Difference in clinical profile between juvenile onset and adult-onset systemic lupus erythematosus: a meta-analysis

The aim was to systematically review the studies that compared clinical and serological variation between adult-onset systematic lupus erythematosus (aSLE) andjuvenile-onset systematic lupus erythematosus (jSLE). A comprehensive literature search was done, in various available electronic databases for relevant publication that compared juvenile onset SLE and adult onset SLE. The data of adverse clinical features, serological profile and mortality were extracted. Juvenile onset was defined as 18 years. The methodological quality of study was assessed by Newcastle Ottawa scale (NOS) criteria and R version 3.3.1 was used for analysis and ORs and 95% CIs, were used as statistical parameter. A total of 14,920 patients; (12,230: aSLE, and 2,690: jSLE) were included. Renal involvement especially nephritis was significantly more in j-SLE OR: 2.18, 95% CI: [1.81;2.62]; I2=10.8% whereas musculoskeletal was significant in aSLE O.R: 0.64; C.I: [0.44; 0.93]; I2=83.4%. Seizure and malar rash were significantly higher in J-SLE OR:1.69, CI: [1.31; 2.18]; I2=31.1%,1.43; C.I [1.04; 1.97]; I2=82%, respectively. Raynaud’s phenomenon and pleuritis were significantly higher in adult onset SLE. Anemia and thrombocytopenia were significantly higher in juvenile onset SLE. Anti-ds DNA, anti-histone, and anti-ribosomal-P were more frequent in juvenile-onset SLE while, anti-Ro was more common in adult-onset disease. The cause of mortality was not significantly different in both groups. Renal biopsy of class III and IV combined and class V were significantly more in adult-onset SLE. SLEDAI was higher in j-SLE. Meta-analysis indicated that, regardless of many similar clinical and serological manifestations, there is still some variation between adult-onset SLE and juvenile-onset SLE. Although, SLE disease is continuum from juvenile to adult but disease aggressive in juvenile onset SLE

Qualification study of SiPMs on a large scale for the CMVD Experiment

A Cosmic Muon Veto (CMV) detector using extruded plastic scintillators is being designed around the mini-Iron Calorimeter (mini-ICAL) detector at the transit campus of the India based Neutrino Observatory, Madurai for the feasibility study of shallow depth underground experiments. The scintillation signals that are produced in the plastic due to muon trajectories are absorbed by wavelength shifting (WLS) fibres. The WLS fibres re-emit photons of longer wavelengths and propagate those to silicon photo-multipliers (SiPMs). The SiPMs detect these photons, producing electronic signals. The CMV detector will use more than 700 scintillators to cover the mini-ICAL detector and will require around 3000 SiPMs. The design goal for the cosmic muon veto efficiency of the CMV is >99.99%. Hence, every SiPM used in the detector needs to be tested and characterised to satisfy the design goal of CMV. A mass testing system was developed for the measurement of gain and choice of the overvoltage ($V_{ov}$) of each SiPMs using an LED driver. The $V_{ov}$ is obtained by studying the noise rate, the gain of the SiPM. This paper describes the experimental setup used to test the SiPMs characteristics along with detailed studies of those characteristics as a function of temperature.Comment: 16 pages, 20 figure

Randomized Clinical Trial of High-Dose Rifampicin With or Without Levofloxacin Versus Standard of Care for Pediatric Tuberculous Meningitis: The TBM-KIDS Trial

Background. Pediatric tuberculous meningitis (TBM) commonly causes death or disability. In adults, high-dose rifampicin may reduce mortality. The role of fluoroquinolones remains unclear. There have been no antimicrobial treatment trials for pediatric TBM. Methods. TBM-KIDS was a phase 2 open-label randomized trial among children with TBM in India and Malawi. Participants received isoniazid and pyrazinamide plus: (i) high-dose rifampicin (30 mg/kg) and ethambutol (R30HZE, arm 1); (ii) high-dose rifampicin and levofloxacin (R30HZL, arm 2); or (iii) standard-dose rifampicin and ethambutol (R15HZE, arm 3) for 8 weeks, followed by 10 months of standard treatment. Functional and neurocognitive outcomes were measured longitudinally using Modified Rankin Scale (MRS) and Mullen Scales of Early Learning (MSEL). Results. Of 2487 children prescreened, 79 were screened and 37 enrolled. Median age was 72 months; 49%, 43%, and 8% had stage I, II, and III disease, respectively. Grade 3 or higher adverse events occurred in 58%, 55%, and 36% of children in arms 1, 2, and 3, with 1 death (arm 1) and 6 early treatment discontinuations (4 in arm 1, 1 each in arms 2 and 3). By week 8, all children recovered to MRS score of 0 or 1. Average MSEL scores were significantly better in arm 1 than arm 3 in fine motor, receptive language, and expressive language domains (P < .01). Conclusions. In a pediatric TBM trial, functional outcomes were excellent overall. The trend toward higher frequency of adverse events but better neurocognitive outcomes in children receiving high-dose rifampicin requires confirmation in a larger trial. Clinical Trials Registration. NCT02958709

Mass testing of SiPMs for the CMVD at IICHEP

A Cosmic Muon Veto Detector (CMVD) is being built around the mini-Iron Calorimeter (mini-ICAL) detector at the transit campus of the India based Neutrino Observatory, Madurai. The CMV detector will be made using extruded plastic scintillators with embedded wavelength shifting (WLS) fibres which propagate re-emitted photons of longer wavelengths to silicon photo-multipliers (SiPMs). The SiPMs detect these scintillation photons, producing electronic signals. The design goal for the cosmic muon veto efficiency of the CMV is $>$99.99% and fake veto rate less than 10$^{-5}$. A testing system was developed, using an LED driver, to measure the noise rate and gain of each SiPM, and thus determine its overvoltage ($V_{ov}$). This paper describes the test results and the analysed characteristics of about 3.5k SiPMs