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Gender disparities in science, technology, engineering, and mathematics (STEM) remain pronounced in many African countries, particularly at the postgraduate level. This study explores the experiences of African women in STEM postgraduate education by integrating data from an online survey of 163 female PhD alumni from 40 African universities in 17 countries and seven focus group discussions (FGDs) with 39 current postgraduate students across three countries. Through a mixed-methods approach, we examine both the challenges women face and the factors that enable their persistence and success. Over 60% of respondents reported financial stress during their PhD, and more than half felt unprepared at the time of program entry. Yet 95% expressed confidence in their ability to succeed, reflecting strong self-efficacy despite structural barriers. In the FGDs, women highlighted the burden of caregiving responsibilities, lack of role models, and cultural norms that pressure them to prioritize family over academic careers. Contrary to common assumptions, most FGD participants preferred male supervisors, citing competitiveness or lack of support from some senior women. Despite these obstacles, participants demonstrated high levels of resilience, often driven by a passion for science and strong family support. Our findings highlight the need for family-friendly policies, structured and tailored mentoring, and flexible, gender-responsive institutional reforms to ensure more inclusive and equitable STEM postgraduate environments in Africa.

ObjectiveTo assess accrual of new vertebral fractures (VF) in patients with idiopathic inflammatory myositis (IIM) over a period of time.MethodsHundred patients who were previously enrolled for a cross-sectional study on prevalence of asymptomatic VF were telephonically requested to review with repeat spinal radiographs and dual-energy X-ray absorptiometry (DEXA) after 3 years. Radiographs were scored using Genant’s semi-quantitative technique. Disease activity and damage were assessed by myositis damage index (MDI) extent of damage and modified MDI for which the osteoporotic fracture item in MDI was removed. VF progressors were compared with non-progressors.ResultsOf 31 patients reviewed, 11 had dermatomyositis, 8 polymyositis, and 6 each overlap and anti-synthetase syndrome. Eighteen patients underwent DEXA scan. Seventeen had VF at baseline. At 91.62 patient years of follow-up, total number of VF increased from 27 to 51. Patients who had previous VF had higher risk of developing a new VF when compared with those with no VF (76.5% vs. 14.28%, RR: 5.35). Patients with old VF accrue fractures at a rate of 26.2 per 100 patient years. The number of fractures correlated significantly with age, T scores at the L4 level, and lower third of radius on DEXA, MDI, and modified MDI. Neither conventional nor disease-related variables differed between progressors and non-progressors.ConclusionPatients with IIM with a prior VF incurred a five times risk of subsequent VF irrespective of disease activity and glucocorticoids.Key Points• Patients with inflammatory myositis are at a high risk of asymptomatic vertebral fractures.• Patients with baseline vertebral fractures incur a high risk of future fractures on follow-up.• Number of fractures is negatively correlated with age, BMD values at lower end of radius, L4, and damage.

Abstract Introduction/Background Scleroderma Overlap conditions are well defined and often behave differently than their limited or diffuse counterparts. The treatment for such patients is usually tailored around the organ system involvement and severity. We present a challenging case of Scleroderma/Sjogren overlap with refractory Raynaud's phenomenon who posed treatment challenges due to severe autonomic dysfunction. Description/Method 76-year-old Caucasian lady, non-smoker, who presented in 1990’s with dry eyes, dry mouth and severe Raynaud's phenomenon with recurrent digital ulceration which became infected on multiple occasions. ANA was 1:400 with Extractable nuclear antigen Ro and La positive. Anti DsDNA was negative and C4 was low. Antiphospholipid antibodies and cryoglobulins are negative. She failed calcium channels blockers and phosphodiesterase 5 inhibitors and was intolerant to intravenous (IV) Iloprost which was tried on multiple occasions. IV latanoprost was tried as well. This treatment was complicated when she developed postural hypotension and multiple fall episodes during vasodilator use. This was attributed to autonomic dysfunction secondary to her Sjogren syndrome. She was initiated on Injection Fludrocortisone, however her hypotensive episodes continued. She received monthly intravenous immunoglobulins 20gm (over two days) infusion for a few months for autonomic dysfunction with some response. She eventually developed recurrent diarrhoea and abdominal pain and bloating which was attributed to small bowel overgrowth with rapid bowel transit on a gastric emptying scan. She had a blocked bile duct as well which was unblocked using Endoscopic Retrograde Cholangiopancreatography. Over the next 8 years, she continued struggling with refractory Raynaud’s, having failed IV regional guanethidine blocks and digital sympathectomy. Her postural hypotension decompensated on multiple occasions necessitating plasmapheresis which provided some benefit. In 2020, she was detected to have a PET avid slowly progressing left upper lobe lung lesion. She underwent left video assisted thoracoscopy surgery with upper lobectomy. Histology was suggestive of adenocarcinoma. In 2021, she had another fall episode due to an acute/subacute infarct of left pons. She continues having postural hypotension and requires regular plasmapheresis sessions to manage her symptoms. She is also presently on Bosentan for her raynaud’s phenomenon. Discussion/Results This is a case of overlap of Sjogren syndrome with scleroderma features. Management of Refractory Raynaud’s as part of her scleroderma phenotype was challenging. This case gave us the opportunity to explore all the treatment options available for Raynaud’s phenomenon albeit with poor outcome. She also struggled with autonomic dysfunction leading to postural hypotension and gastrointestinal symptoms which can be seen in upto 50% of patients with Sjogren syndrome. Autonomic failure is often thought to be immune mediated in Sjogren syndrome. This makes way for the use of intravenous immunoglobulin and plasmapheresis to treat these conditions as was done in this case. Increased risk of lung carcinoma with scleroderma is well documented. Autonomic dysfunction can also present as paraneoplastic syndrome with lung carcinoma, however it is more common with small cell lung carcinoma and our patient was diagnosed with Adenocarcinoma. We would have to wait and see if the resection of the tumour has any demonstrable effect on her dysautonomia. Key learning points/Conclusion Overlap connective tissue diseases are often difficult to manage in view of extensive disease heterogeneity. Clinicians need to be aware of challenges in managing Difficult Raynaud’s with Autonomic dysfunction. Treating physicians need to be aware of the high risk of lung malignancy and regular close monitoring is required. This case-based conference gives us the opportunity to discuss further management approaches for her.

