Life and Times of Yellapragada SubbaRow.

Dr Yellapragada SubbaRow was an Indian-born American biochemist who made numerous discoveries in various fields of science. Born in 1895 into a poor family, he went on to have medical training at the Madras Medical College, Chennai, Tamil Nadu, India. After many hardships, he arrived in the United States of America and earned a diploma in tropical medicine and a PhD in biochemistry from Harvard. His illustrious career began with the isolation of phosphorus in body fluids along with Fiske. They discovered phosphocreatine and adenosine triphosphate (ATP) as well. He later became the director of Lederle Laboratories, where he discovered the tetracycline antibiotic group, which saved many lives. He synthesized many vitamins, including folic acid, niacin, and biotin. In 1948, he discovered methotrexate (MTX) for childhood cancer, which paved the way for many chemotherapeutics and is also used in the management of several autoimmune conditions. Despite numerous medical advancements made by SubbaRow, awareness in the scientific world regarding his life and many contributions remains underrecognized. This article discusses SubbaRow's life, academics, and achievements in a nutshell.

Awareness, perspectives and satisfaction levels among patients with psoriatic arthritis: a multicentric cross-sectional survey.

Perception of the disease and its management impacts patients with Psoriatic arthritis (PsA) to a great degree. Studies examining patients' viewpoints and perception of their disease and its management are scarce. This multicentric cross-sectional survey was undertaken to understand the perspectives of patients with PsA. A survey questionnaire with items on demographics, awareness about their disease, treatment, physical therapy, quality of life and satisfaction with the care received was designed. After internal and external validation, a pilot survey was conducted, and the questionnaire was finalized. The final survey (with translations in local languages) was carried out at 17 centres across India. There were 262 respondents (56% males) with mean age of 45.14 ± 12.89 years. In 40%, the time lag between onset of symptoms and medical assessment for it was more than a year. In most of the patients, the diagnosis of PsA was made by a rheumatologist. Over 83% of patients were consulting their rheumatologist periodically as advised and fully compliant with the treatment. Lack of time and cost of therapy were the most common reasons for non-adherence to therapy. Eighty-eight patients (34%) were not fully satisfied with their current treatment. Over two-third of patients had never seen a physiotherapist due to barriers including a lack of time, pain, and fatigue. The daily activities and employment status were affected in nearly 50% of patients with PsA. The current survey has identified a gap in patients' awareness levels and helps healthcare providers in understanding the varied perceptions of patients with PsA. Addressing these issues in a systematic manner would potentially improve the treatment approaches, outcomes, and patient satisfaction levels.

Harnessing of real-world data and real-world evidence using digital tools: utility and potential models in rheumatology practice.

The diversity of diseases in rheumatology and variability in disease prevalence necessitates greater data parity in disease presentation, treatment responses including adverse events to drugs and various comorbidities. Randomized controlled trials are the gold standard for drug development and performance evaluation. However, when the drug is applied outside the controlled environment, the outcomes may differ in patient populations. In this context, the need to understand the macro and micro changes involved in disease evolution and progression becomes important and so is the need for harvesting and harnessing the real-world data from various resources to use them in generating real-world evidence. Digital tools with potential relevance to rheumatology can potentially be leveraged to obtain greater patient insights, greater information on disease progression and disease micro processes and even in the early diagnosis of diseases. Since the patients spend only a minuscule portion of their time in hospital or in a clinic, using modern digital tools to generate realistic, bias-proof, real-world data in a non-invasive patient-friendly manner becomes critical. In this review we have appraised different digital mediums and mechanisms for collecting real-world data and proposed digital care models for generating real-world evidence in rheumatology.

Musculoskeletal care - at the confluence of data science, sensors, engineering, and computation.

