Rheumatoid arthritis (RA) is a major health burden in Asia Pacific affecting the quality of life of patients and consuming healthcare resources. According to recent estimates from the World Health ...Organization‐International League Against Rheumatism‐Community Oriented Program for Control of Rheumatic Diseases, prevalence is around 0.3%‐0.5%. Management guidelines have helped to improve treatment across this diverse region. To gain better insight into current real‐world management applications in view of these guidelines, virtual meetings were conducted in mid‐2020 to explore perspectives of rheumatologists and patients, as well as discuss the impact of coronavirus disease 2019 on RA management. Patients and rheumatologists from Hong Kong, Malaysia, Singapore, the Philippines, Thailand, India, Pakistan, and Taiwan were included, representing a diverse mix of healthcare systems, wealth, ethnicity and culture. Despite many countries having prospered in recent years, similar challenges in RA diagnosis and treatment were identified. The daily impact and patient experience of RA were also similar across countries, marked by “silent” pain and disability, and universal misunderstanding of the disease. Late diagnosis and treatment, and barriers to access to appropriate treatment, remain problematic. The experience shared by Taiwan offers a glimmer of hope, however, wherein patient advocacy groups have succeeded in being included in policy‐making decisions and securing access to advanced treatment. Real‐world solutions that pay heed to the unique local needs and diversity of Asia Pacific are required to improve RA management, which will take time. In the interim, help can be sought from the trained, non‐rheumatologist community to reduce some of the disease burden.
Because of the dynamic nature of network traffic patterns, such as new traffic application arrivals or flash events, it is becoming increasingly difficult for conventional anomaly detection systems ...to separate various applications based on their traffic patterns. In this paper, by leveraging transport layer packet-level and flow-level features, new structures called application fingerprints are generated, which express such features in a compact and efficient manner. Based on the generated fingerprints, we propose a novel traffic classification framework. The proposed system generates profiles of normal applications using a multi-modal probability distribution. The proposed classification framework is then extended to detect distributed denial of service attacks from the collected statistical information at flow level. To demonstrate the feasibility of the proposed system, we evaluate its performance using five real-world traffic datasets. The experiment results show that the proposed method is capable of achieving an accuracy of over 97%, whereas the misclassification rate is only 2.5%.
In the study presented levofloxacin metal complexes were synthesized with transition metal ions (Mn
II
, Co
II
, Ni
II
, Cu
II
, and Zn
II
) and their structure was elucidated through elemental ...analysis. Further characterization of these complexes was performed by physiochemical and spectroscopic techniques (FT-IR,
1
H NMR). These investigations suggest that levofloxacin interacts with the metal ions as a monoanionic bidentate ligand bound to the metal through the pyridone and one carboxylate oxygen atoms having M(Levo)
2
(H
2
O)
2
·
n
H
2
O formula where M = metal ions. The antibacterial activity of the complexes was tested on eleven different microorganisms. The complexes showed either comparable or increased antibacterial profile in comparison to the parent. Moreover, the immunomodulatory activity of complexes was also tested by means of evaluating their effect on oxidative burst activity in whole blood phagocytes, measuring inhibition of (PHA)-induced T-cell proliferation and cytotoxicity.
The objective of this study was to evaluate the impact of vitamin D supplementation on hemoglobin levels (Hb) in patients with chronic kidney disease (CKD) undergoing hemodialysis. A systematic ...search was conducted in electronic databases (PubMed/Medline, Cochrane Library, and Google Scholar) from inception to April 21, 2023. Inclusion criteria were applied to select relevant studies. Statistical analyses were performed using Review Manager 5.4.1. A random-effects model was used to address heterogeneity, and the mean difference (MD) with the corresponding 95% confidence interval (CI) was reported. Ten studies were included in the analysis, comprising seven clinical trials, two randomized clinical trials, and one retrospective observational study. Subgroup analysis was conducted based on the duration of follow-up: 12 weeks, three months, six months, 12 months, 15 months, and 18 months. A significant increase in hemoglobin levels was observed after 12 months (MD = -0.98 95% CI -1.88, -0.08; p = 0.03; I2 = 91%) and 18 months (MD = -1.80 95% CI -2.56, -1.04; p < 0.00001; I2 = Not applicable). However, there was no statistically significant relationship between vitamin D supplementation and hemoglobin levels at 12 weeks, three months, six months, and 15 months. The pooled analysis demonstrated a significant increase in hemoglobin levels with vitamin D supplementation (MD = -0.61 95% CI -0.96, -0.26; p = 0.03; I2 = 60.7%). This analysis highlights the significant role of vitamin D supplementation in improving anemia in patients with CKD undergoing hemodialysis. Vitamin D supplementation was found to significantly increase hemoglobin levels, particularly after 12 months and 18 months of supplementation.
