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Introduction Patients with SLE (systemic lupus erythematosus) have a higher risk of infection due to dysregulated immune system as well as long-term use of immunosuppressants (IS). This could influence the risk of COVID-19 and its outcome. Methods We conducted a longitudinal prospective study across 15 rheumatology centres during the first wave of the pandemic to understand the risk factors contributing to COVID-19 in SLE patients. During the 6 months follow-up, those who tested positive for COVID-19, their clinical course and outcome information were recorded. Results Through the study period (April–December 2020), 36/1379 lupus patients (2.9%) developed COVID-19. On analysing the COVID-19 positive versus negative cohort during the study period, male gender (adjusted RR 3.72, 95% C.I. 1.85,7.51) and diabetes (adjusted RR 2.94, 95% C.I. 1.28, 6.79) emerged as the strongest risk factors for COVID-19, in the adjusted analysis. There was no significant influence of organ involvement, hydroxychloroquine, glucocorticoid dosage (prednisolone< 7.5 mg or ≥ 7.5 mg/day) or IS on the risk of COVID-19. There was only one death (1/36) among the lupus patients due to COVID-19. Conclusion Traditional risk factors rather than lupus disease process or IS influenced the risk of COVID-19 in our cohort.

Objectives To compare the efficacy and safety of biosimilar adalimumab injection manufactured by Enzene Biosciences Ltd. with innovator adalimumab (iADA, HUMIRA®) in subjects with active ankylosing spondylitis (AS). Methods The prospective, multicenter, randomized, double-blind, phase III study involved 192 subjects with active AS recruited at 20 centers across India. The subjects who fulfilled the eligibility criteria were randomized in a ratio of 2:1 (i.e.,125 subjects in biosimilar adalimumab arm and 67 subjects in the iADA arm). The selected subjects received both the investigational products at a dose of 40 mg subcutaneously (pre-filled syringe contained 40 mg adalimumab in 0.4 ml as the active ingredient) every other week for a total of 12 weeks. Efficacy assessment was done based on ASAS response criteria. Safety assessment was based on complete physical examination, adverse event (AE) monitoring, vital signs, ECG, anti-adalimumab antibody (ADA) assessment, and laboratory tests. Results At 12 weeks, the ASAS 20/40/70 responses were achieved by 97.5%, 94.1%, and 68.9% patients who received biosimilar injection as compared to 98.4%, 96.7%, and 77% patients in iADA arm. Safety assessment showed that 19 (15.2%) subjects reported 33 AEs in the biosimilar adalimumab arm and 8 (11.9%) subjects reported 11 AEs in iADA arm. ADA for positive and negative subjects was statistically non-significant (P 0.3516) between the two arms. Conclusion The ASAS 20/40/70 response rates at week 12 were equivalent between patients treated with biosimilar adalimumab injection manufactured by Enzene Biosciences Ltd and those treated with iADA. Both the drugs had comparable safety and tolerability profiles. Trial registry name: The Clinical Trials Registry- India (CTRI), URL: http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=42640&EncHid=&userName=enzene Trial registration no: no. CTRI/2020/09/028070

Additional file 1: Results of bivariate and multivariate analysis to assess the factors associated with the risk of COVID-19.

Acute onset polyarthritis is a common presentation in rheumatology outpatient consultations, which include both post-infectious arthritis and autoimmune rheumatic diseases (AIRDs). COVID pandemic has added to the list of infectious agents that could result in arthritis.The retrospective observational study was conducted at a tertiary care centre. The study included patients who presented with clinical suspicion of post-infectious arthritis between July-September 2019 and 2020. The study was extended for another 2 months to include patients who presented between October-November 2020. The patients were categorized into post-viral arthritis, post-COVID arthritis, chikungunya arthritis and AIRDs. The demographics, comorbidities, clinical presentation, examination findings and laboratory parameters and the response to treatment for each participant were collected and assessed.In the year 2019 and 2020 (July-Sep), the corresponding number of patients analyzed were 20 and 33. The mean duration of presentation was 1.53 (±3.10) weeks. Chikungunya arthritis was noted in 10% of patients in 2019, while it was 15.15% in 2020. Other post-viral arthritis was identified in 65% and 66.67% of patients in 2019 and 2020 respectively. In the second part of the study, 65.68% of patients were classified as post-viral arthritis, including chikungunya arthritis, post-COVID arthritis and other post-viral arthritis. Around 27% were categorized as AIRDs. Rheumatoid factor negativity and anti-nuclear antibody negativity were found to be significant (P 0.0) in categorizing the patients into post-viral arthritis group, while presence of urinary symptoms (P 0.0) classified the patients into reactive arthritis.The study revealed that the presence of chikungunya arthritis across the two years was comparable. Post-COVID arthritis needs to be considered as a potential differential in post-infectious arthritis. There are no identifiable characteristics (clinical or a simple routine laboratory parameter) that could differentiate the causes of post-infectious arthritis from AIRDs.

