The special edition of Journal Scan

Featuring six published articles from Kauvery Authors

(1). Natarajan Sekar, Jithin Jagan, Arunagiri Viruthagiri, Nedounsejiane Mandjiny, Karthikeyan Sivagnanam. Management of Acute Limb Ischaemia Due to COVID-19 Induced Arterial Thrombosis:A Multi-Centre Indian Experience. Ann Vasc Dis. 2022;15(2):113-20.

https://www.jstage.jst.go.jp/article/avd/advpub/0/advpub_oa.22-00012/_pdf

Objective: To determine the outcomes following various surgical and medical treatments of Coronavirus disease 2019 (COVID-19) induced acute limb ischaemia.

Methods: A retrospective study of patients presenting with COVID induced arterial ischaemia in three hospitals from Southern India during the months of May 2020 to August 2021 was undertaken. These patients were managed by either thrombectomy, primary bypass, thrombolysis, anticoagulation or primary amputation based on the stage of ischaemia and the severity of COVID.

Results: A total of 67 limbs in 59 patients were analysed. The average time to intervention was 15 days. Upper limb involvement was seen in 16 and lower limb in 51 limbs. Of the 67 limbs, 39 (58.2%) were treated by open surgical revascularisation, 5 (7.4%) by catheter directed lysis, 17 (25.3%) were managed conservatively and 6 (8.9%) underwent primary amputation. Successful revascularisation could be carried out in 88.6% of patients. A limb salvage rate of 80.6% was achieved in these patients with a re-intervention rate of 13.6%. Major amputation rate was 14.92% and mortality was 13.56%.

Conclusion: Limb ischaemia after COVID can be safely managed by open thrombectomy or bypass. Similar rates of limb salvage as in non-COVID acute limb ischaemia can be obtained.

(2). Natarajan Sekar, Sivaramakrishnan Manoj, Jithin Jagan, MS. Suprarenal Aortic Occlusion Due to Coral Reef Calcification: Successful Endovascular Management Assisted by Intravascular Lithotripsy and Visceral Protection. J Endovasc Ther. 2022.

https://journals.sagepub.com/doi/abs/10.1177/15266028221108659

Abstract

Purpose: Suprarenal aortic occlusion due to coral reef calcification has been considered not suitable for endovascular therapy because of visceral artery involvement. Unfortunately, open surgical treatment also carries high morbidity and mortality. We describe here successful endovascular management of a case of suprarenal aortic occlusion due to coral reef calcification with the use of intravascular lithotripsy (IVL) and visceral protection. Case

Report: A 72-year-old woman presented with uncontrolled hypertension, heart failure, and intermittent claudication. She was found to have occlusion of suprarenal aorta due to coral reef calcification at the level of the celiac artery. Celiac, superior mesenteric, and left renal arteries had stenosis. Right renal artery was normal. Intravascular lithotripsy-assisted balloon angioplasty and stenting of the aorta was done. Distal embolic protection of right renal artery and superior mesenteric artery was done during this procedure. Post procedure, there was no pressure gradient across the aortic stenosis, and all visceral arterial flow was maintained. Her cardiac function improved and hypertension could be managed with a single drug. Her pedal pulses became palpable

Conclusion: Coral reef calcification of suprarenal aorta can be safely managed by endovascular therapy using IVL and distal embolic protection of the visceral arteries.

(3). Kavitha Mohanasundaram, Sham Santhanam, Raja Natarajan, Hema Murugesan, Thilagavathy Nambi, Balaji Chilikuri, Subramanian Nallasivan. Covid-19 vaccination in autoimmune rheumatic diseases: A multi-center survey from southern India. Int J Rheum Dis. 2022.

https://onlinelibrary.wiley.com/doi/full/10.1111/1756-185X.14378

Abstract

Aim: This survey was conducted to evaluate COVID-19 vaccination status in patients with autoimmune rheumatic diseases (AIRDs). Our objectives were to study vaccine hesitancy, adverse effects, breakthrough infections and flare of underlying disease in this population subgroup.

Methods

This was a multi-center, cross-sectional, interview-based survey done at 6 tertiary care centers across Tamil Nadu, in the southern part of India from September 15, 2021 to October 14, 2021. The survey questionnaire was filled up by AIRD patients attending their clinics. The survey questionnaire comprised a set of 14 questions, distributed between patient characteristics, vaccines taken, their characteristics and COVID-19 infection.

Results

There were 2092 participants, with a mean age of 47.5 ± 13.17 years. Among them, 1293 (61.81%) were vaccinated, of which 837 (64.73%) were fully vaccinated.wo-thirds of our subjects were vaccinated with ChAdOx1 nCov-19 (COVISHIELD) (77.64%) and 21.57% with BBV 152 (COVAXIN). Age, gender, education and comorbidities had no association with vaccine hesitancy. The commonest (421; 52.69%) reason for vaccine hesitancy was fear of side effects. The incidence (n = 72) of breakthrough infections was similar in both the vaccine groups, of which 58 (80.55%) were partially vaccinated and 14 (19.44%) were fully vaccinated. Thirty-two patients had a flare of pre-existing rheumatic disease.

Conclusion

ChAdOx1 nCov-19 and BBV 152 were found to be safe in patients with rheumatic diseases. Fear of side effects was the major cause of vaccine hesitancy. All adverse effects were minor and self-limiting. Breakthrough infections and disease flares occurred only in a small subset of our cohort.

(4). Shyam S Krishnan, Pulak Nigam, Madabhushi C Vasudevan. Trans-Thoracic Extra-Pleural Percutaneous Spinal Fixation – A Technical Note. Neurol India. 2022;70(3):1149-53.

https://www.neurologyindia.com/article.asp?issn=0028-3886;year=2022;volume=70;issue=3;spage=1149;epage=1153;aulast=Krishnan

Abstract

Study Design: Cross-sectional analysis of defined parameters of patients who underwent the presented technique.Patients undergoing thoracic spine fixation for various pathologies.

