Medanta is an Indian chain of multi-specialty medical institutes based in Gurgaon in the National Capital Region of India. Medanta was started in 2009 with one institute, Medanta - The Medicity in Gurgaon, with cardiac surgeon Naresh Trehan as its main director along with co-founder Sunil Sachdeva. Global Health Limited is the company which owns and manages the hospital.The chain has since expanded its outreach to other cities including Gurgaon, Noida, Lucknow, Indore, Ranchi and Patna.
Abstract Background Patients with thrombocytopenia undergoing percutaneous coronary intervention (PCI) are at an elevated risk of bleeding and adverse cardiovascular events due to dual-antiplatelet therapy (DAPT). Limited data exist on the safety of DAPT in this subset of patients. Methods This single-centre prospective cohort study was conducted at SMS Medical College, Jaipur, India, over 12 months (March 2024–March 2025). A total of 368 patients with baseline (pre-PCI) thrombocytopenia who underwent elective or emergency PCI while on DAPT were enrolled. DAPT comprised aspirin plus a P2Y12 inhibitor: clopidogrel in 317 patients (86.1%), ticagrelor in 48 (13.0%), and prasugrel in 3 (0.8%), with the choice based on clinician discretion; the distribution did not differ significantly across thrombocytopenia grades (p = 0.204). DAPT was generally maintained for 6–12 months per institutional protocol, without a standardized de-escalation strategy. Thrombocytopenia was classified based on pre-procedural platelet counts as mild (100,000–150,000/mm³; n = 237, 64.4%), moderate (50,000–100,000/mm³; n = 104, 28.2%), or severe (30,000–50,000/mm³; n = 27, 7.3%). The primary outcomes were major adverse cardiovascular events (MACE), defined as a composite of total death, myocardial infarction (MI), coronary revascularization, stroke, and hospitalization due to heart failure; and bleeding events assessed using Bleeding Academic Research Consortium (BARC) criteria. Secondary outcomes included in-hospital mortality, stent thrombosis, target vessel revascularization, and post-PCI MI. Follow-up was conducted at 1, 2, and 6 months post-PCI. Multivariate logistic regression was used to adjust for confounders across three sequential models (demographics; clinical variables; procedural outcomes). Results Severe thrombocytopenia independently predicted higher risks for MACE (HR: 2.30, CI: 1.89–2.81) and bleeding (HR: 2.88, CI: 2.37–3.49) across all models. Mild thrombocytopenia showed no significant risk after adjustment for confounders. Patients with moderate thrombocytopenia demonstrated consistent risks for both outcomes. Smoking and history of PCI/MI significantly correlated with thrombocytopenia severity (p < 0.01). Conclusion Moderate and severe thrombocytopenia are independently associated with increased risks of bleeding and cardiovascular events in patients on DAPT post-PCI. These observational findings support the incorporation of thrombocytopenia severity into existing risk stratification frameworks; however, as this study did not evaluate alternative management strategies, prospective randomized trials are needed to determine whether modified antiplatelet regimens can improve outcomes in this high-risk population.
