Background: Donor hepatectomy is a complex surgical procedure associated with significant postoperative pain, which can impact both short-term recovery and long-term outcomes. Adequate pain management plays a crucial role in ensuring the well-being of the living liver donor and optimising their overall experience. This review aims to provide a comprehensive overview of current practices and emerging strategies in analgesic management for donor hepatectomy. Methodology: To find relevant material, searches were conducted on PubMed and Google Scholar. The evaluation took into consideration review articles, clinical trials, retrospective studies, observational studies, and case-control studies. Results: The conventional approach to pain control involves a multimodal strategy combining opioids, non-steroidal anti-inflammatory drugs, and regional anaesthesia techniques. However, concerns regarding opioid-related side effects and potential complications have prompted a re-evaluation of analgesic protocols. Alternative methods such as thoracic epidural analgesia, transversus abdominis plane blocks and continuous wound infusion systems have gained attention for their potential to minimise opioid requirements and enhance recovery. Recent advancements in the field of pain management, including the utilisation of enhanced recovery, after surgery protocols, personalised analgesic regimens, and novel pharmaceutical agents, are explored in this review. Additionally, the impact of psychological factors and patient-centred care on postoperative pain experiences is discussed. Conclusion: The review concludes by emphasising the importance of tailoring analgesic strategies to individual patient needs and characteristics. It highlights the potential benefits of incorporating innovative approaches to enhance pain control, reduce opioid consumption and ultimately improve the overall outcome and satisfaction of living liver donors undergoing hepatectomy. Future directions in research and clinical practice are also suggested to further refine and optimise analgesic management in the context of donor hepatectomy.

Preclinical and animal studies have suggested that excess catecholamines can lead to bone mineral loss. However, to date, no systematic review is available that has analyzed the impact of catecholamine excess in the context of pheochromocytoma/paraganglioma (PPGL) on bone metabolism. We conducted this meta-analysis to address this knowledge gap. Electronic databases were searched for studies evaluating bone metabolism, including assessments of bone mineral density (BMD), quantitative computed tomography (qCT), trabecular bone score (TBS), or bone turnover markers in patients with PPGL. These markers included those of bone resorption, such as tartrate-resistant acid phosphatase 5b (TRACP-5b) and cross-linked C-telopeptide of type I collagen (CTx), as well as markers of bone formation, such as bone-specific alkaline phosphatase (BS ALP). Out of the initially screened 1614 articles, data from six studies published in four different patient cohorts with PPGL that met all criteria were analysed. Individuals with PPGL had significantly lower TBS [Mean Difference (MD) -0.04 (95% CI: -0.05--0.03); p < 0.00001; I2 = 0%], higher serum CTx [MD 0.13 ng/ml (95% CI: 0.08-0.17); p < 0.00001; I2 = 0%], and higher BS-ALP [MD 1.47 U/L (95% CI: 0.30-2.64); p = 0.01; I2 = 1%]. TBS at 4-7 months post-surgery was significantly higher compared to baseline [MD 0.05 (95% CI: 0.02-0.07); p < 0.0001]. A decrease in CTx has been documented post-surgery. Bone health deterioration is a major concern in patients with PPGL. In addition to providing a definitive cure for catecholamine excess, monitoring and treating osteoporosis is essential for individuals with secondary osteoporosis due to PPGL. Long-term studies on bone health outcomes in PPGL are warranted.

Over the past two decades, insulin glargine 100 U/mL (Gla-100) has emerged as the "standard of care" basal insulin for the management of type 1 diabetes mellitus (T1DM). Both formulations, insulin glargine 100 U/mL (Gla-100) and glargine 300 U/mL (Gla- 300) have been extensively studied against various comparator basal insulins across various clinical and real-world studies. In this comprehensive article, we reviewed the evidence on both insulin glargine formulations in T1DM across clinical trials and real-world studies. Evidence in T1DM for Gla-100 and Gla-300 since their approvals in 2000 and 2015, respectively, were reviewed. Gla-100 when compared to the second-generation basal insulins, Gla-300 and IDeg-100, demonstrated a comparable risk of overall hypoglycemia, but the risk of nocturnal hypoglycemia was higher with Gla-100. Additional benefits of Gla-300 over Gla-100 include a prolonged (>24- hours) duration of action, a more stable glucose-lowering profile, improved treatment satisfaction, and greater flexibility in the dose administration timing. Both glargine formulations are largely comparable to other basal insulins in terms of glucose-lowering properties in T1DM. Further, risk of hypoglycemia is lower with Gla-100 than Neutral Protamine Hagedorn but comparable to insulin detemir.