Data has always been integral to modern medicine in almost all aspects of patient care and the recent proliferation of data has opened up innumerable opportunities for all the stakeholders in trying to improve the quality of care and health outcomes including quality of life and rehabilitation. Greater usage and adoption of digital technologies have led to the convergence of health data in different forms - clinical, self-reported, electronic health records social media, etc. The application and utilization of patient data set continue to get broadened each day with greater availability and access. These are empowering newer cutting-edge solutions such as connected care and artificial intelligence, 3D printing and real-life mimicking prosthetics. The availability of data at micro and macro levels has the potential to act as a catalyst for personalized care based on behavioral, cultural, genetic, and psychological needs for patients with musculoskeletal disorders. Realistic algorithms coupled with biomarkers which can identify relevant interventions and alert the care providers regarding any deterioration. Although in the nascent stage currently, 3D printing, exoskeletons, and virtual rehabilitation hold tremendous potential of cost-effective, precise interventions for the patients.

Physicians Perception of Rheumatology Practice and Training in India.

OBJECTIVE: To assess physicians' perception and their felt competence in dealing with patients with rheumatic complaints. METHODS: We assessed the quantum of rheumatological disorders seen by physicians in India, their felt competency in dealing with such patients, and their perceived adequacy of undergraduate and postgraduate medical training in Rheumatology by means of an anonymized questionnaire conducted at the annual national conference of internal medicine specialists. RESULTS: Our analysis of 333 respondents revealed that while they saw an average of 10 patients with rheumatic complaints every month, the felt competence in dealing with such cases was only a median of 6/10 (interquartile range 5-7). About 75% professed little or no exposure to Rheumatology as undergraduates, whereas only 20% perceived adequacy of training during internal medicine residency to treat such diseases confidently. 78.37% and 67.7% perceived an inadequacy of rheumatology training at undergraduate and postgraduate level respectively, and 83% felt the need for further training or sensitization in Rheumatology. CONCLUSION: There remains an unmet need to enhance existing undergraduate and postgraduate internal medicine curricula in India to impart greater skills in the diagnosis and management of rheumatic diseases. Initiatives and government funding to establish short-term training courses in Rheumatology for established internal medicine faculty, to enable them to provide basic Rheumatology services at their respective hospitals, are urgently needed.

Digital health: a new dimension in rheumatology patient care.

The new digital health innovations have opened up several opportunities to help the clinicians, patients and other caregivers of rheumatology healthcare system in maximizing efficiencies resulting in better patient outcomes. In the global context, digital health technology has the potential to bridge the distance gap between all the key stakeholders involved in rheumatology health care. In this review, we update on the recent advances in the field of digital health and highlight unique features of these technologies which would help in routine care. Application of technology in any form to enable, facilitate or enhance the quality of care is the foundation of digitised care. The components could be smartphone apps, sensors, video, social media platforms or messenger platforms, wearables or a combination of these enabling healthcare delivery and overcoming the constraints of distance, location and time. Digital therapeutics have started evolving and an important step in this direction is the involvement of FDA in the approval process. Speciality specific apps, personalised patient education as per disease status, remote specialist consultations or virtual health coach to guide on lifestyle modifications are some of the developments which have been facilitated by increased digitization in all walks of life. Assisted care with the help of robots rendering care in the hospitals or an intelligent robot guiding a patient by voice and visual sense at home are already at the threshold of entering the mainstream of patient care. Wearable devices equipped with powerful sensors are coming handy in keeping a watch on patient symptoms all the time and providing useful insights on disease progression, clinical response or complications. In chronic care such as rheumatology the implications, possibilities and benefits seem unprecedented. Real time data analytics and artificial intelligence are helping the clinicians, healthcare systems and policy makers optimise the resources and improve patient outcomes. Digitization of healthcare has gained momentum in the recent years and it is envisaged that it could be a catalyst to change, bridge the quality of care and most important democratise the healthcare access across the globe. However, more data, efficacy and objective results are needed which would be fulfilled by ongoing observational studies, clinical trials, systematic review and meta-analysis to further establish the role of digital health in the realms of patient care.

