Lakeshore Hospital

Autoimmune hepatitis (AIH) in children presents significant diagnostic and therapeutic challenges requiring a multidisciplinary and evidence-based approach. The Indian Society of Pediatric Gastroenterology, Hepatology, and Nutrition (ISPGHAN) convened a consensus meeting on February 23, 2025, bringing together national and international experts to address key clinical and research questions. The deliberations spanned epidemiology, clinical presentation, diagnosis including autoantibodies, immunoglobulin G (IgG), histology and diagnostic scores, therapeutic strategies, management of difficult-to-treat AIH, long-term monitoring, and special scenarios, such as seronegative AIH (SN-AIH), autoimmune sclerosing cholangitis/overlap syndromes and post-transplant complications like recurrence and de novo-AIH. Recommendations were formulated using standard GRADE system and finalized through structured consensus. These guidelines aim to standardize care, assist clinicians in decision-making, and improve outcomes in children with AIH across diverse healthcare settings.

Second victim syndrome (SVS) is an entity known to corrode healthcare providers from within. To analyze the interaction of different factors of SVS, an online questionnaire (based on the Second Victim Experience and Support Tool - Revised) was used for a cross-sectional survey. To know the prevalence and the psychological impact of SVS among Indian surgeons. This cross-sectional online questionnaire survey-based analytical study collected responses of 200 Indian Surgeons of different types and levels of speciality. Inputs on all dimensions of SVS, namely, psychological distress, physical distress, colleague support, supervisor support, institutional support and professional self-efficacy, and outcome parameters, that is, turnover intentions and absenteeism, were collected and analyzed. The SVS prevalence in the sample was 18.5%, the highest among specialists at 24.3%. Affected surgeons experienced significant psychological and physical distress and reported less peer and institutional support, lower self-efficacy, more intent to leave, higher absenteeism, and reduced resilience. Regression analyses identified distress as a predictor for turnover intentions and absenteeism, with SVS severity similar across all specialities and levels. SVS can have significant psychological effects, with its aftermath potentially manifesting as somatic symptoms, self-doubt, insecurity, and both mental and physical disengagement from the workplace. This may contribute to considerations of leaving the profession. There is a clear need for comprehensive institutional support systems to address these challenges and enhance professional outcomes.

With better surgery and chemotherapeutic agents, borderline resectable or locally advanced pancreatobiliary tumours are being treated with curative intent. This study presents real-world evidence of porto-mesenteric vein resections (PVR) with pancreatectomy and generates predictive nomograms for postoperative mortality (POM) and major complications (MC). A retrospective multicentre study, including 11 high-volume centres, evaluated patients undergoing PVR. Factors affecting 90-day POM and MC (Clavien-Dindo grades ≥ 3a) were assessed, and predictive nomograms were generated. Overall survival (OS) and disease-free survival (DFS) were estimated for patients with pancreatic ductal adenocarcinoma (PDAC). Cox regression analysis was performed to ascertain factors affecting OS and DFS. Among 389 patients, POM was 6.4%, and MCs were 32.6%. Charlson comorbidity index > 4, preoperative biliary drainage, preoperative radiotherapy (PRT), segmental PVR, and additional organ resection (AOR) were predictive of POM. The independent predictors of MCs were American Society of Anesthesiologists status 3/4, PRT, and AOR. The generated model had an area under the curve (AUC) of 0.757, cutoff > 1.79 to predict POM, and AUC of 0.669, cutoff > 0.678 for MCs. In the 263 patients with PDAC, the median OS was 25.01 months (95% confidence interval [CI] 21.9-28.11), and DFS was 16.72 months (95% CI 14.56-18.89). Perineural invasion, segmental PVR, and margin positivity predicted worse survival, while completing multi-modality treatment was protective. The POM and MCs of PVR with pancreatectomy were at par with the world standards. The generated predictive nomograms for POM and MC revealed a good predictive potential. In patients with PDAC, completion of multimodality treatment offers better long-term survival.

ABSTRACT Background: Due to the complex histological and genomic nature of sarcomas, diagnosing and treating them has proven challenging. Delving into the genomic profiles and molecular markers linked to different sarcoma subtypes will aid in overcoming these obstacles and identifying new potential therapeutic targets. Objectives: The primary objective of this study was to investigate the genomic complexity of sarcoma, while the secondary objective was to identify potential therapeutic targets in the patients with sarcoma from India. Materials and Methods: This retrospective observational study was conducted from January 2020 to February 2024 at 4basecare Precision Health Pvt. Ltd., Bengaluru, India. We carried out comprehensive genomic profiling using gene panels or exome sequencing, including assessment of immunotherapy biomarkers (tumor mutation burden (TMB), microsatellite instability (MSI), programmed death-Ligand 1 (PD-L1)), in a cohort of 263 patients with sarcoma, categorized into 25 sarcoma types, for the present retrospective analysis. Results: We included 263 patients with sarcoma in our study and identified a diverse landscape of pathogenic variants across 138 genes, in 69.5% (183 patients) of the cohort. SNVs were prevalent in TP53 (25.1%; 66 patients), KIT (5.7%; 15 patients), PTEN (4.6%; 12 patients), and RB1 (4.6%; 12 patients), while CDK4 (5.2%; 17 patients) and MDM2 (5.7%; 15 patients) gene amplifications and SS18-SSX2 (1.1%; 3 patients), EWSR1-FLI1 (0.8%; 2 patients), and ASPSCR1-TFE3 (0.8%; 2 patients) gene fusions were recurrent. The majority of the patients harbored mutations affecting cell cycle control (39.2%; 103 patients), PI3K/AKT/MTOR (17.9%; 47 patients), and RAS/RAF/MAPK (14.8%; 39 patients) pathways. The average TMB was 7 mutations/mb, with 13.3% (35 patients) classified as TMB-H. Around 59.3% of the cohort (156 patients) harbored clinically actionable variants of therapeutic significance, including 8.7% of the cohort (23 patients) who were eligible for FDA/NCCN approved therapies. Conclusion: The findings emphasize the clinical usefulness of genomic profiling in guiding precision medicine for sarcoma treatment. Our research offers valuable insights into the genetic makeup of sarcomas, serving as a basis for devising efficient and precise diagnostic approaches and for planning preclinical and clinical studies to develop innovative treatment strategies.

Epstein Barr virus (EBV), the most prevalent viruses known to infect humans belongs to the herpes family. The genome of the EBV is the first to be fully sequenced. Infectious mononucleosis is a condition that commonly occurs in adulthood presenting with symptoms such as fever, sore throat and generalized lymphadenopathy. Here we present a case in which an infection was disguised as leukemia due to similar presentation of the disease thus, emphasizing the need for proper history to be taken in all patients. It is very essential to get the complete history of the patients to all possible exposures of infection and to include EBV-associated syndromes in differential diagnosis. A Thorough evaluation must be conducted to avoid mistakenly diagnosing the patient with lympho proliferative neoplasms.

Alzheimer's disease (AD), a progressive neurodegenerative disorder, requires early intervention to delay cognitive decline and enhance quality of life. This national survey of 100 neurologists explored their clinical practices in managing early-stage AD, including diagnostic approaches, treatment selection, patient counseling and perceived barriers. While neurologists acknowledged the importance of early intervention, challenges such as limited resources, time constraints and patient non-cooperation hindered optimal care. Variability in diagnostic and counseling practices often stemmed from disparities in resources and training. These findings highlight the need for revised guidelines, enhanced training and improved resources to support neurologists in providing consistent and effective early-stage AD care.