Artemis Hospital is a JCI and NABH accredited hospital in Gurgaon, India. The hospital was founded in 2007 by the promoters of the Apollo Tyres Group, as a multi speciality hospital providing research and technology oriented medical procedures. It acquired the NABH accreditation in 2017 and was the first hospital in Gurgaon to be accredited by Joint Commission International (JCI) in 2013.
Introduction: Partial posterior urethral valves (PUV) constitute a milder but progressive subset of lower urinary tract obstruction (LUTO) that often evades early prenatal detection. Persistent sub-obstruction provokes an inflammatory response in the fetal kidney, resulting in echogenic parenchyma, reduced urine production, and evolving renal dysfunction. This study aimed to describe the role of fetal urine biochemistry in evaluating renal function and prognosis in partial PUV and to outline the underlying inflammatory and biochemical changes associated with progressive obstruction. Methods: Evidence regarding the pathophysiology of partial PUV, fetal renal inflammatory responses, next-generation sequencing (NGS) utility in congenital anomalies of the kidney and urinary tract (CAKUT), and fetal urine biochemical thresholds was synthesized. Key biochemical markers obtainable via vesicocentesis or amniotic fluid sampling were examined for renal functional assessment. Results: Partial PUV induces sustained tubular injury accompanied by cytokine-mediated inflammation involving IL-6, TNF-alpha, and MCP-1, ultimately promoting interstitial fibrosis and nephron loss. Fetal urine biochemical parameters specifically sodium >100 mmol/L, chloride >90 mmol/L, osmolality >210 mOsm/kg, and beta 2-microglobulin >6 mg/L correlate with impaired tubular reabsorption and declining renal function. These abnormalities can appear before overt sonographic indicators of severe obstruction. When NGS results are normal, fetal urine biochemistry provides critical prognostic information and enhances prenatal counseling. Conclusion: Fetal urine biochemistry serves as a valuable functional biomarker for detecting early renal compromise in partial PUV. Integration of biochemical profiling into prenatal diagnostic pathways can improve prognostication, guide counseling, and may be applicable to other subtle forms of urinary tract obstruction due to its reproducible reflection of inflammatory and tubular injury processes.
The appearance of disease‑specific autoantibodies (Aab) is a hallmark of celiac disease (CeD). The recent adaption of a no‑biopsy approach places greater reliance on Aab testing. Despite their widespread use, conventional assay formats such as enzyme-linked immunosorbent assays (ELISA) continue to exhibit inherent methodological deficiencies that cannot be readily mitigated. Radio-binding assays (RBA) have historically defined the benchmark for assay performance, but the requirement for radiolabeled reagents and dedicated facilities renders this strategy an untenable solution beyond a limited number of specialized laboratories. This review aims to outline the future role of Aab in the diagnostic algorithm of CeD and to highlight the next-generation techniques that could replace the conventional testing methods. We discuss the diagnostic utility of ELISA, RBA, Electrochemiluminescence assay (ECL), luciferase immunoprecipitation systems (LIPS), antibody detection by agglutination polymerase chain reaction (ADAP) and dissociation enhanced lanthanide fluorescence immunoassay (DELFIA) techniques with emphasis on measuring anti-Transglutaminase 2 (TG2) Aab in the diagnosis of CeD. With the advantages of automation and multiplexing, the new generation of Aab testing modalities like ECL and ADAP may demonstrate sufficient sensitivity and accuracy to warrant inclusion in future CeD diagnostic guidelines. While multiplexing allows the inclusion of multiple Aabs testing from small volumes of blood in an automated manner, this generation of immunoassays are well suited for large-scale screenings and may replace the conventional ELISA and RBA techniques in the near future.
