Mechanic's Hand Heralding Relapse in an Indian Adolescent with Anti-MDA5 Positive Juvenile Dermatomyositis.

Anti-MDA5 antibodies characterise a distinct phenotype of dermatomyositis in adults as well as children, with ethnic disparity in clinical presentation and severity. They often present as a diagnostic conundrum with rash, ulceration, and polyarthritis, but minimal muscle disease. Mechanic's hands are typically associated with anti-synthetase syndrome, but their presence in anti-MDA5 antibody positive patients, although reported, is not well known. We present the case of a boy in whom mechanic's hand heralded a relapse of juvenile dermatomyositis which was suspected based on remotely assessed patient-reported outcome measures on teleconsultation. This report suggests that mechanic's hands should also prompt testing for myositis antibodies including anti-MDA5 in Indian children with JDM. Diligent awareness of the condition, and timely use of patient reported outcome measures of muscle power and skin assessment may guide management while delivering remote care in challenging situations such as a global pandemic.

Patients with idiopathic inflammatory myopathies suffer from poor self-reported PROMIS physical function after COVID-19 infection: an interview-based study from the MyoCite cohort

Background/Aims Patients with rheumatic diseases are known to exhibit worse outcomes with COVID-19. However, the effect on individual diseases such as idiopathic inflammatory myopathies (IIM) remain unexplored. Methods A self-report e-survey with 36 questions was pilot tested and validated to cover demographics, history of COVID-19 contact, course and severity of COVID-19 infection, influence of COVID-19 infection on physical state one-month after the infection and vaccination status. Baseline characteristics were retrieved from the MyoCite registry and biobank archive. PROMIS-10a, a validated self-report tool was used to quantify physical function. Age and gender similar healthy controls (HC) were included for comparison. Results 10 patients of IIM were compared with 40 controls. Fever was the most common symptom reported by both the groups however, fatigue, chest pain, and breathlessness were experienced more by patients of IIM compared to HC. However, severity of COVID-19 infection as substantiated by pneumonia, hospitalization, and oxygen requirement was comparable in IIM and HC, possibly due to small numbers PROMIS physical function was comparable before COVID-19 in both groups, and in HC physical function remained the same a month before and after COVID-19. On the other hand, the physical function deteriorated at 30-days after COVID-19 in the IIM group as compared with their baseline function as well as HC. Specific tasks were more challenging for IIM, including climbing stairs, bending or kneeling and shampooing hair, although the limitation was mild (Table 1). IIM patients were also less likely to be vaccinated, suggesting prevalent hesitancy in this group (50% vs 90%, p: 0.007) (Table 1). P070 Table 1: Comparison of physical health one-month after Covid-19 in IIM patients and HC and vaccination statusVariables1 month after covid-19 IIM (n-10)1 month after covid-19 HC (n-40)p-valueOverall physical health n (%) Excellent Very good Good Fair Poor1 (10%) 4 (40%) 0 3 (30%) 2 (20%)28 (70%) 5 (12.5%) 5 (12.5%) 2 (5%) 00.006 0.05 0.43 0.03 0.04Fatigue (median±IQR)4 (2-5.75)0 (0-1)Pain (median±IQR)1 (0-6.75)00.67Did your health limit you in doing vigorous activities n (%) Not at all Very little Somewhat Quite a lot Cannot do5 (50%) 1 (10%) 3 (30%) 1 (10%) 025 (62.5%) 8 (20%) 5 (12.5%) 2 (5%) 00.47 0.47 0.19 0.55 -Did your health limit you in walking more than a mile (1.6 km) n (%) Not at all Very little Somewhat Quite a lot Cannot do6 (60%) 0 1 (10%) 3 (30%) 027 (67.5%) 9 (22.5%) 2 (5%) 2 (5%) 00.65 0.21 0.55 0.03 -Did your limit you in climbing a flight of stairs n (%) Not at all Very little Somewhat Quite a lot Cannot do6 (60%) 0 3 (30%) 1 (10%) 027 (67.5%) 10 (25%) 2 (5%) 1 (2.5%) 00.65 0.18 0.03 0.31 -Did your health limit you in lifting or carrying groceries n (%) Not at all Very little Somewhat Quite a lot Cannot do7 (70%) 1 (10%) 2 (20%) 0 030 (75%) 7 (17.5%) 2 (5%) 1 (2.5%) 00.7 0.56 0.14 0.89 -Did your health limit you in bending, kneeling or stooping (%) Not at all Very little Somewhat Quite a lot Cannot do7 (70%) 0 3 (30%) 0 036 (90%) 3 (7.5%) 0 1 (2.5%) 00.12 0.004 0.02 0.89 -Were you able to do chores such as cleaning the floor or yard work n (%) Without any difficulty With a little difficulty With some difficulty With much difficulty Cannot do7 (70%) 0 1 (10%) 0 2 (20%)29 (72.5%) 6 (15%) 0 2 (5%) 3 (7.5%)0.87 0.36 0.12 0.84 0.64Were you able to dress yourself, including tying shoelaces and buttoning your clothes n (%) Without any difficulty With a little difficulty With some difficulty With much difficulty Cannot do8 (80%) 0 1 (10%) 1 (10%) 038 (95%) 2 (5%) 0 0 00.14 0.84 0.12 0.12 -Were you able to shampoo your hair n (%) Without any difficulty With a little difficulty With some difficulty With much difficulty Cannot do7 (70%) 1 (10%) 2 (20%) 0 040 (100%) 0 0 0 00.02 0.12 0.04 - -Were you able to wash and dry your body n (%) Without any difficulty With a little difficulty With some difficulty With much difficulty Cannot do9 (90%) 1 (10%) 0 0 040 (100%) 0 0 0 00 12 0.12 - - -Were you able to sit and get up from the toilet n (%) Without any difficulty With a little difficulty With some difficulty With much difficulty Cannot do8 (80%) 1 (10%) 1 (10%) 0 037 (92.5%) 1 (2.5%) 1 (2.5%) 1 (2.5%) 00.25 0.55 1 0.89 -Did you have any symptoms in the month before and after you got COVID19 n (%) None Rashes Generalized fatigue Muscle weakness Fingertip ulcers Oral ulcers Joint pain or swelling in hands Joint pain or swelling in other joints Chest pain Shortness of breath Raynaud’s Elevated muscle enzyme in blood (high creatine kinase level) Elevated inflammatory markers in blood (high ESR or CRP)4 (40%) 2 (20%) 3 (30%) 3 (30%) 1 (10%) 0 1 (10%) 1 (10%) 0 4 (40%) 0 4 (40%) 5 (50%)26 (65%) 0 7 (17.5%) 0 0 0 0 2 (5%) 0 0 0 - -0.15 0.04 0.38 0.02 0.12 - 0.12 0.55 - 0.009 – -Vaccinated n (%) Yes No5 (50%) 5 (50%)36 (90%) 4 (10%)0.007Type of vaccine n (%) Covishield Covaxin5/5 (100%) 027/36 (75%) 9/36 (25%)0.56Number of doses n (%) 1 23 (30%) 2 (20%)21 (52.5%) 19 (47.5%)0.2 0.1Received at least 1 dose before covid positive report n (%) Yes No0 10 (100%)21(52.5%) 19 (47.5%)0.03 Conclusion Patients with IIM exhibit increase in fatigue, and dyspnoea during COVID-19 although there is no increase in hospitalisation and had similar disease severity compared to HC. Short term physical function is impacted at 30-days post COVID-19, suggesting the need for closer long-term follow-up. Vaccine hesitancy is prevalent and merits addressing in patients with IIM. Disclosure R. Kharbanda: None. K. Ganatra: None. V. Agarwal: None. L. Gupta: None.

Modern Health Journalism and the Impact of Social Media.

Scholarly journals are hubs of hypotheses, evidence-based data, and practice recommendations that shape health research and practice worldwide. The advancement of science and information technologies has made online accessibility a basic requirement, paving the way for the advent of open access publishing, and more recently, to web-based health journalism. Especially in the time of the current pandemic, health professionals have turned to the internet, and primarily to social media, as a source of rapid information transfer and international communication. Hence, the current pandemic has ushered an era of digital transformation of science, and we attempt to understand and assess the impact of this digitization on modern health journalism.