Explore the vast range of titles available.

This book covers the exchange of greenhouse gases in various ecosystems, biomes and climatic zones, and discusses the measurement, modelling and processes involved in these exchange dynamics. It reflects the growing body of knowledge on the characterization, feedback processes and interaction of greenhouse gases with ecosystems and the impact of human activities. Offering a compilation of selected case studies prepared by international researchers working in the field, it represents a valuable resource for researchers and students alike.

Background:Systemic sclerosis (SSc) is a complex and chronic autoimmune connective tissue disease, characterized by vasculopathy, abnormal and excessive deposition of extra cellular matrix in the skin and internal organs and presence of autoantibodies.Patients with SSc have increased susceptibility to infections, primarily stemming from the disease itself and its associated complications.Objectives:This study aims to look for the spectrum of infections and the factors predisposing to infection in patients with systemic sclerosis.Methods:In this retrospective study, demographic, clinical features, details of infections, immunosuppressive therapy, and outcomes of patients with SSc attending clinics at department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India from 1990-2022 were captured. Multivariable-adjusted logistic regression was applied to identify independent predictors of infection.Results:Data of 880 patients, mean age 35.5±12 years, and female: male ratio 7.7:1, were analyzed. One hundred and fifty-three patients had at least 1 infection with a total of 233 infectious episodes. Infections were most common in lung followed by skin and soft tissue. Tuberculosis was diagnosed in 45 patients (29.4%). Klebsiella was the commonest non-tubercular organism in lung and Escherichia coli in urinary tract infections. In comparison to matched control group, patients with infection had a greater number of admissions due to active disease, odds ratio (OR) 6.27 (3.23-12.18, p<0.001), were receiving immunosuppressive medication OR, 5.05 (2.55-10.00, p<0.0001)), and had more digital ulcers OR, 2.53 (1.17-5.45, p<0.01). Patient who had infection had more likelihood for death OR, 13.63 (4.75 -39.18, P<0.0001).Conclusion:Tuberculosis remains the commonest disease and lung remains the major site of infection in patients with SSc. Number of hospital admissions, digital ulcers and immunosuppressive therapy are predictors of serious infection in patients with SSc. Infections are a major cause of mortality in SSc.REFERENCES:[1] Barahona-Correa JE, De la Hoz A, López MJ, Garzón J, Allanore Y, Quintana-López G. Infections and systemic sclerosis: an emerging challenge. Rev Colomb Reumatol Engl Ed. 2020 Apr 1;27:62–84.[2] Rongioletti F, Ferreli C, Atzori L, Bottoni U, Soda G. Scleroderma with an update about clinico-pathological correlation. G Ital Dermatol E Venereol Organo Uff Soc Ital Dermatol E Sifilogr. 2018 Apr;153(2):208–15.Acknowledgements:NIL.Disclosure of Interests:None declared.

This work presents a comparison of various maximum power point tracking (MPPT) techniques applied to 1-[straight phi], single-stage, grid-connected photovoltaic (PV) systems. A representative single-stage grid-connected PV system, based on buck-boost converter topology operating in discontinuous current mode, with sine-triangle pulse width modulation and feeding sinusoidal power into the grid, is considered for this study. MPPT techniques are compared on the basis of the time taken to reach (track) the MPP, operating point oscillations in the vicinity of MPP and the dependence of the algorithms, if any, on array configuration and parameters. Comparison is also made on the basis of the energy extracted from the PV source during the transient tracking phase. In this context, an energy tracking factor term (E^sub TF^) is introduced and defined. It is observed that all the MPPT schemes studied have their own merits and demerits. The ripple correlation and b methods offer an overall good combination of desirable features. All the results of this study are presented.

