Medanta The Medicity

Radiation-associated sarcomas (RAS) are rare tumors developing in previously irradiated areas. Most data come from high-income countries, with limited reports from low- and middle-income countries (LMICs). To our knowledge, this is the largest RAS cohort from India, examining clinical features, genetic predisposition, systemic therapies, and outcomes, in a resource-limited setting. We conducted a retrospective analysis of a sarcoma database at AIIMS, New Delhi, from January 2015 to June 2025. Patients ≥18 year with biopsy-confirmed RAS, meeting modified Cahan criteria, were included. Twenty-three patients (0.32% of 7,138 sarcoma cases evaluated) were diagnosed with RAS. The median age at diagnosis was 51.1 years, with a median latency of 13.25 years following radiotherapy. Breast cancer was the most common antecedent malignancy (21.7%). Soft tissue sarcomas were predominant (14, 60.9%), with undifferentiated pleomorphic sarcoma (8, 34.8%) being the most frequent histologic subtype. At presentation, 12 patients (52.2%) had metastatic disease, while three (13.1%) had locally unresectable tumors. The majority of tumors were high-grade (20, 87.0%), with a median tumor size of 6.9 cm. Among eight patients with resectable disease, seven underwent surgery, achieving R0 resection in 62.5% of cases. Re-irradiation was performed in three patients (13.0%). Sixteen patients (69.6%) received systemic therapy: 12.5% had partial response, 25% had stable disease, and two patients on immunotherapy had progressive disease. At a median follow-up of 68.2 months, the median overall survival was 59.2 months and 13.4 months for patients with nonmetastatic and metastatic disease, respectively. Despite large, high-grade, and advanced tumors, curative surgery was feasible in most nonmetastatic cases, and systemic therapies were widely used. The favorable survival outcomes underscore the importance of centralized, multidisciplinary sarcoma care in LMICs. Lack of immunotherapy responses calls for investigation into resistance mechanisms and histology-specific treatments.

Donor evaluation is a vital aspect of hematopoietic stem cell transplantation (HSCT), ensuring both donor suitability and recipient safety.Along with confirmatory human leukocyte antigen (HLA) typing, infectious disease marker (IDM) testing remains crucial.It helps prevent transmissible infections and improves the outcomes of HSCT.In India, while the trend of haploidentical (half-match) donors is increasing, matched unrelated donor (MUD) HSCT is still clinically relevant.However, to the best of our knowledge, no published Indian data exist on IDM profiles specifically for HSCT MUDs.We reviewed IDM testing results of 42 consecutive potential MUDs identified between May 2012 and December 2024 in Northern India.All donors provided written consent, and we collected anonymized data under ethical approval.The evaluation included enhanced chemiluminescence immunoassay (Vitros 3600, Quidel Ortho, United States) for anti-HIV I/II, anti-HCV, HBsAg, anti-HBc (total IgG IgM), anti-CMV IgG and IgM, and syphilis testing; a malaria rapid detection test; and individual donor nucleic acid testing (ID-NAT, Procleix Ultrio Plus, Grifols) for HIV RNA, HBV DNA, and HCV RNA.All 42 potential MUDs tested negative for HIV, HBV, HCV, syphilis, and malaria, including NAT results.Importantly, all were positive for anti-CMV IgG while negative for IgM, as shown in Table 1.This finding suggests prior CMV exposure, which is common in adult populations since CMV seroprevalence increases with age. 1 The mean age of donors in this study was 35.69 years.This universal CMV IgG seropositivity aligns with previous reports of high CMV seroprevalence in Indian adults (98.6%). 1 Given CMV's well-established role as a major infectious complication after HSCT, donor-recipient serological matching assumes clinical significance. 2Among potential recipient (R)-donor (D) combinations, the R /Dscenario carries the

How to cite this article: Singh AP, Govil D. Beyond the Mean: The Dynamic Fingerprint of Vasoplegia in Septic Shock. Indian J Crit Care Med 2026;30(2):85–87.

Non-motor symptoms (NMS) are increasingly recognized as significant contributors to the overall burden of craniocervical dystonia (CCD), yet they remain underdiagnosed. This international, multi-centre observational study aimed to evaluate the prevalence and burden of NMS in 167 patients with adult-onset idiopathic CCD across Poland, the UK, and Germany, using the validated Dystonia Non-Motor Symptoms Questionnaire (DNMSQUEST). Participants were assessed at the end of their botulinum neurotoxin treatment cycle. The majority of patients (94.6%) reported at least one NMS, and over half experienced five or more, with pain (62.3%) and sleep dysfunction (68.8%) being the most common. Emotional disturbances, including anxiety (34.7%) and depression (35.9%), were also prevalent. The total DNMSQUEST score averaged 5.9 ± 3.8. NMS burden was categorized as low in 42.5%, medium in 35.3%, and high in 22.2% of patients. Combined cervical and cranial dystonia was associated with the highest NMS burden (mean DNMSQUEST score 9.28 ± 3.09). NMS were significantly more prevalent in CCD compared to a small healthy control group. Sleep dysfunction and pain were strongly correlated with higher total NMS scores. Impairments in activities of daily living (69.5%) and a substantial proportion of patients (49.7%) reported balance and gait difficulties. Comparisons with prior DNMSQUESTQ validation cohorts revealed similar symptom patterns, supporting the cross-cultural applicability of the questionnaire. This study highlights the significant and multifaceted burden of NMS in CCD and underscores the importance of incorporating structured NMS assessment into routine clinical care. Particular attention should be paid to sleep dysfunction and pain, which appear to be central to the NMS burden in CCD.