BACKGROUND & AIMS:Noninvasive tests (NITs) are widely used to risk-stratify patients with metabolic dysfunction-associated steatotic liver disease (MASLD); however, their performance may vary according to patient characteristics. We evaluated the accuracy of NITs in a large, multinational MASLD cohort across select subpopulations. METHODS:We analyzed 18,759 adults with biopsy-confirmed MASLD from 41 countries. NITs included FIB-4, liver stiffness measurement (LSM), and Agile-3+. Diagnostic performance for advanced fibrosis (F3-F4) was measured using areas under the curve (AUCs) across subgroups defined by age, sex, type 2 diabetes (T2D), obesity, and alcohol use. Subgroup-specific cutoffs were derived. RESULTS:Advanced fibrosis was present in 37% of patients. Pooled AUCs were 0.79 for FIB-4, 0.83 for LSM, and 0.86 for Agile-3+. FIB-4 accuracy declined with age (AUC 0.70 in ≥65 years vs 0.79 in <65 years, P < .0001) and in middle-aged patients with T2D. The LSM performance remained stable across T2D status but was moderately reduced in patients with obesity and, more profoundly, morbid obesity (body mass index [BMI] >35 kg/m2). Sex and alcohol use had minimal impact on AUCs. Age- and T2D-specific FIB-4 cutoffs varied substantially to maintain predefined accuracy (sensitivity or specificity). The cutoffs for LSM also differed based on patients' BMI, with lower diagnostic cutoffs for advanced fibrosis required in nonobese MASLD (sensitivity 80%: 8.8 kPa in lean, 9.0 kPa overweight, 9.6 kPa in obesity, 11.0 kPa in morbid obesity). CONCLUSIONS:Accuracy of NITs for advanced fibrosis in MASLD is influenced by age, T2D, and obesity. Age-adjusted FIB-4 thresholds may enhance risk stratification. Imaging-based and composite NITs (LSM and Agile-3+) provide more consistent performance across MASLD subpopulations.
Recent advancements in vaccinology and the introduction of new vaccines warrant a revision of the existing immunization guidelines. To review and revise the IAP recommendations (2023) on immunization of children aged 0 to 18 years and issue recommendations on existing and new vaccines. The Advisory Committee on Vaccines and Immunization Practices (ACVIP) of the Indian Academy of Pediatrics (IAP) discussed the updates and drafted evidence-based consensus recommendations after several rounds of meetings convened both in-person and virtually. The contents were finalized during the meeting held at the IAP Office, Navi Mumbai, on November 23, 2025. The major changes include recommendation of replacing the quadrivalent (A/H1N1, A/H3N2, B/Victoria, B/Yamagata) influenza vaccines with trivalent (A/H1N1, A/H3N2, B/Victoria) influenza vaccines. The use of nirsevimab for respiratory syncytial virus is recommended for high-risk cases, after consultation with the parents. Immunocompetent girls aged 9 to 15 years may receive a single dose of the human papilloma virus (HPV) vaccine. A 5-dose intramuscular rabies vaccination schedule administered on days 0, 3, 7, 14, and 28 is recommended for post-exposure prophylaxis (PEP), along with rabies immunoglobulin (RIG) or rabies monoclonal antibody (RMAb) based on the category of exposure.
BACKGROUND:Acute Kidney Injury (AKI) is common in neonates admitted to the Neonatal Intensive Care Unit (NICU). Neonatal AKI is associated with multiple comorbid conditions of greater clinical severity, which also increase the neonate's risk of mortality. Understanding the risk of mortality, in addition to the severity of AKI, may be useful in determining alternative treatment options for neonates with AKI. METHODS:Two independent datasets containing neonatal patient data from eleven healthcare centers were filtered, cleaned, and combined to produce a dataset fit for training and testing with seven Machine Learning algorithms. After initial modeling with 34 training features, feature elimination was utilized to isolate the most contributing features and create streamlined models. The models were fine-tuned using Bayesian search before being compared to select the most accurate and interpretable architecture. RESULTS:A patient cohort of 245 patients included 189 alive and 56 deceased neonates with incidence of AKI. Of the 245 patients included in this study, 73.5% were male and 26.5% were female, alongside a median age at entry of 12 h and interquartile range of 35 h. Three tree-based models, Random Forest, XGBoost, and LightGBM, were found to be the most accurate and interpretable of the seven models tested. Support Vector Machine produced similar results, albeit with less interpretability. The RAMA (Raina, Arnav, Max, Aadi) model followed results of the XGBoost algorithm, with Area under the Receiver Operating Characteristic Curve (AUC-ROC) of 0.882 ± 0.132, Accuracy of 0.878 ± 0.052, and F1 Score of 0.923 ± 0.029. CONCLUSION:RAMA utilizes a tree-based decision-making algorithm, allowing it to determine the risk of mortality in neonates susceptible to AKI.