The current investigation delves into the structural, morphological, optical, and magnetic properties of α-Fe2O3, MgO, and an α-Fe2O3/MgO nanocomposite, synthesized via an innovative hydrothermal methodology, offering novel insights into their potential application in the purification of dye-contaminated water. Through meticulous analysis, x-ray diffraction (XRD) patterns authenticate the successful formation of the nanocomposite, while high-resolution transmission electron microscopy (HRTEM) reveals nanocrystalline particles with dimensions ranging from 19 nm to 30 nm. A noteworthy observation is the demonstration of a tunable optical bandgap, spanning from 2.20 eV to 3.08 eV, via UV–visible (UV–Vis) spectroscopy, indicative of the integration of wide-bandgap semiconductors, a key feature essential for efficient photocatalytic activity. Evaluation of the magnetic properties using vibrating sample magnetometry (VSM) shows a discernible reduction in magnetization in the nanocomposite, attributed to the incorporation of nonmagnetic MgO into the magnetic α-Fe2O3 matrix, thereby revealing unprecedented magnetic modulation. Particularly striking is the exceptional photocatalytic performance of the α-Fe2O3/MgO nanocomposite, achieving 84% degradation of rose Bengal (RB) dye under UV light exposure within a remarkably brief 75-min period. This pronounced enhancement in photocatalytic activity is ascribed to the reduced recombination probability of photo-induced carriers, suggesting effective charge transfer within the nanocomposite, thus elucidating its suitability for efficient wastewater treatment, particularly in the domain of dye removal.

Few controlled trials compared second-generation antipsychotics (SGAs) with first-generation antipsychotics (FGAs) regarding relapse prevention in schizophrenia. We conducted a systematic review/meta-analysis of randomized trials, lasting ⩾6 months comparing SGAs with FGAs in schizophrenia. Primary outcome was study-defined relapse; secondary outcomes included relapse at 3, 6 and 12 months; treatment failure; hospitalization; and dropout owing to any cause, non-adherence and intolerability. Pooled relative risk (RR) (±95% confidence intervals (CIs)) was calculated using random-effects model, with numbers-needed-to-treat (NNT) calculations where appropriate. Across 23 studies ( n =4504, mean duration=61.9±22.4 weeks), none of the individual SGAs outperformed FGAs (mainly haloperidol) regarding study-defined relapse, except for isolated, single trial-based superiority, and except for risperidone's superiority at 3 and 6 months when requiring ≥3 trials. Grouped together, however, SGAs prevented relapse more than FGAs (29.0 versus 37.5%, RR=0.80, CI: 0.70–0.91, P =0.0007, I 2 =37%; NNT=17, CI: 10–50, P =0.003). SGAs were also superior regarding relapse at 3, 6 and 12 months ( P =0.04, P <0.0001, P =0.0001), treatment failure ( P =0.003) and hospitalization ( P =0.004). SGAs showed trend-level superiority for dropout owing to intolerability ( P =0.05). Superiority of SGAs regarding relapse was modest (NNT=17), but confirmed in double-blind trials, first- and multi-episode patients, using preferentially or exclusively raw or estimated relapse rates, and for different haloperidol equivalent comparator doses. There was no significant heterogeneity or publication bias. The relevance of the somewhat greater efficacy of SGAs over FGAs on several key outcomes depends on whether SGAs form a meaningful group and whether mid- or low-potency FGAs differ from haloperidol. Regardless, treatment selection needs to be individualized considering patient- and medication-related factors.