ABSTRACT Ustekinumab (UST), an interleukin-12/23 inhibitor, is used in moderate-to-severe Crohn's disease. It is generally considered safer than tumour necrosis factor-α inhibitors. We report a case of a 62 year-old male patient with Crohn's disease who developed disseminated histoplasmosis after UST treatment, presenting with cholestatic jaundice, lymphadenopathy, and hepatomegaly. Endoscopic ultrasound guided biopsy revealed granulomatous hepatitis and lymphadenitis. Colonoscopy showed ileocolonic ulcerations with histopathology confirming noncaseating granuloma, Grocott-Gomori methenamine silver revealed yeast forms of histoplasmosis. This case highlights the need for high clinical suspicion of opportunistic even with UST, especially in tuberculosis endemic regions like India, where histoplasmosis may be under-recognized.

BackgroundAnti-HLA-DQ donor-specific antibodies are increasingly recognized for their role in early rejection and compromised graft function following kidney transplantation.MethodsA total of 119 prospective kidney transplant recipients were evaluated for pre-transplant HLA sensitization using single antigen bead (SAB) assays for class I and class II donor-specific antibodies (DSAs). All patients had negative complement-dependent cytotoxicity (CDC) crossmatch results; however, flow cytometry crossmatch was positive for T cells in three patients and showed borderline B-cell positivity in one patient. Of these patients, 100 proceeded to kidney transplantation, including 19 ABO-incompatible transplants. All recipients were followed for a minimum of 4 years post-transplant, and induction immunosuppression was administered using either anti-thymocyte globulin (ATG) or ATLG (Grafalon®).ResultsA total of 100 patients underwent kidney transplant. Among them, 34 recipients (34%) had class I HLA antibodies (MFI range: 9,057 to 757) and 5 had class I DSAs (MFI range: 2,084 to 822) without any rejection episodes. Thirty-eight patients (38%) tested positive for class II HLA antibodies, including 20 with anti-HLA-DQ (MFI range: 7,725 to 766); of these, eight had donor-specific anti-DQ antibodies. Only one patient, who underwent an ABO-incompatible transplant and had pre-transplant DQ DSA with MFI 7,725, developed biopsy-proven antibody-mediated rejection (ABMR) but recovered following treatment. All eight DQ DSA-positive recipients showed post-transplant MFI decline within 1 month. Rejection was notably infrequent in recipients who received Grafalon® induction.ConclusionsPreformed anti-HLA-DQ DSAs, especially with MFI >5,000 and in the context of ABO incompatibility, may predispose to AMR. DQ DSAs with lower MFI require vigilant monitoring due to the risk of post-transplant rebound. ATLG-based induction was associated with low rejection incidence and favorable short-term outcomes.

Metallic element (ME) contamination in urban road dust poses critical environmental and health challenges, particularly in Dhanbad, eastern India, representing one of the most intensively coal-mining-impacted urban regions in India, with over 112 active and abandoned mines, extensive overburden dumps, and widespread coal transportation corridors. This study systematically analyzed 44 composite road dust samples to quantify multiple MEs. Spatial interpolations, various geochemical indices, integrated Positive Matrix Factorization (PMF)- human health risk (HHR) framework based on Monte Carlo simulation was applied to comprehend the risk assessment. Excluding Al, all MEs exceeded their background value. Geochemical indices revealed moderate to very high contamination levels, particularly from Cd, As, and Cr. Spatial interpolation maps highlighted that coal mining zones, overburden dumps, and traffic-dense corridors, were the most polluted sites, prevailing in the central and NW-SE directions. Four major source factors of pollution were identified as mixed sources (F1), coal mining operations (F2), automotive and industrial emissions (F3), and lithogenic/overburden rock (F4). Multivariate statistical analyses further corroborated the findings of PMF. The integrated PMF-HHR framework, coupled with Monte Carlo simulation, revealed substantial non-carcinogenic (NCR) and carcinogenic risks (CR) for both adults and children. F2 followed by F3 were the predominant contributors to human health risks. Overall, the integrated PMF-HHR framework effectively linked source contributions to quantified health outcomes, providing a reliable tool for source-oriented risk management and mitigation in coal mining-affected urban environments.