Objectives: Neutrophil-to-lymphocyte ratio (NLR) has emerged as an important parameter in inflammatory network and could pave the way for newer treatment strategies in systemic lupus erythematosus (SLE). The study evaluated NLR as a predictor of disease activity in SLE and attempted to relate the factors influencing the NLR. Methods: The study included 117 SLE patients fulfilling the systemic lupus international collaborating clinics/American College of Rheumatology (SLICC/ACR) criteria (2010). The subjects were classified into mild, moderate, and severe systemic lupus erythematosus disease activity index 2000 (SLEDAI 2K) groups and compared. NLR values were classified as ≤2, >2–4 and >4 groups and its relationship with study variables was evaluated by Notched box-and-Whisker plots, Spearman correlation and Mountain plot. ROC and multiple linear regression were used to verify discriminatory ability and factors influencing NLR respectively. Results: Approximately 24% (n=28) of patients each had mild and moderate SLEDAI disease activities, and 52.14% (n=61) had severe activity. Patients with severe disease activity were significantly younger (31.69±10.09 years) and were on more immunosuppressants/DMARDs. The patients in the >4 NLR group had significantly elevated total leucocyte count (TLC) 5560 (3360-11480) cells/mm3 and CRP 4.46 (0.3-48.2) mg/L and more patients were on steroid therapy. The >2-4 NLR group had moderate inverse correlation with SLEDAI. NLR, ESR, CRP, and C3 did not show agreement with SLEDAI. The NLR was associated with CRP and steroid usage and could not discriminate disease severity. Conclusion: The relationship of the NLR with SLEDAI was not consistent. NLR was associated with CRP and steroid use. NLR as a marker of inflammation or as a predictor of SLE disease activity needs further investigation.

In this work, we have introduced a hybrid novel approach to classify the lung cancer data using ensemble learning. According to this approach, first of all, we present data preprocessing model where missing values are imputed with the help of knn. Later, we incorporated filtering-based feature selection to reduce the feature dimension. Later, decision tree and Naive Bayes classifiers are used to create the ensemble learner. Finally, voting based decisions are made to classify the data. The proposed approach is represented as ISE-DNC (Impute, Select, Decision Tree and Naive Bayes) classifier. The proposed approach is implemented on two lung cancer public datasets which are obtained from the UCI repository. The experimental study shows that the proposed approach achieves 96.87% and 89.78% of classification accuracy for lung cancer and thoracic surgery dataset.

Rheumatoid arthritis is a systemic inflammatory disorder with diverse extra-articular manifestations including vasculitis, lung disease, inflammatory eye disease and subcutaneous nodule formation. Among these manifestations, lung disease has been identified as a primary contributor of morbidity and mortality. The predominance of non-specific interstitial pneumonia pattern has been observed in most forms of connective tissue-associated ILD. Studies have demonstrated that the usual interstitial pneumonia (UIP) pattern is more prevalent among patients with RA-associated ILD. The extra-articular manifestations have been noted in nearly 50% of the patients, and the lung involvement in majority of the cases.8, 9 This study details the occurrence of lung involvement of viral etiology in RA, which could be misdiagnosed as RA-associated ILD.

Rheumatoid arthritis (RA) manifestations in leprosy are very common, but often undiagnosed. The present study discusses a challenging case having dilemma in concluding the diagnosis as lepromatous leprosy or RA with leprosy.

The micromechanical properties of both Nb solid solution (Nbss) and (Nb,Ti) 3 Si silicide in a ternary Nb-16Si-22Ti (in at%) alloy were evaluated by nanoindentation and micropillar compression techniques. Nanoindentation tests showed that (Nb,Ti) 3 Si possesses much higher hardness (15.6±0.6 GPa) and Young's modulus (253.3±8.4 GPa) than Nbss (5.2±0.4 GPa and 124.9±5.1 GPa, respectively). Stress-strain curves of each constituent were obtained by micropillar compression. The stress-strain behavior showed that (Nb,Ti) 3 Si exhibited a brittle fracture mode, while Nbss was able to bear large ductile deformation. The compressive failure strength of (Nb,Ti) 3 Si intermetallic and yield strength of Nbss were found to be 8.4±1.2 GPa and 0.9±0.1 GPa, respectively. The fracture toughness of the (Nb,Ti) 3 Si phase evaluated by cracks emanating from nanoindentation, was measured to be ~2.3 MPa-m 1/2 .