e14060 Background: Gliomas have few approved targeted therapies. Given frequent blood-brain-barrier disruption in gliomas, molecular targets with FDA-approved therapies in other solid tumors represent relevant precision-oncology opportunity. Methods: A total of 235 glioma tumor tissue samples underwent targeted next-generation sequencing at Datar Cancer Genetics. Clinical actionability was assessed using ESCAT. Subgroup analyses were performed based on IDH status. Results: Of 235 samples, 6 were grade I (2.6%), 17 grade II (7.2%), 38 grade III (16.2%), and 159 grade IV (67.8%); grade was unavailable in 15 (6.4%). Overall, 43.8% (103/235) harbored ≥1 tumor-agnostic or cross-indication actionable alteration with an FDA-approved therapy in solid tumors. Tumor-agnostic biomarkers included TMB-H (11.6%; 16/138), dMMR (1.7%; 2/116), BRAF V600E (4.9%; 11/225), and NTRK fusions (0.6%; 1/178); HER2 amplifications and RET fusions were not detected. Canonical CNS alterations included IDH1/2 (24.0%; 54/225), TERT promoter (36.1%; 73/202), TP53 (42.4%; 95/224), H3F3A (3.8%; 7/185), ATRX (8.2%; 18/219), EGFR amplification (21.2%; 43/203), CDKN2A/2B loss (18.8%; 38/202), EGFRvIII (12.9%; 23/178), and EGFR mutations (10.7%; 24/225). Cross-indication alterations involved PI3K-AKT-mTOR ( PIK3CA 8.4% [19/225], PTEN 18.3% [41/224]) and FGFR (4.3%; 10/235); KIAA1549-BRAF and PTPRZ1-MET fusions were each detected in 1.1% (2/178). ESCAT Tier I alterations were present in 29% (69/235) and Tier II–III in 56% (132/235). Though incidence of tumor-agnostic biomarkers was similar in IDH -mutant and IDH -wildtype ( IDH -WT) gliomas (13.0% [7/54] vs 11.6% [21/181]), the cross-indication biomarkers were enriched in IDH -WT gliomas (40.9% [74/181] vs 20.4% [11/54]). In grade IV gliomas, cross-indication biomarkers were more frequent in IDH -WT than IDH -mutant tumors (45.3% [62/137] vs 18.2% [4/22]), with similar findings in combined grade III–IV gliomas (42.9% [66/154] vs 25.6% [11/43]). Conclusions: Despite poorer prognosis, IDH -WT gliomas are enriched for cross-indication actionable alterations, reflecting biological actionability without established clinical benefit, and supporting comprehensive molecular profiling to guide indication-expanded therapies, clinical trial enrolment, and prospective interventional basket trials. Tumor-agnostic and cross-indication actionable alterations in gliomas. Biomarker Overall % (n/N) IDH -WT (%) IDH -Mutant (%) Approved Indication PTEN mutations 18.3 (41/224) 21.8 7.4 Breast FGFR1/2/3 alterations 4.3 (10/235) 5.5 0.0 Multiple ERBB2 mutations 0.0 (0/179) 0.0 0.0 Multiple BRCA1/2 mutations 0.6 (1/156) 0.8 0.0 Multiple PIK3CA mutations 8.4 (19/225) 7.6 11.1 Breast TMB-H 11.6 (16/138) 8.9 23.1 Tumor-agnostic dMMR/MSI-H 1.7 (2/116) 2.0 0.0 Tumor-agnostic NTRK fusions 0.6 (1/178) 0.7 0.0 Tumor-agnostic
Objectives: Chronic obstructive pulmonary disease (COPD) affects approximately 7.4% of Indians above 30 years. Long-acting beta-agonist/inhaled corticosteroid combinations are cornerstone therapy for symptomatic COPD. Poor medication adherence, a critical and modifiable determinant of therapeutic success, is substantially influenced by dosing frequency. The study aimed to compare treatment adherence patterns and associated clinical outcomes between once-daily vilanterol-fluticasone furoate (VI/FF) and twice-daily formoterol-fluticasone propionate (FOR/FP) in real-world COPD management, with a focus on dosing simplification as a pragmatic intervention. Materials and Methods: This prospective observational study enrolled 120 COPD patients (post-bronchodilator forced expiratory volume in 1 s (FEV1)/forced vital capacity <0.70) at a tertiary care center. Patients received VI/FF 25/100 mcg once daily ( n = 60) or FOR/FP 6/250 mcg twice daily ( n = 60) based on physician judgment and patient preference. Primary outcomes included FEV1 changes, exacerbation rates, and COPD assessment test (CAT) scores at 12 and 24 weeks. Adherence was assessed by dose counter review, prescription refill documentation, and structured patient interview. Propensity score matching and multivariable adjustment were employed to address confounding by indication. Results: At 24 weeks, treatment adherence was significantly superior with VI/FF (91.3% vs. 76.4%, p <0.001), driven primarily by once-daily convenience. This adherence advantage was associated with greater trough FEV1 improvement (mean difference 89 mL, 95% confidence interval [CI]: 52–126, p <0.001), superior CAT score reduction (mean difference −2.8 points, 95% CI: −4.5–−1.1, p = 0.002), and 42% fewer exacerbations (rate ratio 0.58, 95% CI: 0.38–0.88, p = 0.011). Mediation analysis suggested adherence accounted for approximately 31% of the exacerbation benefit. Both treatments showed comparable safety profiles. Conclusion: Once-daily VI/FF was associated with substantially superior treatment adherence compared to twice-daily FOR/FP, and this adherence advantage was associated with better clinical outcomes.
