Systematic review of fibroblastic rheumatism:A case report

BACKGROUND Fibroblastic rheumatism(FR)is a rare fibroproliferative disease with an unknown etiology.The absence of typical symptoms makes early diagnosis challenging.This study aims to systematically review FR cases and present a case from our center to provide a comprehensive description of the clinical manifestations,diagnosis,and treatment,thereby assisting clinicians in early identification and timely management of FR,ultimately leading to improved prognosis.CASE SUMMARY FR is a rare fibroproliferative disease with an unknown etiology.It is characterized by rapidly progressive and destructive symmetrical inflammatory multiple arthritis.Here,we present a rare case of a 50-year-old female with symmetric inflammatory polyarthritis.We highlight the importance of a comprehensive medical history,histopathology,immunohistochemistry,and clinical manifestations of skin nodules,arthralgia,and arthritis for successful disease diagnosis.Despite employing non-steroidal anti-inflammatory drugs,corticosteroids,methotrexate,and tacrolimus,the patient's symptoms did not resolve,and joint destruction continued to progress.Early diagnosis,aggressive treatment with appropriate use of steroids and immunosuppressants,and further research to identify effective treatment strategies are crucial in preventing detrimental joint destruction and limb contractures.CONCLUSION A comprehensive review of the available literature emphasizes the importance of early and accurate diagnosis coupled with appropriate treatment for achieving favorable outcomes and preventing joint destruction and limb contractures.

Evaluation of Therapeutic Adherence in Patients Suffering from Chronic Inflammatory Rheumatism in the Rheumatology Wards of Lomé (Togo)

Objectives: Therapeutic compliance can be defined as the degree of adequacy between a patient’s behaviour and his doctor’s recommendations. Non-adherence to treatment has serious consequences in terms of morbidity and mortality. Our aim was to assess adherence among patients treated for chronic inflammatory rheumatism in Lomé. Patients and Methods: This was a multicentre cross-sectional study conducted from January 2015 to December 2021. Patients aged 18 years or older, treated in the rheumatology departments of the Sylvanus Olympio University Hospital or the Bè Hospital during the study period, were included if they were diagnosed with chronic inflammatory rheumatism and started on disease-modifying therapy. Adherence was assessed using the Compliance Questionnaire Rheumatology 19 questionnaire, with a threshold for good compliance set at 80%. Results: Out of 13,214 patients received, 159 suffered from chronic inflammatory rheumatism (hospital frequency 1.5%), and 60 met the inclusion criteria for our study. There were 55 women (91.7%) and 5 men (8.3%), giving a sex-ratio of 1/11. The mean age was 49.5 ± 13.5 years (extremes: 19 and 78 years). Rheumatoid arthritis (68.3%) was the most common rheumatic disease, followed by undefined rheumatic diseases (16.6%) and spondyloarthritis (8.3%). Average compliance with treatment was 76.9% ± 12.4% (extremes 29.8 and 91.2). There was no statistically significant difference according to the type of rheumatism. Conclusion: Overall compliance was poor, with a Compliance Questionnaire Rheumatology 19 of less than 80%. It was non-significantly influenced by socioeconomic status, disease severity and duration of progression.

Detection and Analysis of Blood associated Agent of Canine Rheumatism

[Objective] The paper was to explore the relationship between the occurrence of canine rheumatism and blood-associated agent by detecting blood routine indexes and changes in content of anti streptolysin O( ASO),C-reactive protein( CRP) and antinuclear antibody( ANA). [Method]Totally 13 cases of dogs which had been diagnosed with rheumatism by the reference standard of clinical examinations and laboratory diagnosis were selected for treatment,and their venous blood was collected on the day of diagnosis and at 1,3,5 d after treatment,respectively. Another 13 healthy dogs were selected randomly to collect venous blood as well. The white blood cells( WBC) count,neutrophilic granulocyte( Gran#),lymphocyte count( Lymph#) and blood routine index were determined using automatic animal blood cell analyzer. The content of ASO,CRP and ANA were determined using enzyme-linked immunosorbent assay( ELISA). [Result]Blood routine examination showed that there were significant differences in WBC between untreated rheumatismal dogs and healthy dogs( P < 0. 05),but no significant difference was observed on the day of diagnosis and duration of therepay( P > 0. 05). Detection results of blood-associated agent in rheumatismal dogs showed that there were extremely significant differences in ASO and ANA content between the day of diagnosis and duration of therapy( P < 0. 01); there were significant differences in Lymph# and Gran# content of CRP between the day of diagnosis and duration of therapy( P < 0. 05). The ASO,ANA and CRP content in the serum of untreated rheumatismal dogs were higher than those in healthy dogs,and the content of various indicators decreased significantly after treatment,but were still higher than that in healthy dogs. [Conclusion]The incidence of canine rheumatism is positively correlated with WBC count,ASO content,CRP content and ANA content. The variation of CRP content is the most sensitive indicator of the disease.