Combination of conventional disease-modifying antirheumatic drugs (cDMARDs), which assist in achieving effective disease control and functional outcomes in rheumatoid arthritis (RA), is widely accepted as an effective treatment regimen. Steroid is often used in combination with DMARDs and there are several uncertainties associated with the regimen, including the therapeutic benefits of the combination. Further understanding the pharmacodynamics and mechanism of actions of steroids, and possible drug interactions may assist in improving the treatment outcomes. While the treatment has shown to be effective with better outcome, the use of steroids in the combination regime has been a topic of contradiction. The pharmacodynamic actions of corticosteroids and cDMARDs is variable and overlapping in some domains. In a highly dynamic and constantly adopting immune system, the expression of receptors and signal pathways depends on various factors including the status of cytokine and antigen load. The pattern of introduction of the drugs is one of the major challenges that hampers the effective use of synergism and other interactions associated with the combination. Understanding the drug mechanism and interaction pathways and their variability is essential for customizing the treatment strategies. This review article addresses the current trends of combined treatment in the management of RA. It is also aimed at providing consolidated information on the pharmacodynamic interactions of glucocorticoids and DMARDs in RA.

The entry of daylight into the interiors depends on the orientation of windows, size of the windows, time of the day, as well as weather conditions. The position of the blinds also adds to the above factors to allow day light inside. The illuminance inside a room varies throughout the day depending on the above factors. The introduction of daylight inside the room also aids to increase in temperature inside the room, which hinders the thermal comfort of the user inside the room. Thermal comfort can be achieved by installing Air Conditioner (AC) inside the room. But due to the excessive heat inside, the energy consumption increases to maintain the thermal comfort. This paper deals with the various measures taken to reduce the energy consumption. These values are then fed into a fuzzy logic controller to get the optimum result.

Lighting control systems deliver the correct amount of light at the right time and right place. Lights can automatically turn on, off or dim at set times or under set conditions. Facilities managers can make changes to lighting when appropriate or to meet financial incentives, and users can have control over their own lighting levels to provide optimal working conditions. Lighting control helps to reduce costs and conserve energy by turning off (or dimming) lights when they are not required. Energy savings resulting from daylight harvesting mean not only low electric lighting and reduced peak electrical demands, but also reduction in the load on the air conditioner. On the other hand thermal and visual comforts play a very important role regarding the satisfaction of occupants with their working environments. The most effective method to achieve thermal comfort in offices is to reduce cooling loads in order to avoid additional energy-consuming devices for cooling. Most daylight responsive lighting control systems save energy by reducing lamps output in proportion to the amount of available daylight while maintaining a given illuminance level on the working plane. In this paper, variation of room illuminance with daylight along with variation in room temperature is studied. It is proposed to reduce the total electrical load in a general office. 

Three-dimensional (3D) nondestructive microstructural characterization was performed using full-field transmission X-ray microscopy on an Sn-rich alloy, at a spatial resolution of 60 nm. This study highlights the use of synchrotron radiation along with Fresnel zone plate optics to perform absorption contrast tomography for analyzing nanoscale features of fine second phase particles distributed in the tin matrix, which are representative of the bulk microstructure. The 3D reconstruction was also used to quantify microstructural details of the analyzed volume.

There are studies that have evidence for and are against to suggest that some of the complementary and alternative medicines (CAM) are effective against rheumatoid arthritis (RA). However, there are no adequate studies that have evaluated the role that can be played by CAM in the management of RA. A focused approach in defining the role and limitation as well as the possible adverse events and safety should help in integrating both CAM and mainstream treatment of RA. This review discussed the limitations in the available literature and the direction for future research, which can accelerate the defining role of CAM in RA.

