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.
Obesity is a global health crisis affecting developing nations, including India. The management of obesity continues to evolve with newer drugs, metabolic and bariatric surgery and endoscopic interventions, requiring family physicians and specialists to adapt their clinical practice accordingly. There is an urgent need for a standardized algorithm to diagnose, stage, and treat obesity. The Endocrine Society of India (ESI) and the Obesity Surgeons Society of India (OSSI) appointed a steering committee to develop an evidence-based algorithm for managing patients with obesity in India. This was put to vote by 80 specialists (38 from OSSI and 42 from ESI) in a physical meeting. A proposed stage-wise algorithm based on Edmonton Obesity Staging System, Asian definition of obesity, and resources in India, received 100
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