Training School of Rheumatism Enrolling New Students(In Chinese)

Base on the folk secret formula, the medical personals have developed Qu Feng Powder (祛风散) and Qu Feng Pills (祛风丸) which are made from pure Chinese herbs, indicated for rheumatic diseases, hyperosteopeny, and protrusion of intervertebral disc, etc. In the training course, you can learn the pathogenic mechanism, diagnosis and treatment based on TCM differentiation of syndromes, and preparation of the above drugs. For further details and application form, please contact with the Training school.Address: Training School of Rheumatism, Julu County 055250, Hebei Province, P. R. ChinaTel:

Thoughts on the Diagnosis and Treatment of Postpartum Rheumatism

Postpartum rheumatism belongs to the deficiency in origin and excess in superficiality.The dual deficiency of qi and blood is the main pathological basis of postpartum rheumatism.External pathogen,depression,and blood stasis are important pathogenic factors for postpartum rheumatism.Syndrome differentiation mainly includes deficiency-excess pattern identification.In terms of the treatment,it is necessary to take deficiency and depression as guiding principle.Besides,it is necessary to combine wind-cold-dampness or stasis evil of patients to take different treatment methods.

Outcome of Unclassified Inflammatory Rheumatism: Observation of 7 Cases in Dakar

Introduction: Unclassified inflammatory rheumatism is persistent inflammatory arthralgias with or without synovitis without sufficient classification criteria for an inflammatory rheumatism or a well-defined connective disease. Their outcome is variable and has been little studied in Africa. We report the epidemiological, paraclinical and evolutionary characteristics of seven cases of indeterminate polyarthritis. Material and Method: From January 2012 to May 2021, we selected all the files of patients followed up for unclassified inflammatory rheumatism and in whom a precise diagnosis was retained during the course of the disease. The diagnosis of unclassified inflammatory rheumatism was retained after biological, immunological and radiological explorations without specificities. Our study took place in the Internal Medicine Department of Aristide Le Dantec Hospital (HALD). Results: Seven cases out of 274 consulted were collected. They consisted of seven women with an average age of 39 years at the time of the first consultation (extremes: 19 and 67 years). All seven patients presented with inflammatory polyarthralgia or non-deforming, non-erosive peripheral polyarthritis, without extra-articular manifestations. A biological inflammatory syndrome was present in all seven patients. Autoantibodies (rheumatoid factor, ANA, anti-ENA and ACPA) were negative in all patients. The first-line treatments in all seven cases were hydroxychloroquine (200 - 400 mg/day) and prednisone (5 - 10 mg/day). Methotrexate was added in 3 cases. During follow-up, 2 cases progressed to Polyarthritis Rheumatoid (PR) after 3 and 4 years. Two cases progressed to Sjögren’s syndrome after 4 and 5 years. Two patients progressed to systemic scleroderma after 5 and 8 years. One patient progressed to lupus after 5 years. Conclusion: Regular follow-up is essential in IAN. It allows the early diagnosis of IJR or a well-differentiated connective tissue disease and ensures adequate management, especially early.

