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Background@#Reactive arthritis (ReA) is an often neglected disease that received some attention during the coronavirus disease 2019 (COVID-19) pandemic. There is some evidence that infection with severe acute respiratory syndrome coronavirus 2 can lead to “reactive” arthritis. However, this does not follow the classical definition of ReA that limits the organisms leading to this condition. Also, there is no recommendation by any international society on the management of ReA during the current pandemic. Thus, a survey was conducted to gather information about how modern clinicians across the world approach ReA. @*Methods@#An e-survey was carried out based on convenient sampling via social media platforms. Twenty questions were validated on the pathogenesis, clinical presentation, and management of ReA. These also included information on post-COVID-19 arthritis. Duplicate entries were prevented and standard guidelines were followed for reporting internet-based surveys. @*Results@#There were 193 respondents from 24 countries. Around one-fifth knew the classical definition of ReA. Nearly half considered the triad of conjunctivitis, urethritis and asymmetric oligoarthritis a “must” for diagnosis of ReA. Other common manifestations reported include enthesitis, dermatitis, dactylitis, uveitis, and oral or genital ulcers. Threefourths opined that no test was specific for ReA. Drugs for ReA were non-steroidal antiinflammatory drugs, intra-articular injections, and conventional disease-modifying agents with less than 10% supporting biological use. @*Conclusion@#The survey brought out the gap in existing concepts of ReA. The current definition needs to be updated. There is an unmet need for consensus recommendations for the management of ReA, including the use of biologicals.
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IntroductionSingle-dose COVID-19 vaccines in healthy individuals with past COVID-19 infections seem to provide better immunity than double doses in COVID-19 unexposed individuals. However, it is not known whether the same is true for patients with autoimmune rheumatic diseases (AIRD) who are on immunosuppressants. MethodsWe identified 30 patients with AIRD who took a single dose of the ChAdOx1 vaccine post-COVID-19 infection. Age, sex and disease similar patients were enrolled in to three groups of 30 each who had (1) past infection with COVID-19 but no vaccine, (2) a single dose of ChAdOx1 and (3) double doses of ChAdOx1. Sera were collected from each patient approximately 30 days after last vaccine dose or since the onset of COVID19 symptoms (in the unvaccinated group). Antibodies to spike protein were estimated and virus neutralization potential of sera was tested. ResultsBaseline characteristics including drug usage was similar betweenthe groups. Seroconversion occurred in 25(83%), 23(77%), 27(90%), and 30(100%) in natural infection, single-dose vaccine, double dose vaccine, and infection +single dose vaccine groups respectively. Mean antibody titres (10076.8{+/-}8998) in the last group were at least 6-100x higher than in the other 3 groups. Also, the infection +vaccine group had the highest neutralization potential of 83.37 % as compared to 45.4% in the fully vaccinated group. ConclusionThe hybrid immunity with a single dose of the vector-based vaccine post-infection seems to be superior to double dosage of the vaccine in patients with AIRD. A universal vaccination strategy involving a single dose of vaccine for all individuals with previous COVID-19 infection seems to be effective in these patients also. What is already known about this subject?A single dose of an RNA based COVID-19 vaccine after COVID-19 natural infection provides superior immune protection as compared to double doses of vaccines in infection naive persons A second dose of vaccine in healthy people who had infection previously does not increase the immune protection but may paradoxically induce tolerance Vaccine responses in patients with autoimmune rheumatic diseases(AIRD) may be suboptimal due to underlying disease or the use of immunosuppressants. What does this study add?Hybrid-induced immunity (single vaccine post COVID-19 infection) produces adequate vaccine responses in patients with AIRD, non-inferior to double dose of vaccine Besides mRNA vaccines, the adenoviral vector vaccine AZD1222 also demonstrates this hybrid phenomenon. How might this impact on clinical practice?Vaccination policies can consider providing only a single vaccine in those who had previous COVID-19 infection. This strategy has been shown not to be harmful for patients with AIRD. This will help reduce vaccine shortages.
