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1.
Public Health Res Pract ; 2022.
Article in English | PubMed | ID: covidwho-2100543

ABSTRACT

OBJECTIVES: To report on efforts to engage culturally and linguistically diverse (CALD) communities to provide an effective and appropriate public health response to coronavirus disease 2019 (COVID-19), and to report how a tailored, interagency response addressing specific community needs was rapidly rolled out in a pandemic setting. Type of program or service: A novel, rapid, interagency public health campaign led by NSW Health and Sydney Local Health District (SLHD) was established in response to a local outbreak of COVID-19 in the multicultural suburb of Lakemba, in Sydney's south west, in October 2020. The public education and testing campaign was run over 2 weeks and involved in-language development of COVID-19 resources, establishment of a local pop-up testing clinic, 'COVID Safe' inspections of local businesses, engagement with local community leaders and distribution of written and verbal in-language education by cultural support workers. METHODS: We describe the campaign impact in engaging CALD communities in a pandemic setting, including the impact on COVID-19 testing rates, identification of close contacts and engagement with local businesses, as well as learnings from a multi-agency debrief at the conclusion of the campaign. RESULTS: There was an 87% increase in COVID-19 testing in the local area during the campaign. Despite 890 close contacts being identified during the outbreak, only 17 cases of COVID-19 were identified. Regulators visited 127 local businesses to provide 'COVID Safe' education and advice. SLHD cultural support personnel worked with the community to provide verbal and written in-language resources and education. Community and religious leaders were engaged to act as 'COVID Safe' champions. LESSONS LEARNT: A key to the success of the Lakemba campaign was the rapid, multi-agency collaboration between NSW Health, SLHD and regulators. An important lesson from the COVID-19 pandemic has been the importance of providing a flexible, tailored public health response that reacts to the target community's needs. This is even more important in our CALD communities, where mainstream health messages are insufficient. The Lakemba campaign is an example of how such a response can be undertaken rapidly while maintaining the key principles of community partnership, engagement and equity.

2.
INTELLIGENT HEALTHCARE: Applications of AI in eHealth ; : 259-270, 2021.
Article in English | Web of Science | ID: covidwho-2012535
3.
Annals of the Rheumatic Diseases ; 81:332, 2022.
Article in English | EMBASE | ID: covidwho-2009139

ABSTRACT

Background: Dermatomyositis (DM) patients have fewer risks of COVID-19 infection compared to the general population, however, certain subgroups with DM have worse outcomes. Men. African Americans, those with interstitial lung disease, exhibited higher risks of severe COVID-19. DMARD and glucocorticoid use was associated with frequent hospitalisations and severe sepsis. Objectives: Rheumatic diseases (RDs) like DM, are previously known to be vulnerable towards various types of infections due to its aggressive activity mandating high dose immunosuppressive therapy. The severity of COVID-19 in RDs is limited in literature due to the heterogeneous nature of the condition. Therefore, specifc details on mortality is essential to navigate any precautions required in the treatment. Methods: Retrospective data of individuals with DM and COVID-19 and the general population with COVID-19 between January 2020 to August 2020 was retrieved from the TriNetX database. A one-to-one matched COVID-19 positive control was selected using propensity score (PS) matching. We assessed COVID-19 outcomes such as mortality, hospitalisation, ICU admission, severe COVID-19, mechanical ventilation (MV), acute kidney injury (AKI), venous thromboembo-lism (VTE), ischemic stroke, acute respiratory distress syndrome (ARDS), renal replacement therapy (RRT) and sepsis. Subgroup analyses included gender, race, ILD, cancer patients, disease-modifying rheumatic drugs (DMARDs) use, and glucocorticoids (GC) use (Figure 1). Results: We identifed 5,574 DM patients with COVID-19, and 5,574 general population with COVID-19 (controls). DM with COVID-19 had a lower risk of mortality in comparison to controls [RR 0.76], hospitalisation [RR 0.8], severe COVID-19 [RR 0.76], AKI [RR 0.83], and sepsis [RR 0.73]. Males and African Americans were more likely to develop AKI [RR 1.35, 1.65], while African Americans had higher odds for severe COVID-19 [RR 1.62] and VTE [RR 1.54]. DM with ILD group also experienced higher odds for severe COVID-19 infection [RR 1.64], and VTE [RR 2.06] (Figure 1). DM patients receiving DMARDs and glucocorticoids had higher odds for hospitalisation [RR 1.46, 2.12], and sepsis [RR 3.25] Subgroup analysis of neoplasms amongst DM patients with COVID-19 was inadequate for meaningful comparison (Figure 1). Conclusion: DM patients are protected for certain aspects of COVID-19 disease, including severe COVID-19, hospitalization, and mortality. The African American race, male gender, ILD, DMARDS and glucocorticoid users, are associated with poor outcomes.