Contribution to the Study of the Incidence of Post-Streptococcal Complications in Republic Central African Republic from 2015 to 2018

Introduction: Acute rheumatic fever (AAR) is a non-suppurative complication of late infection by group A. Infections due to streptococci remain a public health problem in the Central African Republic. The present study aims to determine the incidence rate of AAR cases and its complications. Methodology: This was a retrospective and analytical study over a period of 4 years (from January 2015 to December 2018) at the National Laboratory of Clinical Biology and Public Health (LNBCSP) in Bangui. It focused on samples concerning the diagnosis of AAR and patient files seen in consultation in the capital’s reference health establishments. Laboratory registers and patient consultation files were used to collect data. They were entered into Excel 2010 to be analyzed with Epi Info 7. A univariate analysis by logistic regression, Ficher’s exact test, and chi2 at the 5% threshold (p Results: We analyzed 94 cases meeting Jones’s criteria. The ages of the patients ranged from 18 to 85 years (mean age 52 years and mode 45 years). The incidence rate of AAR for the female sex was higher than that of the male sex during the study period (p > 0.05). It went from 166.6 in 2015 to 200 in 2016 and 2018 cases of AAR per 1000 people per year. The average incidence rate was 296.18 cases of AAR per 1000 people per year. The average incidence rate was 223.5 cases of AAR per 1000 people per year for joint damage. Joint damage represented 80.85% (RR = 0.62;Chi2 = 4.88;95% CI [0.39-0.97];p Conclusion: The study allowed data on the impact rate and complications of the AAR in Bangui. Special attention to data management will help produce a complete result on the problem. Joint complications predominated. Sustaining an effective surveillance system and preventing infection would help reduce the risk of AAR occurrence.

Community-acquired multidrug-resistant pneumonia,bacteraemia,and infective endocarditis:A case report

BACKGROUND The prevalence of multidrug-resistant(MDR)bacteria has increased globally,with extensive drug-resistant(XDR)bacteria posing a threat to patients.CASE SUMMARY This case report describes a young man admitted for suspected tropical fever infections who experienced rapid deterioration in health.Despite negative results for tropical fever infections,he had neutrophilic leucocytosis,acute kidney injury,and chest imaging findings suggestive of bilateral consolidations.On day two,he was diagnosed with infective endocarditis with possible rheumatic heart disease and MDR methicillin-resistant Staphylococcus aureus bacteraemia,and communityacquired pneumonia.Despite treatment with broad-spectrum antibiotics,he did not respond and succumbed to death on day five.CONCLUSION This case highlights that clinicians/public should be aware of MDR communityacquired pneumonia,bacteraemia,and endocarditis which ultimately culminate in high rates of morbidity and mortality.Early identification of pathogenic strain and prompt antibiotic treatment are a mainstay for the management and prevention of early fatalities.Simultaneously,route cause analysis of communityacquired MDR/XDR pathogens is a global need.

Epidemiologic study of soft tissue rheumatism in Shantou and Taiyuan, China

Background Soft tissue rheumatism is a group of common rheumatic disorders reported in many countries.For investigating the prevalence rate of soft tissue rheumatism in different population in China, we carried out a population study in Shantou rural and Taiyuan urban area.Methods Samples of 3915 adults in an urban area of Taiyuan, Shanxi Province, and 2350 in a rural area of Shantou,Guangdong Province were surveyed.Modified International League of Association for Rheumatology （ILAR）-Asia Pacific League of Association for Rheumatology （APLAR） Community Oriented Program for Control of Rheumatic Diseases （COPCORD） core questionnaire was implemented as screening tool.The positive responders were then all examined by rheumatologists.Results Prevalence rate of soft tissue rheumatism was 2.0% in Taiyuan, and 5.3% in Shantou.Rotator cuff （shoulder）tendinitis, adhesive capsulitis （frozen shoulder）, lateral epicondylitis （tennis elbow）, and digital flexor tenosynovitis （trigger finger） were the commonly seen soft tissue rheumatism in both areas.Tatarsalgia, plantar fasciitis, and De Quervain＇s tenosynovitis were more commonly seen in Shantou than that in Taiyuan.Only 1 case of fibromyalgia was found in Taiyuan and 2 cases in Shantou.The prevalence of soft tissue rheumatism varied with age, sex and occupation.Conclusions Soft tissue rheumatism is common in Taiyuan and Shantou, China.The prevalence of soft tissue rheumatism was quite different with different geographic, environmental, and socioeconomic conditions; and varying with age, sex, and occupation.The prevalence of fibromyalgia is low in the present survey.

