Posterior segment involvement in systemic lupus erythematosus – A series from South India

Purpose: To report the spectrum of posterior segment manifestations and visual outcomes in a large series of patients with systemic lupus erythematosus (SLE). Methods: Retrospective study at a tertiary referral eye center in south India between 2016 and 2022. Results: Charts of 109 patients diagnosed to have SLE were retrieved from our medical database. Only nine cases of SLE (8.25%) had posterior segment involvement. The male: female ratio was 1:8. The mean age was 28 years. Unilaterality was the most common presentation in eight cases (88.89%). Lupus nephritis was the most common systemic presentation in five cases (55.56%). Antiphospholipid antibodies (APLA) positivity was seen in two cases (22.22%). Ocular manifestations included microangiopathy (cotton wool spots) in one case, occlusive retinal vasculitis with cotton wool spots in four cases (five eyes), optic disc edema with combined venous and arterial occlusion (one case), central retinal vein occlusion with cotton wool spots and hemorrhages (one case), macular edema (four cases), posterior scleritis with optic disc edema and exudative retinal detachment in the posterior pole (one case), and tubercular choroidal granuloma (one case). Treatment included systemic steroids, hydroxychloroquine sulfate (HCQS), and immunosuppression in all cases, blood thinners in two cases, and laser photocoagulation in four cases. HCQS?related retinal toxicity was not seen in any of the 109 cases. Ocular manifestation was the initial presentation of SLE in one case. Visual outcome was poor in three cases. Conclusion: Presence of posterior segment findings in cases with SLE may suggest a severe systemic disease. Early detection and aggressive treatment result in better visual outcomes. Ophthalmologists could play a vital role in guiding systemic therapy.

Clinicopathological and morbidity profile of childhood polyarteritis nodosa in a tertiary referral center

Background: Polyarteritis nodosa (PAN) is a primary systemic necrotizing vasculitis predominantly targeting medium-sized arteries defined as the main visceral arteries and their branches. The objective of this study was to analyze the epidemiology, clinico-pathological and point outcome of PAN in children at a tertiary care centre in Karnataka.Methods: This prospective observational study was conducted among eighteen children diagnosed with PAN from December 2015 to May 2017.' All the children fulfilling EULAR/PRES/PRINTO classification criteria for childhood PAN were included in this study. Clinico-pathological profile of these patients was studied and documented.Results: This study had shown that there are two peaks of age at onset of symptoms at 5 to 7 years and from 11 to 13 years. No sex predilection was noted. Most children present with nonspecific symptoms like myalgia (94%), fever (84%), weight loss (50%) and joint pain (50%). Skin manifestations were seen in all the children. Neurological involvement (61%) in the form of mononeuritis multiplex (38.8%), hypertensive encephalopathy (11%) and stroke (11%) was observed. Four children (22%) presented with pain abdomen while two boys had testicular pain. Only one child had renal manifestation in the form of glomerulonephritis. Most children had neutrophilic leukocytosis, elevated ESR and thrombocytosis. Skin biopsy was performed in ten children and out of these, 9 reports were suggestive of PAN. Angiography was done in four children revealing multiple aneurysms or stenosis in the systemic arteries. All the children received corticosteroids. Cyclophosphamide was used as an induction agent in about 50% of the patients. Corticosteroid treatment alone was sufficient in only one patient. Steroid sparing agent like azathioprine (38%), mycophenolate mofetil (33%) and hydroxychloroquine (5%) were used with low dose steroids as maintenance therapy. Seven children (39%) achieved remission off drugs while 8 children are still on treatment, one child relapsed and three children were lost to follow up.Conclusions: Childhood vasculitis leads to considerable delay in diagnosis the initiation of treatment. High index of suspicion and early referral is required in all cases of vasculitis to reduce morbidity and mortality.

A study of adverse drug reaction profile of tuberculosis patients attending DOTS center at Dr. Bhim Rao Ambedkar memorial hospital, Raipur, Chhattisgarh, India

Background: Tuberculosis is second leading cause of death in the world. The causative organism is Mycobacterium tuberculosis. The objective was to study the adverse reactions of the patients attending the DOTS center and to assess their causality and severity of reported ADRs.Methods: Present study was a prospective observational study carried at the DOTS center of Dr. Bhim Rao Ambedkar Memorial Hospital, Raipur, Chhattisgarh, India between August 2011 to July 2012 (One year). The patients were monitored for adverse drug reactions. The assessment of ADRs were based upon the WHO assessment scale, Naranjo scale, European A.B.O scale.Results: Total number of patients attending DOTS center was 816. The number of males (428) exceeded that of females (388). Majority of patients in this study belonged to 21-30 years (26.96%) next 31-40 years (25.24%) and 41-50 years (16.5%) of age group. Prevalence of ADRs were more in males (57%) than in females 32 (43%). Majority of ADRs reported were moderate 33 (35.22%) followed by 29 (46,77%) were mild, no severe ADRs reported. According to severity of ADRs seen were gastritis 28 (45%) followed by 10 (16% ) rashes , 10 (16,12%) of arthralgia, 3 (4.83%) of hepatitis, 6 (9.7%) of peripheral neuropathy, 2 (3%) onsets of ADRs after starting anti-tubercular drug were 12 (19.35%) in 0-1 week followed by 19 (30%) ADRs showed onset in 1-2 week and 2-3 week, 8 (13%) in 3-4 week 3 (5%) in 4-5 week and 1 (2%) in 5-6 week.Conclusions: The casual link between the ADRs and the suspected anti-tubercular drug by Naranjo scale definitely relationship was established between the anti-tubercular drug and ADRs in 7 (11.25%) patient while 22 (35.45%) probable and 33 (53.22%) ADRs were categorized as possible.