Gender disparities in science, technology, engineering, and mathematics (STEM) remain pronounced in many African countries, particularly at the postgraduate level. This study explores the experiences of African women in STEM postgraduate education by integrating data from an online survey of 163 female PhD alumni from 40 African universities in 17 countries and seven focus group discussions (FGDs) with 39 current postgraduate students across three countries. Through a mixed-methods approach, we examine both the challenges women face and the factors that enable their persistence and success. Over 60% of respondents reported financial stress during their PhD, and more than half felt unprepared at the time of program entry. Yet 95% expressed confidence in their ability to succeed, reflecting strong self-efficacy despite structural barriers. In the FGDs, women highlighted the burden of caregiving responsibilities, lack of role models, and cultural norms that pressure them to prioritize family over academic careers. Contrary to common assumptions, most FGD participants preferred male supervisors, citing competitiveness or lack of support from some senior women. Despite these obstacles, participants demonstrated high levels of resilience, often driven by a passion for science and strong family support. Our findings highlight the need for family-friendly policies, structured and tailored mentoring, and flexible, gender-responsive institutional reforms to ensure more inclusive and equitable STEM postgraduate environments in Africa.

Abstract Introduction/Background Tumor necrosis factor (TNF) inhibitor therapy is one of the primary modalities of treating spondyloarthritis. However, infections secondary to biologic use is a common complication. Clostridium difficile is a gut colonizer which may become pathogenic in the presence of dysbiosis and antibiotic use. Symptomatic clostridium difficile infection(CDI) due to adalimumab(ADA) use causing lymphocytic colitis(LC) is rarely reported. We present a case of axial plus peripheral spondyloarthritis on adalimumab who developed CDI and presented a therapy related dilemma. Description/Method We present a case of a 52-year-old lady who was diagnosed as HLAB27 positive axial spondyloarthritis with bilateral sacroiliitis on MRI bilateral sacroiliac joint in 2016. She failed two non-steroidal antinflammatory drugs (NSAID) with high disease activity scores(BASDAI 8.6, BASFI 6.2, Spinal VAS 9). She was eventually initiated on injection adalimumab in 2017. There was clinical improvement after 6 months of initiating ADA. Repeat MRI spine and SI joint showed resolution of inflammatory changes with adalimumab. Sulfasalazine was added in the treatment protocol due to peripheral arthralgia, however she developed a drug rash to it and it was stopped. In September 2021, she developed recurrent non-bloody watery diarrhoeal episodes. Adalimumab was stopped and she tested positive for Clostridium difficile on three occasions. She received multiple courses of vancomycin, fidoxamycin and metronidazole with partial resolution of diarrhoea. Adalimumab was rechallended in January 2022 since her disease activity was worsening in the absence of NSAID and biologic use. However, it was paused again due to worsening of diarrhoea. Gastroenterology conducted a Colonoscopy and biopsy of colonic polyps which showed increased number of intraepithelial lymphocytes with no thickening of subepithelial collagen plate suggestive of lymphocytic colitis (LC). It was postulated that CDI may have been the trigger for her LC. She has been started on local corticosteroid therapy(budesonide) for her LC. At this junction, we were faced with the decision of restarting adalimumab for her which may have been the original cause of her CDI. Discussion/Results We present this case in view of a dilemma regarding which problem occurred first Did immunosuppression due to adalimumab lead to CDI? Literature is not suggestive of increased risk of CDI with adalimumab, especially in a non-inflammatory bowel disease (IBD) background. Was the lymphocytic colitis triggered by the CDI or was clostridium difficile just incidentally detected on a background of LC? There is a well documented associated of LC with autoimmune conditions and use of NSAIDs along with proton pump inhibitor is another trigger for it. TNF alpha inhibitor is one of the treatment modalities of refractory LC. Would it be appropriate to restart ADA for her since she responded well despite there being a risk of recurrence of a CDI? Finally, what is the role of gut dysbiosis in the role of CDI and LC in this situation. Presently, she is planned to be treated with local steroid therapy for her LC. ADA will be rechallenged once her gut has responded to the steroid course. In the event of her gut worsening on a rechallenge, she will be given a trial of Infliximab. Key learning points/Conclusion The case highlights the crucial point of thinking of causes of diarrhea apart from well documented conditions of ulcerative colitis/Crohn’s disease in an immunosuppressed spondyloarthritis patient. A detailed stool examination including bacterial and parasitic examination is crucial in recurrent diarrhea. The threshold for colonoscopy should be low when episodes are refractory to treatment. The case-based conference gives us an opportunity to receive feedback regarding further management approaches in this case.

