ABSTRACT
BackgroundAnti-synthetase syndrome (ASS) is a rare auto-immune condition that combines autoantibodies and specifics clinical manifestations, including myositis, interstitial lung disease (ILD), polyarthritis, mechanic's hands, Raynaud's phenomenon, and unexplained fever. The hallmark of this syndrome is the presence of anti-aminoacyl-tRNA-synthetase (ARS) antibodies. Several anti-ARS antibodies have been described, anti-Jo1 being the most common, followed by anti-PL7, anti-PL12, anti-OJ, anti-EJ, anti-KS, anti-YRS, and anti-Zo. According to a recent epidemiological survey, the rising number of patients with autoimmune diseases, including idiopathic inflammatory myopathies (IIM) coincides with the COVID-19 pandemic.ObjectivesTo evaluate the clinical characteristics of ASS patients with different anti-ARS antibodies from a tertiary rheumatology center.MethodsWe conducted a retrospective, single-centered study on consecutive patients diagnosed with ASS from 1 January 2015 to 31 December 2022. Clinical and serologic data were obtained by medical records review from hospital database. Myositis-specific antibodies (MSA) and myositis-associated antibodies (MAA) were tested using commercial ELISA kits. We included all patients fulfilling Connor's criteria for ASS.ResultsSixty-one patients (44 females) with mean age 54.4 (13.8) years were included. The most frequently reported clinical manifestation was arthralgia (68.8%), followed by Raynaud's phenomenon (67.2%), ILD (65.6%), myositis (46%), mechanic's hands (44.3%), arthritis (39.3%), and fever (18.0%). The typical triad for ASS, including myositis, arthritis and ILD was present in 17 patients. Twenty-eight (45.9%) patients were PL7+, 21 (34.4%) were Jo1+, 3 (4.9%) were PL12+, and 2 (3.2%) were OJ+. Seven patients were positive for more than two anti-ARS antibodies. The most frequently found MAA was anti-Ro52 (n=23, 37.7%). Of the 61 patients included, 41 (67.2%) patients were diagnosed in the last 3 years (COVID-19 pandemic). The most frequently detected MSA in ASS patients diagnosed during COVID-19 pandemic was anti-PL7 (25/28), while anti-Jo1 was the most common MSA in ASS patients diagnosed before 2020 (p<0.05) (Fig 1).The anti-Jo1+ patients were younger, have significantly more frequent muscle involvement and significantly higher levels of CK than anti-PL7+ patients (p<0.05). The co-occurance of anti-Ro52 antibodies was more frequently observed in anti-Jo1+ patients (n=11, 52.4%) than in anti-PL7+ patients (n=6, 21.4%) (p<0.05). We did not find statistically significant differences between ASS groups regarding sex, disease duration, clinical manifestations including dermatologic lesions, Raynaud's phenomenon, arthralgia/arthritis, ILD, fever, and cancers (all p>0.05).ConclusionASS patients have heterogenous manifestations, and different types of anti-ARS antibodies are associated to distinct clinical and immunological features. The COVID-19 pandemic led to increase prevalence of ASS cases and to a remarkable shift in the anti-ARS antibodies profile, with increased frequency of anti-PL7 antibodies. Further studies are needed to investigate the link between SARS-CoV-2 infections and myositis.References[1]Witt LJ, et al. The Diagnosis and Treatment of Antisynthetase Syndrome. Clin Pulm Med. 2016 Sep;23(5):218-226.[2]Gracia-Ramos AE, et al. New Onset of Autoimmune Diseases Following COVID-19 Diagnosis. Cells. 2021 Dec 20;10(12):3592.[3]Connors GR, et al. Interstitial lung disease associated with the idiopathic inflammatory myopathies: what progress has been made in the past 35 years? Chest. 2010 Dec;138(6):1464-74.[4]García-Bravo Let al. Association of anti-SARS-COV-2 vaccine with increased incidence of myositis-related anti-RNA-synthetases auto-antibodies. J Transl Autoimmun. 2022 Jun 30;5:100160.Figure 1.ASS patients with positive anti-ARS antibodies per year (from 2015 to 2022). The green line shows the PL7+ patients;and the orange line shows the Jo1+ cases.[Figure omitted. See PDF]AcknowledgementsI have no acknowledgements to declare.Disclosure of Inter stsNone Declared.
