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Background: Atezolizumab-bevacizumab (atezo/bev) combination is a recommended first-line systemic therapy for unresectable hepatocellular carcinoma (uHCC). There are no studies from India reporting the safety and efficacy of this drug in real-world settings where most patients present in an advanced stage. Methods: In this retrospective study from two centers in India, we included patients with uHCC who received atezo/bev as first-line systemic therapy. Comparison of overall survival (OS) among the different Child-Turcotte-Pugh (CTP) classes was the primary objective, while progression-free survival (PFS), radiologic response, and adverse events to the therapy were secondary objectives. Results: The median age of the 67 patients who received atezo/bev therapy was 61 (29-82) years, and 86% were males. Nonalcoholic steatohepatitis (55.2%) was the commonest cause of cirrhosis, and most patients belonged to BCLC-C (74.6%%). There were 24 patients in CTP A, 36 in CTP B, and 7 in CTP C. The median OS was 12 (95%CI, 8.16-15.83) months in the cohort. The median OS in CTP class A, B, and C was 21 (95%CI, 0-42.06) months, 9 (95%CI, 5.46-12.53) months, and 4 (95%CI, 2.14-5.85) months, respectively (P < 0.001). The median PFS in the whole cohort was 8 (95%CI, 6.03-9.96) months. The median PFS in Child A, B, and C was 18 (95%CI, 0.16-35.84) months, 8 (95%CI, 6.14-9.85) months, and 2 (95%CI, 1.77-2.23) months (P < 0.001). On mRECIST evaluation, 12.9% had achieved a complete response, 25.8% had a partial response, 27.41% had stable disease, and the rest had progressed. The objective response rate was 38.7%, and the disease control rate was 66.12%. Of the 64% who developed adverse events, 13.43% discontinued the drug. The incidence of grade ≥3 events was significantly higher in CTP C (85.7%) compared to CTP A (12.5%) and CTP B (14%) (P < 0.001). Conclusions: Atezolizumab-bevacizumab is safe and effective in uHCC in real-world settings. Candidate selection is of utmost importance in treating uHCC with atezolizumab-bevacizumab to achieve a good response. Current evidence strongly suggests limited use of atezolizumab-bevacizumab in patients with CTP C, and such individuals should not be considered for this combination therapy.
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INTRODUCTION: Obstructive uropathy is very common cause of pain abdomen. Recognition of the cause of the pain and level of obstruction is the goal. Ultrasound is the primary modality used for detection and characterization of obstructive uropathy along with conventional radiographs. Obstructive uropathy in early stages can be difficult to diagnose using standard B-mode USG or arterial sensitive index. AIM: The purpose of this study is to evaluate the diagnostic accuracy of renal venous doppler ultrasound in diagnosing acute obstructive uropathy either alone or in addition to arterial doppler study of inter lobar arteries. As there is limited literature available till date on Indian population regarding renal venous doppler in obstructive uropathy, this study can be useful. MATERIALS AND METHODS: Fifty patients presenting with features suggestive of obstructive uropathy were studied and compared with non-obstructed kidney of the same patient. Fifty normal individuals were studied and taken as controls. RESULTS: The mean venous impedance index on the obstructed side (0.26 ± 0.07) was less than the mean venous impedance index on the unobstructed side (0.41 ± 0.08) and was statistically highly significant. There was no statistically significant difference in mean arterial Resistivity Index (RI). CONCLUSION: Thus renal venous doppler study is a reliable tool in diagnosing cases of acute obstructive uropathy. Though its use as single parameter to identify obstruction still needs further studies, it can be used in conjugation with b mode ultrasound and arterial Doppler to identify obstruction.
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BACKGROUND: Few bony injuries and most soft tissue injuries cannot be detected on plain radiography. Magnetic resonance imaging (MRI) can detect such occult bony injuries due to signal changes in bone marrow. In addition to excluding serious bony injuries, it can also identify tendon, ligament, cartilage and other soft tissue injuries and thus help in localizing the cause of morbidity. AIMS AND OBJECTIVES: To determine the MRI imaging patterns in recent bone injuries (less than 4 weeks) following negative or inconclusive plain radiographs. To determine the role of MRI in recent fractures. RESULTS: Out of the 75 individuals with history of recent injury of less than 4 weeks duration, fracture line was demonstrated in 16 patients (21%) who had no obvious evidence of bone injury on plain radiographs. Bone contusion or bruising of the bone was demonstrated in 39 (52%) patients. This was the commonest abnormality detected in MRI. The remaining 20 patients did not show any obvious injury to the bone on MR imaging however, soft tissue injury could be demonstrated in 12 (16%) patients which show that the extent of soft tissue injury was relatively well demonstrated by MR imaging. The present study showed that occult injuries commonly occur at the Knee followed by Ankle, Wrist, Foot, Elbow, Leg, Hands, Hips & Spine. CONCLUSION: The study showed that MR is efficient in the detection of occult bone injuries which are missed on radiography. Compared to radiographs, MRI clearly depicted the extent of injuries and associated soft tissue involvement. MRI demonstrates both acute and chronic injuries and also differentiates both, whereas radiography has poor sensitivity for acute injuries. Also, the soft tissue injuries like tendionous and ligamentous injuries cannot be identified on radiographs.