Objectives Primary objectives estimated prevalence of traditional cardiovascular disease (CVD) risk factors and compared different CVD risk prediction algorithms in an Indian rheumatoid arthritis (RA) population. Secondary objectives evaluated associations between carotid intima-media thickness (CIMT) and subclinical atherosclerosis (SCA) with CVD risk factors and CVD risk scores. Methods The presence of CVD risk factors were recorded, and 10-year CVD risk was predicted using Framingham risk scoring (FRS) using lipids (FRS-Lipids), FRS using body mass index (FRS-BMI), QRISK-2, SCORE, and the algorithm recommended by ACC/AHA (ASCVD). CIMT was measured on the far-wall of the common carotid artery. Subclinical atherosclerosis was defined as CIMT > 0.9 mm or the presence of carotid plaque. Results A total of 332 patents were enrolled, 12% had diabetes mellitus, 21.4% hypertension, and 6.9% were current/past smokers. Proportions of RA with predicted 10-year CVD risk > 10% varied from 16.2 to 41.9% between scores. Highest magnitude of risk was predicted by FRS-BMI. Agreement between scores in predicting risk was moderate in general. Mean CIMT was 0.70 ± 0.15 mm. Age, male sex, and extra-articular manifestations associated with greater CIMT. All risk scores except SCORE moderately correlated with CIMT. About one-seventh had SCA defined as CIMT > 0.9 mm or the presence of carotid plaques, associated with increasing age, male gender, or higher ratio of total cholesterol to high-density lipoprotein cholesterol. ASCVD and QRISK-2 scores had maximum area under curve for distinguishing SCA. Conclusion Individual CVD risk scores predict 10-year CVD risk differently in Indian patients with RA, and require validation for predicting hard end points (CVD events, mortality). Key Points • Diabetes mellitus and hypertension are the most prevalent cardiovascular disease risk factors in Indian patients with RA. • Individual cardiovascular risk prediction scores predict risk differently in Indian patients with RA, highest risk being predicted by the FRS-BMI. • Carotid intima-media thickness in RA associated with increasing age, male sex and extra-articular manifestations. • 14% RA had subclinical atherosclerosis, associated with increasing age, male sex, and higher total cholesterol to HDL-C ratio, best distinguished by ASCVD and QRISK-2 scores.

Polymyositis is a diagnosis of exclusion. In patients with odd features, it can be of infective etiology. A high index of suspicion is required for diagnosis. A 55-year-old gentleman presented with gradual-onset proximal muscle weakness. Examination revealed mild distal weakness but no rash. Muscle enzymes were raised and tests for autoantibodies were negative. Biopsy revealed microsporidiosis. In view of this unusual infection, immunodeficiency was considered and he was found to have lymphopenia which antedated his illness. Later, he developed cranial nerve palsies due to multiple lesions in the pons. In addition, he had Cytomegalovirus viremia. Literature was reviewed to identify 20 cases of microsporidial myositis, its presentation, underlying immunodeficient state, and clinical course. Infective polymyositis should be considered in a patient with paucity of clinical and serological autoimmune features. Lymphopenia can point to underlying immunodeficiency. CMV infection could be the contributor to or bystander-effect of idiopathic lymphopenia.

Recently, industrialization has become an ecosystem threat and ultimately hazardous to health of living organisms. But the fact is that industries are required for the economy modernization and development of the city like Bhopal. Therefore, environmental pollution with toxic chemicals and metals is a global problem. Keeping this into account, this research was carried out to analyze the effect of Lead and Chromium on the in vitro plantlets of Datura inoxia. Datura inoxia is an important plant for phytoremediation of soil by heavy metals but its potential for phytoremediation of contaminated sites is unknown yet. The main objective of the present study was to determine the effect of Lead and Chromium on growth and metal uptake in different parts of Datura inoxia shoots grown in vitro in a medium containing these heavy metals.