4.
Annals of the Rheumatic Diseases ; 81:966-967, 2022.
Article in English | EMBASE | ID: covidwho-2009100

ABSTRACT

Background: COVID-19 vaccines have been proven to be safe and effective in the healthy population at large. However, signifcant gaps remain in the evidence of their safety in patients with systemic autoimmune and infammatory disorders (SAIDs). Patients and rheumatologists have expressed concerns regarding vaccination triggered allergic reactions, thrombogenic events, and other adverse events (ADEs) contributing to vaccine hesitancy (1) Objectives: This study aimed to assess and compare short term COVID-19 vaccination associated ADEs in patients with SAIDs and healthy controls (HC) seven days post-vaccination, as well as between patients with SAIDs receiving different vaccines. Methods: We developed an comprehensive, patient self-reporting electronic-survey to collect respondent demographics, SAID details, COVID-19 infection history, COVID-19 vaccination details, 7-day post vaccination adverse events and patient reported outcome measures using the PROMIS tool. After pilot testing, validation, translation into 18 languages on the online platform surveymonkey.com, and vetting by international experts, the survey was circulated in early 2021 by a multicenter study group of >110 collaborators in 94 countries. ADEs were categorized as injection site pain, minor ADEs, major ADEs, and hospitalizations. We analyzed data from the baseline survey for descriptive and intergroup comparative statistics based on data distribution and variable type (data as median, IQR). Results: 10900 respondents [42 (30-55) years, 74% females and 45% Caucasians] were analyzed. 5,867 patients (54%) with SAIDs were compared with 5033 HCs. All respondents included in the fnal analysis had received a single dose of the vaccine and 69% had received 2 primary doses. Pfzer (39.8%) was the most common vaccine received, followed by Oxford/AstraZeneca (13.4%), and Covishield (10.9%). Baseline demographics differed by an older SAID population (mean age 42 vs. 33 years) and a greater female predominance (M:F= 1:4.7 vs. 1:1.8) compared to HCs. 79% had minor and only 3% had major vaccine ADEs requiring urgent medical attention overall. In adjusted analysis, among minor ADEs, abdominal pain [mul-tivariate OR 1. 6 (1.14-2.3)], dizziness [multivariate OR 1. 3 (1.2-1.5)], and headache [multivariate OR 1.67 (1.3-2.2)], were more frequent in SAIDs than HCs. Overall major ADEs [multivariate OR 1. 9 (1.6-2.2)], and throat closure [multivar-iate OR 5.7 (2.9-11.3)] were more frequent in SAIDs though absolute risk was small (0-4%) and rates of hospitalization were similarly small in both groups, with a small absolute risk (0-4%). Specific minor ADEs frequencies were different among different vaccine types, however, major ADEs and hospitalizations overall were rare (0-4%) and comparable across vaccine types in patients with SAIDs (Figure 1). Conclusion: Vaccination against COVID-19 is relatively safe and tolerable in patients with SAIDs. Certain minor vaccine ADEs are more frequent in SAIDs than HCs in this study, though are not severe and do not require urgent medical attention. SAIDs were at a higher risk of major ADEs than HCs, though absolute risk was small, and did not lead to increased hospitalizations. There are small differences in minor ADEs between vaccine types in patients with SAIDs.

