Mysore Medical College

Abstract This case report presents a rare manifestation of systemic lupus erythematosus (SLE) in a female patient in her late 20s. The patient initially presented with bilateral hip pain and was diagnosed with Grade II bilateral avascular necrosis (AVN) of the femoral heads. Concurrent severe autoimmune cytopenias were discovered, including autoimmune hemolytic anemia and immune thrombocytopenia. Laboratory findings revealed positive antinuclear antibody, anti-dsDNA, and other SLE-specific antibodies, along with hypocomplementemia and proteinuria. The patient met both the 2019 European Alliance of Associations for Rheumatology and the American College of Rheumatology and the 2012 Systemic Lupus International Collaborating Clinics classification criteria for SLE. Notably, this presentation occurred without prior corticosteroid use or antiphospholipid syndrome, which are typically associated with AVN in SLE patients. Treatment included high-dose intravenous methylprednisolone, oral prednisone, mycophenolate mofetil, packed red blood cell transfusions, and intravenous immunoglobulin. While cytopenias and proteinuria improved with treatment, the advanced stage of AVN necessitated bilateral total hip arthroplasty. This case highlights the potential for SLE to cause AVN through mechanisms such as vasculitis or hypercoagulable states, independent of steroid use. It also demonstrates the importance of considering SLE in patients presenting with concurrent AVN and severe autoimmune cytopenias, even in the absence of typical risk factors.

Background: Meconium aspiration syndrome (MAS) is an important cause of respiratory problems in term newborns. Early identification of infants at risk for adverse outcomes is essential for timely intervention. Umbilical cord blood lactate dehydrogenase (LDH), a marker of tissue hypoxia and cellular injury, may serve as an early prognostic biomarker in MAS. Methods: A hospital-based cross-sectional observational study was conducted over 18 months at a tertiary care hospital in Mysore. One hundred term newborns with MAS born through meconium-stained amniotic fluid (MSAF) were enrolled. Umbilical cord blood samples collected immediately after birth were analysed for LDH levels using the UV assay method. The demographic, perinatal, and clinical data were collected. Appropriate statistical tests were performed to analyse associations between cord blood LDH levels and short‐term neonatal outcomes, with p<0.05 considered statistically significant. Results: Thick MSAF was seen in 64% of the newborns, and 72% required resuscitation at birth. The most frequent presentation was moderate MAS (50%); 30% had severe disease. 11% developed persistent pulmonary hypertension, 25% developed sepsis, and overall mortality was 8%. Higher cord blood LDH levels were significantly associated with adverse short-term outcomes, such as prolonged oxygen requirement and longer NICU stay. Conclusions: Umbilical cord blood LDH is a simple, easily available, and promising biomarker for short term outcome prediction in term newborns with MAS. Its early assessment may be beneficial in risk stratification and management in tertiary care settings.

Introduction: Self-medication is common in India and highly prevalent among healthcare professionals. It may be frequent among non-medical healthcare workers who have easy access to medicines but limited formal training in rational drug use. Aim: To evaluate the prevalence, patterns, and determinants of self-medication among non-medical healthcare workers in a tertiary-care teaching hospital in South India. Material and Method: A cross-sectional and non-interventional academic study was conducted among 260 non-medical healthcare employees (Group B, C, and D) at a tertiary-care teaching hospital in Mysore after obtaining approval of the Institutional Ethics Committee. Data were collected using a pre-validated questionnaire after obtaining written informed consent. Descriptive statistics were used to analyse the data, and chi-square test and independent t test were applied to explore associations between self-medication and socio-demographic or health-related factors, with p<0.05 considered significant. Multivariable logistic regression analysis was used to find association between the various determinants and self medication. Results: The mean age of participants was 40.1 years, the majority were female (68.1%), Group D employees (73.8%), urban residents (90%), and below the poverty line (69.2%). The prevalence of self-medication was 73.8% in non-medical healthcare workers. It was more common in younger workers, females, those with longer work experience, smokers, and those with a past history of disease. Common reasons included convenience, previous prescriptions, and perception of minor illness. Frequently used medicines were paracetamol, analgesics, and antacids. Most participants were somewhat aware of the ill effects of self-medication, and over 90% might or would definitely consider stopping after understanding the risks. Conclusion: Self-medication is highly prevalent among non-medical healthcare workers for minor illnesses using easily available medicines, but many express willingness to modify this behavior. Workplace-based education and stricter control of non-prescription drug use may help promote safer medicine practices.

Background: Diabetes is a chronic health condition that affects millions of people worldwide. It's a condition that knows no boundaries, striking across age, gender, and cultural differences. The prevalence of diabetes has been steadily rising, making it a global health concern. India has become diabetic capital of the world, surpassing China. Most of diabetic patients can be managed by proper life style practices, adhering to OHA, and practicing appropriate self-care practices like die, regular exercise, and periodic foot examination. Objectives : 1) To assess adherence to Medication. 2) To study the factors associated with drug adherence among study population Methods – A cross sectional study conducted among Type 2 Diabetes patients > 18 years who are on medications (both OHA and Insulin) for at least 1 year attending the medical OPD of Government medical college Hospital, Mysuru. Sample size of 254 was calculated based on prevalence of good self-care practices of 60%. Considering non-response rate of 10%, the total sample size was 280. Information regarding drug adherence will be collected after taking consent using pre-tested and validated Medication Compliance Questionnaire (MAC) respectively. Data entry and statistical analysis will be done by using SPSS (trail version) software. Results and Conclusion : Among 280 patients with type 2 diabetes mellitus (mean age 53.19 ± 13.3 years; 56.8% males), 65.0% were non-adherent to prescribed antidiabetic medications. Most participants were on oral hypoglycemic agents (83.2%), and 15.0% reported using alternate systems of medicine. Medication adherence was significantly associated with educational status ( p = 0.009), socio-economic status ( p < 0.001), body mass index ( p = 0.026), and type of medication ( p < 0.001). No significant association was observed with age, sex, marital status, occupation, or duration of diabetes.

Biological E’s BEVAC® is a recombinant DNA hepatitis B vaccine that has been used in India for more than a decade in routine early-life immunization and has recently been prequalified by the World Health Organization (WHO). This multicentre, single-blind, parallel-group, randomized phase IV trial, conducted at seven study sites in India, compared the immunogenicity and safety of BEVAC® with a licensed comparator vaccine (GeneVac-B®, Serum Institute of India Pvt. Ltd, Pune, India.) in healthy term neonates and infants. Participants received three 0.5 mL doses administered intramuscularly at birth (within 24 h), 6 weeks of age, and 14 weeks of age. The primary endpoint was seroprotection (anti-HBs IgG ≥10 mIU/mL) at 28 days after the third dose (Day 126), compared using a non-inferiority margin of −10%. Secondary endpoints included safety and tolerability outcomes through Day 126. A total of 468 neonates were randomized (234 per group), of whom 44% were female. At Day 126, seroprotection rates were 98.2% (95% CI: 95.39, 99.50) with BEVAC® and 99.1% (95% CI: 96.78, 99.89) with the comparator; the between-group difference was −0.9% (95% CI: −3.09, 1.24), meeting the prespecified non-inferiority criterion. Solicited adverse events within 7 days after any dose occurred in 29.1% (95% CI: 23.3, 35.3) of BEVAC® recipients and 35.0% (95% CI: 28.9, 41.5) of comparator recipients, most commonly pyrexia, injection-site pain, and swelling; all were mild-to-moderate. No serious adverse events were reported. BEVAC® demonstrated non-inferior immunogenicity to the licensed comparator and a comparable safety profile.