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Varghese N, Loghin-Oprea N, Sadovici-Bobeica V. AB1148 POST COVID-19 RHEUMATIC AND MUSCULOSKELETAL DISEASES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundRecent data suggests that SARS-Cov-2 can alter self-tolerance and trigger autoimmune responses through cross-reactivity with host cells; therefore it can lead to late autoimmune and inflammatory manifestations. With regard to rheumatic and musculoskeletal diseases (RMDs), medical literature displays sporadic case reports describing a variety of conditions diagnosed after COVID-19, but it remains still unclear what are the most common problems in patients presenting to rheumatology clinic following COVID-19 disease.ObjectivesTo describe the pattern of post-COVID-19 RMDs in a consecutive group of patients from rheumatology outpatient clinic.MethodsWe have performed an observational descriptive study of a group of adult patients who received a new diagnosis of RMD within a timeframe of 12 weeks after the confirmation of COVID-19. Data was collected based on clinical presentation, paraclinical pattern and radiological examinations.ResultsThe study included 23 patients who were consulted in rheumatology outpatient clinic and had post COVID-19 new onset joint, periarticular, bone or inflammatory syndrome manifestations. The general characteristics of the study group were as follows: mean age 45.5±11.3 (range 21-63) years and female to male ratio of 1.8:1. The majority of subjects consulted for joint symptoms (91.4%), in other cases reason for consultation was persistent low grade fever and fatigue (4.3%) and skin rash with dyspnea (4.3%). The mean duration of symptoms was 9.8±10.5 (range 1-42) weeks, and the time of onset after COVID-19 diagnosis was 4.9±4.1 (range 0-12) weeks. Concerning COVID-19 severity, it was established that in 60.9% it was mild, 17.4 % - moderate and 21.7% - severe. After clinical and paraclinical examination, the following diseases were diagnosed: ReA, lupus like syndromes, avascular necrosis, new onset RA and new onset PsA. In 69.7% of patients were diagnosed with ReA, the clinical pattern being joint or periarticular involvement of the hand, knee and feet. In 13.0% cases patients had multisystemic involvement (myocarditis, pericarditis, skin rash, inflammatory arthritis and/or low grade fever) and positive ANA and or dsDNA Ab, these cases were diagnosed as lupus like syndromes and followed a severe form of COVID-19. In 8.7% of patients who presented with non-inflammatory hip pain, avascular necrosis was diagnosed, in both cases femoral head being the affected part. No be noted that patients with avascular necrosis had a severe form of COVID-19 disease and joint pain started later after COVID-19 diagnosis (10-12 weeks). In 4.3% of cases each, new onset RA and PsA were identified.ConclusionIn the present study we have found that COVID-19 can be followed by a variety of RMDs. The most common symptom of patients presenting with RMD was joint pain. The most common disease was post-COVID ReA (69.7%). Avascular necrosis (8.7%) and lupus like syndromes (13.0%) were found in patients who experienced a severe form of COVID-19. More rarely, patients had new onset of rheumatoid arthritis (4.3%) or psoriatic arthritis (4.3%). Our findings suggest that during the COVID-19 recovery period patients might experience onset of RDMs; therefore, in the presence of joint symptoms or other manifestations suggesting an autoimmune disease, patients should be referred to a rheumatologist for careful clinical examination.References[1]Kocyigit, B. F., & Akyol, A. (2021). Reactive arthritis after COVID-19: a case-based review. Rheumatology international, 41(11), 2031–2039.[2]Liu, Y., Sawalha, A. H., & Lu, Q. (2021). COVID-19 and autoimmune diseases. Current opinion in rheumatology, 33(2), 155–162.Disclosure of InterestsNone declared