New perspective on the treatment of rheumatic arthritis based on“strengthening body resistance(Fú Zhèng)”in the theory of co-inhibitory receptor-regulated T-cell immunity

Co-inhibitory receptors serve as crucial regulators of T-cell function,playing a pivotal role in modulating the delicate balance between immune tolerance and autoimmunity.Initially identified in autoimmune disease models,co-inhibitory receptors,including CTLA-4,PD-1,TIM-3,and TIGIT,were found to be integral to immune regulation.Their blockade or absence in these models resulted in the induction or exacerbation of autoimmune diseases.Additionally,scholars have observed that co-inhibitory receptors on lymphocytes hold the potential to influence the prognosis in the context of chronic inflammation.Consequently,the blocking of co-suppressor receptors has emerged as a novel therapeutic approach for inhibiting refractory inflammatory diseases,particularly rheumatoid arthritis.From the standpoint of traditional Chinese medicine(TCM),the treatment of rheumatoid arthritis based on the“strengthening body resistance(FúZhèng)”theory can be construed as the regulation of co-suppressor receptors to modulate the body’s immune function in combating chronic inflammation.This article provides a succinct overview of the role of co-suppressor receptors in anti-inflammatory processes and explores the research prospects of co-suppressor receptor intervention in the treatment of rheumatoid arthritis.The exploration integrates the“strengthening body resistance(FúZhèng)”theory with relevant Chinese medicine formulations.

Prognostic Role of Preoperative Tricuspid Annular Plane Systolic Excursion (TAPSE) in Mitral Valve Replacement (MVR) for Rheumatic Mitral Stenosis Patients

Tricuspid annular plane systolic excursion has been proposed as a simple and reproducible parameter for quantitative assessment of the right ventricular ejection fraction. The prognostic importance of preoperative TAPSE in patients with mitral valve replacement for rheumatic mitral stenosis patients is still under focused. Therefore, the objective of the study was to predict the outcome after MVR in rheumatic mitral stenosis patients in relation to preoperative TAPSE. This comparative cross-sectional study was conducted at the Department of Cardiac Surgery, National Heart Foundation Hospital and Research Institute. A total of 72 patients of rheumatic mitral stenosis patients who underwent mitral valve replacement were included in the study. They were divided into two groups: Group A and B. Group A included 36 patients with TAPSE 0.05) except for the preoperative TAPSE. Mean TAPSE of Group A was 13.17 (±1.40) and Group B was 18.61 (±1.57), the difference was statistically significant (p 0.05). Among the postoperative complications, including postoperative atrial fibrillation was higher in Group A (30.56%) than Group B (11.11%), mean ventilation time was higher in Group A (27.78%) than Group B (5.56%), length of intensive care was higher in Group A (33.33%) than Group B (11.12%), and hospital stay was higher in Group A (25.0%) than Group B (5.56%), (p < 0.05). Higher preoperative TASPE could be used as a prognostic tool for MVR in rheumatic mitral stenosis patients in our settings.

Prevalence and pattern of soft‐tissue rheumatism in a rural community in South‐South Nigeria: A cross‐sectional survey

Background:Soft tissue rheumatism arises from the pathology of periarticular structures.They are marked by pain and disability.Epidemiological studies in sub‐Saharan Africa are sparse.This study aimed to determine the epidemiology of soft‐tissue rheumatism in a rural community in South‐South Nigeria.Methods:This was a community‐based,cross‐sectional study conducted from February to July 2017 in South‐South Nigeria among 319 participants using the Community Oriented Program for the Control of Rheumatic Diseases(COPCORD)methodology.Participants aged 18 years and older were included in the study.Subjects reporting positive musculoskeletal pain were examined for specific soft tissue rheumatism.The diagnosis was based on established criteria.Results:The mean age of the study population was 48.87±19.58 years.The prevalence of soft‐tissue rheumatism was 11.0%(35/319).Soft tissue rheumatism was more prevalent in females(24,68.6%)than in males(11,31.4%).The most common form of soft‐tissue rheumatism diagnosed was adhesive capsulitis(20.0%),closely followed by rotator cuff tendinitis(14.3%),carpal tunnel syndrome(14.3%),and plantar fasciitis(14.3%).Age(p=0.06),body mass index(p=0.034),and dyslipidemia(p=0.028)were significantly associated with the prevalence of soft‐tissue rheumatism.A significant disability index(HAQ‐DI≥1)was recorded in 40.0%of participants with soft tissue rheumatism.Twelve(34.3%)participants with soft‐tissue rheumatism attributed the disorder to their work,and 74.3%used hospital‐prescribed medications for treatment.Conclusion:Soft‐tissue rheumatism is associated with a significant disability affecting activities of daily living.Factors associated with its prevalence include increasing age and obesity.

