 genes. MATERIAL AND METHODS: This is a case control study wherein all available patients and volunteers were recruited. 142 controls subjects with no known history of disease and 85 study group cases were included. RESULTS: Comparison of genotype frequencies showed a statistically significant difference between the studied groups (p<0.004). A statistically significant difference was found when the allelic frequencies between the two groups were compared (p<0.0001), with the 17T allele having a-1.7518 fold higher risk of having RA (risk ratio (RR)=1.7518, 95%CI of RR=1.2988-2.3627, OR =3.2914; 95%CI =1.9608-5.5251). Significant difference was also found when the allelic frequencies between the two groups were compared (p<0.0001), with the 118G allele having a 1.5-fold higher risk of developing RA (RR)=1.5801, 95%CI =1.3091-1.9071, OR=3.1357; 95%CI 2.1083-4.6638). CONCLUSION: The study definitely needs to be extended to larger cohort of patients and control samples and to a larger set of candidate µ opioid receptors. Extending the studies to a larger cohort will also allow genetic analyses of clinically defined endophenotypes observed in the patients of this chronic metabolic disease with attributes of autoimmune disorder and multiple symptoms in patients.

Intensity guided cost metric for fast stereo matching under radiometric variations.

Reliable and efficient stereo matching is a challenging task due to the presence of multiple radiometric variations. In stereo matching, correspondence between left and right images can become hard owing to low correlation between radiometric changes in left and right images. Previously presented cost metrics are not robust enough against intensive radiometric variations and/or are computationally expensive. In this work, we propose a new similarity metric coined as Intensity Guided Cost Metric (IGCM). IGCM turns out to significantly contribute to the depth accuracy by rejecting outliers and reducing the edge-fattening effect in object boundaries. IGCM is further combined explicitly with a color formation model to handle various radiometric changes that occur between stereo images. Experimental results on Middlebury dataset show 13.8%, 22.8%, 20.9%, 19.5 % and 9.1% decrease in average error rate compared to Adaptive Normalized Cross-Correlation (ANCC), Dense Adaptive Self-Correlation (DASC), Adaptive Descriptor(AD), Fast Cost Volume Filtering (FCVF) and Iterative Guided Filter (IGF)-based methods, respectively. Moreover, using integral images IGCM can achieve a speedup of 20x, 6x, 41x, 25x and 45x compared to the aforementioned methods.

Two-way switch: Maximizing productivity of tilted panel in membrane bioreactor.

Membrane fouling is a major challenge in membrane bioreactors (MBRs) and its effective handling is the key to improve their competitiveness. Tilting panel system offers significant improvements for fouling control but is strictly limited to one-sided panel. In this study, we assess a two-way switch tilting panel system that enables two-sided membranes and project its implications on performance and energy footprint. Results show that tilting a panel improves permeance by up to 20% to reach a plateau flux thanks to better contacts between air bubbles and the membrane surface to scour-off the foulant. A plateau permeance could be achieved at aeration rate of as low as 0.90 l min-1, a condition untenable by vertical panel even at twice of the aeration rate. Switching at short periods (<5min) can maintain the hydraulic performance as in no-switch (static system), enables application of a two-sided switching panel. A comparison of vertical panel under 1.80 l min-1 aeration rate with a switching panel at a half of the rate, switched at 1 min period shows ≈10% higher permeance of the later. Since periodic switching consumes a very low energy (0.55% of the total of 0.276 kWh m-3), with reduction of aeration by 50%, the switching tilted panel offers 41% more energy efficient than a referenced full-scale MBR (0.390 kWh m-3). Overall results are very compelling and highly attractive for significant improvements of MBR technologies.

Do we use antibiotics judiciously enough? A study in Accident & Emergency Department of tertiary care hospital in Pakistan.

OBJECTIVE: To determine whether antibiotics are necessary for all minor wounds presenting to the Accident and Emergency Department at a tertiary care Centre in Pakistan. METHODS: One hundred and five patients presenting to the Accident & Emergency Department, Jinnah Postgraduate Medical Centre, Karachi, with open wounds were included in the study and divided into two: Groups A (study) and B (control), with Group-A receiving conservative therapy. Eighty-four patients were included in the final analysis as the rest were lost to follow up. Follow up was done after one week to see how many patients had developed infection. RESULTS: The average age of patients was 27.3 +/-9.7 years with similar baseline characteristics. From these, 51% had superficial wounds; average number of wounds was 1.63 +/-0.99, with an average length of 2.7 +/-1.6 cm. A total of 10 out of 84 patients developed infection at 7-10 days after presentation to the A&E. From these, 3 patients receiving conservative treatment (A, 10%, OR=0.107), and seven patients receiving prophylactic antibiotics (B, 12.96%, OR=0.149) developed an infection. Calculated odds ratio for increased risk of infection in Group-A = 0.72. CONCLUSION: A conservative approach to antibiotic prescription for minor trauma may be appropriate despite absence of strict asepsis during emergency wound care.