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BackgroundMulti System Inflammatory Syndrome in children (MIS-C) associated with COVID-19 is a recently recognised potentially life-threatening entity. There is limited data on post MIS-C sequelae. Methods21 children fulfilling the WHO criteria for MIS-C were included in our study. Data was collected at baseline and at 12-16 weeks post discharge to look for any persistent sequelae mainly relating to the lungs or heart including coronary arteries ResultsFever was the most common presentation, found in 18 (85.7%) patients. All had marked hyper-inflammatory state. Low ejection fraction (EF) was found in 10 (47.6%), but none had any coronary artery abnormality. All received corticosteroids, while 7 (33.3%) children required additional treatment with intravenous Immunoglobulins. 20 children improved while 1 left against medical advice. At discharge, 3 children had impaired left ventricular function. At median 15 weeks follow-up, no persistent complications were found. EF had returned to normal and no coronary artery abnormalities were found during repeat echocardiography. Chest radiographs showed no fibrosis and all biochemical parameters had normalized. ConclusionThe children with MIS-C are extremely sick during the acute stage. Timely and adequate management led to full recovery without any sequelae at a median follow-up of 15 weeks.
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IntroductionThere is limited information on the effectiveness of COVID-19 vaccination in patients with autoimmune rheumatic diseases (AIRD). Methods136 consecutive patients with rheumatic diseases who never had a diagnosis of COVID-19 previously, and had completed vaccination with either the ChAdOx1 or BBV152 vaccines were recruited. Their IgG antibody titres to the Spike protein were estimated 1 month after the second dose. Results102 patients had AIRD while the 34 had non-AIRD. Lesser patients with AIRD (92/102) had positive antibodies titres than ones with non-AIRD(33/34) [p<0.001]. Amongst patients who received the ChAdOX1 vaccine, the AIRD group had lower antibody titres. Although the AIRD patients receiving BBV152 had similarly lower titres numerically, this did not attain statistical significance probably due to lesser numbers. Comparing the two vaccines, 114(95%) of those who received ChAdOx1 (n=120) and 11(68.7%) of those who received BBV152(n=16) had detectable antibodies [p=0.004]. Antibody titres also were higher in ChAdOx1 recipients when compared to BBV152. To validate the findings, we estimated antibody titres in 30 healthy people each who had received either vaccine. All 30 who had received ChAdOX1 and only 23/30 of those who had received BBV152 had positive antibodies (p=0.011). ConclusionIn this preliminary analysis, patients with AIRD had lower seroconversion rates as well as lower antibody titres as compared to patients with non-AIRD. Also,the humoral immunogenicity of the BBV152 vaccine appears to be less than that of the ChAdOX1 vaccine. Validation using larger numbers and testing of cellular immunity is urgently required.
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Background@#The Publons platform provides integrated information on researchers, peer reviewers, publications and certain author metrics. Central Asia is a potentially growing region in terms of young researchers. @*Methods@#Using the inbuilt Publons search, the top institutes of nine countries of Central Asia and neighbours were identified and data on their reviewers, number of publications, number of peer reviews completed were extracted. These were compared with demographics of the countries such as population, gross domestic product, number of physicians and proportion of population enrolled for higher education. @*Results@#Amongst the top 15 institutes in Central Asia, China has claim to 12 while Kazakhstan has two and Iran has one. The number of top peer reviewers, number of verified reviews and Web of Science indexed publications from these top institutes varied directly with the number of researchers each had. Afghanistan, Tajikistan and Turkmenistan are not performing well on most of these while China seems to be an outlier on the upper edge of the graphs. There is good correlation between the number of researchers in the top institutes per country and both number of publications and number of completed reviews. The number of total publications per top ten institutes of each country has high correlation with various demographic parameters like total population (Spearman rho, ρ = 0.85), gross domestic product (ρ = 0.82), total number of physicians (ρ =0.72), and number enrolled for higher education (ρ = 0.93). @*Conclusion@#There appears to be much disparity among the rankings, number of researchers, reviewers and published manuscripts across various countries in Central Asia. The gross heterogeneity of Central Asia needs to be minimized by nurturing and mentoring potentially upcoming researchers in publication, peer reviewing as well as in ethics involved.
