ABSTRACT
Background: Patients with systemic lupus erythematosus (SLE) are at an increased risk of infection relative to the general population. We aimed to describe the frequency and risk factors for serious infections in patients with moderate-to-severe SLE treated with rituximab, belimumab, and standard of care therapies in a large national observational cohort. Method(s): The British Isles Lupus Assessment Group Biologics Register (BILAG-BR) is a UK-based prospective register of patients with SLE. Patients were recruited by their treating physician as part of their scheduled care from 64 centres across the UK by use of a standardised case report form. Inclusion criteria for the BILAG-BR included age older than 5 years, ability to provide informed consent, a diagnosis of SLE, and starting a new biological therapy within the last 12 months or a new standard of care drug within the last month. The primary outcome for this study was the rate of serious infections within the first 12 months of therapy. Serious infections were defined as those requiring intravenous antibiotic treatment, hospital admission, or resulting in morbidity or death. Infection and mortality data were collected from study centres and further mortality data were collected from the UK Office for National Statistics. The relationship between serious infection and drug type was analysed using a multiple-failure Cox proportional hazards model. Finding(s): Between July 1, 2010, and Feb 23, 2021, 1383 individuals were recruited to the BILAG-BR. 335 patients were excluded from this analysis. The remaining 1048 participants contributed 1002.7 person-years of follow-up and included 746 (71%) participants on rituximab, 119 (11%) participants on belimumab, and 183 (17%) participants on standard of care. The median age of the cohort was 39 years (IQR 30-50), 942 (90%) of 1048 patients were women and 106 (10%) were men. Of the patients with available ethnicity data, 514 (56%) of 911 were White, 169 (19%) were Asian, 161 (18%) were Black, and 67 (7%) were of multiple-mixed or other ethnic backgrounds. 118 serious infections occurred in 76 individuals during the 12-month study period, which included 92 serious infections in 58 individuals on rituximab, eight serious infections in five individuals receiving belimumab, and 18 serious infections in 13 individuals on standard of care. The overall crude incidence rate of serious infection was 117.7 (95% CI 98.3-141.0) per 1000 person-years. Compared with standard of care, the serious infection risk was similar in the rituximab (adjusted hazard ratio [HR] 1.68 [0.60-4.68]) and belimumab groups (1.01 [0.21-4.80]). Across the whole cohort in multivariate analysis, serious infection risk was associated with prednisolone dose (>10 mg;2.38 [95%CI 1.47-3.84]), hypogammaglobulinaemia (<6 g/L;2.16 [1.38-3.37]), and multimorbidity (1.45 [1.17-1.80]). Additional concomitant immunosuppressive use appeared to be associated with a reduced risk (0.60 [0.41-0.90]). We found no significant safety signals regarding atypical infections. Six infection-related deaths occurred at a median of 121 days (IQR 60-151) days from cohort entry. Interpretation(s): In patients with moderate-to-severe SLE, rituximab, belimumab, and standard immunosuppressive therapy have similar serious infection risks. Key risk factors for serious infections included multimorbidity, hypogammaglobulinaemia, and increased glucocorticoid doses. When considering the risk of serious infection, we propose that immunosupppressives, rituximab, and belimumab should be prioritised as mainstay therapies to optimise SLE management and support proactive minimisation of glucocorticoid use. Funding(s): None.Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
ABSTRACT
Coronavirus or Covid-19 is a new kind of viral respiratory tract disease which was declared as a lethal pandemic for the world. COVID-19 affects different people in different ways. The most common symptoms include fever, sore throat and dry cough. But some patients are asymptomatic also which somehow increases the risk for transmission. More than 210 countries are currently facing this disease and are fighting from COVID-19 but better approaches of diagnostics and medical facilities have helped some countries to recover at some extent. Some vaccines are under development for SARSCoV-2 infection and once it will be approved and available for human use, it will help a lot in controlling this pandemic.
