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Abstract Inhibition of the mitochondrial oxidative phosphorylation (OXPHOS) system can lead to metabolic disorders and neurodegenerative diseases. In primary mitochondrial disorders, reactive astrocytes often accompany neuronal degeneration and may contribute to neurotoxic inflammatory cascades that elicit brain lesions. The influence of mitochondria to astrocyte reactivity as well as the underlying molecular mechanisms remain elusive. Here we report that mitochondrial Complex I dysfunction promotes neural progenitor cell differentiation into astrocytes that are more responsive to neuroinflammatory stimuli. We show that the SWItch/Sucrose Non-Fermentable (SWI/SNF/BAF) chromatin remodeling complex takes part in the epigenetic regulation of astrocyte responsiveness, since its pharmacological inhibition abrogates the expression of inflammatory genes. Furthermore, we demonstrate that Complex I deficient human iPSC-derived astrocytes negatively influence neuronal physiology upon cytokine stimulation. Together, our data describe the SWI/SNF/BAF complex as a sensor of altered mitochondrial OXPHOS and a downstream epigenetic regulator of astrocyte-mediated neuroinflammation.

Breast cancer is the most common malignant tumour in women in the world, with an incidence of 13.5% in India. For patients diagnosed with breast cancer, surgical options include breast conserving therapy (BCT) or modified radical mastectomy (MRM). This study aims to compare early post-operative complications in carcinoma breast patients undergoing MRM vs BCS at a tertiary care center in India. Patients undergoing BCS and MRM for carcinoma breast were prospectively studied over an 18-month period and postoperatively followed up for 3 months. Incidence of early post-operative complications such as seroma, flap necrosis, wound dehiscence and quality of life (QOL) were compared between the two groups. 106 patients were included in this study, of which 75 underwent MRM and 31 underwent BCS. There was no significant difference noted between these two groups with respect to the following; seroma formation (16.1% BCS vs. 13.3% MRM; p value =0.710), flap necrosis (3.2% vs. 2.7%; p value =0.87), wound dehiscence (3.2% vs. 5.3%; p value =0.63), wound infection (6.5% vs. 5.3% p value =0.823), average number of days of lymphorrhoea (15 ±9.76 vs. 15.7 ±7.49) and QOL post-surgery. Comparison of cost (> Rs.50,000) showed that expense of surgical treatment was significantly higher in MRM (24.0%) compared to BCS (9.7%). Early postoperative complications seen in BCS and MRM are comparable, with the most common early complication being seroma and lymphorroea. Patients should be educated regarding breast conservative surgery, its comparable results with MRM and social and physical impact irrespective of age and menstrual status.

A study was carried out to identify the prevalence of clinical lameness and associated claw affections in dairy cows using claw health indicators, claw dimensions and locomotion scoring. Hundred postpartum lactating dairy cattle reared under similar managemental conditions were subjected to body weight estimation, body condition scoring (BCS), evaluation of claw health indicators, claw dimension measurement and lameness scoring. Animals with higher score on claw health indicators and locomotion score were subjected to functional hoof trimming. A prevalence of 20 per cent clinical lameness was observed in the present study. Significantly increased claw length and reduced heel height were observed in dairy cows with higher locomotion score while body weight, body condition score and claw health indicators had no significant relationship with locomotion score on statistical analysis. Sole ulcers and white line lesion were identified as the major sole lesions causing clinical lameness in postpartum lactating dairy cattle.

The present study was undertaken to evaluate silage made from hybrid Napier grass (Pennisetum purpureum) ensiled in the laboratory using various additives with regard to sensory as well as chemical characteristics. Four different silages were prepared viz., grass ensiled without additives (GS) as control, and grass silage with Lactobacillus plantarum at 1 x 105 CFU per gram of fresh forage (GSL), grass silage with propionic acid at the rate 0.45 kg per ton of fodder (GSA), and grass silage with combination of Lactobacillus plantarum (1 x 105 CFU per gram of fresh forage) and propionic acid (0.45 kg per ton of fodder) (GSLA) in triplicates. One from each triplicate was opened on 21, 30 and 45 days of ensiling and was evaluated for sensory (colour, aroma, presence or absence of extraneous matter) and chemical (pH, lactic acid, proximate analysis and fibre fractions) characteristics. From the overall results, it could be concluded that hybrid Napier grass, ensiled for 21 days using L. plantarum was effective in preserving its nutritive value.

A study was conducted to assess the effect of feeding low protein diets supplemented with selected amino acids on growth performance and gut health in early weaned Large White Yorkshire piglets. Thirty Large White Yorkshire female piglets belonging to Centre for Pig Production and Research, Mannuthy, weaned at 21 days of age were allotted to three dietary treatment groups (T1, T2 and T3) with five replicates for each treatment. Piglets were fed pre-starter ration till they gained a body weight of 5 kg and then on starter ration from 5 to 18 kg body weight. The dietary protein in treatments T2 and T3 were reduced by 15 and 25 per cent respectively than that of control treatment (T1). Five amino acids viz., lysine, methionine, threonine, valine and isoleucine were supplemented to all treatment groups to meet the requirements as per NRC (1998). Body weights of animals were taken at weekly intervals. There was no significant difference in average body weight among three treatment groups from first to third week. From fourth to eleventh week, the average weekly body weight of T1 was significantly higher than T3. The average daily gain was significantly different among three treatment groups with highest values observed for group T1, followed by T2 and T3. The feed conversion efficiency was statistically similar among treatment groups. Total viable count and coliform count were significantly lower in the faeces of piglets fed with low protein diets, indicating a reduction in microbial population in faeces of piglets in relation to reduction in dietary protein level. From the overall results, it could be concluded that reducing the dietary protein levels had resulted in reduced growth performance in early weaned piglets, in spite of being supplemented with selected essential amino acids