Study of Bone Mineral Density (BMD) in Patients with Rheumatoid Arthritis and its Co-relation with Severity of the Disease.

INTRODUCTION: Rheumatoid arthritis (RA) is a chronic inflammatory disease of unknown etiology marked by a symmetric, peripheral polyarthritis.1-3 People with rheumatoid arthritis are at increased risk of osteoporosis. Hence this article intends to highlight the importance of BMD measurement in patients with RA as a tool for assessment of disease activity and severity. OBJECTIVE: To evaluate Bone Mineral Density in patients of Rheumatoid Arthritis and Co-relate it with severity of disease. MATERIAL AND METHODS: Hand bone density was measured on the plain radiographs of the right hand using digital x-ray radiogrammetry (Pronosco Xposure System 2.0). This BMD was correlated with markers of disease activity using DAS 28 Scoring system.4. RESULTS: In our study there were 200 patients with equal number of controls. 70 patients in study group and 131 patients in control group were <45 years old and had normal Z-score while in age group >45 years 26 and 20 cases in study and control groups respectively had their Z-score within normal range. There were total 21 and 2 cases of study and control groups respectively (age <45 years) who had osteoporosis while in age group >45 years 12 and 10 cases in study and control groups respectively had osteopenia. CONCLUSIONS: Patients with RA are more susceptible for bone loss in comparison to normal age and gender related subjects. Patients with longer duration and higher disease activity are more susceptible for developing osteopenia and osteoporosis. Occurrence of joint deformities increases with longer disease duration. Limitation of physical activity impairs the bone mineral density. Patient taking anti-rheumatic therapy (steroids and Disease-modifying antirheumatic drugs) are at increased risk of bone loss. All these factors contribute to bone loss independent of each other.

A Study of Genetic Markers in Patients of Rheumatoid Arthritis and their Co-Relation with Severity of the Disease.

INTRODUCTION: Dyslipidemia has been reported to attribute to early death due to increased atherosclerosis leading to CVDs in patients with RA. Recent reports have suggested a role of adipocytokines in mediating joint damage rheumatoid arthritis (RA). RA has long been associated with increased cardiovascular risk as atherosclerosis is more prevalent in patients of RA than in the general population. Specific alleles of APOE gene have been reported to be associated with risk for atherosclerosis and LEP gene alleles have been associated with increased BMI. We evaluated the association of polymorphisms in the APOE and the LEP gene, with risk for developing RA and severity of joint damage in patients with RA. MATERIAL & METHODS: Peripheral blood samples from age and ethnicity matched healthy controls and RA patients, recruited for the study, were collected and used for DNA isolation and allele typing for D7S1875 (LEP gene) and APOE using PCR-LP/RFLP based method reported in literature4,5 followed by data analysis using Medcalc. RESULTS AND CONCLUSIONS: Based on the findings of this study no correlation was seen between RA and LEP gene (D7S1875) allele/genotypes. It was seen that the APOE*4 allele was more prevalent in controls than in cases indicating that this allele is probably playing a significant protective role (p=0.0002, OR=0.3336, CI:0.1856-0.5997) as opposed to the other two Apo E alleles. The Apo E*3 allele was the most prevalent allele in both cases and controls which is similar to earlier reports from several different groups. No significant association was observed between the APOE genotype and the DAS28 score. Finally, it can be concluded that while the short allele of the D7S1875 (LEP gene) marker increases the risk for developing RA (OR=1.72, p=0.038) the APOE*4 allele seems to play a protective role in RA (OR=0.3336, p=0.0002).

HEPATOBILIARY ASCARIASIS COMPLICATED BY PANCREATITIS.

Ascaris lumbricoides is the commonest organism causing soil-transmitted helminth infection. It is particularly common in poor sanitary conditions. Nevertheless, involvement of the gallbladder by Ascaris is a rare entity. A lady presented to us with long-standing history of vague abdominal symptoms suggesting dyspepsia. Ultrasound showed a tube like structure invading the biliary channels. Serum amylase was elevated and the patient was managed conservatively, as for acute pancreatitis. She improved clinically, but subsequent imaging with magnetic resonance cholangiopancreatography revealed worm in the gallbladder. Laparoscopic cholecystectomy was done and Ascaris lumbricoides was removed. Ascaris infestation is an important differential diagnosis of patients with upper abdominal symptoms and screening with stool examination and ultrasound is warranted in high-risk population.