Context: Breast cancer patients awaiting surgery experience heightened distress that could affect postoperative outcomes. Aims : The aim of our study was to evaluate the effects of yoga intervention on mood states, treatment-related symptoms, quality of life and immune outcomes in breast cancer patients undergoing surgery. Settings and Design : Ninety-eight recently diagnosed stage II and III breast cancer patients were recruited for a randomized controlled trial comparing the effects of a yoga program with supportive therapy plus exercise rehabilitation on postoperative outcomes following surgery. Methods and Material : Subjects were assessed prior to surgery and four weeks thereafter. Psychometric instruments were used to assess self-reported anxiety, depression, treatment-related distress and quality of life. Blood samples were collected for enumeration of T lymphocyte subsets (CD4 %, CD8 % and natural killer (NK) cell % counts) and serum immunoglobulins (IgG, IgA and IgM). Statistical analysis used : We used analysis of covariance to compare interventions postoperatively. Results: Sixty-nine patients contributed data to the current analysis (yoga n = 33, control n = 36). The results suggest a significant decrease in the state ( P = 0.04) and trait ( P = 0.004) of anxiety, depression ( P = 0.01), symptom severity ( P = 0.01), distress ( P < 0.01) and improvement in quality of life ( P = 0.01) in the yoga group as compared to the controls. There was also a significantly lesser decrease in CD 56% ( P = 0.02) and lower levels of serum IgA ( P = 0.001) in the yoga group as compared to controls following surgery. Conclusions : The results suggest possible benefits for yoga in reducing postoperative distress and preventing immune suppression following surgery.

Literature evidence indicates a direct association between advancing age and the incidence of musculoskeletal symptoms and limitation of movement.1 Elderly subjects, particularly after the age of 60-65, constitute a special category requiring greater attention and care.2 Various socioeconomic and age-related factors influence the quality of life in this group of subjects. The complexity of caring for elderly subjects could be grouped into three domains: medical complexities, challenges in interpersonal relationship, and administrative domain.3 The incidence of rheumatic diseases like polymyalgia rheumatica (PMR) is more in this age group. Some of the management challenges confronted are: atypical presentation due to malignancy, increased comorbidities, and variable clinical presentations due to physiological conditions like edema surrounding the inflammatory joint. This editorial for the special issue on ‘Geriatric Rheumatology’ discusses how the management of rheumatic disease in elderly should differ from the regular approach.

We are reporting a small pilot case-control study exploring the role of stressors of day-to-day life in triggering ankylosing spondylitis (AS) and the effect of various coping strategies adopted by the patients. We consider AS as a good model to study the hypothesis due to its close association with the well-described genetic marker, HLA B27. The onset of rheumatic diseases has been commonly observed. However, the role of stress and stressful life events in the development of rheumatic disease is a matter of debate. Though there are explainable hypothesis, clinical evidence on this association is limited.

S Chandrashekara ChanRe Rheumatology and Immunology Center and Research, Basaveshwaranagar, Bangalore, India Abstract: Early treatment of rheumatoid arthritis (RA) with disease-modifying antirheumatic drugs will improve the outcome significantly. Early diagnosis of RA continues to be a challenge. The disease needs to be distinguished from other self-limiting arthritis and connective tissue disease. Currently available autoantibodies like rheumatoid factors and anticitrullinated cyclic peptide have limited sensitivity and specificity. RA, being a heterogeneous disease, with no unique or distinct defect that has been described, is less likely to have a single pathognomonic marker. There are defined predisposing genetic factors, cell characteristics, cytokine changes, autoantibodies, and products of disease process that have been demonstrated to distinguish rheumatoid from normal and other arthritis. Studies have demonstrated that combinations of factors allow for more specific RA diagnosis; however, when considerations are given to the factors separately, sensitivity increases at the cost of specificity. The present review briefly describes the value of some of the candidate factors and their combinations as diagnostic markers of early RA. Well-designed multicenter studies to evaluate these combinations using a scoring system are recommended for the development of precise and widely applicable biomarkers for early diagnosis of RA. Keywords: autoantibodies, combination, early RA, specificity

Inflammation is a natural response against any external or internal stimuli that disturb the body homeostasis. Although inflammation was initially described in terms of simple clinical symptoms, it has evolved to define a more complex phenomenon. In spite of the advances in immunology, uncertainty prevails on the precise definition of inflammation.