Background: Scleroderma associated pulmonary arterial hypertension and interstitial lung disease (ILD) with pulmonary hypertension are considered to be separate pathological processes with different approach to management. In this study, we looked at the demographics, clinical features, and outcome of patients with both type of pulmonary hypertension in systemic sclerosis Methods: Patients diagnosed with scleroderma and with pulmonary hypertension as per transthoracic ECHO in the time period between 2010 and 2023 were retrospectively identified enrolled in the study. They were divided into two groups-isolated PAH and ILD-PH. ECHO parameters, clinical data were recorded Results: There were 800 patients with a diagnosis of systemic sclerosis during this period. In total, 49 incident scleroderma PH cases were identified (6.13%); 25 with diffuse cutaneous SSc (51.02%), 19 with limited cutaneous SSc (38.78%), and 5 with sine scleroderma (10.2%). Among the study group, 39 (79.59%) patients had ILD with PH and 10 (20.4%) had isolated PH (Table 1). Though the baseline ECHO parameters were similar in both the groups, features of severe PH - Right atrial and ventricular dilatation with Right ventricular dysfunction was more in Isolated PH than ILD-PH (50% vs 23%). Other clinical features were similar in both the groups (Table 2). Isolated PH was treated with vasodilatory therapy and all patients with ILD -PAH were treated with immunosuppression along with vasodilatory therapy. Follow up of ECHO parameters of the two groups at the end of 2 years showed better improvement in the ILD-PH group. Unsatisfactory long-term outcome as defined by clinical NYHA progression, hospitalization and need for long term oxygen therapy was similar in both isolated PH and PH-ILD (40% vs 41%). 1 year survival was 95.9% (2/49 lost to follow up). Conclusions: The prevalence of Pulmonary Hypertension in our scleroderma cohort of a tertiary care center was 6.13%. ILD-PH was 4 times more prevalent than isolated PH.46.94% of all our PH patients had it at presentation. The one-year survival of our cohort was 95.9% almost equivalent to other international cohorts

Background: LUNAR trial failed in lupus nephritis. However case series across the globe have shown good outcome with rituximab in lupus nephritis. So we evaluated the efficacy and safety of rituximab in lupus nephritis in Indian patients Methods: This was single centre, retrospective study done in patients of lupus nephritis receiving rituximab between 2013 to 2022. All patients fulfilled the SLICC criteria. Rituximab was given if there was a flare with background immunosuppression or upfront for early steroid tapering. Patients were followed up at 3, 6 and 12 months. Complete kidney Response (CR) is defined as return of serum creatinine(Scr) to previous level with a decline in 24 hour urine protein to

Background: Interstitial lung disease (ILD) is a significant cause of mortality in patients with Rheumatoid Arthritis (RA). Existing studies on the efficacy of Mycophenolate (MPA) for RA-associated ILD are limited, with the largest study including only 26 patients. This study aims to evaluate the efficacy of MPA in stabilizing or improving lung function in a larger cohort of RA-ILD patients over an extended follow-up period. Methods: Patients diagnosed with RA-ILD and treated with MPA for [Formula: see text] 1year, attending our clinics between 2017 and 2023 were included. Data regarding demography, spirometry, HRCT and treatment were noted retrospectively at the diagnosis of ILD (baseline) and 6 monthly visits thereafter till last follow up. Data were collected on patient demographics, spirometry, high-resolution CT (HRCT) scans, and treatment regimens. The primary outcome was the change in predicted forced vital capacity (FVC) over the follow-up period, with a [Formula: see text] 10% decline considered as progression. Clinical improvements in cough, dyspnea, and HRCT findings were recorded as binary outcomes. Results: Of the 73 patients (58 females), 70% showed stability or improvement in FVC, while 18% experienced a decline. Clinically, 86% of patients improved or remained stable, while 12% worsened. HRCT results showed stable or improved disease in 34% of patients, 30% had worsening of fibrosis, while 36% did not undergo follow-up HRCT due to clinical stability. Physiologically - 52(70%) met the primary outcome of stability/ improvement in % FVC while 18% had worsening in % FVC. Use of rituximab was not associated with better outcomes. None of the baseline clinical parameters predicted better outcomes in univariate. The most common adverse events were dyspepsia and serious infections, occurring in 12% of patients Conclusion: MPA is an effective and relatively safe treatment option for RA-ILD, with 70% of patients achieving stabilization or improvement in lung function.

