ABSTRACT
Background: Confinement and economic uncertainty, along with disease-specific issues such as pain and suffering may uniquely impact rheumatology patients, putting non-COVID morbidity at par with COVID-related losses.Methods: We conducted a review of records to explore the clinical profile and interventions in rheumatology patients at a tertiary care center in Northern India to identify the potential problems and propose direction for the future.Results: In our experience spanning 5 weeks, among 508 rheumatology patients who sought teleconsultations, rheumatoid arthritis was the most common diagnosis (35.2'), and 43' were asked to continue the same treatment over tele consults, whereas investigations were awaited for another 16'. Nearly one-third (29.9') required an intervention, though this largely consisted of dose titrations (104 of 152, 68.4'). Certain diseases such as myositis were under-represented among consults (1.2') but over-represented (33.3') among admissions. Among the 54 patients who were asked to rate their teleconsultation experience, the voice and consultation quality were rated and average of 9.9 each, and 88.9' (48/54) said they would prefer teleconsultations until the pandemic is over.Conclusion: A sizeable proportion of rheumatology patients can be managed with teleconsultations, with some requiring greater assistance, calling for a triage protocol for the times ahead. With propositions for a deliberate transition into the realm of virtual consulting, chronic caregivers can hope to reach an optimal balance between e-consults and in-person visits.
ABSTRACT
Publication metrics enable the assessment of the performance of citations or utilization of published work. Journal-level metrics depend on the database whose citations are analyzed. Publication metrics from the Web of Science include the widely-used journal impact factor (JIF) and other indices such as Journal Citation Impact, Eigenfactor, normalized Eigenfactor, and Article Influence Score. Metrics from Scopus include the CiteScore, Source Normalized Impact Factor, and SCImago Journal Rank. Author-level metrics such as total citations, h-index, i10-index, and g-index inevitably increase with time and can be inflated by self-citations. Article-level metrics such as total citations and online attention scores derived from Scopus (PlumX Metrics) or Altmetric indicate the extent of utilization and discussion in scientific circles of a particular article. Publication metrics are useful to provide a bird's eye view of how well an individual journal or article has been cited or used. They do not necessarily reflect article quality. As an example, some of the articles with the highest Altmetric Attention Scores are actually retracted publications that attained high scores due to the negative debate that they elicited. Journal-level metrics such as the JIF are fluid and prone to historical fluctuations from year to year, most recently observed by increases in the JIF of journals which published a lot of coronavirus disease 19-related content. Research assessment of individual scientists often misuses publication metrics such as the JIF, when they should instead rely on a critical appraisal of research articles by assessors.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
ABSTRACT
Aim/Introduction: COVID-19 can cause lung dysfunction postinfection. Respiratory complications are critical sequelae of severe COVID-19 infection and several patients suffer from PCLD after testing RT-PCR negative. Interleukin-6 (IL-6) acts as a key cytokine playing a role in inflammation in lung and other tissues in COVID-19. IL-6 level is increased in patients with non-specific interstitial pneumonia/fibrosis. Injured lungs are major source of IL- 6. Studies have shown association between IL-6 and development of lung injury evaluated by CT scan. Persistent 18F-FDG uptake in lung parenchyma is seen in PCLD patients indicating residual inflammation. Thus the study aimed to evaluate the metabolic activity of lung disease on FDG PET/CT and correlate it with IL-6 in PCLD patients. Material(s) and Method(s): The study was approved by Institutional Review Board and Ethics committee. 32 patients having persistent (>4 weeks) respiratory symptoms post-acute COVID-19 infection after testing RTPCR negative (PCLD) underwent 18F-FDG PET/CT. Simultaneously blood sample was collected on the day of the FDG PET/CT scan in EDTA vial before FDG injection. Serum level of IL-6 was measured by ELISA. FDG PET/CT images were analyzed and SUVmax of metabolic active lung lesions were calculated. The FDG PET/CT findings were correlated with IL-6 using PSM correlation test. Result(s): The mean age of patients (n = 32) was 55.7 years (range 36-71 years) of which 25 were males. 13 (41%) patients had dyspnoea at rest while the remaining had dyspnoea on exertion (59%). Similar age and gender-matched healthy controls were included in our study. All patients had bilateral ground-glass opacities (GGO) in the lung parenchyma. Out of 32 patients, 30 (94%) had a metabolically active lesion in the bilateral lung parenchyma. The mean SUVmax was 3.6 (range 2 - 12.7) and the median was 2.7. Corresponding CT had extensive lung disease including bilateral GGO seen in all patients, consolidation (n=14), and interstitial thickening (n = 20), with more than one feature in some. The Median IL-6 level was significantly higher in patients suffering from PCLD compared to healthy control (326.96 vs 281.5, p=0.0023). Serum IL-6 strongly correlated with SUVmax score of PCLD (r=0.675). The patients were treated with steroids and antifibrotic as per institute's protocol. Conclusion(s): PCLD with ongoing active inflammation as detected by 18F-FDG PET/CT is noted in patients with persistent pulmonary symptoms and it correlates strongly with elevated IL-6 levels. This may play a role in future to monitor the patient with prolonged disease.
ABSTRACT
Coronavirus disease 2019 (COVID-19) is a global pandemic where several comorbidities have been shown to have a significant effect on mortality. Patients with diabetes mellitus (DM) have a higher mortality rate than non-DM patients if they get COVID-19. Recent studies have indicated that patients with a history of diabetes can increase the risk of severe acute respiratory syndrome coronavirus 2 infection. Additionally, patients without any history of diabetes can acquire new-onset DM when infected with COVID-19. Thus, there is a need to explore the bidirectional link between these two conditions, confirming the vicious loop between “DM/COVID-19”. This narrative review presents (1) the bidirectional association between the DM and COVID-19, (2) the manifestations of the DM/COVID-19 loop leading to cardiovascular disease, (3) an understanding of primary and secondary factors that influence mortality due to the DM/COVID-19 loop, (4) the role of vitamin-D in DM patients during COVID-19, and finally, (5) the monitoring tools for tracking atherosclerosis burden in DM patients during COVID-19 and “COVID-triggered DM” patients. We conclude that the bidirectional nature of DM/COVID-19 causes acceleration towards cardiovascular events. Due to this alarming condition, early monitoring of atherosclerotic burden is required in “Diabetes patients during COVID-19” or “new-onset Diabetes triggered by COVID-19 in non-Diabetes patients”.