Background: Coronavirus disease-19 (COVID-19) has sparked the deterioration of human health at an unprecedented scale globally and affected the patient’s musculoskeletal health also. It is conceivable that active rheumatoid arthritis (ARA) patients recovered from COVID-19 after second wave are at enhanced risk of cardiovascular complications. Aim and Objectives: In this context, the present study was intended to estimate the soluble vascular cell adhesion molecule-1 (sVCAM-1), serum paraoxonase (PON), and markers of oxi-inflammatory stress in ARA patients diagnosed reverse transcriptase-polymerase chain reaction negative after second wave of COVID-19 and to determine their role in predicting cardiovascular disease (CVD) risk. Materials and Methods: Sixty ARA patients (30–45 years) of Delhi-NCR region were recruited and categorized into two groups (n=30 in each group; on the basis of their history of COVID infection). Using standard methods, study group parameters were estimated in ARA patients and statistically compared it with that of 30 healthy controls by using student’s t-test. Results: Serum sVCAM-1, malondialdehyde (MDA), and C-reactive protein (CRP) levels were significantly high (P<0.001) in Group II and Group III subjects as compared to healthy controls. Conversely, serum PON activity was found to be significantly low (P<0.001) in Group III as compared healthy controls. However, PON activity was altered insignificantly (P<0.1) with respect to Group II subjects. sVCAM-1 levels were positively correlated with MDA, CRP, and atherogenic index; and negatively correlated with PON activity (P<0.001) in post-COVID ARA patients. Conclusion: Thus, enhanced sVCAM-1 and reduced PON activity along with enhanced oxi-inflammatory stress status are more efficient molecular signatures of CVD risk among post-COVID ARA patients. Therefore, the present study emphasizes the dire need of special attention to provide cardiovascular rehabilitation strategy among post-COVID ARA patients along with reduction of oxi-inflammatory stress to reduce the CVD mortality in ARA population.
Background: In this study, we have compared the addition of fentanyl 25 mcg and dexmedetomidine 5 mcg to 15 mg of 0.5% hyperbaric bupivacaine for spinal anesthesia separately for patient undergoing lower limb orthopedic surgery. Dexmedetomidine is an α-2 adrenoreceptor agonist and it can prolong the motor and sensory block for long spinal anesthesia. It act by binding to presynaptic C-fiber and postsynaptic dorsal horn neurons. The analgesic action is a result of depression of release of C-fiber transmitters and hyperpolarization of postsynaptic dorsal horn neurons. Aims and Objectives: The present study compares the onset, duration of sensory and motor block, postoperative analgesia, hemodynamic changes, and adverse effects of intrathecal dexmedetomidine and intrathecal fentanyl as an adjuvant to bupivacaine during spinal anesthesia for lower limb orthopedic surgery. Materials and Methods: Patient was randomly grouped by close-envelope technique into the three equal group of 30 in each group. Total 90 patients were including in this study. The blind nature of the study was maintained and the study drug is given according as, Group-1: 15 mg of 0.5% hyperbaric bupivacaine. (Control group), Group-2: 15 mg of 0.5% hyperbaric bupivacaine with 25 mcg of fentanyl, and Group-3: 15 mg of 0.5% hyperbaric bupivacaine with 5 mcg dexmedetomidine for spinal anesthesia. Results: Patients in dexmedetomidine Group-3 had a significantly longer sensory (160±18.5 min) and motor block (242±22 min) time as compared to patients in fentanyl and control group (P<0.001). The time to first request of analgesic in the post-operative period was also longer in dexmedetomidine group (245±3.6 min) when compared to bupivacaine and fentanyl in which it was 125±1.0 min and 220±2.5 min, respectively (P<0.001). Conclusion: We concluded that intrathecal dexmedetomidine with bupivacaine for spinal anesthesia is associated with prolong motor and sensory block then fentanyl 25 μg with bupivacaine and bupivacaine alone.
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