Rheumatic valvular heart disease treated with traditional Chinese medicine:A case report

BACKGROUND Rheumatic heart disease(RHD)is an autoimmune disease that leads to irreversible valve damage and heart failure.Surgery is an effective treatment;however,it is invasive and carries risks,restricting its broad application.Therefore,it is essential to find alternative nonsurgical treatments for RHD.CASE SUMMARY A 57-year-old woman was assessed with cardiac color Doppler ultrasound,left heart function tests,and tissue Doppler imaging evaluation at Zhongshan Hospital of Fudan University.The results showed mild mitral valve stenosis with mild to moderate mitral and aortic regurgitation,confirming a diagnosis of rheumatic valve disease.After her symptoms became severe,with frequent ventricular tachycardia and supraventricular tachycardia>200 beats per minute,her physicians recommended surgery.During a 10-day preoperative waiting period,the patient asked to be treated with traditional Chinese medicine.After 1 week of this treatment,her symptoms improved significantly,including resolution of the ventricular tachycardia,and the surgery was postponed pending further follow-up.At 3-month follow-up,color Doppler ultrasound showed mild mitral valve stenosis with mild mitral and aortic regurgitation.Therefore,it was determined that no surgical treatment was required.CONCLUSION Traditional Chinese medicine treatment effectively relieves symptoms of RHD,particularly mitral valve stenosis and mitral and aortic regurgitation.

Epidemiological and Clinical Aspects of Hospitalized Patients with Chronic Rheumatic Disease at Cocody University Hospital in Abidjan

Objective: To study the epidemiological and diagnostic features of chronic rheumatic disease (CRD) in a black population in sub-Saharan Africa. Patients and Methods: Retrospective descriptive study over eight years (January 2005 to December 2012) of patients seen for CRD in rheumatology hospitalization at the CHU de Cocody in Abidjan, Côte d’Ivoire. Results: Of 3147 hospitalized patients, 92 had CRD, a frequency of 2.9%. The mean age of patients was 43.50 ± 15.6 years (extremes: 10 to 79 years). The sex ratio was 0.08 (7 men and 85 women). The socio-economic level was low in 44 patients (47.8%), medium in 44 patients (47.8%), and high in 4 patients (4.4%). The reasons for consultation were polyarthritis (64.1%), polyarthralgia (30.4%), and oligoarthritis (5.4%). The mean duration of symptomatology was 19 months (range: 3 to 20 years). The mean length of hospital stay was 14.2 ± 7.7 days (range: 2 to 36 days). The CRD observed were: rheumatoid arthritis (59.8%), systemic lupus erythematosus (23.9%), mixed connective tissue disease (6.5%), undifferentiated connective tissue disease (3.3%), polymyositis (3.3%), systemic scleroderma (2.2%), and systemic vasculitis (1%). Conclusion: CRD is not uncommon in rheumatology hospitals in Abidjan. Diagnostic delays are long, and rheumatoid arthritis and systemic lupus erythematosus are the most frequently encountered conditions.

Expression of PDGFR-α in Patients with Valvular Atrial Fibrillation

Objective: To investigate the expression of Platelet-derived growth factor receptor alpha (PDGFR-α) in patients who have valvular atrial fibrillation. Methods: In this research, eighty-four patients with rheumatic heart disease who were going to undertake cardiac surgery were included. The subjects were divided into two groups: the AF group and the sinus rhythm group, the quantities are 39 and 45 respectively. Before the surgery, baseline demographics, physical examination, routine laboratory testing, echocardiography, echocardiographic data and additional clinical data were available for all patients. The right atrial tissue of the subjects was separated during surgery, with an area of approximately 0.3 - 0.5 mm3. Immunofluorescence staining was used to analyze the distribution of PDGFR-α of atrial tissue. mRNA of PDGFR-α in atrial tissue were determined by real-time quantitative PCR (Polymerase Chain Reaction);Western-Blot technique was used to measure the protein of PDGFR-α in atrial tissue. Results: There were no significant differences (P > 0.05) in sex ratio, age, blood pressure, blood biochemistry, and other aspects of medical history between the two groups. However, the right and left atrium diameters in the AF group were markedly larger than those in the SR group (P α from right atrial tissue were obviously higher in the AF group than that in the SR group (P Conclusion: The expression of PDGFR-α in the right atrial tissue of patients with atrial fibrillation was found to be significantly higher.

