COVID-19 Vaccine Hesitancy in Systemic Lupus Erythematosus – Experience From a Tertiary Care Rheumatology Centre in South India

Background: Patients with rheumatological diseases like SLE are at an increased risk of COVID-19 infection and hence should be prioritized for vaccination. Vaccine hesitancy is a major hindrance in achieving herd immunity against COVID-19. In this study, we aim to determine the COVID-19 vaccination rate in our SLE population and the factors associated with vaccine hesitancy. Materials and methods: We conducted an interview-based cross-sectional study on patients >18 years attending the lupus clinic of our Institute. Questionnaires were used to collect demographic details, disease status, vaccination-related data, and information regarding attitude and beliefs about COVID-19 vaccination. Descriptive statistics were used for analysis. Results: Of the 584 patients studied, the vaccination rate was 67%, and there was vaccine hesitancy of 21%, and vaccine resistance of 12%. Non-vaccination was strongly associated with older age, rural living, unemployment, and in patients with anti-phospholipid antibodies, prior stroke, prior COVID- 19 infection, and those who were currently using corticosteroids. The major reasons for vaccine hesitancy were fear of worsening lupus, fear of side effects, and religious reasons. We also came to know about various misconceptions regarding COVID vaccination prevalent among SLE patients under our follow-up causing them to opt against the vaccine. The vaccine-hesitant group may rethink their decision if there is proper reassurance and guidance from their treating physician or if more friends and family members start accepting vaccines. Conclusions: Vaccine hesitancy is a major problem in our group of SLE patients keeping the vaccination rates low. The reasons for vaccine hesitancy must be looked into and addressed to improve the vaccination rates and thereby achieve herd immunity. Proper guidance from the treating rheumatologist was reported as the major factor which may encourage the vaccine-hesitant population to opt in for the vaccination.

Idiopathic abdominal cocoon: An enigma

Abdominal cocoon is often described by various terminologies like encapsulating peritoneal sclerosis (EPS) or sclerosing encapsulating peritonitis or peritonitis chronica fibrosa incapsulata is defined as syndromes associated with symptoms due to formation of a fibro-collagenous peritoneal membrane involving commonly the small intestinal loop. Clinical presentation ranges from abdominal pain to features of intestinal obstruction which may be acute or sub-acute. It is believed to be mesenchymal transition of mesothelial cells. This condition is commonly associated with tuberculosis, peritoneal dialysis and previous abdominal surgeries but may also be idiopathic. Though a wide range of medical management has been tried for conservative management of the patient, surgery is the preferred choice of treatment to alleviate the persisting symptoms. This is one condition where on table intra op diagnosis supersedes the imaging and histological diagnosis. Here, we discuss the case report of 32 year old male, known diabetic for 4 years, who presented with complaints of abdominal pain, intermittent for over 5 years, with no evidence of intestinal obstruction. Imaging showed abdominal cocoon of small bowel loops and mid gut rotation anomaly with internal hernia. Laparoscopically the cocoon sac was removed and adhesiolysis was done. This case report is to add richness to limited amount literary resources available about abdominal cocoon syndrome.

Clinicoradiological profile of extra axial intracranial tumors

Background: Extra-axial tumors are the most common adult intracranial neoplasms. Meningiomas are the most common Extra-axial tumors. Their Clinical presentation, survival rates, and prognosis vary depending on the site and specific type of tumor, hence necessitating a detailed clinical and radiological evaluation. Materials and methods: A prospective observational study on 15 symptomatic subjects who presented to a tertiary care hospital with Supratentorial intracranial tumors confirmed by CT was done. After getting a detailed history, clinical examination and CT (including contrast) were done. Results: In the study population, 73% had meningioma. 13% had a Pituitary Adenoma. 13% had craniopharyngioma. A headache was the most commonly reported symptom (73%). Majority of meningiomas were located in convexity of the brain (36.4%) and parasagittal areas (36.4 %). Conclusions: Neuroradiology plays a key role in the identification of supratentorial extra-axial tumors with CT allowing accurate anatomical description which can go a long way in management and defining prognosis.

Cloning and sequencing of 28 kDa outer membrane protein gene of Brucella melitensis Rev. 1.

Brucella melitensis is an organism of paramount zoonotic importance. The 28 kDa outer membrane protein (OMP) is one of the immunodominant antigens of B. melitensis. The gene encoding 28 kDa OMP (omp28) has been amplified from B. melitensis Rev. 1 strain. A PCR product of 753 bp, encoding complete omp28 gene of B. melitensis, was obtained. The gene was further cloned and sequenced. The nucleotide sequence of B. melitensis Rev. 1 strain showed substitution of 2 nucleotides from that of 16M strain.