5.
Annals of the Rheumatic Diseases ; 81:748, 2022.
Article in English | EMBASE | ID: covidwho-2009053

ABSTRACT

Background: Idiopathic inflammatory myopathies (IIM) are a rare, multisystem, heterogeneous diseases, and contribute to high psychological burden. The patients' perception of physical health, deteriorating independence and social and environmental relationships may not always be a direct function of disease activity. To face with these aspects, several worldwide specialized organization have recommended the use of patient reported outcome measures (PROMs) both in clinical trials and observational studies to highlight patient's perception of the disease (1). Unfortunately, data on fatigue scores in IIM is limited. Objectives: We compared fatigue VAS scores in patients with IIM, autoimmune diseases (AIDs) and healthy controls (HCs) and triangulated them with PROMIS physical function in a large international cohort made up of answers from the e-survey regarding the COVID-19 Vaccination in Autoimmune Diseases (COVAD) study. Methods: Data of 16327 respondents was extracted from the COVAD database on August 31th 2021. VAS fatigue scores were compared between AID, HC and IIM using univariate followed by multivariate analysis after adjusting for baseline differences. We further performed a propensity score matched analysis on 1827 subjects after adjusting for age, gender and ethnicity. The Kruskal-Wallis test was used for continuous variables and chi-square test for categorical variables, and Bonferroni's correction was applied for the post hoc analyses considering IIMs as a reference group. Results: We analyzed answers from 6988 patients, with a mean age of 43.8 years (SD 16.2). The overall percentage of female was 72% and the population ethnicity was mainly composed of White (55.1%), followed by Asian (24.6%), and Hispanic (13.8%). The overall fatigue VAS was 3.6 mm (SD 2.7). IIMs VAS was 4.8 mm (SD 2.6), AIDs 4.5 mm (SD 2.6), and HC 2.8 mm (SD 2.6) (P <0,001). VAS fatigue scores of IIMs were comparable with AIDs (P 0.084), albeit signifcantly higher than the HCs (P <0,001). Notably, fatigue VAS was lower in IIMs than AIDs in two distinct subsets: inactive disease as defned by the patient's perception and the 'excellent' general health condition group, where IIMs had worse scores (P <0,05). Interestingly, fatigue VAS was comparable in active disease defned by physician assessment, patient perception, based on general functional status, or when defned by steroid dose being prescribed. Notably, after propensity matched analysis of patients adjusting for gender, age and ethnicity (1.827 answers, I.e. 609 subjects per group, P =1) the differences disappeared and IIMs and AIDs had comparable fatigue levels across all levels of disease activity, although the fatigue discrepancies with HCs were substantially confrmed. After application of a multivariate linear regression analysis we found that lower fatigue VAS scores were related to HC (P <0,001), male gender (P <0,001), Asian and Hispanic ethnicities (P <0,001 and 0,003). Conclusion: Our study confrms that there is a higher prevalence of fatigue in all the AIDs patients, with comparable VAS scores between IIMs and other AIDs. We can also read our data commenting that females and/or Caucasians patients suffer a higher impact of this manifestation of chronic autoimmune diseases upon their lives. This is why these subjects, to our judgement, should be carefully evaluated during outpatients visits and to whom we should spend some extra time to discuss health related issues and how to improve them.