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Varghese N, Salaru V, Sadovici-Bobeica V. AB1141 THE PATTERN OF POST COVID-19 REACTIVE ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundAccording to the recent medical literature, COVID-19 disease can lead to a constellation of clinical syndromes lasting well beyond the first 30 days of infection. The most common post COVID sequalae includes pulmonary, nervous system and neurocognitive, mental, metabolic, cardiovascular, gastrointestinal and several other clinical manifestations. Regarding joint involvement and particularly reactive arthritis (ReA), literature data is limited and describes case reports or series of cases of patients diagnosed with this condition following COVID-19 disease.ObjectivesTo describe the pattern and the management of post-COVID reactive arthritis.MethodsWe have conducted a descriptive study of consecutive adult patients who presented to rheumatology outpatient clinic for joint or peri-articular pain/swelling/stiffness and received a diagnosis of post-COVID 19 reactive arthritis, by excluding other types of rheumatological conditions. The assessed clinical variables were: visual analogue scale (VAS) pain, swollen joint count (SJC), tender joint count (TJC), duration of morning stiffness, presence of enthesitis/tendinitis and axial involvement. Biochemistry and serology was performed: rheumatoid factor, ACPA, ANA, HLA B27, antiChlamydia Trachomatis, Ureaplasma Urealyticum and Mycoplasma Hominis Ab, anti HBs and HBc Ab, and anti HCV. COVID-19 disease prior to diagnosis of ReA was confirmed by PCR test.ResultsIn the study were included 16 patients with confirmed post COVID-19 ReA. The mean age of the study group was 43.5±10.8 (range 21-60), the female: male ratio was 4:1 and the duration of joint symptoms was 10.4±11.8 (range 1-42) weeks. The severity of COVID-19 disease was mild in 68.7% cases, moderate in 18.7% and severe in only 6.2% of the cases. The duration between COVID-19 diagnosis and ReA varied between cases, with a mean value of 4.3±4.2 (range 1-12) weeks. In 43.7% of the cases patients had peripheral joint involvement (synovitis), in 37.5% - periarticular involvement (enthesitis), 6.25% - isolate axial involvement (sacroiliac joints), 6.25% enthesitis and axial involvement (cervical spine) and 6.25% synovitis and enthesitis. In patients with peripheral joint pattern, the distribution of pain was symmetric (71.4%). The pattern of synovitis was determined by a TJC of 6.25±5.2 (range 1-16) joints and SJC 1.6±2.4 (range 0-7) joints. Both TJC and SJC correlated positively with the duration of morning stiffness (r=0.9 and r=0.6), but did not correlate with the VAS pain scale. In most of the cases synovitis affected the hand (wrist, MCP and PIP) 62.5% and the knee, feet and ankles – 50%. Two patients presented with monoarthritis, 1 with oligoarthritis and 5 with polyarthritis, in the majority of cases, involvement being symmetric (75%). Periarticular pattern was determined by enthesitis, affecting the elbow and shoulder (50%), costo-sternal enthesitis (25%) and trochanteritis (25%). From the entire study group, 31.2% had elevated serum inflammatory markers (ESR and/or CRP). Patients responded well to NSAIDs alone in 68.7% cases, local (intra-articular or peri-articular infiltrations) or and systemic corticoids (5 mg Prednisolone equivalent) were administered in 5.3% and 12.5% cases respectively, in 12.5% cases (two patients) Methotrexate was administered.ConclusionReactive arthritis represents a post COVID-19 sequelae. The time of onset of ReA varied between 1 and 12 weeks after COVID-19 diagnosis. The clinical pattern of the disease was expressed by joint or periarticular involvement, mainly affecting the hand, feet and knee symmetrically. Cases of axial manifestations were less common. Most of the patients responded well to NSAIDs, only in a few particular cases, low doses of corticoids and/or Methotrexate were recommended.References[1]Kocyigit, B. F., & Akyol, A. (2021). Reactive arthritis after COVID-19: a case-based review. Rheumatology international, 41(11), 2031–2039.[2]Xie, Y., Bowe, B., & Al-Aly, Z. (2021). Burdens of post-acute sequelae of COVID-19 by severity of acute infection, demographics and health status. Nature communications, 12(1), 6571.Disclosure of InterestsNone declared
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Kanakalakshmi ST, Prabhu M, Varghese N, Pandey V. A randomized comparison between interscalene block and dexmedetomidine for arthroscopic shoulder surgery. Colomb J Anesthesiol 2022. [DOI: 10.5554/22562087.e1028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: Management of intraoperative hemodynamics and postoperative analgesia during arthroscopic shoulder surgeries remains a challenge. Although interscalene brachial plexus block (ISB) is considered ideal for shoulder anesthesia it requires skill and proficiency unlike intravenous (IV) dexmedetomidine.
