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Background:Clinical patterns and disease burden of PsA varies in different parts of the world. Demographic studies from Indian subcontinent are sparseObjectives:To study the cutaneous, articular profile of PsA and describe their disease activity, disability and co-morbidities (CMs)Methods:This is a multicenter, cross-sectional, non-interventional study from Karnataka, India. All consecutive PsA patients defined by CASPAR or expert diagnosis were evaluated over 8 months from 17 Rheumatology centers across Karnataka using standard parameters such as PASI, DAPSA, Indian version of HAQ-DI1, psoriatic co-morbidity index2 (Cidx) and MDA 5. Patient consent and EC obtainedResults:549 PsA patients were evaluated and their disease characteristics are shown in Table 1 & 2. PsA preceded psoriasis in in 81 (14.7%).Table 1.Patient characteristics (n=549)DEMOGRAPHICSPsACommonest age group of PsA (yrs)31-40PsA SubclassificationM:F6:5Symmetric polyarthritis216(40.7%)Type 1 PsoriasisType 2 Psoriasis279(55.8%)221(44.2%)Mean duration (yrs)Asymmetric oligoarthritis202(38.1%)Psoriasis8.8(±7.8)DIP predominant88(16.6%)PsA5.2(±6.3)Arthritis mutilans16(4.2%)PsA preceded psoriasis81(14.7%)Dactylitis182(33.9%)Family h/oPsoriasis107(19.7%)Enthesitis109(20.3%)PsA33(6%)Mean TJC686.3(±8.9)AS11(2%)Mean SJC683.5(±5.2)Uveitis5(0.9%)Type of PsoriasisPlaque253(59.9%)IBD3(0.5%)Erythrodermic 31(7.3%)Type I & II psoriasis did not differ in PASI, DAPSA, HAQ-DI or having a family h/o psoriasis. Type II psoriasis had higher Cidx than type I (p=0.0001). Pt pain VAS, DAPSA, PhyGA, PtGA & SJC significantly correlated with higher HAQ-DI (p<0.0001). TJC, ESR, CRP & PASI had minor correlation with HAQ-DI. Females had higher HAQ-DI compared to males (p=0.02). Knee joint involvement caused disability most frequently. Cidx was higher in males (p=0.008). Minor correlation was found between Cidx with age, HAQ-DI & DAPSA. Mean BMI of our cohort was 26.8(±14.8) kg/m2. 56.5% were overweight. Higher BMI was not associated with age, duration of arthritis, DAPSA, PASI, HAQ-DI & Cidx.Infections (any time) were recorded in 10.8%, of which skin was the commonest site in 38.9%; 30.5% of these needed hospitalizations.Conclusion:Despite mild skin disease in majority, more than half of the patients have moderate to severe joint activity. Mild to moderate functional disability in nearly half of our cohort indicate high burden of damage. High incidence of co-morbidities in PsA compared with general population is in line with published literature. In addition to aggressive control of articular activity, detection and control of co-morbidities must be an integral part of PsA management.References:[1]https://doi.org/10.1093/rheumatology/41.12.1457[2]http://dx.doi.org/10.1136/annrheumdis-2016-eular.4598Table 2.Disease characteristicsDISEASE ACTIVITYDISABILITYCO-MORBIDITIESMean PASI: 3.8(7.4)Mean HAQ-DI: 0.3(0.45)Mean Cidx: 0.98(1.6)Mild (PASI 0-5)480(80%)Mild-mod disability260(48.2%)N with 1 or more CMs232(42.3%)Severe (>10)57(10.6%)ADL with most frequent disabilityClimbing a flight of stairs 189(35%)HTNT2DMSmokingPsA severity19.8%16.6%5.4%3.2%Mean DAPSA: 18.8(16.6)ADL with highest disability scoreSitting cross-legged/squattingAnxietyIHDDyslipidemiaOthers3.1%2.3%2%<2% eachRemission100(19.9%)Low DA145(28.8%)Moderate DA137(27.2%)High DA123(24.5%)Family h/o CV dis/stroke72(15.2%)Disclosure of Interests:None declared

