Adult onset refractory nxp2 dermatomyositis following covid 19 infection

Background: Dermatomyositis is a type of systemic inflammatory autoimmune disorder characterised by muscle inflammation and skin rashes. We present a rare adult onset refractory Nxp2 dermatomyositis following COVID 19 infection Methods: 36-year- old male came with the complaints of: Redness of right eye, Easy fatgiuability ,dysphagia of 3 months duration * Patient had uncomplicated COVID-19 1 month prior to onset of present complaints * On examination he had anasarca proximal muscle weakness and muscle tenderness and had neck and pharyngeal muscle weakness dysphagia and nasal regurgitation.He also had malar rash and periribital rash and swelling (Figure 1) * Investigations revealed biochemical radiological and Electrophysiological evidence of myositis (Table 1) * He was managed with pulse sterids ivig rituximab and tacrolimus with gradual but definite resolution Conclusion(s): Auto-antibodies against NXP2 are detected in 15% to 25% cases of Juvenile dermatomyositis and in only 1% of adult cases. This form of DM is characterized by accompanying calcinosis and severe and chronic disease course and is often carcinoma-associated (breast, uterine or pancreatic carcinoma). Post COVID NXP2 DM has not yet been reported. (Figure Presented).

THE EFFECTS of TELEREHABILITATION with REMOTELY SPINAL STABILIZATION EXERCISES on CLINICAL VARIABLES, FUNCTIONAL ACTIVITIES, EXERCISE ADHERENCE and MUSCLE ARCHITECTURE of NECK MUSCLES in INDIVIDUALS with CHRONIC NECK PAIN

Background: Doing a job with functional activity may aggravate chronic neck pain(CNP). Thickness, PCSA of the neck muscles can be improved with exercise. During the Covid-19 pandemic, people has caused an increase in home workload, the frequency of performing functional activities related to performance has increased. The distance between physiotherapists and the patient should be at least 2 meters in clinics due to the risk of transmission. As a result, the importance of telerehabilitation has increased. Objectives: Our aim is to investigate the effect of remotely spinal stabilization exercises(SSE) with telerehabilitation on clinical variables, the functional activities, exercise adherence and muscle architecture patients with CNP. Methods: The demographic characteristics were recorded. Pain intensity with Visual Analog Scale (VAS), disability level with Neck Disability Index (NDI), neck awareness with Fremantle Neck Awareness Questionnaire (FreNAQ), the functional capacity levels with neck function capacity evaluation test, the difficulty of functional activities with VAS were assessed. Muscle thickness of M. Sterno-cleideomastoideus, M. Upper Trapezius, PCSA of M. Longus Colli, M. Cervical Multifdus was evaluated in the resting with 3.5-10 MHz ultrasound. The exercise adherence with Exercise Adherence Rating Scale and exercise program satisfaction with VAS were evaluated. The telerehabilitation group (TG) used exercises videos and video conferences, control group (CG) did SSE in the clinic. To study the effects of the interventions, the outcome measures were compared time-by-group interaction effects, one the within-groups factor (time) and one the between-groups factor (group) by repeated-measures two-way ANOVA. The Mann Whitney-U test was performed to compare two groups for non-parametric data. Results: Twenty-eight patients were randomly allocated to the TG and the CG. The VAS, NDI, FreNAQ, the functional capacity levels, muscle architecture showed similar changes over time in both groups. Results showed no signifcant time-by-group interaction effects of VAS, NDI, FreNAQ, the functional capacity levels, the difficulty of functional activities and muscle architecture (p>0.05);a signifcant effect for time in the VAS, NDI, FreNAQ, the functional capacity levels, the difficulty of functional activities and muscle architecture (p<0.001). There was no difference between the groups in terms of VAS, NDI, FreNAQ, the functional capacity levels, the difficulty of functional activities and muscle architecture. Results showed no signifcant effect for the group in the VAS, NDI, FreNAQ, the functional capacity levels, the difficulty of functional activities and muscle architecture (p>0.05). Both groups adapted well to the exercise program and were highly satisfed with the SSE (p<0.05). Conclusion: The VAS, NDI, difficulty of functional activities decreased;FreNAQ, functional capacity levels, architecture of neck muscles increased in both groups after 8 weeks SSE. It was determined that telerehabilitation with remotely SSE was benefcial as face-to-face SSE.

Quadriparesis after COVID-19 Vaccination: Two Cases with Different Diagnosis

Aim and objective: During the recent COVID-19 pandemic various vaccines have been developed and approved for emergency use, including adenovirus vector-based ChAdOx1 nCov-19. There are few reports of serious adverse events following immunization (AEFI). Materials and methods: Here, we report two cases of serious AEFI who required ICU admission. Results: Case 1: A 55-y-m hospitalized with complaints of giddiness for 4 days and onset of weakness of all four limbs with altered sensorium for 1 day. He had no history of any comorbidity, non-smoker and non-alcoholic, and no previous episodes of transient ischemic attacks. He was vaccinated with a second dose of adenoviral vector-based ChAdOx1 nCov-19 vaccine (8 days before the onset of first symptoms). After hospitalization, immediate intubation was done for airway protection. His neurological examination revealed blinking of eyes spontaneously, motor power of 0/5 in all four limbs, deep tendon reflex of +2, and mute plantar. MRI Brain was done on the next day (day of illness, DOI-4), which revealed acute infarct in the pons and bilateral cerebellar hemisphere. He was referred to our ICU on DOI-12. Repeat MRI Brain on DOI-16 showed subacute infarcts in the pons, bilateral middle cerebellar peduncles, and left cerebral hemisphere with thrombosed basilar artery. Lipid profile, homocysteine levels, auto-immune work-up were normal. Echocardiography showed normal LV function with no evidence of LA clot. Carotid Doppler showed normal carotid vessels. In view of ischemic stroke and basilar artery thrombosis anti-platelet agent and therapeutic anticoagulation continued. Over the next 3 weeks, he showed gradual improvement in motor power (3/5 in upper limbs and 2/5 in lower limbs) and weaned off from mechanical ventilation. Case 2: A 19-y-m hospitalized with complaints of acute onset paraesthesia and progressive weakness in both lower limbs for 4 days and difficulty in speech and swallowing for 1 day. He had no history of any comorbidity, and no history of preceding viral/bacterial infection except that he had received the first dose of the adenoviral vector-based ChAdOx1 nCov-19 vaccine (16 days before the onset of first symptoms). After hospitalization, he required intubation in view of pooling of oral secretions and respiratory distress. Clinical examination revealed bifacial weakness, severe neck muscle weakness, and flaccid areflexic quadriparesis with prominent proximal upper and lower limb weakness. Pin-prick sensation was distally reduced in both lower limbs with associated autonomic instability in the form of tachycardia and hypertension. MRI Brain was normal in the study. In further work, Guillain-Barré syndrome (GBS) was diagnosed. CSF showed albumin-cytologic dissociation (protein 1.14 g/L and nil cell), and bilateral motor nerve axonal neuropathy on nerve conduction study. Immunoglobulin (IVIG) therapy was started on DOI-6. He did not show significant improvement and was referred to our ICU for further management. During the 5th week of illness, the IVIG dose was repeated without any improvement and continuing requirement of mechanical ventilation. Conclusion: Though vaccination is one of the important public health interventions implemented to tackle the COVID-19 pandemic, there are known and unknown serious AEFI being reported. Both cases presented quadriparesis with different diagnoses, who received vaccination for COVID-19.