6.
Annals of the Rheumatic Diseases ; 81:334-336, 2022.
Article in English | EMBASE | ID: covidwho-2008938

ABSTRACT

Background: Signifcant gaps are present in the evidence of the spectrum and severity of COVID-19 infection in idiopathic infammatory myopathies (IIM). IIM patients typically require immunosuppressive therapy, may have multiple disease sequelae, and frequent comorbidities, and thus may be more susceptible to severe COVID-19 infection and complications (1). The possibility of attenuated immunogenicity and reduced efficacy of COVID-19 vaccines due to concomitant immunosuppressive medication is a major concern in these patients, and there is little data available on COVID-19 vaccine breakthrough infections (BI) in IIM (2). Objectives: This study aimed to compare disease spectrum and severity and COVID-19 BI in patients with IIM, other systemic autoimmune and infammatory diseases (SAIDs) and healthy controls (HCs). Methods: We developed an extensive self-reporting electronic-survey (COVAD survey) featuring 36 questions to collect respondent demographics, SAID details, COVID-19 infection history, COVID-19 vaccination details, 7-day post vaccination adverse events and patient reported outcome measures using the PROMIS tool. After pilot testing, validation, translation into 18 languages on the online platform surveymonkey.com, and vetting by international experts, the COVAD survey was circulated in early 2021 by a multicenter study group of >110 collaborators in 94 countries. BI was defned as COVID-19 infection occurring more than 2 weeks after receiving 1st or 2nd dose of a COVID-19 vaccine. We analyzed data from the baseline survey for descriptive and intergroup comparative statistics based on data distribution and variable type. Results: 10900 respondents [mean age 42 (30-55) years, 74% females and 45% Caucasians] were analyzed. 1,227 (11.2%) had IIM, 4,640 (42.6%) had other SAIDs, and 5,033 (46.2%) were HC. All respondents included in the fnal analysis had received a single dose of the vaccine and 69% had received 2 primary doses. Pfzer (39.8%) was the most common vaccine received, followed by Oxford/AstraZeneca (13.4%), and Covishield (10.9%). IIM patients were older, had a higher Caucasian representation and higher Pfzer uptake than other SAIDs, and HC. A higher proportion of IIM patients received immu-nosuppressants than other SAIDs. IIMs were at a lower risk of symptomatic pre-vaccination COVID-19 infection compared to SAIDs [multivariate OR 0.6 (0.4-0.8)] and HCs [multivariate OR 0.39 (0.28-0.54)], yet at a higher risk of hospitalization due to COVID-19 compared to SAIDs [univariate OR 2.3 (1.2-3.5)] and HCs [multivariate OR 2.5 (1.1-5.8)]. BIs were very uncommon in IIM patients, with only 17 (1.4%) reporting BI. IIM patients were at a higher risk of contracting COVID-19 prior to vaccination than ≤2 weeks of vaccination [univariate OR 8 (4.1-15)] or BI [univariate OR 4.6 (2.7-8.0)]. BIs were equally severe compared to when they occurred prior to vaccination in IIMs, and were comparable between IIM, SAIDs, and HC (Figure 1), though BI disease duration was shorter in IIMs than SAIDs (7 vs 11 days, p 0.027). 13/17 IIM patients with BI were on immunosuppressants. Conclusion: IIM patients experienced COVID-19 infection less frequently prior to vaccination but were at a higher risk of hospitalization and requirement for oxygen therapy compared with patients with HC. Breakthrough COVID-19 infections were rare (1.4%) in vaccinated IIM patients, and were similar to HC and SAIDs, except for shorter disease duration in IIM.