Background: Gastrointestinal manifestations are common in Systemic Sclerosis, but studies in the Indian population are sparse. Methods: This is a retrospective study of 100 patients who presented to the Department of Clinical Immunology and Rheumatology between 2014 to 2019. The charts and investigations were reviewed for clinical and serological profile, and the investigations done were recorded. Results: 100 patients diagnosed with systemic sclerosis (SSc) who fulfilled the ACR/EULAR 2013 criteria were included in the study-81 patients were classified as diffuse SSc, 15 as limited SSc and 4 as Sine Scleroderma. In total, 72 out of 100 patients reported reflux symptoms and 4 reported chronic diarrhoea. The imaging studies done for the patients and the findings are summarised in Table 1; the indications for endoscopy and the findings are summarised in Table 2. 2 patients were diagnosed with Chronic liver disease. 90 out of 100 patients were treated with a combination of proton pump inhibitors (PPIs) and prokinetics and 10 patients with PPIs alone. H Pylori eradication and antifungal therapy as per scopy findings were administered. 3 patients with chronic diarrhoea were empirically treated with Rifaximin for probable SIBO with symptomatic improvement. Conclusions: GI involvement is common in Scleroderma patients (93%- symptomatic and subclinical combined); however, the symptoms are under reported. Complications of GERD are less common in our popular, probably due to early initiation of PPIs and prokinetics. HRCT identified esophageal dilatation in 79% of the patients. Patients with refractory symptoms need to undergo scopies to rule out infections and malignancies. Further studies are required for better assessment and management of GI symptoms.

Background The durability of immune responses after vaccination against SARS CoV-2 in patients with autoimmune rheumatic diseases (AIRD) is not well studied. Objective We aimed to determine the longevity of humoral immune response to homologous vaccination with 2 doses of ChAdOx1 nCoV-19 and BBV152 in adult patients with AIRD. Methods In this prospective observational study, patients aged 18 to 60 years, diagnosed with SLE, primary systemic vasculitis and inflammatory arthritis (IA) who were scheduled to or had received vaccination with either ChAdOx1 nCoV-19 or BBV152 were recruited between June 2021 to March 2023. IgG antibodies against SARS CoV-2 spike protein (anti-S) were estimated in serum or plasma of patients prior to vaccination if feasible (T0), 15 to 28 days (T1), 75-100 days (T2), 170-190 days (T3), 240-290 days (T4), 340-370 days (T5) after receiving Vx2 by Diasorin chemiluminescence assay. The association of antibody titers with baseline parameters is estimated using chi-square or Mann Whitney tests using SPSS 16. Results Overall, 118 patients (93 females; age: 37.1, IQR: 28- 45 years; disease duration: 60 ((IQR) 29-103) months) with AIRD (SLE:48(40.6%), IA:53(44.9%), systemic vasculitis:7(5.9%) and spondyloarthropathy: 9(7.6%)) were recruited. Baseline demographic data has been depicted in (Table 1). The median antibody titer did not differ significantly between the two vaccines at T1 while the titers at T2, T3 and T4 were significantly lower for those vaccinated with BBV 152 (Table 2). The steroid dose prior to T1 and T2, intake of DMARDs in peri-vaccination period, type of AIRD (IA vs CTD) was not associated with significant difference in antibody titers at T1 and T2. Conclusion The anti-S humoral immune response persisted beyond 1 year for most of our patients with AIRD. After 3 months of vaccination, these responses were higher for ChAdOx1 nCoV-19 as compared with BBV152 in our patients with AIRD.

Introduction: To study the clinical characteristics and treatment outcomes of patients with anti-melanoma differentiation-associated gene 5 (MDA5) dermatomyositis (DM). Methods: This was a retrospective study done between 2019 and 2021 in a tertiary care center in South India. All consecutive patients, presenting to the adult rheumatology department, classified as idiopathic inflammatory myositis (IIM), and positive for anti-MDA5 antibodies, were included in the study. Baseline characteristics of anti-MDA5 patients were compared with the data of non-MDA5 patients over the last 10 years. Clinical, biochemical, and treatment responses were assessed on follow-up. Complete and partial responders were identified using predefined criteria. Factors predicting mortality were determined by logistic regression analysis. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 25. Results: A total of 29 adult patients of IIM were positive for anti-MDA5 antibody during the study period. The mean (±standard deviation) age of the patients was 40.3 (±13.02) years with a female:male ratio of 1.4:1. Panniculitis, calcinosis, palmar papules, and ulcerated Gottron's were the specific cutaneous manifestations, seen in 3 (10%), 7 (24%), 4 (13.4%), and 7 (24%) patients, respectively. A total of 14 patients (48.1%) had clinically amyopathic DM and 17 patients (60.7%) had interstitial lung disease (ILD) diagnosed by high-resolution computerized tomography scan, of which organizing pneumonia was the predominant pattern. Complete response was seen in 10 patients (43.4%), while a partial response was seen in 8 patients (34.7%). Five patients died on follow-up, accounting for mortality of 21%. Age >50 years was significantly associated with mortality (P = 0.025). Gottron's sign (P < 0.001), panniculitis (P < 0.001), calcinosis (P < 0.001), cutaneous ulcerations (P < 0.001), inflammatory arthritis (P < 0.001), and ILD (P < 0.02) were present more commonly in the anti-MDA5 IIM group, whereas myopathy (P < 0.001), elevated creatine phosphokinase (P < 0.001), and lactate dehydrogenase (P < 0.001) were more frequently present in the non-anti-MDA5 IIM group (n = 421). Conclusions: Anti-MDA5 DM represents a distinct and unique subset of IIM with characteristic clinical manifestations. Elderly age is a poor prognostic factor of mortality.