Integrity of Authorship and Peer Review Practices: Challenges and Opportunities for Improvement.

Integrity of authorship and peer review practices are important considerations for ethical publishing. Criteria for authorship, as delineated in the guidelines by the International Committee of Medical Journal Editors (ICMJE), have undergone evolution over the decades, and now require fulfillment of four criteria, including the need to be able to take responsibility for all aspects of the manuscript in question. Although such updated authorship criteria were published nearly five years ago, still, many major medical and specialist journals have yet to revise their author instructions to conform to this. Inappropriate authorship practices may include gift, guest or ghost authorship. Existing literature suggests that such practices are still widely prevalent, especially in non-English speaking countries. Another emerging problem is that of peer review fraud, mostly by authors, but also rarely by handling editors. There is literature to suggest that a proportion of such fake peer review may be driven by the support of some unscrupulous external editing agencies. Such inappropriate practices with authorship malpractices or disagreement, or peer review fraud, have resulted in more than 600 retractions each, as identified on the retractions database of Retractionwatch.com. There is a need to generate greater awareness, especially in authors from non-English speaking regions of the world, about inappropriate authorship and unethical practices in peer review. Also, support of any external editing agency should be clearly disclosed by authors at the time of submission of a manuscript.

Publishing in black and white: the relevance of listing of scientific journals.

Scientific publishing, including in the field of Rheumatology, is evolving rapidly. Predatory journals are one of the major threats to contemporary publishing, especially to eager and naïve authors. In this narrative review, we discuss mechanisms that authors can employ to white list genuine scientific journals and blacklist "predatory" ones. Inclusion of a journal in reputed indices such as Medline (but not just Pubmed), Web of Science, Scopus or Embase raises the likelihood that the journal is genuine, more so if it is included in the current Journal Citation Reports. Other commercially available whitelists also exist, so also whitelists published by regulatory authorities in some countries. A commercially available blacklist has emerged since the very useful Beall's blacklist became defunct. In the absence of access to a whitelist or blacklist, certain characteristics such as repeated email solicitations for articles with an extremely narrow deadline from unknown sources, lack of inclusion in reputed indices, journals not published or endorsed by national or international society and scarcity of currently published articles should render authors suspicious of the genuine nature of a journal. National societies should work together to generate subject-specific (including Rheumatology specific) whitelists that can be available free of cost to authors from all over the world.

Musculoskeletal problems in pregnancy.

Physiological changes during normal pregnancy are likely to give rise to musculoskeletal symptoms. On the other hand, autoimmune rheumatological diseases disproportionately affect women, often presenting during the childbearing years and sometimes during pregnancy. Contrary to autoimmune rheumatological diseases, the management of non-autoimmune musculoskeletal manifestations is generally conservative and often tends to resolve after pregnancy. It is therefore important to be aware of various musculoskeletal problems seen in the course of pregnancy. In this narrative review, commonly encountered non-autoimmune musculoskeletal problems during pregnancy have been described.

Lupus pregnancy outcomes in women with previous adverse outcomes: a prospective cohort study.