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Background@#The five Central Asian republics comprise of Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan. Their research and publication activities are gradually improving but there is limited data on how good their peer reviewing practices are. @*Methods@#We have use the Publons database to extract information on the reviewers registered including the number of verified review, Publons award winners, and top universities in the domain of peer reviewing. This has been analysed overall and country wise. @*Results@#Of 15,764 researchers registered on Publons, only 370 (11.7%) have verified records of peer-reviewing. There are 8 Publons award winners. There is great heterogeneity in the number of active reviewers across the five countries. Kazakhstan and Uzbekistan account for more than 90% of verified reviewers. Only Kazakhstan has more than 100 active reviewers and 6 Publons award recipients. Amongst the top 20 reviewers from Central Asia, half of them are from the Nazarbayev University, Nur-Sultan, Kazakhstan. Three countries have less than 10 universities registered on Publons. @*Conclusion@#Central Asia has a good number of peer reviewers on Publons though only a minority of researchers are involved in peer reviewing. However, the heterogeneity between the nations can be best dealt with by promoting awareness and international networking including e-learning and mentoring programs.
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Background@#The Publons platform provides integrated information on researchers, peer reviewers, publications and certain author metrics. Central Asia is a potentially growing region in terms of young researchers. @*Methods@#Using the inbuilt Publons search, the top institutes of nine countries of Central Asia and neighbours were identified and data on their reviewers, number of publications, number of peer reviews completed were extracted. These were compared with demographics of the countries such as population, gross domestic product, number of physicians and proportion of population enrolled for higher education. @*Results@#Amongst the top 15 institutes in Central Asia, China has claim to 12 while Kazakhstan has two and Iran has one. The number of top peer reviewers, number of verified reviews and Web of Science indexed publications from these top institutes varied directly with the number of researchers each had. Afghanistan, Tajikistan and Turkmenistan are not performing well on most of these while China seems to be an outlier on the upper edge of the graphs. There is good correlation between the number of researchers in the top institutes per country and both number of publications and number of completed reviews. The number of total publications per top ten institutes of each country has high correlation with various demographic parameters like total population (Spearman rho, ρ = 0.85), gross domestic product (ρ = 0.82), total number of physicians (ρ =0.72), and number enrolled for higher education (ρ = 0.93). @*Conclusion@#There appears to be much disparity among the rankings, number of researchers, reviewers and published manuscripts across various countries in Central Asia. The gross heterogeneity of Central Asia needs to be minimized by nurturing and mentoring potentially upcoming researchers in publication, peer reviewing as well as in ethics involved.
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Background@#The five Central Asian republics comprise of Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan. Their research and publication activities are gradually improving but there is limited data on how good their peer reviewing practices are. @*Methods@#We have use the Publons database to extract information on the reviewers registered including the number of verified review, Publons award winners, and top universities in the domain of peer reviewing. This has been analysed overall and country wise. @*Results@#Of 15,764 researchers registered on Publons, only 370 (11.7%) have verified records of peer-reviewing. There are 8 Publons award winners. There is great heterogeneity in the number of active reviewers across the five countries. Kazakhstan and Uzbekistan account for more than 90% of verified reviewers. Only Kazakhstan has more than 100 active reviewers and 6 Publons award recipients. Amongst the top 20 reviewers from Central Asia, half of them are from the Nazarbayev University, Nur-Sultan, Kazakhstan. Three countries have less than 10 universities registered on Publons. @*Conclusion@#Central Asia has a good number of peer reviewers on Publons though only a minority of researchers are involved in peer reviewing. However, the heterogeneity between the nations can be best dealt with by promoting awareness and international networking including e-learning and mentoring programs.