7.
Annals of the Rheumatic Diseases ; 81:720-722, 2022.
Article in English | EMBASE | ID: covidwho-2008862

ABSTRACT

Background: Evaluation of physical function is fundamental in the management of idiopathic infammatory myopathies (IIMs). Patient-Reported Outcome Measurement Information System (PROMIS) is a National Institute of Health initiative established in 2004 to develop patient-reported outcome measures (PROMs) with improved validity and efficacy. PROMIS Physical Function (PF) short forms have been validated for use in IIMs [1]. Objectives: To investigate the physical function status of IIM patients compared to those with non-IIM autoimmune diseases (AIDs) and healthy controls (HCs) utilizing PROMIS PF data obtained in the coronavirus disease-2019 (COVID-19) Vaccination in Autoimmune Diseases (COVAD) study, a large-scale, international self-reported e-survey assessing the safety of COVID-19 vaccines in AID patients [2]. Methods: The survey data regarding demographics, IIM and AID diagnosis, disease activity, and PROMIS PF short form-10a scores were extracted from the COVAD study database. The disease activity (active vs inactive) of each patient was assessed in 3 different ways: (1) physician's assessment (active if there was an increased immunosuppression), (2) patient's assessment (active vs inactive as per patient), and (3) current steroid use. These 3 defnitions of disease activity were applied independently to each patient. PROMIS PF-10a scores were compared between each disease category (IIMs vs non-IIM AIDs vs HCs), stratifed by disease activity based on the 3 defnitions stated above, employing negative binominal regression model. Multivariable regression analysis adjusted for age, gender, and ethnicity was performed clustering countries, and the predicted PROMIS PF-10a score was calculated based on the regression result. Factors affecting PROMIS PF-10a scores other than disease activity were identifed by another multivariable regression analysis in the patients with inactive disease (IIMs or non-IIM AIDs). Results: 1057 IIM patients, 3635 non-IIM AID patients, and 3981 HCs responded to the COVAD survey until August 2021. The median age of the respondents was 43 [IQR 30-56] years old, and 74.8% were female. Among IIM patients, dermatomyositis was the most prevalent diagnosis (34.8%), followed by inclusion body myositis (IBM) (23.6%), polymyositis (PM) (16.2%), anti-syn-thetase syndrome (11.8%), overlap myositis (7.9%), and immune-mediated necrotizing myopathy (IMNM) (4.6%). The predicted mean of PROMIS PF-10a scores was signifcantly lower in IIMs compared to non-IIM AIDs or HCs (36.3 [95% (CI) 35.5-37.1] vs 41.3 [95% CI 40.2-42.5] vs 46.2 [95% CI 45.8-46.6], P < 0.001), irrespective of disease activity or the defnitions of disease activity used (physician's assessment, patient's assessment, or steroid use) (Figure 1). The largest difference between active IIMs and non-IIM AIDs was observed when the disease activity was defned by patient's assessment (35.0 [95% CI 34.1-35.9] vs 40.1 [95% CI 38.7-41.5]). Considering the subgroups of IIMs, the scores were signifcantly lower in IBM in comparison with non-IBM IIMs (P < 0.001). The independent factors associated with low PROMIS PF-10a scores in the patients with inactive disease were older age, female gender, and the disease category being IBM, PM, or IMNM. Conclusion: Physical function is signifcantly impaired in IIMs compared to non-IIM AIDs or HCs, even in patients with inactive disease. The elderly, women, and IBM groups are the worst affected, suggesting that developing targeted strategies to minimize functional disability in certain groups may improve patient reported physical function and disease outcomes.

9.
Indian Journal of Rheumatology ; 17(2):208-209, 2022.
Article in English | EMBASE | ID: covidwho-1928758
10.
Diabetes Research and Clinical Practice ; 186, 2022.
Article in English | EMBASE | ID: covidwho-1894929