BackgroundP-glycoprotein (p-gp) and multidrug resistance protein 1 (MRP-1) contribute towards resistance to glucocorticoids and/or immunosuppressive drugs in lupus nephritis (LN). Long-lived plasma cells (PCs) persistently produce antibodies and are resistant to most immunosuppressive therapies including B-cell depletion. Elevated T helper 17 lymphocytes (Th17) are associated with resistant LN phenotypes. We hypothesize the overexpression of p-gp and MRP-1 on these two cell types which might eventually contribute towards drug-resistant phenotype in LN.Objectives:1.To evaluate the frequency of peripheral blood PCs and Th17 cells expressing p-gp and MRP-1 in LN compared with healthy controls (HCs).2.To evaluate the frequency of PCs expressing p-gp in bone marrow of LN.MethodsPatients with LN fulfilling the 2019 ACR/EULAR classification criteria and HCs were recruited after written informed consent. p-gp and MRP-1 expression on peripheral PCs (CD45+ CD138+), p-gp expression on Th17 (CD4+ IL-17+ p-gp), Th1 (CD4+IFN-γ), Th2 (CD4+ IL-4) and regulatory T lymphocytes (Tregs, CD4+ CD25+ FoxP3+) were determined using flowcytometry (BD FACS Canto II). Proportions of T lymphocytes were normalized to Tregs. Frequencies of P-gp+ PCs were enumerated in bone marrow aspirate of two patients and one control. Results were expressed as median (interquartile range, IQR). Inter-group comparisons were performed with Mann-Whitney U test. p-value were corrected for multiple testing using Bonferroni-Sidak method. Statistical significance was set at p<0.05.ResultsTwenty-one LN [17 females, median (interquartile range – IQR) age 26 (23.25-35) years] and 10 controls [7 females, median (IQR) age 28 (27–31) years] were recruited. Of 21 LN, 13 had active disease (66% had low complements, 59% had elevated anti-dsDNA). Median SLEDAI-2K score of LN patients was 12 (2-21). In peripheral blood, overall PCs as well as PCs expressing P-gp or MRP-1 were increased in LN than in HC. Th17/Tregs ratio, p-gp-expressing Th17 lymphocytes and MRP-1-expressing Th17 lymphocytes were significantly increased in LN compared to HC (Table 1). p-gp expressing Th17 lymphocytes and PCs were significantly increased in active LN than in inactive LN (Table 1). As an exploratory analysis, p-gp-expressing PCs were more prevalent in bone marrow aspirate of LN than non-lupus controls (Figure 1).ConclusionWe observed for the first time an increased frequency of P-gp and MRP-1-expressing PCs and Th17 lymphocytes in the peripheral blood of LN, which were also associated with disease activity. Whether these cell populations contribute to refractory LN requires evaluation.Table 1.Peripheral blood cell populations in LN and HCCell PopulationLupus Nephritis [median(Q1-Q3)]Healthy Control [median(Q1-Q3)] (n=10)p- value*Active (n=13)Inactive (n=8)LN vs HCActive vs InactiveTh135.9(35.1-38.7)%35.13 (33.73-39.55) %10.5(9.16-13.08) %0.0010.998Th1/Treg10.64(7.98-12.16)10.51(9.71-12.21)4.24(3.83-4.92)0.0010.998Th246.3(41.02-50.1) %44.85(39.93-48.79) %10.45(8.37-13.3) %0.0010.997Th2/Treg13.78(11.72-15.18)12.58 (11.27-15.16)4.30(4.07-5.28)0.0010.997Th172.9(2.2-3.5)%1.79(1.59-2.28) %0.27(0.2-0.44) %0.0010.876Th17/Treg0.73(0.64-0.98)0.53 (0.40-0.82)0.11(0.05-0.23)0.0010.641Th17+P-gp+2.6(1.97-3.34) %1.32(0.89-1.73) %0.07(0.06-0.1) %0.0010.016Th17+P-gp+/ Treg0.78(0.55-1.06)0.37 (0.33- 0.49)0.03(0.018-0.04)0.0010.053Th17+MRP1+2.06(1.7-2.5) %1.56 (1.10-2.00) %0.15(0.09-0.23) %0.0010.815Th17+MRP1+/Treg0.66(0.47-0.82)0.42 (0.31-0.70)0.05(0.03-0.11)0.0010.806Treg3.3(2.7-3.5) %3.45(3.00-3.9) %2.55(1.95-3.18) %0.0400.998PCs3.2(2.59-4.8) %2.36(2.25-3.22) %0.53(0.35-0.98) %0.0010.791p-gp+PCs3.23(2.88-3.9) %1.61(1.21-2.21) %0.11(0.09-0.21) %0.0010.010MRP1+PCs4.2(3.01-7.1) %3.40(2.69-5.93) %0.885(0.63-1) %0.0010.998*corrected for multiple testingFigure 1.Plasma cells and p-gp expressing plasma cells in bone marrow of lupus nephritis and control subjects.AcknowledgementsFunding from Indian Council of Medical Research (ICMR) – grant number No. 3/1/1(20)/2022-NCD-I.Disclosure of InterestsNone Declared.