Background and Aims: Systemic sclerosis is an autoimmune disease, of which cutaneous sclerosis is a cardinal feature. Other skin manifestations include Raynaud's phenomenon, digital ulcers, gangrene, flexion contractures, and telangiectasias. It has been noted that the clinical and antibody profile varies within ethnic groups. The objective of the study was to study the clinical profile of patients with systemic sclerosis in a tertiary center in South India and to compare to other ethnic groups. Materials and Methods: Thirty-five patients were recruited in the study period between February 2014 and September 2015. A record of the disease details, systemic manifestations, morphology, and distribution of the cutaneous manifestations and investigations were done by the principal investigator. The severity of cutaneous sclerosis was assessed by modified Rodnan Skin Score (mRSS). Results: Our study had a female preponderance with diffuse type of disease in 91% of patients. The common cutaneous presenting complaints were sclerosis (n = 35, 100%), Raynaud's phenomenon (n = 25, 71.4%), and pigmentary disturbances (n = 33, 94.3%). Respiratory system was the most common system involved, with interstitial lung disease seen in 78.1% (n = 25). A significant association (P = 0.026) was noticed between the increase in mRSS and interstitial lung disease. Conclusion: Pigmentary disturbances were higher in our population, whereas Raynaud's phenomenon, digital ulcers, and telangiectasia were less common than in Western population. A significant association (P = 0.026) was found between mRSS and interstitial lung disease.

Statin-naïve immune-mediated necrotizing myopathy (IMNM) is a rare disease entity, the diagnosis of which is complicated in the absence of a reliable biomarker. In this context, this case, which is the first one reported from a tertiary care center in South India, is unique. The presence of hydroxy-3-methyl-glutaryl-coenzyme A reductase (HMGCR) antibody supplements the clinical diagnosis, specifically in the serological absence of myositis-specific antibodies. A comprehensive diagnostic approach including HMGCR antibody positivity is advisable in IMNM.

Background: Systemic lupus erythematosus (SLE), a rare multisystem disorder with a female preponderance, has a high cost for the care; however, there is no evidence relevant to the Indian setting. The primary objective of our study was to determine the financial burden of the index admission (IA) and subsequent costs during follow-up and ascertain the proportion with a catastrophic health expenditure (CHE). Methodology: This was an observational retrospective cohort study where inpatients of a general medicine ward were recruited from January 2019 to October 2020. Clinical details and costs were obtained from the hospital's electronic records and bills. Patients were telephonically interviewed for follow-up clinical details and costs incurred. A patient-family payer perspective was used. Linear regression analysis was used. Results: Of the 73 patients recruited during the study period, 96% were females and the majority (71%) were admitted through casualty, with 59% of patients having high disease activity (SLE Disease Activity Index >12). The hospital mortality was 9.6%. After a median follow-up of 12 months, there was good quality of life with no difference between the two severity groups. The total cost of the IA was 135,768 INR (94,053–223,954) and it was higher for the severe disease group (P = 0.038). The direct medical costs compromised 83% of admission costs. In the multivariate regression, the duration of hospital and intensive care unit stay were predictors of high cost. The median 6 months follow-up cost was 32,978 (14,240–80,940) and the total calculated annualized cost was 202,124 (136,188–331,508), which was not statistically different between the two groups. There was a CHE among 86% of patient-families. Conclusion: This study demonstrates that there is high morbidity and cost involved in the management of a flare of SLE. However, with appropriate care, there are reasonably good outcomes and quality of life beyond six months.

Introduction: Safety of rituximab (RTX) in autoimmune rheumatic diseases (AIRDs) has been a concern during this ongoing coronavirus (COVID-19) pandemic. Delayed worsening of COVID symptoms, increased hospital stays, and mortality has been reported among those infected post-RTX. This study describes the occurrence and course of COVID-19 infection among AIRD Indian patients who received RTX during this pandemic. Patients and Methods: Adult patients (≥18 years) with any AIRD, who received RTX between October 2019 and May 2021, were enrolled in this study. Patients satisfying the inclusion criteria were telephonically enquired about contracting confirmed COVID-19, its course, treatment, and outcome. Baseline parameters, immunoglobulin G level, vaccination, and comorbidity status before RTX were compared between the COVID-19 infected and noninfected patients to determine factors affecting the outcome. Results: Out of 1081 patients admitted during the study period, 218 patients received RTX. The mean age of these patients was 40.1 ± 14.2 years and comprised mostly of women (81.7%). Rheumatoid arthritis followed by lupus and anti-neutrophilic cytoplasmic antibodies-associated vasculitis was the predominant AIRD. Among the patients contacted (207/218 [94.9%]), 11 (5.3%) patients reported confirmed COVID-19 infections. Out of these, three (27.3%) had severe COVID-19 and one patient succumbed to it. Others became symptom-free after a mean duration of 14.4 ± 4.7 days of onset of symptoms. No significant difference among the baseline parameters observed predicted COVID-19 susceptibility. Conclusion: Among our AIRD patients treated with RTX, occurrence, and mortality of COVID-19 infection was low. Younger age of our patient cohort and female predominance might have contributed in reducing the severity of SARS-CoV-2 infection.

