B. J. Medical College

BACKGROUND AND AIMS:Lean metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized; however, its long-term hepatic risk relative to obese MASLD remains elusive. This study evaluated differential risk of progressive hepatic outcomes and identified predictors of adverse outcomes within the lean phenotype. METHODS:A large, multicenter retrospective cohort study was conducted using the TriNetX Global Health Research Network, including adults with noncirrhotic MASLD between 2010 and 2024. Lean MASLD was defined as the body mass index (BMI) < 25 kg/m2. Primary analyses compared lean versus nonlean MASLD (BMI ≥ 25 kg/m2), with a prespecified secondary analysis comparing lean versus obese MASLD (BMI ≥ 30 kg/m2), excluding overweight individuals. Outcomes included incident fibrosis, cirrhosis, portal hypertension and related complications, hepatocellular carcinoma (HCC), liver transplantation, and all-cause mortality over 3-year, 5-year, and 10-year follow-up. Propensity score matching and multivariable Cox regression were applied. RESULTS:Among 1,130,297 patients with MASLD, 229,084 had lean MASLD. After matching, lean MASLD was associated with consistently higher odds of fibrosis, cirrhosis, portal hypertensive complications, HCC, liver transplantation, and mortality compared with nonlean, overweight, and obese MASLD across all time horizons (all p < 0.001). Within the lean MASLD cohort, those with older age, diabetes, hypoalbuminemia, thrombocytopenia, and elevated aspartate aminotransferase independently predicted adverse hepatic outcomes. CONCLUSIONS:Lean MASLD is associated with substantial long-term hepatic morbidity and mortality. Currently, obesity-centered paradigms guide MASLD screening and risk stratification. Thus, efforts should be made to ensure that lean individuals with MASLD are not systematically under-screened or under-surveilled for progressive liver disease as they carry a higher risk of worsening.

BACKGROUND:The dynamic spectrum of tuberculosis (TB) often results in underdiagnosis warranting the need for better diagnostics to accurately detect Mycobacterium tuberculosis (Mtb) in persons with asymptomatic, paucibacillary or extrapulmonary TB, and to identify individuals at high risk of developing TB disease early. This study aimed to evaluate a dual target-based digital droplet PCR (ddPCR) assay to detect circulating cell-free Mtb DNA in plasma of individuals at high risk of developing TB disease and in those lacking a clear diagnosis of TB (asymptomatic or clinically diagnosed TB). METHODS:Forty-six healthy household contacts (HHCs) of patients with pulmonary TB who developed TB within two years of follow-up (Progressors), and 92 HHCs who did not progress to TB (Non-progressors) were included in the study. Plasma was obtained and subjected to testing using a ddPCR assay targeting two M. tuberculosis (Mtb)-specific insertion sequences, IS6110 and IS1081. Sensitivity, specificity, and ROC curves were used to assess the diagnostic performance of the test. FINDINGS:IS6110 and IS1081 targets were detected in 10/11 asymptomatic TB cases giving a sensitivity of 90.9% (95% CI: 62.3-99.5), and in 9/11 unconfirmed/possible TB cases giving a sensitivity of 81.8% (95% CI: 52.3-96.8). Further, the test detected Mtb-ccfDNA in 15/19 Progressors even at six months prior to TB diagnosis (79.0% sensitivity, 95% CI: 56.7-91.5; 97.8% specificity, 95% CI: 92.4-99.6). Detection rates at 12- and 18-months prior to onset of TB were 55.0% (95% CI: 34.2-74.2) and 50.0% (95% CI: 29.9-70.1), respectively. Notably, the test showed 100% sensitivity (95% CI: 43.9-100.0) in detecting extrapulmonary TB up to six months prior to clinical diagnosis. INTERPRETATION:The study highlights the potential of ddPCR-based detection of Mtb ccfDNA as a valuable tool for early identification of individuals at risk of developing active TB disease and for clarifying the diagnosis of TB in diagnostically challenging cases. Further validation in a larger cohort will confirm the findings of the study and endorse the utility of the test in clinical practice. FUNDING:This work was supported by the Indian Council of Medical Research (Grant number:5/8/5/45/Adhoc/2022/ECD-1). The CTRIUMPh cohort study which provided samples for this study was supported by the NIH/DBT Indo-US Vaccine Action Programme.

Background: Comparative Evaluation of Hemodynamic Stability between Spinal and General Anesthesia in Elective Lower Abdominal Surgeries is a clinically relevant diagnostic and anatomical problem in routine tertiary care practice. The purpose of this study was to compare the intraoperative hemodynamic stability, the requirement of vasopressors and early recovery between spinal and general anesthesia. Method: Prospective observational comparative study was done in the Department of Anaesthesiology in a tertiary care hospital. A total of 140 adult patients who were undergoing elective surgery for the lower abdomen were included in the study. The participants/specimens were divided into two groups: spinal anesthesia group and general anesthesia group. Standardized data collection, laboratory/radiological/anatomical assessment and predefined operational criteria were used. Results: MAP variability during surgery was significantly lower in the spinal anesthesia group (10.8 +/- 4.1 mmHg) than in the general anesthesia group (15.6 +/- 5.2 mmHg, p<0.001). The use of vasopressors was greater in the spinal anesthesia group (28.6% vs 15.7%, p=0.041), while tachycardia and hypertensive response to incision were more common in the general anesthesia group (p=0.008). The spinal group had better early recovery score at 30 minutes. Conclusions: Both techniques were safe, but the latter (spinal anesthesia) allowed for more predictable hypotension that required prompt vasopressor support, and smoother intraoperative hemodynamic trends.

Visceral artery pseudoaneurysms (VAPAs) are a rare complication of pancreatitis, with the left gastric artery (LGA) among the least commonly involved vessels. Endoscopic ultrasound-guided coiling and glue embolization have shown great success in their management; however, the literature on the disease course of LGA VAPAs after successful embolization is limited. We report a case of LGA VAPA, as a complication of chronic pancreatitis, which recurred 3 times and required a total of 4 embolization procedures (3 endoscopic ultrasound-guided). This case highlights the need for regular postembolization monitoring for recurrence of the LGA VAPA, despite a successful embolization procedure.