Background:Since the literature on patient-reported outcome measures (PROMs) in Takayasu arteritis (TAK) is scarce [1], we comprehensively assessed PROMs in a cohort of TAK longitudinally and compared them with healthy individuals.Objectives:Comparison of PROMs in patients with Takayasu arteritis and healthy controls.Comparison of PROMs in inactive and active Takayasu arteritis.To evaluate changes in PROMs on longitudinal follow-up.Methods:Consecutive adult patients with TAK were prospectively evaluated for quality of life (QOL, using EQ-5D-3L questionnaire), physical function [using health assessment questionnaire (HAQ)], physical activity (using International Physical Activity Questionnaire – Short Form (IPAQ-SF)], work productivity [using Work Productivity and Activity Impairment- General Health v2(WPAI)], anxiety [using generalized anxiety disorder assessment 7 questionnaire (GAD-7)], depression [using patient health questionnaire 9 (PHQ-9)], fatigue [using 13-item Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT, lower FACIT scores indicate greater fatigue) and Multidimensional Fatigue Inventory (MFI)], and fibromyalgia [using 2010 diagnostic criteria from the American College of Rheumatology (ACR), including the polysymptomatic distress scale (PSD) score]. PROMs were compared between TAK and healthy controls, and between TAK with active or inactive disease as per physician global assessment. PROMs were reassessed in TAK after 6-18 months to assess the stability of observations. Medians with interquartile range (Q1-Q3) were used to represent the data (unpaired data compared using Mann-Whitney U test, paired data using Wilcoxon matched-pairs signed rank test). Categorical data were compared using Chi-square test. p<0.05 were considered significant.Results:Eighty-four patients with TAK [61 females, median age 34(25-44) years, disease duration 66.5 (37.7-125.8) months] were compared with 61 healthy controls [45 females, age 30 (28-40) years]. TAK had worse QOL on EQ-5D visual analog scale and higher scores in domains of mobility, self-care, usual activities, pain/discomfort, and anxiety/depression of the EQ-5D-3L than healthy controls (Figure 1A). Patients with TAK had worse physical function (HAQ), greater activity impairment due to health (using the WPAI), higher anxiety (GAD-7) and depression (PHQ-9) scores, worse fatigue scores (MFI, FACIT) and PSD scores than healthy controls (Figure 2A). Similar proportions of TAK (6/84) or controls (1/61) fulfilled the 2010 ACR diagnostic criteria for fibromyalgia (p=0.239). Active TAK (n=13) had worse scores on the mobility domain of EQ-5D-3L (Figure 1B), higher activity impairment due to health (using WPAI) and worse fatigue (MFI, FACIT) and PSD scores than inactive TAK (n-71) (Figure 2B). Repeat measurements of PROMs in 75 patients with TAK after a median 6.5 (6-9) months revealed no significant differences (Figures 1C and 2C).Conclusion:Patients with TAK have worse patient-reported outcome measures than healthy controls which remain similar on longitudinal assessment. Active TAK have worse fatigue and work impairment than inactive TAK.REFERENCES:[1] Misra DP, et al. Rheumatol Ther 2021;8(3):1073-93.Figure 1.EQ-5D-3L in TAK. 1A. Comparison between TAK and healthy controls. 1B. Comparison between inactive and active TAK. 1C. Comparison between TAK on longitudinal follow-up. p values for comparison are presented in figures.Figure 2.PROMs in TAK. 2A. Comparison between TAK and healthy controls. 2B. Comparison between inactive and active TAK. 2C. Comparison between TAK on longitudinal follow-up. p values for comparison are presented in figures.Acknowledgements:NIL.Disclosure of Interests:None declared.

