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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.
Pilonidal sinus disease typically occurs in the sacrococcygeal region, with the intermammary location being exceptionally rare. We report the first documented case of an intermammary pilonidal sinus from eastern India in a 14-year-old Asian female. A 14-year-old Asian female presented with 1-year history of intermammary swelling that evolved into a discharging sinus after 11 months. Physical examination revealed multiple sinus tract openings in the intermammary region with surrounding induration. Complete excision of the sinus tract with primary closure was performed under general anesthesia. Histopathological examination confirmed chronic inflammatory tissue consistent with the pilonidal sinus. The patient had an uncomplicated recovery with no recurrence at follow-up. Inclusion of intermammary pilonidal sinus in the differential diagnosis of chronic intermammary lesions should be considered, particularly in young females with large, pendulous breasts. Early recognition and complete surgical excision remain the gold standards for treatment, with excellent outcomes.
Next-generation sequencing (NGS)-based tests are being increasingly employed by clinicians for obtaining a genetic diagnosis in individuals and families with possible genetic disorders. However, there is a significant disparity in the genomic knowledge and skills of the clinicians employing these tests for care and management of families with rare genetic disorders. Through the current document, the Society for Indian Academy of Medical Genetics (SIAMG) aims to provide guidance and consideration in terms of the type of tests available, their appropriate applications, and result interpretation in order to make judicious use of these tests for rare disease diagnosis.
Prenatal diagnosis (PND) is an effective measure to prevent births with transfusion-dependent β-thalassemia (TDT) and other severe hemoglobinopathies. However, multicentric consolidated data from high-volume Indian referral laboratories is limited. The authors collated a multi-center experience of invasive PND for β-thalassemia and the major hemoglobinopathies, including center-wise volumes, affected-fetus rates, trends in primigravida referrals, and diagnostic challenges from seven Indian tertiary-care referral centers with a minimum of 10 y PND services. Retrospective data were contributed by SGRH-New Delhi, ICMR-NIIH-Mumbai, PGIMER-Chandigarh, AIIMS-New Delhi, NIMS-CDFD-Hyderabad, CMC-Vellore and SGPGI-Lucknow. Carrier evaluation was based on blood counts and Hb-HPLC. Fetal diagnosis utilized chorionic villus sampling or amniocentesis with molecular testing by ARMS-PCR, reverse dot-blot and/or Sanger sequencing as per local practices. Descriptive analyses summarized volumes, proportions of fetuses with biallelic HBB variants, and primigravida referral trends. Across centers, 6,780 PND procedures were performed over 2015–2024, with ICMR-NIIH and SGRH contributing 58.2
