Hepatocellular carcinoma (HCC) is generally diagnosed at an advanced stage, which limits curative treatment options for these patients. Locoregional therapy (LRT) is the standard approach to bridge ...and downstage unresectable HCC (uHCC) for liver transplantation (LT). Atezolizumab-bevacizumab (atezo-bev) can induce objective responses in nearly one-third of patients; however, the role and outcomes of downstaging using atezobev remains unknown.
In this retrospective single-center study, we included consecutive patients between November 2020 and August 2023, who received atezo-bev with or without LRT and were subsequently considered for resection/LT after downstaging.
Of the 115 patients who received atezo-bev, 12 patients (10.4%) achieved complete or partial response and were willing to undergo LT; they (age: 58.5 years; women-17%; Barcelona Clinic Liver Cancer Stage System B/C:5/7) had received 3-12 cycles of atezo-bev, and 4 of them had received prior LRT. Three patients died before LT, while three were awaiting LT. Six patients underwent curative therapies: four underwent living donor LT after a median of 79.5 (54-114) days following the last atezo-bev dose, one underwent deceased donor LT 38 days after the last dose, and one underwent resection. All but one patient had complete pathologic response with no viable HCC. Three patients experienced wound healing complications, and one required re-exploration and succumbed to sepsis. After a median follow-up of 10 (4-30) months, none of the alive patients developed HCC recurrence or graft rejection.
Surgical therapy, including LT, is possible after atezo-bev therapy in wellselected patients after downstaging.
Abstract Introduction Bariatric procedures have become popular in treating not only the morbid obesity but also the metabolic derangements. Sleeve Gastrectomy has recently become popular as a ...standalone procedure and its usefulness as a metabolic procedure especially glycemic control is still under investigation. One of the most commonly used measure of insulin resistance is statistically derived ‘Homeostatic model assessment of insulin resistance (HOMA-IR). Aim The effect of Laparoscopic Sleeve Gastrectomy (LSG) on clinical and measurable change in glycemic control as seen by reduction of insulin resistance ie HOMA-IR levels in morbidly obese patients. Material and methods All the patients with BMI ≥ 35 kg/m2 with co morbidities and BMI ≥ 40 kg/m2 even without co morbidities were included in the study. The period of the study was from Feb 2013 to Sep 2014. Fasting (FBS), post prandial blood sugar (PPBS) and Insulin levels were checked before the surgery, 1month and 3 month after the surgery. We also recorded BMI and diabetic status. HOMA-IR was calculated and trends were recorded. Statistical analysis Statistical analysis was carried out using SPSS 16.0. Results Out of 28 patients 8 were males and 20 were females. The mean age was 43 yrs. 11 (39%) patients were diabetic and mean BMI was 44 kg/m2 and a range of (35-61.3) kg/m2. 11 patients had BMI>45kg/m2. The HOMA-IR values decreased significantly after the surgery both in diabetics and non diabetics. Conclusion LSG results in improvement in glycemic control in both diabetics and non diabetics.
Coronavirus disease-2019 (COVID-19) cholangiopathy is a recently known entity. There are very few reports of liver transplantation (LT) for COVID-19-induced cholangiopathy. It is well known that ...vaccines can prevent severe disease and improve outcomes. However, there are no reports on the impact of COVID-19 vaccines on cholestasis. Therefore, we aimed to compare the course and outcome of patients who developed cholestasis following COVID-19 infection among vaccinated and unvaccinated individuals. Methods: Patients diagnosed with post-COVID cholestasis during the pandemic were included in the study after excluding other causes of cholestasis.
Eight unvaccinated and seven vaccinated individuals developed cholestasis following COVID-19 infection. Baseline demographics, presentation, severity, and management of COVID-19 were similar in both groups. However, patients in the unvaccinated group had a protracted course. The peak ALP was 312 (239–517) U/L in the vaccinated group and 571.5 (368–1058) U/L in the unvaccinated group (P = 0.02). Similarly, the peak γ-glutamyl transpeptidase values were lower in the vaccinated (325 237–600 U/L) than in the unvaccinated group (832 491–1640 U/L; P = 0.004). However, the peak values of total bilirubin, transaminases, and INR were similar in both groups. Five patients developed ascites gradually in the unvaccinated group whereas none in the vaccinated group developed ascites. Plasma exchange was done in five patients, and two were successfully bridged to living donor LT in the unvaccinated group. Only two patients recovered with conservative management in the unvaccinated group, whereas all recovered with conservative management in the vaccinated group. The other four patients in the unvaccinated group were planned for LT.
Post-COVID-19 cholestasis is associated with high morbidity and mortality, meriting early identification and appropriate management. Vaccination can modify the course of severe COVID-19 infection and improve outcomes.