ABSTRACT

Background: There is a lack of data on effectiveness of diabetes self-management education and support (DSMES) programs for South Asian adults with type 1 diabetes mellitus (T1DM). Aim: This formative research was conducted to explore existing practices on the said subject and gather information for planning an enhanced usual care (EUC) intervention program. The suggestions were incorporated for the intervention to be delivered especially during Covid-19. Method: We conducted in-depth semi-structured interviews with endocrinologists, dieticians, diabetes educators and adults with T1DM for this qualitative formative research. The participants were selected from a mix of public and private health facilities. Thematic analysis using inductive and deductive approach was undertaken. Results: In total, 28 in-depth interviews were conducted, 18 with health care professionals and 10 with adult individuals with T1DM. The results demonstrated deficiencies in the implementation of a structured self-management program for diabetes owing to several patient and healthcare system-related factors in usual practice. A detailed nutritional counselling was provided at all sites by a qualified dietitian, however, carbohydrate counting was not routinely practiced. The content of this formative research revolved around two broad domains hence explored: (a) evaluation of the existing usual care and gaps in implementation of a structured DSMES program, and (b) development of approaches that will help in formulation of an intervention package and its effective delivery to the participants. Principles of FUSED and COM-B models were also reported to be significant components for the success and refinement of such interventions. During the pandemic, the challenges reported in diabetes management were in maintaining monitoring chart of blood glucose levels due to lack of monitoring strips, procurement of insulin, procurement of diabetes supplies and management of disease condition during acute complications with lack of hospital facilities. Blood sampling was reported to be halted due to complete lockdown and restricted red zones. For effective delivery of such EUC interventions, it was suggested to conduct the sessions via video conferencing apps. Similarly, the follow-ups and reinforcement during this period were suggested to continue via telephonic calls, audio clips, video calls, video clips and SMS modes. As a part, it was suggested to relax blood glucose monitoring, the insulin of same type but different brands were suggested to be prescribed among choices available in local area and other mentioned challenges were suggested to be continuously looked after and provide timely advice for the same emphasizing sick day rules. Further, it was suggested to get the blood tests performed from reliable (accredited) labs at the recommended intervals. Discussion: This research study comprehensively investigated the existing practices among diabetes-health care professionals caring for persons living with T1DM, deficiencies in carbohydrate counting meal-planning technique and rendered insights towards development of a scientific DSMES program.

11.
American Journal of Respiratory and Critical Care Medicine ; 205:1, 2022.
Article in English | English Web of Science | ID: covidwho-1880171
12.
Rheumatology (United Kingdom) ; 61(SUPPL 1):i54-i55, 2022.
Article in English | EMBASE | ID: covidwho-1868381

ABSTRACT

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). 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.

14.
International Journal of Pharmaceutical and Clinical Research ; 14(1):530-535, 2022.
Article in English | EMBASE | ID: covidwho-1688385

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic led to far-reaching restrictions of social and professional life, affecting societies all over the world. To contain the virus, medical colleges had to restructure their curriculum by switching to online learning. This study was conducted to find out the faculty’s perception about these live online classes conducted for 1st year MBBS students in lockdown period of COVID-19 pandemic in India. This is questionnaire-based study. Questions were prepared with help of Google forms. The google forms were sent to 90 faculties of different medical colleges. Faculties were involved in online teaching classes during COVID-19 pandemic lockdown period. Questions asked to the faculties regarding online teaching included various E learning tools and methods used, teachers perspective on advantages and disadvantages of E learning. Methods used for online classes were Zoom, Google classroom, Live webex, Whatsapp group, discussion, Telegram App, Microsoft Teams, Skype. Advantages of online classes were its best alternative for physical mode classes, Ability to stay at home in pandemic, Comfortable surroundings, Teacher centered teaching. Disadvantages of online classes were technical problems, Lack of Student –Teacher interaction, Lack of proper students assessment, Difficult to demonstrate practicals, Lack of Students Discipline. E-learning is a powerful tool for teaching medical students. However, successful implementation of online learning into the curriculum requires a well-thought-out strategy and a more active approach.

15.
Lecture Notes on Data Engineering and Communications Technologies ; 90:11-19, 2022.
Article in English | Scopus | ID: covidwho-1626201

ABSTRACT

Due to COVID-19 situation, we need to wear face masks in public places. Reports say that wearing face mask at public places and at workspace reduces the transmission of virus as the SARS-CoV-2 spreads through atmosphere among people, at gathering in any environment. In this paper, a real-time face mask detection system is presented which will detect mask presence on the face using TensorFlow. We are using MobileNetV2 model to provide a greater accuracy in determining the mask presence. Accuracy obtained is 99%. Older systems do not provide a proper working system. A face mask detector has been designed with computer vision using Python, OpenCV, Keras, and TensorFlow. Video surveillance input can be given directly, and our primary purpose is to identify to check people are wearing masks on daily basis or not wearing masks and prepare a weekly and monthly report based on this observation and display the data on an interactive web application. System provides option to see the historical records, thereby reducing transmission. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