Citrin deficiency is an autosomal recessive metabolic liver disease caused by mutations in the SLC25A13 gene. The disease typically presents with cholestasis, elevated liver enzymes, hyperammonemia, hypercitrullinemia, and fatty liver in young infants, resulting in a phenotype known as "neonatal intrahepatic cholestasis caused by citrin deficiency" (NICCD). The diagnosis relies on clinical manifestation, biochemical evidence of hypercitrullinemia, and identifying mutations in the SLC25A13 gene. Several common mutations have been found in patients of East Asian background. The mainstay treatment is nutritional therapy in early infancy utilizing a lactose-free and medium-chain triglyceride formula. This approach leads to the majority of patients recovering liver function by 1 year of age. Some patients may remain asymptomatic or undiagnosed, but a small proportion of cases can progress to cirrhosis and liver failure, necessitating liver transplantation. Recently, advancements in newborn screening methods have improved the age of diagnosis. Early diagnosis and timely management improve patient outcomes. Further studies are needed to elucidate the long-term follow-up of NICCD patients into adolescence and adulthood.

Liver transplant surgery has been performed in India for the last 25 years. We aimed to analyse the trends, characteristics, and key elements in the field of liver transplantation research from India. On April 23, 2023, we conducted a search of the Scopus database for the literature on liver transplantation research, using a well-defined search strategy. MS Excel and VOS viewersoftware programs were used to examine the articles for organisation, author, journal, keywords, and high-cited literature. This analysis examined a total of 556 papers, which constituted only a 1.55% share of the global output. These papers involved 442 organizations, 1575 authors, and 147 journals. External funding was received in 4.13% and 23.56% were involved in international collaboration. Three Delhi-NCR organizations, namely the Medanta-The Medicity (n=63), Institute of Liver & Biliary Sciences (n=60), and Indraprastha Apollo Hospital (n=48) led in publication productivity. M. Rela (n=90) and A.S. Soin (n=63) were the leading authors in publication productivity, while S. Sudhindran and P. Bhangui were the most impactful authors. Liver Transplantation (n=96) and Journal of Clinical & Experimental Hepatology (n=65) published the maximum number of these papers, whereas, Annals of Surgery and Journal of Hepatology led in the citation impact per paper. The most significant keywords were "Liver Transplantation" (n=484), and "Living Donor" (n=254). Only 1.80% (n=10) of the papers were highly cited papers that received 50 to 142 citations and they together registered 69.9 citations per paper. Although the number of publications on liver transplantation from India started growing recently, it forms only 1.55% of the global report. There is an unmet need to increase government-supported research and multicenter collaborative studies at national and international levels for high-quality patient care.

Coronary artery disease (CAD) has the highest mortality rate; therefore, its diagnosis is vital. Intravascular ultrasound (IVUS) is a high-resolution imaging solution that can image coronary arteries, but the diagnosis software via wall segmentation and quantification has been evolving. In this study, a deep learning (DL) paradigm was explored along with its bias. Using a PRISMA model, 145 best UNet-based and non-UNet-based methods for wall segmentation were selected and analyzed for their characteristics and scientific and clinical validation. This study computed the coronary wall thickness by estimating the inner and outer borders of the coronary artery IVUS cross-sectional scans. Further, the review explored the bias in the DL system for the first time when it comes to wall segmentation in IVUS scans. Three bias methods, namely (i) ranking, (ii) radial, and (iii) regional area, were applied and compared using a Venn diagram. Finally, the study presented explainable AI (XAI) paradigms in the DL framework. UNet provides a powerful paradigm for the segmentation of coronary walls in IVUS scans due to its ability to extract automated features at different scales in encoders, reconstruct the segmented image using decoders, and embed the variants in skip connections. Most of the research was hampered by a lack of motivation for XAI and pruned AI (PAI) models. None of the UNet models met the criteria for bias-free design. For clinical assessment and settings, it is necessary to move from a paper-to-practice approach.