Background:Social networks in the healthcare system are used widely for education, research, dissemination of information, telemedicine, networking and medical communities. To better use the benefits of social networks, it is imperative to identify patterns and potential obstacles to their use by healthcare professionals in various geo-political regions to maintain academic connectivity.Objectives:The primary purpose of this cross-sectional study is to examine the use and patterns of social media use by medical professionals from Kazakhstan to understand better the existing knowledge and practice of this group of doctors.Methods:Between November 2022 and January 2022, we conducted an online survey among 144 medical professionals, including physiotherapists, occupational therapists, rheumatologists, and internal medicine doctors. The 30-question questionnaire covered demographic details, job profile, and academic background and explored social media usage, platforms, frequency, reasons for use, utility in professional life, and reasons for non-use.Results:Three hundred and three healthcare professionals responded to the survey, and the final analysis included 144 participants after excluding partial responses. The median age of the participants was 32.01 (IQR: 29 – 35) years. Nearly 80% of participants utilized social media (SoMe) for information, with 65.3% using it for accessing new resources, 66.0% for learning new skills, and 47.9% for expanding professional networks. A significant majority (91.7%) acknowledged receiving valuable educational or professional knowledge from others. Webinars were considered the most useful by 53.5%, while fewer participants relied on podcasts (14.6%) and infographics (4.2%).However, 34.7% found social networks unsafe for communication, and 75.0% felt overwhelmed by content. One in five participants used separate personal and professional accounts on social networks. Broadband and connectivity issues were other perceived barriers (30.6%) to optimal SoMe use. About one-third (31.9%) of respondents attended courses on optimizing the use of social media for professional growth.Despite challenges, participants’ attitudes improved over the last five years, and two-thirds reported social media positively impacting their lives. These observations underscore the importance of incorporating social media into healthcare curricula for optimal academic development.Table 1.Demographic detailsRespondent characteristicsN (%)Age32.01GenderDo not wish to disclose1 (0.7%)Female77 (53.5%)Male65 (45.1%)Other1 (0.7%)Current job settingClinical work112 (77.8%)Teaching50 (34.7%)Research32 (22.2%)Laboratory work9 (6.3%)Which of the following best describes your current job roleStudent14 (9.7%)Practicing physician93 (64.6%)Non-clinical academic/researcher12 (8.3%)Clinical academic/researcher40 (27.8%)Administrator19 (13.2%)Healthcare Professional68 (47.2%)Registered Nursing Practitioner4 (2.8%)Physiotherapist11 (7.6%)Occupational Health Therapist4 (2.8%)Academic roleNo81 (56.3%)Other4 (2.8%)Yes - Assistant Professor/Associate professor or similar13 (9.0%)Yes - PhD student40 (27.8%)Yes – Postdoc(4.2%)Years of experience7.0Figure 1.Survey results for social media useConclusion:This study is the first to determine the landscape of social media use by rheumatology and allied healthcare professionals in Kazakhstan, indicating a predominantly positive impact on their professional lives despite wider challenges. Future directions include the development of pathways to guide professionals in optimal social media use for professional advancement. This involves introducing diverse educational resources and content formats and providing clear recommendations on best practices and potential pitfalls in the professional use of social media and digital resources.REFERENCES:NIL.Acknowledgements:We want to thank all the colleagues who filled out the questionnaire and participated in the distribution.Disclosure of Interests:None declared.

BackgroundSalivary Gland ultrasound is a sensitive point of care investigation for the assessment of salivary gland dysfunction. It can be abnormal in patients with primary Sjögren’s syndrome(pSS), Sarcoidosis, IgG4 disease, Systemic sclerosis, Infections and Tumors.ObjectivesTo understand the utility of Anti-SSA, ANA and Anti-SSA/SSB and Salivary gland ultrasound for diagnosing primary Sjögren’s Syndrome in patients with Sicca symptoms.MethodsIn the current study, In patients referred to the department of Clinical Immunology and Rheumatology, King George’s Medical University, with Sicca Symptoms, a salivary Gland Ultrasound was performed and in those with abnormal ultrasound (Hocevar Score ≥1) Clinical and serological evaluation were performed. The Sensitivity and Specificity of Salivary Gland ultrasound with a Hocevar score ≥17 to diagnose primary Sjögren’s Syndrome was assessed, and the utility of ANA, Anti-SSA and Anti-SSB positivity in patients with abnormal ultrasound was assessed.ResultsA total of 78 patients with sicca symptoms and abnormal salivary gland ultrasound (Hocevar Score ≥1) were included of these, 36 were diagnosed with primary Sjögren’s syndrome and 42 with other diseases, including 12 with Rheumatoid arthritis, 8 with Systemic lupus erythematosus, 7 with systemic sclerosis, 4 with IgG4 related disease and 4 with Sarcoidosis. 7 patients did not have any autoimmune rheumatic disease after evaluation. The mean age of pSS patients was 36.42 ±11.68 and for non-pSS patients was 44.45 ±15.31. A Hocevar score ≥17 has a sensitivity and specificity of 80.56% and 78.57%, respectively. Adding ANA to the screening protocol improved the sensitivity but reduced the specificity while adding Anti-SSA to the screening protocol improved sensitivity, specificity, positive likelihood ration, accuracy and area under curve for diagnosing pSS.ConclusionAnti-SSA positivity and abnormal salivary gland ultrasound in patients with Sicca symptoms can be effective screening tools for diagnosis primary Sjögren’s Syndrome.Table 1.Performance of different Screening methods in pSS ScreeningUltrasoundUltrasound + ANAUltrasound + Anti SSA/ Anti SSBUltrasound + Anti SSASensitivity80.56%82.35%82.35%82.35%Specificity78.57%60.87%90.00%90.00%Positive Likelihood Ratio3.75932.10468.23538.2353Negative Likelihood Ratio0.24750.28990.19610.1961Accuracy79.49%73.68%84.09%84.09%Area Under curve0.79560.71610.86180.8618REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.