Purpose Usual interstitial pneumonia (UIP) pattern of interstitial lung disease (ILD) can have varied etiology, with connective tissue disease (CTD) being a common known cause. The anterior upper lobe (AUL) sign, exuberant honeycombing (EHC), and straight edge (SE) sign are recently described computed tomography (CT) signs in CTD-related UIP. We test the diagnostic value of these CT signs for CTD in patients with UIP and compare the incidence of these signs between CTD-related UIP and non–CTD-related UIP. We also evaluated the interobserver agreement in detection of these CT signs. Methods Retrospective study of all patients who had UIP pattern of ILD on CT thorax done from January 1, 2016 to January 31, 2019, was grouped into two: non–CTD-related UIP or CTD-related UIP. CT thorax was reviewed for the presence of these signs—AUL, SE, and EHC. The diagnostic values of these signs in diagnosing CTD-related UIP was assessed. For assessment of interobserver agreement, another radiologist reviewed a subset of 30 randomly selected cases and looked for the presence of these signs. Results Of the 156 patients included, 76 had CTD. The incidence of CT signs were significantly higher in CTD-related UIP. The specificities of AUL, EHC, and SE were 82.5, 75, and 85%, respectively. The EHC sign had highest sensitivity of 48.7%. Inclusion of more than one sign increased the specificity of diagnosis of CTD-related UIP; however, the sensitivity decreases. There was excellent interobserver agreement (0.81–0.87) for each of these signs. Conclusion The presence of SE, AUL, and EHC signs in cases with UIP pattern are specific imaging markers to diagnose underlying CTD; however, due to its low sensitivity, the absence of these signs cannot exclude the same. Because of its excellent interobserver agreement, these signs are reliable in the evaluation of CTD-related ILD.

Postpartum diseases of uterus represent a foremost predicament in cattle farms affecting reproductive efficiency. Postpartum (PP) uterine diseases include metritis, endometritis and subclinical endometritis (SCE). Barring SCE, all other diseases project the clinical signs. Diagnosis of SCE at the early stage of PP has been a challenging task for many veterinarians. The present study aimed to validate and correlate the proficiency of transitional changes in uterus and cervix assessed by transrectal ultrasonography (TRUS) and endometrial cytology (EC) in the diagnosis of SCE in PP cattle. The research was carried out in two phases i.e, 30th day postpartum (DPP) (n=74) and first exhibited oestrus after 45th DPP (n=24) (54.63 ± 1.13 d) to emphasise the proficiency of both the diagnostic modalities. Endometrial cytology could discriminate between cows positive and negative for SCE significantly at 30th DPP (20.54 ± 0.48 vs 5.55 ± 0.41). It was potent in diagnosing SCE after 45th DPP also, as a significant reduction in the per cent of PMN cells (20.54 ± 0.48 to 7.56 ± 0.32) was noticed. Uterine parameters assessed by TRUS like cervical and uterine diameter and endometrial thickness in both the phases of assessment did not correlate to the EC changes and also could not discriminate between SCE positive and negative animals. The results of the study signify that EC is efficacious in the diagnosis of SCE in cows, while TRUS is impractical as a sole diagnostic modality for SCE.

Background: Antinuclear antibodies (ANA) are often used in diagnosing autoimmune rheumatological diseases, but their behavior in response to biological therapies, particularly in Asian patients, is not well-documented. The impact of these therapies on ANA status is crucial for understanding disease management and treatment efficacy. This study aims to evaluate the prevalence and significance of ANA positivity following the administration of biological agents in patients with autoimmune rheumatological diseases. Methods: This pilot study was a prospective cohort study involving 100 patients with autoimmune rheumatological diseases who were initially ANA negative at baseline. Predominantly included patients were axial spondyloarthritis (AxSpA) (n=95) and ANCA vasculitis (n=5). Patients with AxSpA were diagnosed according to the 2009 ASAS criteria, and treated with biological agents (e.g., TNF inhibitors such as adalimumab, etanercept, or IL-17 inhibitors such as secukinumab) and followed at a tertiary care center in India from January 2021 to December 2023. ANA levels were measured before and after 3, 6, 9, or 12 months of biological therapy. Changes in ANA positivity, clinical outcomes, and correlations with disease activity were analyzed. Results: Out of the 100 patients enrolled, 67 (67%) completed the study. All participants were ANA negative at baseline. After biological therapy, ANA positivity developed in 4 patients (5.9%). Despite this increase in Ana positivity, there was no significant correlation between ANA positivity and clinical disease activity, as measured by the Ankylosing Spondylitis Disease Activity Score (ASDAS) and the visual analog scale (VAS) for pain, BVAS suggesting effective therapeutic response despite changes in ANA status. Additionally, 30 patients were lost to follow-up, highlighting challenges related to the financial sustainability of biological therapy in the resource limited countries. Conclusion: Biological therapies for AxSpA are associated with an increase in ANA positivity although this change does not appear to impact clinical disease activity. The rise in ANA titres may reflect disease-related changes or treatment effects rather than a direct correlation with therapeutic efficacy. Further longitudinal studies are needed to understand the clinical significance of these findings and to refine the interpretation of ANA results during biological therapy.