Background
Post‐COVID‐19 cholangiopathy is an emerging cholestatic liver disease observed in patients recovering from severe COVID‐19 infection. Its prognosis is poor, necessitating liver ...transplantation in some cases. This study aimed to investigate the outcomes of liver transplantation for post‐COVID‐19 cholangiopathy.
Methods
Seven patients who underwent liver transplantation for post‐COVID‐19 cholangiopathy at three institutions between 2020 and 2022 were included in this retrospective multi‐center case series.
Results
At the time of initial COVID‐19 infection, all patients developed acute respiratory distress syndrome, and six patients (86%) required ICU admission. Median time intervals from the initial COVID‐19 diagnosis to the diagnosis of post‐COVID‐19 cholangiopathy and liver transplantation were 4 and 12 months, respectively. Four patients underwent living donor liver transplantation, and three patients underwent deceased donor liver transplantation. The median MELD score was 22 (range, 10–38). No significant intraoperative complications were observed. The median ICU and hospital stays were 2.5 and 12.5 days, respectively. One patient died due to respiratory failure 5 months after liver transplantation. Currently, the patient and graft survival rate is 86% at a median follow‐up of 11 months.
Conclusions
Liver transplantation is a viable option for patients with post‐COVID‐19 cholangiopathy with acceptable outcome. Timely identification of this disease and appropriate management, including evaluation for liver transplantation, are essential.
Hodgkin's lymphoma (HL) is a malignant disease of the lymphoid tissue originating from the germinal center and postgerminal center B-cells comprising 10% of all lymphomas and 0.6% among all cancers. ...Here, we report a case of a 22-year-old male with a chief complaint of painless swelling in the right submandibular region for the past 6 months with no contributory medical history. Correlating the history and clinical examination, a clinical diagnosis of benign sialadenoma was made. Benign sialadenoma was confirmed on radiographic investigations such as ultrasonography and magnetic resonance imaging. Furthermore, excisional biopsy and immunohistochemistry performed revealed a case of classical HL (lymphocyte-rich type). The positron-emission tomography-computed tomography revealed metastasis to the inguinal and cervical lymph nodes.
Cohort studies demonstrating an association of hepatocellular carcinoma (HCC) screening with reduced mortality are prone to lead-time and length-time biases.
To characterize the clinical benefits of ...HCC screening, adjusting for lead-time and length-time biases, in a diverse, contemporary cohort of at-risk patients.
This retrospective cohort study of patients with HCC was conducted between January 2008 and December 2022 at 2 large US health systems. Data analysis was performed from September to November 2023.
The primary outcome was screen-detected HCC, defined by abnormal screening-intent abdominal imaging or α-fetoprotein level within 6 months before diagnosis. Cox regression analysis was used to characterize differences in overall survival between patients with screen-detected and non-screen-detected HCC; lead-time and length-time adjustments were calculated using the Duffy parametric formula.
Among 1313 patients with HCC (mean SD age, 61.7 9.6 years; 993 male 75.6%; 739 56.3% with Barcelona Clinic Liver Cancer stage 0/A disease), HCC was screen-detected in 556 (42.3%) and non-screen detected in 757 (57.7%). Patients with screen-detected HCC had higher proportions of early-stage HCC (393 patients 70.7% vs 346 patients 45.7%; risk ratio RR, 1.54; 95% CI, 1.41-1.70) and curative treatment receipt (283 patients 51.1% vs 252 patients 33.5%; RR, 1.52; 95% CI, 1.34-1.74) compared with patients with non-screen-detected HCC. The screen-detected group had significantly lower mortality, which persisted after correcting for lead-time bias (hazard ratio, 0.75; 95% CI, 0.65-0.87) in fully adjusted models. Both groups had similar tumor doubling times (median IQR, 3.8 2.2-10.7 vs 5.6 1.7-11.4 months) and proportions of indolent tumors (28 patients 35.4% vs 24 patients 38.1%; RR, 0.93; 95% CI, 0.60-1.43). Adjustment for length-time bias decreased survival estimates, although 3-year and 5-year survival for patients with screen-detected HCC remained longer than that for patients with non-screen-detected HCC.
The findings of this cohort study suggest that HCC screening is associated with reduced mortality even after accounting for lead-time and length-time biases. However, these biases should be considered in future studies.