Background:Biologics have been the focus of recent treatment guidelines and ‘Treat to Target’ strategies for both psoriasis (PsO) & psoriatic Arthritis (PsA). However, in day-today practice, combination DMARDs anchored around methotrexate are mainstay in majority of patients.Objectives:To describe experience and effectiveness of Methotrexate in combination with conventional DMARDs in Karnataka Psoriatic Arthritis Cohort.Methods:Treatment information was extracted from KPsAC (n=549) which is a cross sectional, non-interventional study conducted across 17 rheumatology practicing centres in Karnataka, India using a structured proforma. This study was approved by respective Ethical committee. Information on efficacy was extracted for various csDMARDs in combination with methotrexate. Standard disease activity outcome measures were used for assessing the response to therapy (DAPSA, PASI, HAQ, MDA5). All participating rheumatologists underwent training to calculate PASI and other outcome scores.Results:Nearly half of the patients in our cohort were on methotrexate (44%) monotherapy. Proportion of patients who received combination csDMARD anchored on methotrexate were 29%. The choice of add on csDMARD was as per clinician discretion or subject preference. Patients were divided in to three groups based on treatments they were receiving at the time of study: Methotrexate (Mtx)+Leflunomide (Lef), Mtx+Sulfasalazine (SSz) and Mtx+Apremilast(Apr). Their characteristics along with outcome measures are depicted in table 1. In Mtx+Apr group: remission or low disease activity was present in 42%, HAQ score of <0.5 was seen in 82%, and only one patient had a PASI of > 10. PASI was significantly lower in the Mtx+Apr group compared to Mtx+Lef group (p<0.009) and Mtx +Ssz group (p < 0.020)Conclusion:Apremilast is an orally administered, small molecule inhibitor of phosphodiesterase 4 (PDE4)**. In this observational study, 3 groups of methotrexate plus csDMARD- leflunomide, sulphasalazine and apremilast fared similarly for articular domain of PsA. However, in cutaneous domain, PASI was significantly lower in apremilast + methotrexate group. To our knowledge, this is the first real life report of the use of combination DMARDs in unselected PsA patients demonstrating effectiveness of apremilast in cutaneous domain. Methotrexate remains anchor DMARD for treatment of PsA in 2/3rd of PsA patients. Addition of apremilast to methotrexate inadequate responders appears to be beneficial in PsA with persistent cutaneous disease. However, being an observational study, this needs to be confirmed in controlled clinical trials.References:** Apremilast: A Review in Psoriasis and Psoriatic Arthritis, Drugs March 2017, Volume 77, Issue 4.Table.Characteristics and comparison of combination csDMARDsMTX+SSZ(N=39)MTX+LEF (n=77)MTX+APR(N=45)Median Age (years)373935Median disease duration (months)96101112Enthesitis (Ever)6(15%)21(27%)4(8%)Dactylitis (Ever)9((23%)28(36%)12 (26%)DAPSA < 46(15%)9(11%)10(22%) 4-1414(36%)25(32%)13(29%) 14-287(18%)24(31%)11(24%)PASI >107(18%) #14(18%) *1(2%) *#HAQ < 0.530(77%)60(78%)37(82%)MDA 5 achieved16(41%)25(32%)19(42%)*P value < 0.009 #P value <0.02Disclosure of Interests:None declared

The power system utilities are increasing everyday,to enhance the distribution power quality and maintains the voltage stability is a challenging tasks in the complex distribution This can be achieved through the Distributed Generation (DG).DGs are the final link between the high voltage transmission and the consumers,it is also known as Active Distribution networks(ADN).This will effectively improve the acive power loss reduction This paper represents technique to minimize power losses in a distribution feeder by optimizing DG model in terms of size, location and operating point of DG. Sensitivity analysis for power losses in terms of DG size and DG operating point has been performed. The proposed sensitivity indices can indicate the changes in power losses with respect to DG current injection. The proposed technique has been developed with considering load characteristics and representing constant current model. The effectiveness of the proposed technique is tested and verified using MATLAB software on long radial distribution system.