Objective: This technique attempts to limit the incision size in extrapleural thoracotomy for multi-level spinal fixation.

Summary of Background Data: Dorsal spine is traditionally approached by either transpleural or extrapleural approach. The extrapleural approach carries a limitation of being restricted in number of levels it can address. By incrementally modifying the present technique, we were able to employ the approach in greater number of levels with lesser morbidities.

Method: Classical extrapleural thoracotomy approach is employed with incision size limited to the levels of pathology (~5 cm). Thereafter, proper exposure using Kittner dissection and defining of screw entry points follows. Stab incision is made and screws placed percutaneously through a K-wire-defined trajectory.

Results: Eighteen patients underwent fixation through this technique, of which 11 were infectious, four were traumatic, and the rest were neoplastic in pathology. None except three patients had ICU stay of more than 1 day. All patients had a pain score of 6 or lower except for two.

Conclusion: Combining the technique of percutaneous screw placement with traditional extrapleural thoracotomy reduces the size of the incision, tissue damage, and morbidity while reducing the cost and duration of hospitalization without comprising the extent of pathology that can be dealt with.

(5). Priya Chockalingam, Vaishnav Natarajan, Tharani Sekar, Rajaram Anantharaman, Meeranghani Mohamed Yusuf, Sengottuvelu Gunasekaran, Pradeep G. Nayar, V. Chockalingam. Effectiveness of a Home-Based Cardiovascular Disease Prevention Program during the COVID-19 Pandemic. Clin Prev Cardiol 2022;11:37-43.

https://www.jcpconline.org/article.asp?issn=2250-3528;year=2022;volume=11;issue=2;spage=37;epage=43;aulast=Chockalingam

Abstract

Purpose: Home-based cardiovascular disease (CVD) primary prevention (HBPP) and cardiac rehabilitation (HBCR) programs which occupied a small proportion of the overall Preventive Cardiology work in the past have become mainstream during the COVID-19 pandemic. This study aims to analyze the effectiveness of a home-based CVD prevention program implemented during the pandemic in India. Methods: A retrospective study was conducted on prepandemic and pandemic enrollees. Health behavior, CVD risk factors, physical and mental component score (PCS, MCS) from SF-12 questionnaire, body mass index (BMI), 6-min walk distance (6MWD), and clinical and biochemical parameters were assessed. A multidisciplinary team consisting of Physician, Physiotherapist, Dietician, and Counseling Psychologist provided the program using telehealth platforms. Results: Of the 66 subjects (55 ± 13 years, 73% male), 17 (26%) enrolled prepandemic and 49 (74%) enrolled during pandemic, 28 (42%) were HBPP, and 38 (58%) were HBCR participants. Majority of the subjects (n = 51, 77%) with significantly more HBCR than HBPP participants harbored 4 or more risk factors (P = 0.04). In the 60 (91%) program completers, BMI, 6MWD, PCS, and MCS had improved significantly. Systolic blood pressure, diastolic blood pressure, left ventricular ejection fraction, glycosylated hemoglobin, total cholesterol, and low-density lipoproteins had improved significantly in affected subjects.

Completely home-based participants (n = 44, 67%) who never had any in-person contact with he team during the program also showed significant improvement. No adverse events were reported.

Conclusions

Comprehensive home-based CVD prevention programs are effective in improving anthropometric, clinical, biochemical, and psychosocial parameters, are a safe alternative to conventional programs, and could potentially become the standard-of-care in the post-pandemic era.

(6). Sham Santhanam, Hema Murugesan, Kavitha Mohanasundaram. Clinical Profile and Outcome of Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: A Retrospective Observational Study from South India. Indian J Rheumatol. 2022;XX(XX).

https://www.indianjrheumatol.com/preprintarticle.asp?id=350019;type=0

Abstract

Aim: The aim was to study the clinical profile and outcome of patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV).

Methods: This was a retrospective observational study of patients with a diagnosis of AAV (granulomatosis with polyangiitis [GPA], microscopic polyangiitis [MPA], and eosinophilic granulomatosis with polyangiitis [EGPA]). Patient records from January 2015 to December 2020 were retrieved and included in the analysis. We used the European Medicines Agency (EMA)algorithm for classification of patients.

Results: Forty (14 males and 26 females) patients were included (34 – GPA, 4 – MPA, and 2 – EGPA). The median age was 48 years (54.5 – males and 46 – females). The median disease duration was 6 months, and the median follow-up duration was 18.5 months. As per European Vasculitis Society disease categorization, 25 had organ/life-threatening type, 10 had rapidly progressive renal failure/pulmonary hemorrhage, 4 nonorgan threatening, and 1 refractory disease. The median erythrocyte sedimentation rate (mm/h) and C-reactive protein (mg/L) were 64 and 52.49, respectively. The median Birmingham Vasculitis Activity Score was 15.5.

Twenty-six had constitutional features, 22 musculoskeletal, 24 pulmonary, 19 renal, 13 ocular, 13 ENT involvement, 10 mucocutaneous, 11 peripheral nervous system, 1 central nervous system, and 3 had cardiovascular involvement. As induction therapy, cyclophosphamide was used in 15 and rituximab in 20 patients.

Conclusion: The age of onset of AAV was relatively delayed in comparison to other Indian studies. We had female predominance similar to other Indian studies but in contrast to European and US cohorts. In comparison to other Indian studies, prevalence of ENT and ocular manifestations were less and none of the subjects had gastrointestinal involvement.

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