Deenanath Mangeshkar Hospital (Marathi: दीनानाथ मंगेशकर रुग्णालय) is a large hospital in Pune, India spread over 6 acres (2.4 ha) with over 900 beds. It is named after the Marathi theatre actor, Natya Sangeet musician and exceptional Hindustani classical vocalist Deenanath Mangeshkar. The first human milk bank in Pune was established at this hospital.
BACKGROUND:Screening for latent tuberculosis (LTB) before initiating advanced therapy for inflammatory bowel disease (IBD) helps reduce the risk of tuberculosis (TB) development. However, there is limited data on screening practices from TB-endemic regions. AIM:To study the practices of screening for LTB and study the incidence of TB in patients with IBD on biological and small molecule inhibitors. METHODS:This retrospective multicentre study analyzed LTB screening practices in IBD patients starting advanced therapies between 2018 and 2022. We included patients who were initiated on biologics (infliximab, adalimumab, vedolizumab) or small molecule inhibitors (tofacitinib). We assessed compliance with LTB screening methods, including the tuberculin skin test, interferon-gamma release assay (IGRA), chest X-ray, and computed tomography chest, both at initiation and annually. We also evaluated the incidence of active TB and its predictors. RESULTS:Of 378 patients (mean age: 36.9 ± 14.9 years, males: 56.9%), 158 (41.8%) and 216 (57.1%) had ulcerative colitis and Crohn's disease, respectively. Advanced therapy used were anti-tumor necrosis factor in 309 (81.74%), tofacitinib in 41 (10.84%) and vedolizumab in 28 (7.40%). Standard screening and diligent screening strategy was employed in 59% and 33% of patients, respectively. Compliance with tuberculin skin test and IGRA was noted in 261 (69.04%) and 298 (78.83%) patients, respectively. Chest X-Ray and computed tomography chest were performed in 300 (79.36%) and 242 (64.02%), respectively. Annual screening in those on advanced therapy for > 1 year was performed in 27.2% (50/184). Active TB developed in 17 (4.49%); 15 (88.23%) were on anti-tumor necrosis factor. LTB was detected in 40 (10.72%), with most diagnosed on the basis of IGRA (21/40, 52.50%). Among 17 patients who developed active TB, LTB screen was negative in 12 (70.58%). CONCLUSION:Standard screening practices for LTB, prior to starting advanced therapy, remain suboptimal (< 60%) in India despite high TB endemicity.
e15566 Background: Colorectal cancer (CRC) is a significant contributor to cancer-related mortality worldwide. Bevacizumab is an established VEGF inhibitor for the management of metastatic CRC in addition to doublet chemotherapy. The data pertaining to comparison of biosimilars is limited. Methods: A systematic search after protocol registration (CRD420251179090) was conducted across PubMed, Cochrane, Google Scholar, Clinicaltrials.gov to identify relevant published articles or conference abstracts of randomized studies. The primary outcomes were objective response rate (ORR) and incidence of grade 3 or higher adverse events (AEs). Secondary outcomes were overall survival (OS), progression-free survival (PFS). Data was pooled as odds ratios (ORs) for binary outcomes and hazard ratio (HR) for time-to event outcomes with 95% confidence intervals (CIs). A pairwise and network meta-analysis was performed. Pooled estimates were generated using the Mantel–Haenszel method with random-effects models in RevMan 5.4. Analyses were stratified by the type of doublet chemotherapy, Oxaliplatin-based (O) or Irinotecan-based (I) regimen, with heterogeneity assessed using I² statistics. A network meta-analysis using the Bayesian approach was performed using the gemtc package in R v4.5.2. Ranking of biosimilars was done using the Surface Under the Cumulative Ranking Curve (SUCRA) values, with reference bevacizumab as the control. Results: Data from a total of 7 randomized studies with 1428 patients was pooled and analyzed. The ORR of all biosimilars together was comparable to the reference molecule (OR 0.94 95%CI 0.73-1.21, I 2 = 0%) as well as between the two chemotherapy regimens (OR O: 0.91 95%CI 0.70-1.18, I 2 = 0% and I: 1.32 95%CI 0.51-3.43, I 2 = 26%). The incidence of Grade 3 or higher AEs was also comparable between all biosimilars together and reference bevacizumab and between the chemotherapy regimens (OR 0.99 95%CI 0.76-1.30, I 2 = 0%; O: 1.07 95%CI 0.79-1.44, I 2 = 0%, I: 0.74 95%CI 0.41-1.33, I 2 = 0%). Survival outcomes did not differ significantly between biosimilar and reference bevacizumab (OS: HR 0.93 95%CI 0.70-1.24, I 2 = 0%; PFS: HR 1.02 95%CI 0.80-1.30, I 2 = 0%). Indirect comparison of individual biosimilars demonstrated clinical equivalence to one another for both ORR as well as the incidence of grade 3 or higher AEs. For ORR, BE1040V ranked highest (0.78 95% Crl -0.56, 2.19; SUCRA: 83.01%) in terms of efficacy. For grade 3 or higher AEs, DRL_BZ ranked highest (-0.68 95% Crl -0.51,1.93; SUCRA: 84.6%) in terms of safety. Conclusions: This analysis highlights biosimilar molecules of bevacizumab to bear clinical comparability to the reference molecule with BE1040V and DRL_BZ proving most effective for ORR and grade 3 AEs respectively. These findings emphasize the use of bevacizumab biosimilars in patients with metastatic CRC, guiding discretion of individualized treatment decisions.
