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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

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.