BackgroundAtezolizumab-bevacizumab (atezo-bev) is recommended as first-line therapy for patients with unresectable hepatocellular carcinoma (uHCC). However, its effectiveness and safety in other ...populations, including those with Child-Turcotte-Pugh (CTP) class B cirrhosis, is unclear. MethodsFor this systematic review and meta-analysis, electronic databases, including PubMed, Embase, and Scopus, were searched from 1st May, 2020 till 5th October, 2022; the last date of access was January 31, 2023. Pooled progression-free survival (PFS), overall survival (OS), and radiological response rate among patients receiving atezo-bev were compared between patients with CTP-A and CTP-B cirrhosis, with tyrosine kinase inhibitors (TKIs) and among those receiving the drug as first-line and later line therapy. The protocol was registered in Prospero (CRD42022364430). FindingsAmong 47 studies (n = 5400 patients), pooled PFS and OS were 6.86 (95% CI, 6.31-7.41) and 13.8 months (95% CI, 11.81-15.8), respectively. Objective response rate (ORR) and disease control rate were 26.7% (24.6-29.1) and 75.3% (73.1-77.4) using RECIST criteria, and 34% (30.3-37.8) and 73.6% (68.8-78) using mRECIST criteria, respectively. Among those receiving atezo-bev, patients with CTP-B cirrhosis had similar ORRs by RECIST (odds ratio OR, 1.42 0.77-2.6; P = 0.25) and mRECIST criteria (OR, 1.33 0.52-3.39; P = 0.53) but shorter PFS (mean difference MD:3.83 months 1.81-5.84) than those with CTP-A cirrhosis. Compared to patients receiving TKIs, those receiving atezo-bev had longer PFS (MD: 2.27 months 0.94-3.5) and higher ORR (RECIST: OR, 1.44 1.01-2.04 and mRECIST: OR, 1.33 1.01-1.75). Compared to first-line therapy, later-line therapy had lower ORR (RECIST: OR, 1.82 1.3-2.53; P < 0.001 and mRECIST: OR, 2.02 1.34-3.05) but comparable PFS (MD: 0.58 months -0.18 to 1.35) among nine studies. The incidence of grade ≥3 adverse events among patients with CTP-A and CTP-B cirrhosis was comparable (OR, 0.89 0.45-1.74) as it was for patients receiving atezo-bev and TKIs (OR, 0.86 0.61-1.2). InterpretationOur findings suggest that atezo-bev is safe and effective as first-line systemic therapy for patients with uHCC and CTP-A or CTP-B cirrhosis. FundingAn unsolicited grant from ROCHE Products India Pvt Ltd. was received for publication.
A blood collection monitor is a device used during the blood collection process to provide a shaking moment to the blood being received from the donor thereby mixing the blood homogeneous with the ...anticoagulants in the blood bag. The shaking moment and anticoagulants prevent blood coagulation. The amount of blood to be collected varies from donor to donor which ranges from 350 ml to 450 ml. The existing electronic blood collection monitors being used in hospitals and laboratories include not only mechanical but also an electric mechanism that provides oscillations to a blood bag, quantify the blood amount and measure the flow of blood. However, the dependency of these devices on external electric power sources limits its application in rural areas as well as large-scale donation camps. The present study offers a mechanical blood collection monitor which does not require any external power for its functioning and thereby overcomes the drawbacks of the conventional device. The present paper offers the design considerations and systematic study of the proposed mechanical blood collection monitor. Additionally, the linkage mechanism and associated gear train were analysed using ANSYS and ADAMS which further opens up the ways to study the variations in kinetic energy and torquing moment.
Background: In India, infectious diseases continue to be predominant with emerging non-communicable diseases, imposing a double burden of diseases on health care system. Hence, the tertiary health ...care hospital-based study was done to compare the morbidity pattern of communicable diseases with respect to non-communicable diseases. Methods: A 2 years’ record-based data of admitted patients was collected in a tertiary health care hospital. The data was analysed using Microsoft Excel version 365. Significance of association and difference in proportions has been checked with chi-square test and Z test for SEDP respectively at significance level of 0.05. Results: During the study period of two years, 6818 patients were admitted in the hospital, of which 74.51% suffered from communicable diseases while 25.49% suffered from other types of disease including non-communicable diseases. Of the 5080, patients with communicable diseases, 57.74% were males and 42.26% were females. Communicable diseases and non-communicable diseases had male predominance (p<0.05) and was higher amongst age group 0-15 years (p<0.05). Hospital stay was prolonged in patients suffering from communicable disease (p<0.05). Significant increased difference was found in AFI, Malaria, Dengue and in Leptospirosis prevalence and significant decreased difference was found in acute gastroenteritis, IV, Covid-19, Respiratory infections and enteric fever (p<0.05). Conclusions: Communicable diseases continue to be a major threat to public health system in India. Through effective surveillance programmes, any change in trends of disease can be identified and suitable measures can be adapted to control and prevent it.
PDF