ABSTRACT
Background This paper describes the development and implementation of a unique laparoscopic suturing course in a resource-constrained setting and reviews the initial experience with the program. Methods This study describes the development of Grey's laparoscopic suturing course (GLSC) and reviews the questionnaires and feedback over the past year. Results The GLSC has been run for over a year and has enrolled 47 participants. Most participants were registrars, followed by consultants and medical officers, and most participants had limited minimal access surgery (MAS) experience. Only three had previously undertaken a formal course or observership. The mean result for the pre-course test was 50%, and for the post-course test, 88%. During the skills laboratory session, every participant competently performed intra-corporeal suturing. The entire group unanimously agreed that the GLSC should be recommended for all surgical trainees in the evaluation form. All participants expressed interest in an advanced MAS course. Conclusion We have demonstrated that developing a local MAS suturing course with limited resources and industry support during the Covid 19 pandemic is possible. It has benefited a large group of trainees thus far and hopefully will become part of the curriculum of surgical trainees in South Africa.
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Introduction: Patients on dialysis are a great risk of acquiring COVID-19 infection, with higher mortality rates. We compared the outcomes and mortality of first and second waves of COVID-19 in dialysis patients hospitalized in a Peruvian hospital Methods: This is an observational, analytic, retrospective cohort study of patients with ESKD on KTS hospitalized from March 2020 to June 2021. Peru's first pandemic wave started from March to August 2020 and the second wave began from December 2020 to June 2021. Patient demographics and clinical features were collected from the Hospital Nacional Alberto Sabogal Sologuren electronic medical record. We evaluated the survival in the first year post-COVID-19 of discharged patients Results: Out of the 310 ESKD patients who had COVID-19, 61.94% (192) were male, and the mean age was 63.75 years. The most frequent comorbidities were arterial hypertension in 86.8% (269), diabetes mellitus in 46.1% (143), obesity in 5.2% (16), and cardiovascular disease in 10.3% (32). There were 1.94% on peritoneal dialysis and 98.06% on hemodialysis. COVID-19 diagnosis was by molecular PCR in 16.1%, antigen swab test in 17.42%, serological test in 35.81%, and radiological clinical criteria in 30.65%. At admission, the average oxygen saturation was 88.94% (40-99) with a PaFi of 245.52% (38-681). 56.77% (176) used reservoir masks, 26.8% binasal cannulas, and 2.9% mechanical ventilators. The average hospitalization time was 11.67 days and the average number of dialysis sessions was 3.78 (0-25). Up to 25.81% (80) of the patients had an indication for ICU management, however, only 3.23% (10) received it. Up to 48.71% (151) died during hospitalization, of which 90% (9) were in the ICU and 75% (60) had an indication for ICU management but did not receive it. The risk of death of patients with an ICU indication is 1.9 higher than those who did not have an indication. (CI: 1.57 - 2.38) Patients were admitted with intermediate ISARIC4C scores of 8.1% (25), high 53.5% (166), and very high 37.7% (117). Of which 20% (5) died with an intermediate score, 39.2% (65) with a high score, and 68.4% (80) with a very high score. (p=0.001) 67.5% (102) of the deceased were male (p=0.047) and the risk of death for males versus females is 1.59 (CI: 1.004 - 2.536). In the first wave, 176 ESKD patients who had COVID-19 were registered between March and August 2020. In the second wave, 134 ESKD patients were registered between December 2020 and May 2021. Mortality between the first and second waves was 50% (88) in the first and 45.5% (61) in the second (p=0.43). Regarding the evolution after one year of patients who were discharged (159), mortality was 22% (35), with the main causes being cardiovascular diseases (28.5%), and acute respiratory failure (25.7%). and infectious (22.8%). [Formula presented] Conclusion(s): COVID-19 had devastating outcomes for vulnerable groups such as ESKD patients. In our study, we demonstrated higher mortality (48.1%), particularly in the male sex. The ISARIC4C score represented a higher mortality risk with a higher score level. No conflict of interestCopyright © 2023