Objective: This randomized trial was performed to observe the efficacy of dexmedetomidine infusion which is less invasive and demands lesser skills than plexus block.
Methodology: All patients scheduled for elective arthroscopic shoulder surgery under general anesthesia were assigned either to group DEX, which received an IV dexmedetomidine bolus of 0.5 mcg/kg over 20 minutes, followed by an infusion of 0.5 mcg/kg/hour that was stopped 30 minutes before surgery the end of surgery or to group BLOCK which received ultrasound guided ISB with 20ml of 0.25% bupivacaine. The primary outcome assessed was intraoperative hemodynamics; the secondary outcomes were immediate postoperative pain, operating condition as assessed by the surgeon, recovery time, and patient satisfaction after 24 hours. Blinded investigator and composite scores were used for the assessment.
Results: Both groups displayed equivalent scores for intraoperative hemodynamics whereas ISB resulted in a better post-operative analgesia (p < 0.001). Surgeon’s opinion and recovery time were comparable. Overall, the patients had a satisfactory experience with both techniques, according to the quality assessment.
Conclusion: IV dexmedetomidine infusion is an effective alternative to ISB for reconstructive shoulder surgeries under general anesthesia.
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Sharma A, Varghese N, Venkateswaran R. Effect of intrathecal dexmedetomidine versus intravenous dexmedetomidine on subarachnoid anesthesia with hyperbaric bupivacaine. J Anaesthesiol Clin Pharmacol 2020; 36:381-385. [PMID: 33487907 PMCID: PMC7812950 DOI: 10.4103/joacp.joacp_323_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 12/25/2018] [Accepted: 06/22/2019] [Indexed: 11/09/2022] Open
Abstract
Background and Aim: Alpha-2 agonists such as dexmedetomidine when given intravenously or intrathecally as an adjuvant potentiate subarachnoid anesthesia. We studied the difference in subarachnoid anesthesia when supplemented with either intrathecal or intravenous dexmedetomidine. Material and Methods: Seventy-five patients posted for lower limb and infraumbilical procedures were enrolled for a prospective, randomized, double-blind, placebo-controlled study and divided into three groups: Group B (n = 25) received intravenous 20 mL 0.9%N aCl over 10 min followed by intrathecal 2.4 mL 0.5%bupivacaine + 0.2 mL sterile water; Group BDexIT (n = 25) received intravenous 20 mL 0.9%N aCl over 10 min followed by intrathecal 2.4 mL 0.5%b upivacaine + 0.2 mL (5 μg) dexmedetomidine; Group BDexIV (n = 25) received intravenous dexmedetomidine 1 μg/kg in 20 mL 0.9%N aCl over 10 min followed by intrathecal 2.4 mL 0.5%b upivacaine + 0.2 mL sterile water. Onset and recovery from motor and sensory blockade, and sedation score were recorded. Onset of sensory and motor blockade was assessed using Kruskal–Wallis test, whereas 2-segment regression and recovery was analyzed using ANOVA and post hoc Tukey's test to determine difference between the three groups. P value <0.05 was considered statistically significant. Results: Although onset of sensory and motor block was similar in the three groups, motor recovery (modified Bromage scale 1) and two-segment sensory regression was prolonged in Group BDexIT > Group BDexIV > Group B (P < 0.001). Patients in Group BDexIT and Group BDexIV were sedated but easily arousable. Conclusion: Intrathecal dexmedetomidine prolongs the effect of subarachnoid anesthesia with arousable sedation when compared with intravenous dexmedetomidine.