Longitudinal research generates data with correlated measurements and clustered data structures. The main interest in longitudinal studies is to find the change in outcome over time and to analyze the influence of predictor variables on the outcome. Model-based approach is a powerful tool to integrate the multiple measurements and complexity of such data. Mixed effect models provide the framework to identify the role of individual differences in responses, while incorporating information from multifactorial measures at the individual and group levels to advance our understanding of the underlying components influencing response. This methodology is flexible, could be extended to different data patterns and computes more accurate and stable estimates. Using a multilevel modeling approach, the hierarchical structure can be explicitly modeled. With the availability of standard statistical software for both classical and Bayesian approaches, its applicability has increased in various fields such as genome-wide association studies, understanding of disease/recovery process, disease-marker association and behavioral studies to understand personality traits and health outcomes. This review seeks to focus on the methodological approaches to model multiple failure time data, conceptual issues, arising due to correlation, heterogeneity, and clustering and estimation procedures. The article also emphasizes on their application in data analysis especially in immunology and rheumatology studies.

Background Pain is a chief symptom of rheumatoid arthritis (RA) indicating the disease flare. Variation in pain sensitivity with inflammatory load may assist in measuring the disease activity. Tender joint counts, one of the currently used pain measures, is more a measure of active joints rather than the pain. Although visual analogue scale (VAS) reflects the perception of pain, it does not indicate the true change in the pain. Aim To evaluate whether pressure pain threshold (PPT) represents disease activity by comparing it with DAS-28 and inflammatory markers like ESR and CRP. Materials and methods Twenty freshly diagnosed female RA subjects were recruited after careful exclusion of patients with fibromyalgia (FM). They were assessed for tender joint count, swollen joint count, visual analogue scale (pain/general health), ESR, and CRP during their three consecutive follow-up of six week intervals. PPT was measured using digital algometer at three pairs of joint areas (metacarpophalangeals, wrists and most inflamed joint) and at three FM tender point sites (sub-occipital, mid-trapezius and buttocks). Arithmetic mean of all areas (average PPT) and average PPT of FM points were calculated. The data was analyzed using Pearson correlation co-efficient, Deming regression analysis and correlation of change. Results Average PPT and PPT of most inflamed joint have moderate to large correlation with DAS-ESR and DAS-CRP. In contrast, small to trivial correlation with ESR and CRP was noted. Similar results were seen for FM tender point sites. Conclusion PPT at inflamed as well as at FM sites correlates significantly with DAS-ESR and DAS-CRP. It does not correlate independently with changes in inflammatory parameters ESR and CRP. PPT in conjuncture with DAS could be useful in routine clinical practice to measure the pain as well disease activity, in RA patients .

Reconfigurable computing involves the use of reconfigurable devices such as Field-Programmable Gate Arrays for computing applications. It has demonstrated impressive performance while providing a high degree of flexibility compared with application-specific integrated circuits. Recent research has shown the promising prospect of financial applications for reconfigurable computing. In this paper an attempt is made to explore the architecture for reconfigurable financial computing system

Context : Pre- and postoperative distress in breast cancer patients can cause complications and delay recovery from surgery. Objective : The aim of our study was to evaluate the effects of yoga intervention on postoperative outcomes and wound healing in early operable breast cancer patients undergoing surgery. Methods : Ninety-eight recently diagnosed stage II and III breast cancer patients were recruited in a randomized controlled trial comparing the effects of a yoga program with supportive therapy and exercise rehabilitation on postoperative outcomes and wound healing following surgery. Subjects were assessed at the baseline prior to surgery and four weeks later. Sociodemographic, clinical and investigative notes were ascertained in the beginning of the study. Blood samples were collected for estimation of plasma cytokines-soluble Interleukin (IL)-2 receptor (IL-2R), tumor necrosis factor (TNF)-alpha and interferon (IFN)-gamma. Postoperative outcomes such as the duration of hospital stay and drain retention, time of suture removal and postoperative complications were ascertained. We used independent samples t test and nonparametric Mann Whitney U tests to compare groups for postoperative outcomes and plasma cytokines. Regression analysis was done to determine predictors for postoperative outcomes. Results : Sixty-nine patients contributed data to the current analysis (yoga: n = 33, control: n = 36). The results suggest a significant decrease in the duration of hospital stay ( P = 0.003), days of drain retention ( P = 0.001) and days for suture removal ( P = 0.03) in the yoga group as compared to the controls. There was also a significant decrease in plasma TNF alpha levels following surgery in the yoga group ( P < 0.001), as compared to the controls. Regression analysis on postoperative outcomes showed that the yoga intervention affected the duration of drain retention and hospital stay as well as TNF alpha levels. Conclusion : The results suggest possible benefits of yoga in reducing postoperative complications in breast cancer patients.