The partitioning of N and utilization of C in various processes in chickpea (Cicer arielinum L.) was studied at 10 d intervals from 35 to 135 d after sowing (DAS). Dry matter, C and N content of the plant increased throughout the study period. The maximum amounts of C and N were fixed during the flowering and early fruiting phase (75–115 DAS) and the minimum during the seed filling phase (115–135 DAS). Efficiency of nitrogen fixation in relation to net C utilization and respiratory output of the whole plant, nodules and nodulated root, varied widely, but was maximum during 75–115 DAS. The crop experienced severe respiratory losses, particularly during the vegetative phase, when 83% of the total fixed C was lost in respiration. The crop produced 54·6 g of glucose units, 2·36 g of seed dry matter and 495 mg of seed protein. Possible reasons for the poor efficiency of chickpea, in terms of photosynthate utilization for dry matter and protein production are discussed.

Budgets for C and N were computed for pigeonpea (Cajanus cajan L.) at 15 d intervals, for the entire life cycle. Maximum C and N in dry matter was observed at 90 d after sowing. Of the plants total respiratory loss during the vegetative phase, shoots, roots and nodules accounted for 65%, 23% and 12%, respectively. During the reproductive phases, the respiratory burden of the roots increased, while that of shoots and nodules decreased. Total respiratory loss as a proportion of net photosynthate remained more or less constant until ‘flowering and pod-setting’ but increased heavily during seed filling, losing nearly 75% of the photosynthate in respiration. The efficiency of nitrogen fixation, in relation to respiratory output of the whole plant and nodulated roots, decreased during the period 60–90 d after sowing, while that of nodules decreased from day 45 onwards. Photosynthate supply to nodules and nodulated roots increased up to 75 d and 90 d after sowing, respectively. During 45–90 d, nodules were fixing a constant proportion of N per unit of C translocated (0.2 mg N mg−1 C). Nodulated roots, on an average, fixed 0.07 mg N mg−1 C translocated in the vegetative phase and this value decreased considerably during the subsequent phases. The crop produced during its life cycle 50.4 g of glucose equivalents and yielded 3.8 g seed dry matter and 0.8 g seed protein giving an average of 13.2 g g−1 seed dry matter and 62.8 g g−1 seed protein. Selection criteria for the improvement of C, N economy in pigeonpea have been suggested.

Levels of allantoin and allantoic acid in shoots, roots, nodules and leaves of pigeonpea plant, in general, followed the pattern of acetylene reduction in nodules, increasing progressively from 15 days after sowing (DAS) and attaining peaks at 75 DAS and 60 DAS, respectively, except in shoots where their contents evinced maximum values at pod-setting (90 DAS). Activity of GS in nodules and shoots reached a maximum at 60 DAS and 75 DAS, respectively. However, in leaves and roots, the enzyme showed a biphasic behaviour with peaks at days 60 and 105 in leaves and at days 75 and 105 in roots. GDH activity in nodules peaked at 60 DAS, whereas, in leaves and roots, the maximum activity was observed at flowering (75 DAS). Uricase was present only in nodules with peak activity at flowering. Allantoinase activity again peaked at flowering, where nodules had maximum activity followed by leaves, roots and shoots. Urease could be detected in all the organs with maximum activity at 60 DAS in leaves followed by roots and nodules. Except uricase, all the enzymes reported above were also present in reproductive structures. Compared to GS, GDH was more active both in flower buds and developing pods. Seeds, compared to podwalls, contained higher activities of GDH, allantoinase and urease at day 105. Only allantoin could be detected in seeds and podwalls at day 105.