OBJECTIVES: The primary objective of this prospective cohort study was to assess the usefulness of a predefined multidisciplinary care pathway-based management on pregnancy outcome(s) in women with SLE who already had at least one adverse obstetric outcome(s). METHODS: Between March 2010 and March 2023, all consecutive, consenting women with SLE who already had at least one previous adverse obstetric outcome (preterm labour, pre-eclampsia, termination of pregnancy, miscarriage, intrauterine growth retardation (IUGR), preterm birth, low birth weight (LBW), intrauterine death (IUD) or stillbirth] were prospectively screened and counselled. The protocol comprised preconception and post-natal drug and disease status review, periodic ante-natal visits for the monitoring of pregnancy and drug and disease status review and post-natal drug and disease status review and contraception advice. Therapeutic changes were made as necessary at each visit. RESULTS: A total of 213 women were screened and 197 women (age, 28 ± 6.34 years) were enrolled who had 226 pregnancies. Previous poor obstetric outcomes were miscarriage(s), 186; termination of pregnancy, 4; preterm labour, 51; IUGR, 36; IUD or stillbirth, 16; low birth weight (LBW), 44 and pre-eclampsia, 4. Seventy-seven (39%) women had secondary APS and 37 (19%) had a history of lupus nephritis. There were 194/226 (86%) live births [40 LBW (18%); caesarean section in 101 (45%)]. Thirty pregnancies culminated in miscarriages and 2 in IUDs (14%). Sixty-eight patients (30%) experienced lupus flare during pregnancy (36 mild, 20 moderate and 8 severe). CONCLUSION: Our experience underscores the usefulness of a predefined multidisciplinary care pathway-based management for improving pregnancy outcomes in women with SLE who had previous adverse outcomes. Key Points • In women with SLE who had previous adverse obstetric outcome(s) a risk of poor outcome in subsequent pregnancy remains. • Good pregnancy outcomes in these women could be achieved by predefined  multidisciplinary care pathways focussed on addressing all relevant issues. • Improved access to rheumatology services and collaboration between rheumatologists and obstetricians is key to improving outcomes in SLE pregnancies.

Molecular profiling and therapeutic tailoring to address disease heterogeneity in systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is a chronic, heterogeneous, systemic autoimmune disease characterized by autoantibody production, complement activation, and immune complex deposition. SLE predominantly affects young, middle-aged, and child-bearing women with episodes of flare-up and remission, although it affects males at a much lower frequency (female: male; 7:1 to 15:1). Technological and molecular advancements have helped in patient stratification and improved patient prognosis, morbidity, and treatment regimens overall, impacting quality of life. Despite several attempts to comprehend the pathogenesis of SLE, knowledge about the precise molecular mechanisms underlying this disease is still lacking. The current treatment options for SLE are pragmatic and aim to develop composite biomarkers for daily practice, which necessitates the robust development of novel treatment strategies and drugs targeting specific responsive pathways. In this communication, we review and aim to explore emerging therapeutic modalities, including multiomics-based approaches, rational drug design, and CAR-T-cell-based immunotherapy, for the management of SLE.

Role of insulin resistance indices in predicting new-onset diabetes after kidney transplantation.

New-onset diabetes mellitus (NODAT) is a serious complication following renal transplantation. In this cohort study, we studied 118 nondiabetic renal transplant recipients to examine whether indices of insulin resistance and secretion calculated before transplantation and at 3 months post-transplantation are associated with the development of NODAT within 1 year. We also analysed the long-term impact of early diagnosed NODAT. Insulin indices were calculated using homeostasis model assessment (HOMA) and McAuley's Index. NODAT was diagnosed using fasting plasma glucose. Median follow-up was 11 years. The cumulative incidence of NODAT at 1 year was 37%. By logistic regression, recipient age (per year) was the only significant pretransplant predictor of NODAT (OR 1.04, CI 1.009-1.072), while age (OR 1.04, CI 1.005-1.084) and impaired fasting glucose (OR 2.97, CI 1.009-8.733) were significant predictors at 3 months. Pretransplant and 3-month insulin resistance and secretion indices did not predict NODAT. All-cause mortality was significantly higher in recipients developing NODAT within 1 year compared with those remaining nondiabetic (44% vs. 22%, log-rank P = 0.008). By Cox's regression analysis, age (HR 1.075, CI 1.042-1.110), 1-year creatinine (HR 1.007, CI 1.004-1.010) and NODAT within 3 months (HR 2.4, CI 1.2-4.9) were independent predictors of death. In conclusion, NODAT developing early after renal transplantation was associated with poor long-term patient survival. Insulin indices calculated pretransplantation using HOMA and McAuley's Index did not predict NODAT.