AMRI Hospitals

IntroductionThe delay in diagnosis and management of cerebral aspergillosis leads to high mortality. The major challenges include low recognition of the disease, long turnaround time, and low sensitivity of available diagnostic modalities, and absence of standardized molecular diagnosis. Management is also suboptimal due to lack of optimal surgical strategies, the emergence of antifungal resistance, and poor penetration of antifungal drugs into the brain parenchyma. This article emphasizes new modalities for early diagnosis and optimal management that may improve outcomes. Area coveredWe searched the PubMed and Embase databases (since 2015 till 31 March 2025) using the terms 'cerebral aspergillosis,' 'diagnosis ca,' 'management ca,' and 'treatment ca.' The search was augmented by reviewing the references of those articles. Expert opinionEarly diagnosis may be achieved by high index of suspicion, neuroimaging, stereotactic brain biopsy, and the use of galactomannan in serum and cerebrospinal fluid. Whole-genome sequencing and detection of cell-free nucleic acid can improve diagnostic capabilities. Surgical debridement of infected tissue will reduce disease burden and allow enhanced antifungal drug penetration. Voriconazole, posaconazole, and isavuconazole are recommended as primary therapy and therapeutic drug monitoring guided higher doses of azoles may improve outcomes. Olorofim and fosmanogepix are promising agents for the future.

The color and physical appearance of pills influence people’s expectations of their effectiveness, alongside their actual medicinal purpose. Therefore, the present study aimed to evaluate how pill color influences medication adherence. This questionnaire-based survey was conducted among Indian patients visiting cardiologists with cardiovascular diseases. Patients were asked to fill out a form that included 9 questions designed to assess the impact of pill color on drug adherence. In addition, demographic characteristics of the patients were collected. A total of 901 patients were included in the study. Approximately 91% of the 876 patients reported that they were taking medications that needed to be taken daily. When taking multiple pills, 29.4% of patients remember the medication by the pill color, 28.4% remember by the strip color, and 28.0% remember by the brand name. The proportion of patients aged >50 years who reported that similar-looking medications confused identifying their medication was significantly higher compared to those aged ≤50 years (63.2% vs. 50.5%; P < 0.001). When managing multiple medications, female patients primarily relied on pill color (33.1% vs. 26.6%) and strip color (30.7% vs. 26.4%) for identification compared to male patients. The proportion of patients with a high school education who believed that unique pill colors could help in easy identification, reduce forgetfulness, and enhance medication adherence was significantly higher compared to those with a college education and above ( P < 0.001). This study emphasizes that pill color significantly aids in medication identification and adherence, particularly among older adults, women, and individuals with lower educational levels.

Managing atrial fibrillation (AF) in elderly patients with comorbidities is a clinical challenge requiring multiple strategies. They are at high risk of bleeding and thromboembolism requiring alternative approaches such as left atrial appendage occlusion (LAAO). Some of these patients may have symptomatic bradycardia with complete heart block and require permanent pacemaker implantation (PPI). However, there is limited global experience on the safety of simultaneous implantation of both devices through the same venous access. We report a case of simultaneous implantation of LAAO device and leadless pacemaker in a multi-morbid very elderly frail individual with Tachy-brady syndrome and high bleeding risk.