Rheumatic Heart Disease in Children: Epidemiological Aspects. Diagnostic and Evolutive at the Dakar Chu

Rheumatic heart disease is the ultimate consequence of acute articular rheumatism. It remains a public health problem in developing countries. It is a pathology found in all countries of the world, with a clear predominance in developing countries. In Senegal, the hospital prevalence of rheumatic heart disease is 30.5%. Its seriousness lies in the risk of valvular sequel responsible for cardiac dysfunction that can lead to death. The objective of this study was to describe the epidemiological, diagnostic and evolutionary aspects of rheumatic heart disease at the Albert Royer National Hospital Center of child (CHNEAR). We had carried out a retrospective, descriptive and analytical study lasting 3 years from January 1, 2017 to December 31, 2019. All children aged 4 to 17 hospitalized at CHNEAR for rheumatic heart disease were included. The hospital prevalence was 0.8%. The average age was 10.9 years with a sex ratio of 0.875 in favor of girls. 85.47% of cases came from parents who had a low economic level of life. The history of repeated angina and acute articular rhumatism (AAR) was found respectively in 22.69 and 15.13% of cases. The clinical symptomatology was dominated by heart failure with 58.3% of cases, arthralgia in 7.5% of cases. The biological inflammatory syndrome was found in 86.1%. 73% of the patients had a positive antistreptolysin O antibody (ASLO). Cardiomegaly was found in 89.7%. Heart doppler ultrasound found polyvalvular involvement in more than half of the cases. Mitral insufficiency was the predominant valve disease in 98.20% of cases. The evolution was favorable in the majority of cases but 9.32% of deaths were observed.

Atrial Fibrillation: Epidemiological, Etiological and Hospital Management Aspects in Thies (Senegal)

Introduction: The objective of this work was to describe the epidemiological, etiological, clinical and therapeutic aspects of atrial fibrillation (AF) in Thies, Senegal. Materials and Methods: This was a retrospective, multicentre, descriptive study from February 1st, to May 28th, 2019 carried out in the 3 hospitals of the city of Thies that focused on patients with AF documented by an ECG. Valvular and non-valvular AF classification was used and the CHA2DS2-VASc score was used to assess thromboembolic risk. Results: We collected 67 patients with a female predominance (M/F sex ratio of 0.71). The prevalence of AF was 1.7%. The average age of patients was 66.67 ± 13.48 years. Forty-eight patients (71.64%) had palpitations and 32 patients (47.76%) had heart failure. Hypertension was the most common etiological factor found in 41 patients (61.19%) followed by rheumatic valvular disease in 25 patients (37.31%). The non-valvular AF was found in 42 patients (62.69%) of which 34 (80.95%) had a CHA2DS2-VASc score ≥ 2. Vitamin K antagonists (VKAs) were prescribed in 47 patients (79.66%) and aspirin alone in 12 patients (20.34%). Direct Oral Anticoagulants (DOACs) were not prescribed in any patient. Seven patients (10.44%) had a medical regulator treatment and no electrical cardioversion was performed. Conclusion: AF was a frequent rhythm disorder. Hypertension and rheumatic mitral valve disease were the most frequently associated etiological factors. The diagnosis was often late in the heart failure stage. Anticoagulant treatment was insufficiently prescribed and based exclusively on VKAs.

Transcranial direct current electrical stimulation in combination with aerobic exercise:A pilot study in post-COVID-19 systemic autoimmune rheumatic patients