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Background: In the context of the coronavirus (SARS-CoV-2) pandemic, several studies looked at the relation between rheumatic disease and SARS-CoV-2. It remains unclear whether these patients are at increased risk of developing more severe cases of coronavirus disease (COVID-19) or not. Objectives: The objective of this descriptive study is to report the characteristics and outcomes of rheumatic patients that had a history of confirmed SARS-CoV-2 infection. Findings have also been compared to some of the existing publications on COVID-19 in these patients. Methods: Between November 17, 2020 and January 18, 2021, a single-centre observational study was conducted in the rheumatology department of the Emergency Clinical County Hospital and the University of Medicine and Pharmacy Iuliu Hatieganu in Cluj-Napoca, Romania. The sample consisted of 62 rheumatic patients with a positive polymerase chain reaction test from nasopharyngeal/oral swab. Data on both systemic autoimmune disease and COVID-19 was collected using a survey, by means of telephone or in the outpatient clinic setting. Data on the patient rheumatologic condition was also collected from the electronic health records available within our department Results: 62 patients were included, with 85.48% females and 14.51% males, and a median age of 52 years (SD +/-14). The most frequent comorbidities were high blood pressure (HBP) 46.77%, dyslipidaemia 19.35%, liver disease 17.74%, and interstitial lung disease (ILD) 12.90%. Recurrent COVID-19 symptoms included: cough (62%), fever (46,77%), anosmia (46.77%), ageusia (30.64%), headache (29.03%), gastrointestinal symptoms (27.41%) and myalgia (25.80%). Out of the entire 62 sample, 41 patients had an inflammatory arthritis (IA) diagnosis, with the most frequent being rheumatoid arthritis (RA) -68.29%, followed by ankylosing spondylitis -21.95%, psoriatic arthritis -7.31% and 2.43% with Still disease. Only 10 patients suffered from connective tissue disease (CTD): 3 systemic lupus erythematosus, 2 poli/dermatomyositis, 2 Sjogren syndrome (SjS), 2 mixed connective tissue disease, 1 systemic sclerosis (SSc). Another 10 patients had overlapping syndromes with the most frequent (40%) overlap between RA and SSc. One patient had osteoarthritis. 49 patients followed a treatment with conventional synthetic disease-modifying anti-rheumatic drugs with 51.2% of them being treated with Methotrexate. 14 of our patients received glucocorticoids (GC), but no relation between the GC dose and COVID-19 severity could be observed. Only 3 patients with doses greater than 10mg/day were present in the cohort and 2 developed mild while 1 developed an asymptomatic COVID-19 course. 22 patients had received biological treatment. Anti TNF alpha medication was administered to 13 of these, and mostly consisted of Adalimumab, Etanercept and Golimumab. The anti TNF alpha patients were asymptomatic or had mild forms of COVID-19 (93.30%). 8 cases had ILD: 3 RA patients, 3 overlapping syndromes, 1 SSc and 1 SjS. The median age was 59,5 years (SD +/-10). 25% exhibited severe, 37,5% moderate, 25% mild and 12.5% asymptomatic COVID-19. The COVID-19 severity in our sample was as follows: 12.90% of the patients were asymptomatic, 59.67% exhibited a mild form, 19.35% a moderate one, and out of the 8.06% with a severe case of COVID-19, 1 patient died. The median age in the severe cases of COVID-19 was 66 years (SD +/-12) and HBP was the most common comorbidity. Conclusion: Most patients in this sample were either asymptomatic or had a mild COVID-19 evolution. Although the research design has multiple limitations, rheumatic pathology does not seem to be a higher risk factor for severe COVID-19 than other associated comorbidities. With that in mind, ILD patients should be closely monitored as even in on our limited sample size a worse evolution of COVID-19 has been observed. Biological treatments, especially anti TNF alpha might help in reducing the severity of COVID-19, but this outcome could have been associated in our sample with other factors like lower media age and less comorbidities.