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Background/Aims Vaccination against coronavirus is a cornerstone in the fight against the COVID-19 pandemic. Although the safety and efficacy of vaccines was established prior to roll out, long-term data and reports of rare adverse reactions remain inadequate. Literature reviews revealed two cases of PMR-like syndrome, left elbow arthritis and a case of rheumatoid arthritis (RA) flare following COVID-19 vaccination. Additionally, a case of new onset RA and case of reactive arthritis was reported with COVID infection. Methods We present four patients with polymyalgia rheumatica (PMR) following COVID-19 vaccination. The clinical details of the four patients are outlined in the table: Ultrasound (US) revealed typical finding of bilateral sub deltoid bursitis and biceps tendonitis in the first patient and there was severe right sub deltoid bursitis with biceps tendonitis in the second patient. None of the patients had features to suggest malignancy, giant cell arteritis, seronegative spondyloarthropathies or connective tissue disease. Results After exclusion of other inflammatory causes of shoulder pain, they were diagnosed with PMR based on clinical judgement and high inflammatory marker at time of presentations, ultrasound findings and significant improvement with prednisolone. Conclusion PMR following COVID-19 vaccination is exceptional and cannot be proven. In these patients post vaccination chronology of events favours this diagnosis. It is known that immunological illness may start after viral infection or vaccination (hapten or immune stimulation). The patients have responded well to the prednisolone similar to typical PMR cases. We need further studies to look at possible link between COVID-19 vaccination and PMR.
ABSTRACT
The COVID-19 pandemic has already spread over 200 countries in a few months and taken a toll on many lives. At this critical time, there is a need to follow some precautions to control the virus spreading rapidly through direct and indirect contact. The World Health Organization (WHO) has already recommended the importance of face masks for protection from the virus. Hence, one of the prime changes we have had to incorporate in our lives is wearing a face mask. This work reports the development of Ag particles containing polydimethylsiloxane (PDMS) based e-skin sensor, which generates signals on touch (contact mode) or proximity (non-contact mode) near the sensor. These signals are retrieved using IoT. The signals indicate a person's presence, which activates face mask detection using deep learning. This model is an IoT and Machine Learning-based system. When a human touches or places a hand near the PDMS-Ag sensor, this model performs face masks detection. This model is also suitable for security purposes. Since controlling the number of new COVID-19 cases is the need of the hour, we are using face mask detection in this study. © 2021 IEEE.
ABSTRACT
Background We report a patient with COVID 19 who presented with STEMI and high thrombus burden, needing intracoronary (IC) alteplase infusion and subsequent PCI. Case 55 year old female with past history of diabetes, CVA (8 years back), recently diagnosed COVID 19 who presented to ED with chest pain for 18 hours. She was noted to have ST elevation in anterolateral leads and was taken for emergent angiogram. Angiogram showed large ostial LAD thrombus with thrombotic occlusion of distal LAD1. Decision-making Considering thrombus burden, several runs of aspiration thrombectomy was performed followed by balloon dilation. No distal flow was noted. Subsequently, 2 mg IC alteplase was infused twice, followed by thrombectomy. Repeat angiogram showed TIMI 0 flow. Intracoronary ultrasound (IVUS) was performed which showed heavy thrombus burden with no plaque rupture. PTCA of ostial LAD was performed afterwards with 4.0 x 15 mm compliant balloon. Thrombus was persistently noted in ostial LAD with TIMI 0 flow distally. She was started on aspirin, ticagrelor, heparin drip and 12 hour tirofiban infusion. 24 hours later she was taken back to the cath lab due to on and off chest pain and persistent ST elevation on EKG. Repeat angiogram showed persistent ostial LAD thrombus with TIMI 2 distal flow. PCI of ostial LAD was subsequently performed with excellent final result2. Conclusion IC alteplase can be considered in COVID patients with STEMI who have high burden burden when conventional measures fail to establish adequate flow. [Formula presented]