Background: TAFRO SYNDROME mimics SLE. Differentiating both is essential for correct manangement. Case report: 40 year old lady came with complaints of fever, insidious onset of painless abdominal distension which was gradually progressive to form tense ascities in a span of 2 months. On examination she was pallor, having pedal edema, tense ascities and cervical and axillary lymph node enlargement (mazimum 1* 1 cm). Lymph nodes were firm, non matted, not fixed. On evaluation found to have pancytopenia. (Hb: 5.3 gm%, platelet count, Wbc-3600/cu mm, 90,000/cu mm), Her LFT -alkaline phosphate -639 U/L, Hyperbilirubinemia with total Bil of 1.73 mg/dl and direct fraction of 1 mg/dl and LDH of 139 U/L. Renal - 24 hour urine protien = 301 mg. She had malena at presentation and her Hb dropped to 3.2 gm% platelets count of 10,000. Ct abdomen showed -Mild to moderate ascites, mild hepatomegaly. Ascitic Tap of 3 litre was done which showed high SAAG and High protein. Ugi endoscopy was done which showed Antral gastritis and no feature of porat hypertension. Infective workup including tuberculosis came negative. Autoimmune work ANA - 2+ speckled. (1:100 dilution) Coombs test direct - 3+ C3 = 115 (90 to 180) C4 = 39.8 (10 to 40) Ds DNA = 121 (< 100 IU/ ml) Urine UP/UC = 0.48 24 hour urine protien = 301 mg Anti SSA ELISA test - 63 (< 20 RU/ml) Anti SM ELISA test 1 (< 20 Ru/ml) ELISA Anti RNP - 2 Ru/ml (< 20) APLA work up was within normal limit and lupus anticoagulant was mildy positve. She was satifying the ACR EULAR 2019 classification criteria for SLE and SLE can have lymphadenopathy features suggestive of castle man disease. She was intially diagnosed as SLE and treated with Sle protocol and was not reposnding. Lymphnode biopsy later was done suggestive of Hypervascular type of castle man disease and intiated on R - CEP (Rituximab, Cyclophosphamide, etosposide, prednsiolone) LEARNING POINT 1) SLE is a great mimicker of variety of other diseases and rheumatologist should be aware of the disease that mimics SLE. 2) TAFRO syndrome is variety of castleman disease. T-Thrombocytopenia A-Ascities F-Fever R-renal dysfunction O-Organomegaly 3) TAFRO syndrome has autoimmune manifestations that mimics SLE and it an aggressive variety of castleman disease

Background: Immunodeficiency 70 is a rare disease and there are only very few cases in the literature. Case History: Young boy in his early 20’s from Indian subcontinent presented with recurrent episodes of fever, oral ulcers, loss of weight for past 3 years. Four episodes (july 2019, april 2020, APRIL 2021, Jan 2022) of fever, each high grade associated with chills, rigor, nausea, myalgia, throat pain, holo-cranial headache, painful oral ulcers over the tongue and painless over lips. Initial episode of fever was associated with leucopenia (3200) and thrombocytopenia (122000), acute kidney injury (creatinie-3.0) and pyelonephritis, transaminitis. He received 2 weeks of parenteral antibiotics and improved. Subsequent episodes of fever is not associated with any localizing symptoms or signs. No history Suggestive of connective tissue disease. Family history was non contributory. Physical examination: He was febrile (101 degree F), pulse rate 100/minute, respiratory rate 18/minute, tongue ulceration in lateral border, no lymphadenopathy, no organomegaly, normal sytemic examination. Evaluation: The patient was evaluated for chronic infections, hematalogical malignancy, Behcet’s disease, auto inflammatory syndromes like Haplo insufficiency of A20. His complete blood count, electrolytes, renal function test, liver function test urine microscopy, blood culture were normal. CRP was elevated (58 mg/l). Tzanck smear from buccal mucosa was negative. CT thorax and abdomen showed no significant lymphadenopathy, organomegaly, evidence of infections or malignancy. In view of oral ulcers & fever Behcet’s disease was considered and HLA b51 was sent and came negative. Exome genome sequencing was done to diagnose immunodeficiency or autoinflammatory syndromes which came positive for immunodeficiency 70. Treatment: He was treated with colchicine and fever subsided and leucopenia improved Discussion: Immunodeficiency-70 (IMD70) is an autosomal dominant immunologic disorder characterized by severe cutaneous warts on the hands, feet, and face, suggesting increased susceptibility to human papillomavirus (HPV) infection. Affected individuals may also have recurrent bacterial infections like pneumonia, boils, sinusitis, as well as feature of autoinflammation, such as colitis, celiac disease, and retinal vasculitis. Laboratory studies show decreased CD4+ T cells and decreased CD19+ B cells; hypogammaglobulinemia, combined T cell and B cell immunodeficiency characterized by decreased CD4+ T cells, decreased CD19+ B cells, recurrent bacterial infections, and severe cutaneous warts on the hands, feet, and face that has material basis in heterozygous mutation in IVNS1ABP on chromosome 1q25.3.