e15170 Background: Despite significant morphological overlap between sub-groups, significant clinical heterogeneity is the hallmark of NENs. We sought to examine the molecular profiles of NENs to demonstrate the molecular heterogeneity that underpins differences in tumor biology. Methods: Tissue samples from 76 patients with NENs were analyzed, encompassing six WHO categories and various anatomic sites of origin (ASO). Molecular profiling was conducted using a semiconductor-based NGS platform at Datar Cancer Genetics. Mutation frequencies and pathway alterations were evaluated across WHO categories. Results: The cohort was distributed across WHO categories: NET grade 1 (N = 1), NET grade 2 (N = 9), NET grade 3 (N = 8), small cell NEC (N = 25), large cell NEC (N = 18), and mixed neuroendocrine-non-neuroendocrine neoplasms (MiNENs) (N = 5). An additional 10 tumors were classified as poorly differentiated NEC. Lung was the most common ASO (37%), followed by the pancreas (16%), gastrointestinal tract accounted (15%), female genitourinary tract (8%) and other rare sites contributed the rest. PD-L1 22C3 analysis (N = 42) showed negative status in 90% of cases, and 10% of cases showed positivity, with positive cases being limited to NECs. MSI status was stable in all cases (N = 40). High TMB (>10 muts/mb) was observed in 27% of samples (N = 13/48).High TMB was restricted to NECs, except for two cases of pancreatic NETs showing high TMB. Molecular profiling of the entire cohort together showed TP53 muattions as most frequent alterations (49%), followed by RB1 mutations (17%), CTNND2 amplifications (16%), RICTOR (11%), and MYC (10%) amplifications, along with NF1 mutations (9%). The PI3K/AKT/mTOR pathway was altered in 25% of tumors, and MAPK/ERK alterations in 16% of cases. PIK3CA , KRAS , and RB1 alterations were restricted to NECs and absent in NETs. Except for TP53 acting as a sole driver in 5% of cases, no two tumors shared an identical molecular profile, highlighting the pronounced molecular heterogeneity even within the same grade and organ of origin. Conclusions: We highlight the significant molecular heterogeneity among NENs, even within the same grade and ASO. These findings emphasize the necessity of integrating molecular profiling into the clinical management of NENs to enable personalized therapeutic strategies. Further studies in larger cohorts may shed added light into further characterisation of NENs. Incidence of genomic alterations across neuroendocrine tumor grades/subtypes. Gene NETGrade 1/2 NETGrade 3 Small cell NEC Large cell NEC MiNEN SNVs /InDels TP53 10.0% 37.5% 56.0% 55.6% 60.0% RB1 -- -- 36.0% 11.1% -- NF1 -- 12.5% 4.0% 16.7% -- KRAS -- -- -- 16.7% 20.0% PIK3CA -- -- -- 11.1% 20.0% CDKN2A 10.0% 12.5% 4.0% -- -- RET 10.0% 12.5% -- -- -- BRAF -- -- -- -- 20.0% Amplifications MYC -- -- 4.0% 16.7% -- CTNND2 -- -- 16.0% 11.1% 20.0% RICTOR -- -- 12.0% 11.1% 20.0% PIK3CA -- -- 20.0% -- 20.0% FGFR1 -- -- -- 11.1% -- PDGFRA -- -- -- 5.6% 20.0% ERBB2 -- -- -- 5.6% --

Context: Microalbuminuria (MAU) is an early indicator of kidney damage in uncontrolled diabetes linked with elevated cardiovascular and renal risks. Aims: This study aims to determine the prevalence of MAU and identify clinical predictors in type 2 diabetes mellitus (T2DM) patients. Settings and Design: A retrospective, multicenter analysis of clinical records from 2600 diabetes centers across India, conducted during the “World Diabetes Day” campaign (November 14–30, 2022). Materials and Methods: Clinical records of 63,570 T2DM patients screened using Micral ® test for MAU were analyzed. Data on demographics, comorbidities, and clinical parameters were collected. Statistical Analysis Used: The statistical analyses were conducted using R Studio Version 2022.07.2. Results: MAU prevalence was 36.9% ( n = 17,275). The mean age of patients was 54.8 ± 11.9 years, with 64% being male. Key predictors included hemoglobin A1c (odds ratio [OR] = 1.18, P < 0.001), diabetes duration (OR = 1.04, P < 0.001), hypertension duration (OR = 1.03, P < 0.001), and diastolic BP (OR = 1.01, P < 0.001). Males had slightly lower odds of MAU compared to females (OR = 0.96, P = 0.198). Conclusions: Four out of ten patients with type 2 diabetes suffered from MAU in our study. Therefore, it is strongly recommended to screen every diabetes patient in clinical practice to detect early signs of kidney damage.