Background:Submuscular plating with use of a non-locking plate is indicated for the treatment of extra-articular proximal femoral fractures in children ≥6 up to 14 years old. There is no specific weight limit for the use of this procedure. The aim of the procedure is fracture stabilization and facilitation of fracture union through the use of a minimally invasive approach1. Description:The surgical technique is performed with the patient under general anesthesia and in the supine position on a fracture table. A stainless steel non-locking dynamic compression plate (4.5-mm system) is placed on the anterior aspect of the thigh and examined with use of a C-arm to confirm that the chosen length is appropriate, then placed along the lateral aspect of the thigh under C-arm visualization to determine the site for proximal contouring. Proximal plate contouring is performed with use of a plate bender. Through a distal incision, a submuscular tunnel is made. A proximal incision is then made over the greater trochanter. The plate is slid from the distal to the proximal end. The plate is temporarily stabilized with use of Kirschner wires via the proximal and distal holes. After confirming the plate position with use of the C-arm, non-locking screws are placed first on the distal and then on the proximal end of the plate. A total of 3 screws are inserted into each of the distal and proximal fragments1. Length, rotation, and alignment are confirmed postoperatively on clinical evaluation and radiographs. The patient is kept non-weight-bearing until early signs of healing are seen on radiographs, then active hip and knee range-of-motion exercises are started. Follow-up visits are conducted at 2, 4, 8, and 12 weeks postoperatively. Toe-touch weight-bearing is allowed at 8 weeks after signs of callus on radiographs. Progression to full weight-bearing is allowed on observation of radiographic fracture union. At 10 weeks, the patient is expected to be full weight-bearing. Implant removal is offered at 1 year postoperatively. Alternatives:Alternatives for treating pediatric extra-articular proximal femoral fractures include the use of titanium elastic nails, rigid intramedullary nails, locking plates, limited-contact dynamic compression plates, and external fixators2-11. Rationale:Extra-articular proximal femoral fractures by definition include fractures of the subtrochanteric region2,3. These fractures are challenging to treat because of the strong muscular deforming forces on the proximal femur. These fractures can be length-unstable. Expected Outcomes:The results of this technique in 15 patients have been published1. All fractures healed uneventfully, with a mean time to union of 11.8 ± 1.2 weeks. No patients required a subsequent surgery for complications or malunion. Thirteen patients achieved excellent outcomes according to the Flynn criteria. Important Tips:It is important to achieve length and coronal and rotational alignment, and use the correct plate size and place it appropriately.Avoid excessive bending of the plate as it may produce varus or valgus malalignment.Choose the correct length of the plate in order to achieve stable fixation.Do not open the fracture site, as it preserves the hematoma and provides biological fixation. It is critical to stay extraperiosteal and to place the plate on the lateral surface of the femur.Keep the patient non-weight-bearing until early callus is radiographically visible. Premature weight-bearing should be avoided. Acronyms and Abbreviations:EPFF = extra-articular proximal femoral fractureDCP = dynamic compression plateAP = anteroposteriorK-wire = Kirschner wireORIF = open reduction and internal fixation.
Visceral artery pseudoaneurysms (VAPAs) are a rare complication of pancreatitis, with the left gastric artery (LGA) among the least commonly involved vessels. Endoscopic ultrasound-guided coiling and glue embolization have shown great success in their management; however, the literature on the disease course of LGA VAPAs after successful embolization is limited. We report a case of LGA VAPA, as a complication of chronic pancreatitis, which recurred 3 times and required a total of 4 embolization procedures (3 endoscopic ultrasound-guided). This case highlights the need for regular postembolization monitoring for recurrence of the LGA VAPA, despite a successful embolization procedure.
Aims:Surgical management of intermediate and malignant tumours in the pelvis is complex. Complications are frequent and either related to the surgery itself or to post-surgical failure of the reconstruction technique. This systematic review and meta-analysis aims at analyzing all reported complications following PI to PIII pelvic resections for intermediate and malignant tumours. Methods:Based on a systematic literature search on PubMed adhering to the PRISMA guidelines, 1,683 study records were identified, of which we included 90 original studies published until 22 July 2025. Overall complication rates were assessed with random-effects meta-analysis. Differences in complication rates between reconstruction types (i.e. megaprosthetic, mostly biological, none) were evaluated with meta regression analysis. Results:Data on 2,199 patients (1,250 males (57%)) with mainly PI to PIII pelvic resections were analyzed. The most common reconstruction types were custom-made implants (21%; n = 451) and ice-cream cone prostheses (14%; n = 312). Pooled rates of infections, wound healing problems, nerve injuries, and deep vein thrombosis (DVT) amounted to 15% (95% CI 12% to 18%), 13% (95% CI 10% to 15%), 7% (95% CI 5% to 9%), and 4% (95% CI 2% to 6%), respectively. Further, pooled implant revision/removal and secondary external hemipelvectomy rates were 14% (95% CI 11% to 17%) and 4% (95% CI 3% to 5%). Mostly biological reconstructions were associated with higher rates of nerve injuries (p < 0.001), construct failures (p = 0.010), and secondary implant revision/removal (p = 0.003) compared to megaprosthetic reconstruction. Further, biological reconstructions were associated with increased secondary external hemipelvectomy rates compared to megaprosthetic reconstructions (p = 0.005) or no reconstructions (p = 0.001). Conclusion:Treatment of pelvic malignancies is challenging, with technically demanding resections and complex reconstructions. Across all reconstruction techniques following sacrum-sparing pelvic resections, infections and wound healing problems are the most common complications, yet there is also a considerable proportion of patients with neurovascular complications and DVTs.