This article discusses the perceptions, attitudes, and barriers to effective obesity care among people with obesity (PwO) and healthcare professionals (HCPs) in India. The study found that the majority of PwO and HCPs recognized obesity as a disease, but many PwO assumed self-responsibility for weight loss. Lack of exercise and unhealthy eating habits were identified as major barriers to weight loss. The study also highlighted the importance of initiating weight management discussions and addressing weight stigma. The authors suggest the need for a multidisciplinary approach and increasing awareness about obesity. [Extracted from the article]

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Immunoglobulin G4-related disease (IgG4-RD) is a systemic autoimmune disorder with a variety of manifestations. Association with other systemic autoimmune diseases is uncommonly reported in the literature. Hence, we intended to understand better the uniqueness of the overlapping associations of IgG4RD with other systemic autoimmune diseases. Retrospective electronic medical records-based review of IgG4RD occurring as an overlap with other systemic autoimmune diseases seen in the rheumatology department was done. We present two cases of IgG4 disease overlapping with systemic rheumatic diseases with a brief review of the literature. The first case was an overlap IgG4RD with lupus and the second interesting case had IgG4RD overlapping with 2 autoimmune diseases (lupus and rheumatoid arthritis) in the same patient. Both patients were treated with high-dose steroids and mycophenolate mofetil with good response, however, the second patient needed to be additionally treated with rituximab for better control of arthritis. Although uncommon, here, we report the first case series of 2 patients with IgG4 disease overlapping with other systemic autoimmune diseases. In our case series, the presence of the overlap did not impact the immediate clinical outcome or treatment response of IgG4RD or the co-existent systemic autoimmune disease.

Introduction: Nail fold dermoscopy is a noninvasive technique which aids in the diagnosis of systemic sclerosis. It also helps in predicting the extent and stage of microvascular damage. There are only a few studies describing the pattern of nail fold capillaries in systemic sclerosis in the Indian population. Objectives: To study the patterns of nail fold capillaries using a hand-held dermoscope and to correlate these findings with cutaneous and systemic manifestations in patients with systemic sclerosis. Methods: Thirty-five patients were recruited in the study period between February 2014 and September 2015. All patients with systemic sclerosis were examined for cutaneous manifestations and dermoscopy of the nail fold capillaries was performed using Heine delta 20 dermoscope. Results: Our study had a female preponderance with the diffuse type of disease in 91% of patients. The most common abnormal nail fold dermoscopic pattern was dilated capillaries (91%). Scleroderma pattern was seen in 77% of our patients with the most common being active pattern. Early, active, and late type of the capillary pattern were associated with increased duration of disease but was not statistically significant. There was no significant association between capillary pattern and systemic manifestations. Conclusions: Majority (77%) of our patients had scleroderma patterns of which the active scleroderma pattern was the most common. There was no significant association between capillary pattern and systemic manifestations.

Anti-transcription intermediary factor-1 γ (TIF-1 γ) antibody is a myositis-specific antibody. These cases had specific clinical features in the past studies. There is no published data on such patients from South Asia. We retrospectively looked at data from patients with positive anti-TIF-1 γ antibodies from our hospital database between May 2019 and October 2020. Their clinical presentation, muscle and extra muscular involvement, investigations, presence of malignancy, and treatment with subsequent follow-up were retrieved using the electronic medical records. TIF-1 γ was rare at our center and was 2.46% out of the total positive myositis immunoblot results. Seven adult patients had significant anti-TIF-1 γ positivity. Five out of them had clinical muscle weakness; none had severe or respiratory muscle weakness. No patients had cancer-associated myositis. The skin was the most common extra muscular organ involved. The absence of cancer-associated myositis with anti-TIF-1 γ subjects in our series may represent the difference in phenotype in the South Asian population.

Sarcoidosis is a multisystem inflammatory disorder, which can have a myriad of presentations, with atypical presentation not being uncommon. Unless the clinician has a strong suspicion of sarcoidosis, it can be easily missed out. Here, we present an interesting case of a 44-year-old gentleman who had presented with inflammatory arthritis and vomiting. His serum cortisol levels were low. On further evaluation, he was found to have panhypopituitarism. Magnetic resonance imaging brain showed infiltrative disease involving the pituitary stalk. Imaging of the chest revealed mediastinal nodes which showed nonnecrotizing granulomatous inflammation on histopathology. After ruling out infectious causes a diagnosis of sarcoidosis was made, and the patient had a full recovery with steroids and methotrexate. Sarcoidosis can be a great mimicker presenting with a myriad of complications. Clinicians must be aware of the atypical presentations to diagnose the disease earlier.

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality.Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children

A study was carried out to find the influence of different dietary protein levels on serum biochemical parameters of dairy cows during the transition period. Twenty cross bred cows, three weeks prior to their expected date of calving were selected from University Livestock Farm and Fodder Research and Development Scheme (ULF&FRDS), College of Veterinary and Animal Sciences, Mannuthy as experimental animals. The cows were randomly allotted to two dietary treatments – T1 (12 per cent CP (crude protein) TMR (Total Mixed Ration)) and T2 (14 per cent CP TMR). After calving, half of the animals in T1 were allotted to T3 (16 per cent CP TMR) and remaining half to T4 (18 per cent CP TMR). Similarly half of the animals in T2 were allotted to T3 and remaining half to T4. All these rations were iso-caloric. The feeding trial was carried out for a period of 3 weeks prepartum and 45 days postpartum. The serum biochemical parameters such as serum glucose levels were significantly higher (p

Summary:. The nipple-areola complex (NAC) must be considered as an integral part of the breast with regard to morale and self-assurance. Achieving good aesthetic outcome is a challenge after excision of the NAC in retroareolar tumors. This article looks into immediate reconstruction of the NAC using inferior pedicle skin in patients after central excision of retroareolar tumors. Sixteen patients had breast conservation surgery for retroareolar tumors by a single surgeon between September 2016 and November 2021, and six of them had nipple-areola reconstruction with inferior pedicle skin. None of the patients having NAC reconstruction had any recorded complications and none needed reexcision of the margins. Five out of six patients undergoing NAC reconstruction had good to excellent aesthetic outcome as recorded in the patient questionnaire. There was no locoregional recurrence or distant metastasis in the whole group after a median follow-up of 17 months (2–62).