16.
JK Science ; 23(1):1-2, 2021.
Article in English | EMBASE | ID: covidwho-1472790
17.
Indian Journal of Rheumatology ; 16(2):123-126, 2021.
Article in English | EMBASE | ID: covidwho-1314834
18.
Indian Journal of Rheumatology ; 16(2):169-178, 2021.
Article in English | Scopus | ID: covidwho-1311425

ABSTRACT

Background/Objectives: The use of hydroxychloroquine (HCQ) for COVID-19 has raised concerns for adverse effects. We aimed to understand the practice, perceptions, and experience of adverse drug reactions (ADRs) with HCQ use for COVID-19 and other indications. Methods: A validated e-survey with 30 questions was circulated among rheumatologists and other specialists using SurveyMonkey. Responses from rheumatologists were compared with other doctors (odds ratio [OR], median, interquartile range), and ADRs encountered based on their indications. Results: Among 410 respondents (71.2% rheumatologists, 27% academicians) with a lifetime experience of 17886 (4884-52074) patients over 12 (7-20) years, and 148 (48-349) prescription of HCQ per month, one-third (135) were managing COVID-19 with 10 (0-60) prescriptions per physician. Electrocardiograms were seldom ordered preprescription (5%), but visual scans were requested by one-thirds, especially by rheumatologists (OR-1.9). Agreement on the safety of HCQ for non-COVID indications was nearly unanimous (99%), but only two-third (64%) perceived it to be safe for COVID-19, with most (72%) being uncomfortable using HCQ with macrolides. ADRs were most often encountered after middle-age with skin pigmentation (554 [123-2063]) being the most frequent, followed by gastrointestinal intolerance (222 [42-980] per million prescriptions). Cardiac toxicity was rarely reported. ADRs other than cutaneous and visual were noted more frequently by nonrheumatologists. Rheumatologists were less likely to consider HCQ unsafe (OR-0.04) and reportedly faced a greater challenge in drug procurance (OR-2.6) during the pandemic. Conclusions: Most ADRs are rare with HCQ use in our respondent population with a large user experience. HCQ use was considered unsafe by one-thirds in the setting of COVID-19 but not outside it, lesser so by rheumatologists. © 2021 Wolters Kluwer Medknow Publications. All rights reserved.

19.
Indian Journal of Rheumatology ; 16(2):229-230, 2021.
Article in English | Scopus | ID: covidwho-1311422
20.
Egyptian Rheumatologist ; 43(4):271-274, 2021.
Article in English | Scopus | ID: covidwho-1281410

ABSTRACT

Background: Anti-melanoma differentiation-associated protein 5 (MDA5) associated idiopathic inflammatory myopathy (IIM) often manifests with minimal muscle weakness and rapidly progressive interstitial lung disease (RP-ILD) with a poor prognosis. The clinical presentation may be varied in different ethnic groups. The ongoing coronavirus disease (COVID-19) pandemic has made management even more challenging as certain manifestations may be difficult to diagnose remotely. Aim of the work: To throw light on the rare association of CMV infection in established anti-MDA5 myositis with severe consequences. Similar cases were presented and compared. Case report: A 42-year-old lady presented with heliotrope rash, periorbital edema, ulcerated Gottron's papules, proximal muscle weakness and intermittent fever of six-month duration. Anti-MDA5 antibodies were positive. Active disease, including myocarditis and RP-ILD, were challenging to diagnose on teleconsultation. Upon initiating tofacitinib, cytomegalovirus (CMV) polymerized chain reaction (PCR) came positive. Ganciclovir was started with the possibility of viral activation being the potential driving force for interferon pathway activation and dermatomyositis (DM) flare, but the patient succumbed to the illness. Conclusion: Viral triggers are known to induce autoimmune disease in the genetically predisposed. However, CMV infection in established anti-MDA5 myositis is uncommon and further association with myocarditis is a rare occurrence. Ulcerated Gottron's and periorbital oedema may carry a sinister connotation in Indians with anti-MDA5 DM, with worse manifestations such as myocarditis– which albeit rare, can be fatal. © 2021 THE AUTHORS

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