Assessment of knowledge of pharmacotherapeutics amongst medical undergraduates of a tertiary care teaching hospital of Chhattisgarh, India: a questionnaire based study

Background: Knowledge of pharmacology forms the basis of rational pharmacotherapy practice. Teaching the medical students about systematic application of pharmacology in patients’ care forms an essential component. It facilitates the medical students to develop a methodical approach in solving patients’ clinical problems.Methods: A questionnaire-based study was conducted, at Government Medical College Rajnandgaon involving second year MBBS students. Total 100 students participated in the study.Results: Hundred percent of the students responded that pharmacology was presently taught to them, seventy nine percent of them agreed with the fact that pharmacology was preferred to pass the MBBS, eighty eight percent of them responded that in pharmacokinetics was the least preferred topic, ninety seven of them were not aware of the essential drug list. Their suggestions regarding the change in teaching methodology was recorded.Conclusions: This study concludes that efforts are needed to develop a curriculum that encompasses important aspects of clinical pharmacology and therapeutics along with incorporation of the useful suggestions by the undergraduate students.

Rationality verses irrationality in fixed dose combinations: at a tertiary teaching hospital of rural Chhattisgarh, India

Background: Rational drug prescribing can be defined as appropriate drugs prescribed in the right dose, at correct time intervals and for a sufficient duration. Irrational drug use is a common problem in many countries of the world.Methods: A prospective observational study was conducted, total 300 patients attending various outpatient departments of tertiary health care rural hospital in Rajnandgaon district were interviewed and their prescriptions were analysed.Results: Total 350 drugs were prescribed 60 (17.14%) were prescribed by generic name and the rest 290 (82.86%) were prescribed by brand name. Only 18 (5.14%) drugs were not prescribed from hospital formulary. 264 (75.43%) drugs were dispensed from hospital pharmacy. On the basis of rationality score 53% prescriptions were rational, 30% semi rational and 17% irrational.Conclusions: In a rural hospital, where hospital formulary is based on WHO Essential medicine list, hundred percent utilization of hospital pharmacy service doctors and patients would ensure rational prescribing benefits of the patients coming from rural and uneducated background.

Clinical Profile of Hand, Foot, and Mouth Disease and its Associated Complications among Children in Shimoga City, Southern Karnataka: A Hospital-Based Study.

Hand, foot, and mouth disease (HFMD) is one of the important public health problems. It has become a common childhood illness in our part of the country. In most instances, this is a mild self-limiting illness. The affected children are often given outpatient care. However, over the last decade, HFMD has emerged as a growing health problem in Asian countries following frequent outbreaks of deaths associated with HFMD caused by a more virulent member of human enterovirus (HEV), namely, HEV71. A hospital-based descriptive study about the clinical presentations and complications of HFMD at the hospitals of Shimoga city between March 2013 and August 2013 is documented and presented here. HFMD was more common in the 1-3-year old age group, with aseptic meningitis being the most common complication. Surveillance of HFMD must be maintained as there is no effective chemoprophylaxis or vaccine available.

Heart failure: a unique presentation of typical atrioventricular nodal reentrant tachycardia.

Cardiomyopathy due to various ventricular and supraventricular arrhythmias, including isolated cases of atypical atrioventricular nodal reentrant tachycardia, have been described. In this case report typical slowfast atrioventricular nodal reentrant tachycardia resulting in cardiomyopathy is being documented for the first time. In the setting of depressed left ventricular function, an episode of tachycardia pushed this patient into heart failure. Radiofrequency ablation of the slow pathway was successful in eliminating her tachycardia with the return of left ventricular function to normal. A follow-up of two years post-ablation revealed the patient to be symptom-free.

The clinical study of chronic pancreatitis.

Chronic pancreatitis is a relentlessly progressive fibro inflammatory process which may eventually lead to pancreatic insufficiency. This study is done to review the various treatments for chronic pancreatitis and to analyze the clinical features, different etiological factors, comparing different clinical trials in India as well as western countries. One hundred and eight patients with the diagnosis of chronic pancreatitis were included in this study from January 1996 to June 1999. In this present series, most of the patients presented in the 3rd and 4th decades of life. The most common presentation was recurrent episodes of pain in the epigastrium radiating to the back. Most patients are non-alcoholic and the etiological factor in this group may be attributed to the nutritional, idiopathic, hereditary etc, though the single most common etiological factor seemed to be alcohol. The most specific investigation to detect the presence of pancreatic calculi, pseudo cysts, and duct dilatation was ultrasonography. Among the drugs, antioxidant therapy found to have effective role in the conservative management. Puestow's lateral pancreaticojejunostomy is most commonly performed surgery which has good results.