Evaluation of prediction models is crucial to achieving valid information on erosion processes and their management choices. WEPP model efficiency in predicting ephemeral gully (EG) erosion was recently tested and compared with both EGEM and empirical models. The models abilities to predict EG erosion were validated using measured estimates at the 6 eroding locations around Mubi area in Northeast Nigeria between April 2008 and October 2009. Each location consisted of 3 watersheds where data on soils, climate, slope, management practices, EG shapes and dimensions were collected. Data on relevant soil properties were collected in the field and then analyzed in laboratory. The mass of soil loss (MSL) predicted by empirical, EGEM and WEPP models were compared with the measured using paired T-test, regression graphs (r2-values), error analysis, and analysis of variance (ANOVA) in a completely randomized design. The EG erosion losses varied significantly (P ≤ 0.05) between sites and years. No significant (P ≤ 0.05) differences were observed between measured and the empirically predicted aggregate MSL. The measured aggregate MSL strongly correlated with those predicted by empirical (r2 = 0.67), than with EGEM (r2 = 0.57), and WEPP (r2 = 0.53) models. Slight over and under-prediction instances against the measured erosion were noted with all the models. The WEPP model was found to slightly over-predict MSL when compared to either the empirical or EGEM model. The prediction quality of the models was generally impressive. Future works should focus more on local inputs such as climate, plants, management, and tillage data for use with WEPP.

Introduction: The aim of this study was to analyse if inframammary fold nipple sparing mastectomy (IMF NSM) could safely accommodate larger implants in relation to weight of the breast as opposed to nipple sacrificing mastectomy (NSacriM) in implant reconstruction with biological mesh. Methods: A review of prospectively collected data of implant-based reconstruction using biological mesh between Nov 2016 and December 2019 by a single surgeon. The volume of the implant was measured against the weight of the breast. The data was analysed using Chi-squared test and independent t-test, and a P value of < 0.05 was considered significant. Results: Sixty-five patients had 86 implant reconstructions during this period. Median follow-up was 18 months (1–38). There was no statistical difference between IMF NSM and NSacriM with regard to smoking, obesity (BMI>30) and radiotherapy (P>0.05). The volume of the implants was more than the weight of the breast in IMF NSM group compared to the NSacriM group (22/34 vs 21/52; P = 0.026). Significantly more patients in IMF NSM group had an implant volume within 100 g of the mastectomy weight compared to NSacriM group (31/34 vs 33/52; P = 0.003). None of the 34 IMF NSM had wound necrosis or threatened wound compared to 7/52 in NSacriM group (P = 0.025); 4 were managed in the clinic and 3 were managed in theatre. One patient in the NSacriM group lost her implant post radiotherapy at 5 months, and another patient lost her implant at 3 years. Comparisons were made between IMF-NSM and skin sparing mastectomy (SSM) having fixed volume silicone implants. The analysis showed that 22/33 (67%) IMF-NSM, had a volume of the implant more than the weight of the breast compared to 15/35 (43%) having SSM, this was statistically significant. There was a statistical difference between these two groups with regard to ischemic complications in favour of IMF-NSM. Conclusion: IMF NSM allows safer insertion of larger volume implants in relation to the weight of the breast as opposed to NSacriM.

Purpose: The purpose of the study was to compare the efficacy of two vertically integrated teaching–learning methods, a peer-led ocular basic science workshop (OBSW) versus lecture by ophthalmology faculty, in enhancing the underlying basic science knowledge and examination skills of ophthalmic clinical tests among second clinical year medical students. Design: This was a prospective, interventional comparative study. Students were randomly assigned to peer-led OBSW and interactive lecture-based method of teaching by a faculty. Change in knowledge was assessed using pre and post multiple-choice question test score. Quantitative assessment of clinical examination skills between the two groups was done using objective structured clinical examination (OSCE) at 2-week postintervention. All assessors were blinded. Student's attitude toward the teaching–learning methods was assessed using a 5-point Likert scale. Setting: This study was conducted in the departments of ophthalmology, anatomy, and physiology of a tertiary care medical college in southern India. Participants: Second clinical year students starting their ophthalmology rotation, 5 peer teachers, and 47 students were recruited. All completed the study. Results: Post intervention, there was a significant change in basic science knowledge from baseline among both the arms. Mean improvement in posttest score immediately following the OBSW was 9.25 (standard deviation [SD]: 3.34, 95% confidence interval (CI): 7.84–10.66, t = 13.57, P = 0.00) and 7.83 (SD: 3.66), 95% CI: 6.24–9.41, t = 10.24, P = 0.00) after the lecture. The improvement in scores continued in the 2-week posttest scores. There was no statistically significant difference in the OSCE scores between the two groups. Conclusions: The vertically integrated OBSW and lecture methods were equally effective in improving knowledge and clinical skills of basic ocular examination skills among the second clinical year medical students.