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Affiliation(s)
- Anshu Sharma
- Department of Anaesthesiology, Kasturba Medical College, Manipal, Karnataka, India
| | - Nita Varghese
- Department of Anaesthesiology, Kasturba Medical College, Manipal, Karnataka, India
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Reddy AM, Varghese N, Herekar B, Shenoy UK. Does prewarming of i-gel improve insertion and ventilation in anaesthetised and paralysed patients? A prospective, randomised, control trial. Saudi J Anaesth 2019; 13:215-221. [PMID: 31333366 PMCID: PMC6625302 DOI: 10.4103/sja.sja_110_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Context: I-gel are supraglottic airway devices with non-inflatable gel-like cuff that is believed to mould to body temperature, to seal the airway. Hence a pre-warmed i-gel may seal faster, provide better ventilation and superior leak pressure. Aims: To determine if pre-warming i-gel to 40°C improves insertion and efficacy of ventilation. Methods and Materials: A prospective, randomised, controlled trial was done on 64 patients requiring anaesthesia with muscle relaxation for short duration. For those in group W, i-gel warmed to 40°C for 15 minutes before insertion was used, whereas for those in group C, i-gel kept at room temperature (approximately 23°C) was used. The airway sealing pressure over time, number of attempts and time taken for a successful insertion were noted. Statistical Analysis: Mean sealing pressure between two groups was compared using independent sample t-test. Repeated Measures ANOVA was used to analyse mean sealing pressure at 0, 15 and 30 min. P value ≤0.05 was considered statistically significant. Results: Sealing pressure improves over time in both the groups but the mean sealing pressure was higher in group C when compared to group W at all points of time, however this was clinically and statistically insignificant. Ease of insertion, time for successful insertion, insertion attempts, intra-operative manoeuvres were all comparable between the groups with no adverse effects. Conclusions: Pre-warming of i-gel to 40°C does not improve the success rate of insertion or provide a higher sealing pressure in anaesthetised and paralysed patients when compared to i-gel at room temperature.
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Affiliation(s)
| | - Nita Varghese
- Department of Anaesthesiology, Kasturba Medical College, Manipal, Karnataka, India
| | - Basavaraj Herekar
- Department of Anaesthesiology, Kasturba Medical College, Manipal, Karnataka, India
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Affiliation(s)
- Nita Varghese
- Department of Anaesthesiology, Kasturba Medical College, Manipal, Karnataka, India
| | - Nandhini Joseph
- Department of Anaesthesiology, Kasturba Medical College, Manipal, Karnataka, India
| | - Siri Kandavar
- Department of Anaesthesiology, Kasturba Medical College, Manipal, Karnataka, India
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Samuel SR, Maiya AG, Varghese N. Effectiveness of transcutaneous electrical nerve stimulation as a supplement to multimodal analgesia for acute post-operative pain following abdominal surgery. Indian J Anaesth 2016; 60:151-2. [PMID: 27013764 PMCID: PMC4787136 DOI: 10.4103/0019-5049.176287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Arun G Maiya
- Department of Physiotherapy, SOAHS, Manipal University, Manipal, India
| | - Nita Varghese
- Department of Anaesthesiology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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Shetty S, Kandavar S, Varghese N, Rao M. Curious case of raccoon eye under general anaesthesia. Indian J Anaesth 2016; 60:442-3. [PMID: 27330215 PMCID: PMC4910493 DOI: 10.4103/0019-5049.183382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Krishnan LK, Varghese N, Muraleedharan CV, Bhuvaneshwar GS, Derangère F, Sampeur Y, Suryanarayanan R. Quantitation of platelet adhesion to Ti and DLC-coated Ti in vitro using (125)I-labeled platelets. Biomol Eng 2002; 19:251-3. [PMID: 12202191 DOI: 10.1016/s1389-0344(02)00029-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Measurement of platelet adhesion in vitro is a good indicator of its reactivity to implant devices in vivo. Platelets were labeled with I-125 without affecting its normal morphology and function and the labeled platelets were suspended in platelet poor plasma and exposed to Ti and diamond like carbon-coated (DLC) Ti discs, under dynamic conditions, using a parallel plate flow chamber. The test materials were washed, dried, exposed to a phosphor screen and scanned to get the images. The number of platelets that adhered to Ti was found to be higher than those that adhered to DLC coated Ti sample, irrespective of the shear stress which was varied between 2 and 16 dynes/cm(2).
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Affiliation(s)
- L K Krishnan
- BMT Wing, Si Chitra Tirunal Institute of Medical Sciences, Thiruvanandhapuram 690512, India
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Varghese N, Thorp J. An analysis of truncated fractal growths in the stability boundaries of three-node swing equations. ACTA ACUST UNITED AC 1988. [DOI: 10.1109/31.1829] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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