Background. Table olives are becoming well recognized as a source of probiotic bacteria that might be used to create a health-promoting fermented food product by traditional procedures based on the ...activities of indigenous microbial consortia present in local environments. Methodology. In the present study, the characterization of probiotic bacteria isolated from mince, chunks, and brine of fermented green and black olives (Olea europaea) was done based on morphological, biochemical, and physiological characteristics. Results. Bacterial isolates demonstrated excellent survival abilities at 25, 37, and 45°C and at a variable range of pH. However, the optimum temperature is 37 and the optimum pH is 7 for all three isolates. An antimicrobial susceptibility pattern was found among these isolates through the disc diffusion method. Most of the isolates were susceptible to streptomycin, imipenem, and chloramphenicol, whereas, amoxicillin showed resistance to these isolates, and variable results were recorded for the rest of the antibiotics tested. The growth of the isolates was optimum with the supplementation of 3% NaCl and 0.3% bile salt. The isolated bacteria were able to ferment skimmed milk into yogurt, hence making it capable of producing organic acid. Conclusion. Isolates of Lactobacillus crispatus MB417, Lactococcus lactis MB418 from black olives, and Carnobacterium divergens MB421 from green olives were characterized as potential candidates for use as starter cultures to induce fermentation of other probiotic food products.
Objective: To determine the short-term efficacy and safety of Secukinumab in Pakistani patients with ankylosing spondylitis and psoriatic arthritis in regular clinical practice.
Study Design: Case ...series.
Place and Duration of Study: Department of Rheumatology, National Hospital and Medical Centre, Lahore Pakistan from Aug 2019 to Feb 2021.
Methodology: Patients diagnosed with ankylosing spondylitis according to assessment of spondyloarthritis International Society criteria and psoriatic arthritis according to classification criteria for psoriatic arthritis (CASPAR), who were started on Secukinumab, were enrolled. Disease activity scores and adverse events were recorded in the 12th and 24th weeks. The primary outcomes were remission and low disease activity, and the secondary outcomes were the recording of Adverse events on each visit.
Results: There were 42 patients registered. The mean duration of disease was 11.86±7.31 years for AS and 9.19±4.87 years for PsA patients. At 24 weeks of follow-up, 10% of patients discontinued treatment, 73.7% of AS patients, and 94.7% of PsA patients achieved complete remission or low disease activity. No significant AEs were noted at 24 weeks, except for upper respiratory tract infections. One patient developed a lower respiratory tract infection after 24 weeks of treatment, and one died during treatment (possible myocardial infarction).
Conclusion: Secukinumab was effective and safe in patients with Ankylosing Spondylitis and Psoriatic Arthritis in this study,despite advanced disease with long disease duration.Keywords: Ankylosing spondylitis, Efficacy, Psoriatic arthritis, Safety, Secukinumab.
This article presents the design of a uni-planar MIMO antenna system for sub-6 GHz 5G-enabled smartphones. The MIMO antenna designed comprises four loop-shaped radiators placed at each corner of the ...mobile phone board, which follows the principle of pattern diversity. The single-antenna element resonates at 3.5 GHz, its impedance bandwidth is noted to be 1.28 GHz (3–4.28 GHz) for S11≤ −6 dB, and it is equal to 720 MHz (3.18–3.9 GHz) for S11≤ −10 dB. For a single-antenna element, a peak gain of 3.64 dBi is observed with an antenna efficiency of >90%. The isolation of >10 dB between antenna elements is achieved for the MIMO configuration. Furthermore, the MIMO antenna designed provides enough radiation coverage to support different sides of the mobile phone board, which is an important feature for future 5G-enabled handsets. In addition, the impacts of human hands and heads on MIMO antenna performance are investigated, and acceptable performance in the data and conversation modes is observed.