BACKGROUND Systemic autoimmune rheumatic diseases(SARDs)are a group of diseases with multiorgan involvement and a high prevalence of chronic pain and fatigue.Patients with SARDs and post-coronavirus disease 2019(COVID-19)syndrome experience aggravation of symptoms.In this context,it is essential to establish strategies to reduce chronic pain and fatigue and improve quality of life.AIM To assess the efficacy of transcranial direct current stimulation(tDCS)for the treatment of fatigue and pain-associated post-COVID-19 syndrome in patients with SARDs.METHODS This study included nine patients with different types of SARDs.All patients had reverse transcription-polymerase chain reaction(RT-PCR)test confirmed COVID-19 as well as significant,persistent fatigue and pain that began to worsen after infection.Anodal tDCS was administered in five daily sessions(2mA,20 min).Concomitantly,patients were involved in aerobic exercise program.All participants were evaluated using specific questionnaires and strength assessment by handgrip and physical function by timed-up-and-go test and sit-to-stand test at baseline(within one week before tDCS protocol),and one week after tDCS protocol.During all procedures,the patients’treatments remained unchanged.RESULTS The sample comprised eight women and one man with a mean age of 48.7±9.6 years.After the tDCS protocol,pain and fatigue significantly improved on the visual analog scale(P<0.05).The physical function also improved 9.5±2.7 vs 6.8±0.8(P=0.001)for timed-up-go-test and 10.3±3.7 vs 15.1±4.0(P=0.037)for sit-to-stand test.None of the patients experienced any adverse events.CONCLUSION The present study showed that tDCS in combination with aerobic exercise was effective in improving physical function,and reducing fatigue/pain in SARDs patients with post-COVID-19 syndrome.

Prevalence of Preoperative Anemia in Elective Rheumatic Valve Surgery at a Tertiary Care Center in Nepal

Background: Rheumatic Valvular Heart disease (RVHD) is common in developing countries often associated with anemia;however its burden is often overlooked. Anemic patients undergoing surgery are likely to receive blood transfusion, increasing morbidity and mortality. Prevalence of anemia in cardiac surgical patients are studied extensively, however its burden in RVHD is lacking. This study attempted to investigate the prevalence of preoperative anemia in RVHD and its effect on blood transfusion, morbidity and mortality in patients undergoing valve surgery. Methods: This is a retrospective observational study conducted at a tertiary care hospital in Nepal. We considered 340 patients who underwent Rheumatic valve replacement surgery from 2014 January to December 2016 and data on their socio-demographic and clinical characteristics were extracted from the patient’s records. The analyses meeting the study objectives were conducted using IBM SPSS v25 for Windows (IBM Statistical Package for Social Sciences, 2015IBM Corporation, New York, United States). Results: The prevalence of no anemia, mild, moderate, and severe anemia was 34.1%, 57.7%, 39.6%, 2.5%, respectively. The units of Red Blood Cell used for transfusion were 1.2 units, 2.0 units, 2.3 units, and 1.6 units in patients without anemia, and those with mild, moderate and severe anemia respectively. The incidence of reexploration was higher in patients with severe anemia as compared to the non anemic with an incidence of 66.6%. A proportion of the patients with no anemia, mild, moderate and severe anemia with less than 7 days stay in the intensive care unit were 89%, 82%, 84.7% and 100% respectively. The length of hospital stay more than 10 days was seen in 58.9%, 71.6%, 63% and 100% in patients with no anemia, mild, moderate and severe anemia. An overall incidence of mortality in anemic patients was 11% while in non anemic patients was 5.3%. Conclusions: The prevalence of anemia was high in the Nepalese patients with Rheumatic valvular heart disease planned for elective surgery. There was an increased incidence of blood transfusion, longer hospital stay, and increased mortality in anemic patients compared to their non anemic counterparts.

Application of Clinical Nursing Pathway in the Peri-Treatment Period of Immunoadsorption Therapy for Rheumatic Immune Diseases

Objective: The paper aims to investigate the clinical nursing pathway (CNP) in the application of immunosorption therapy in patients with rheumatic immune disease. Methods: Convenience sampling method was used to select inpatients who received immunoadsorption therapy from January 2020 to December 2022 in the rheumatology and Immunology department of a 3A hospital in Jingzhou City. 30 patients from January 2020 to June 2021 were selected as control group, and 30 patients from July 2021 to December 2022 were selected as observation group. The control group was given routine nursing. On the basis of the control group, the observation group used a clinical nursing pathway for intervention during the perioperative period of immunosorbent therapy. The incidence of adverse reactions, patient satisfaction, and nurse satisfaction during immunosorbent therapy between the control group and the observation group were compared. Results: After intervention, the incidence of adverse reactions in the observation group was significantly lower than that in the control group, while patient satisfaction and nurse satisfaction in the observation group were significantly higher than those in the control group. The results are all statistically significant (P Conclusion: Clinical nursing pathway is beneficial to reduce the incidence of adverse reactions in patients with immunoadsorption during peri-treatment and improve the satisfaction of patients and nurses.