Background
This analysis aimed to evaluate the extent of treat-to-target (T2T) achievement after 1-year intensive treatment in patients enrolled to the APLAR SpA registry.
Methods
Patients who ...fulfilled the CASPAR2006 for psoriatic arthritis (PsA), and 2009ASAS criteria for axial spondylitis (AxSpA) were recruited. Current analysis included the first 143 patients reaching the 1-year timepoint across 7 Asia-Pacific regions (Hong Kong, Singapore, Korea, India, Pakistan, Qatar and Thailand).
Results
79 patients with PsA(age: 52±13 years, 43(55%) male, disease duration: 8.0±8.3 years) and 64 patients with AxSpA (age:41±16 years, 48(75%) male, disease duration: 4.8±7.2 years) were included. There were significant improvement in Disease Activity in Psoriatic Arthritis (DAPSA) (22.1±14.4 at baseline vs 11.5±10.0 at 1-year, p<0.001) while Ankylosing Spondylitis Disease Activity Score (ASDAS) remained stable. Other characteristics are listed in Table 1. Concerning the medication use, there was an increase in the number of patients receiving biologic/target synthetic disease-modifying drug (b/tsDMARDS, 29% at baseline to 61% at 1-year for PsA, and 52% at baseline to 64% at 1-year for AxSpA) (Fig. 1). Regarding T2T, 62% and 45% of PsA patient achieved DAPSA-low disease activity (DAPSA-LDA) and minimal disease activity (MDA) respectively, while 53% of patients with Axial SpA achieved ASDAS-LDA. The use of b/tsDMARDs was significantly higher in patient who achieved MDA when compared to those who did not (Fig. 1). The MDA/ASDAS-LDA achievement rate were comparable to that of the tight control arm of TICOPA cohort (41%) or TICOSPA study (60%) respectively. Treatment was escalated in 86% of visits when treatment target was not met. The reason for non-escalation of drug included: patients’choice (42%), mild symptoms only and physician decides to keep current regime (27%), adverse events (19%), no viable alternatives (8%) and others (4%).
Conclusions
Implementing the T2T strategy in patient with SpA was feasible in selected centres from the APLAR region, with similar target achievement rate compared to T2T studies conducted in Europe.
Background:
Studies have reported that female patients with spondyloarthritis have different disease courses and treatment responses compared to male patients. Whether patients’ sex is associated ...with a different outcome after receiving one-year of tight control, treat-to-target (T2T) strategy remains uncertain. Thus, this study aimed to evaluate the differences in the clinical response between male and female patients from the APLAR SpA Registry.
Methods:
Patients who fulfilled the CASPAR 2006 classification criteria for PsA and 2009 ASAS classification for axSpA were recruited. They received 1 year of protocolized treatment aiming at 1) MDA or DAPSA-LDA for PsA patients, and 2) ASDAS-LDA for axSpA patients. Patients were assessed every 3-monthly and treatment was escalated if target was not reached.
Results:
Ninety-one male (age: 45.6±16.1, 43 PsA, 48 axSpA) and 52 female (age: 49.2±13.4, 36 PsA, 16 axSpA) patients were included. There was no significant difference between the 2 sexes at baseline, except a higher ESR and more severe enthesitis in female patients. During the study period, the use of csDMARDs and NSAIDs decreased slightly, whilst the use of bDMARDs significantly increased across both sexes (Fig. 1a). Considering the whole cohort, there were significant improvement in disease activity in PsA after 1-year and disease activity in axSpA remained low. Despite similar bDMARDs use at 1-year, female PsA patients had a lower MDA achievement rate (36% in female vs 51% in male). Female patients also remained to have a higher physician global assessment score (2.61±1.76 in female vs 1.98±1.57 in male, p=0.03), greater functional impairment (HAQ: 0.54±0.57 in female vs 0.32±0.46 in male, p=0.01) and more severe enthesitis (SPARCC: 0.83±1.67 in female vs 0.16±1.09 in male, p=0.005) at 1-year. There was also a trend of higher perceived disease burden and peripheral involvement in female (Fig. 1b).
Conclusion:
There may be differential treat-to-target responses between male and female SpA patients. The causes of such differential characteristics should be further explored to potentially implement a sex-specific treat-to-target strategy for spondyloarthritis.