Sirolimus (mammalian target of rapamycin inhibitor) is a potent immunosuppressive agent, used in patients receiving hematopoietic stem cell transplant (HSCT) for Graft vs Host disease prophylaxis. Compared to calcineurin inhibitors, sirolimus has no neurotoxicity or nephrotoxicity, but sirolimus causes dose-dependent thrombocytopenia, leukopenia, delayed wound healing, hyperlipidemia, and hypertriglyceridemia. Here we report a case of acute pancreatitis and diabetic ketoacidosis in a patient with sickle cell disease post haploidentical family donor HSCT which was managed conservatively without plasmapheresis. Based on our review of the literature, this is the first reported case of developing acute pancreatitis as an adverse effect of sirolimus-induced hypertriglyceridemia leading to diabetic ketoacidosis in a recipient of HSCT.

Background: Bariatric surgery now days is a commonly done procedure for morbid obese or super obese patients. With the development of less invasive procedures like laparoscopy &amp; robotic surgery, the use of bariatric surgery is becoming more common. The present study was conducted with an idea to compare the post operative outcomes in 2 groups (robotic sleeve gastrectomy &amp; robotic mini gastric bypass) in terms of various parameters such as operative time, post-op. pain, length of hospital stay. Methods: Present study has been conducted on 35 patients, divided into two groups, based on two commonly performed procedures, Group one-21 patients (Robotic one anastomosis gastric bypass/Mini gastric bypass) and group two-14 patients (Robotic Sleeve Gastrectomy). All the cases in both groups were selected according to the patient’s BMI, associated symptoms and patient’s own preference for the procedure; both groups were followed for a period of 6 months. Results: On analysis, group 2 patients had a shorter operating time (p&lt;0.01) and shorter hospital stay (P value&lt;0.05) with almost similar results in term of weight loss after 6 months. Only one patient in group 1 had significant post operative complication in term of pulmonary embolism that was successfully managed conservatively Conclusions: Group 2 had a significantly shorter operating time &amp; shorter hospital stay, with almost similar weight reduction after 6 months period of follow up and had no post operative complication, group 1 had one post operatively complications in term of pulmonary embolism which was managed by conservative means.

Background Thalidomide has been demonstrated to induce global gene expression hereby increasing the proliferation of erythroid cells. Recent studies have revealed encouraging data regarding the efficacy and safety of thalidomide in both transfusion dependent (TDT) and non-transfusion dependent (NTDT) thalassemia. However, the optimal dose of thalidomide remains unclear. The study was designed to compare the efficacy and safety of thalidomide at low-dose (1 mg/kg/d) vs standard-dose (2 mg/kg/d). Methods Patients with TDT &amp;gt; 12 years of age with no recent (previous 6 months) intake of Hb enhancers were enrolled in a non-inferiority trial across 4 sites in India. Patients with hypersplenism, prior history of thromboembolism, HIV, active hepatitis B/C infection, or any other known systemic illness like neurological, renal, significant hepatopathy, and sexually-active females unwilling to use contraceptives/undergo medical termination of pregnancy in case of accidental pregnancy while on the drug were excluded. Patients were randomised to receive low-dose or standard-dose thalidomide for 6 months. Pre-transfusion Hb, transfusion frequency and volumes, and adverse effects were recorded at each visit. Response was graded based on reduction in transfusion requirement at 24 weeks: Good (&amp;gt; 50 %), moderate (25-50 %), or minimal (&amp;lt;25%). Results: A total of 188 patients with mean age of 18.1 ± 5.2 years and M:F ratio of 2.1:1 were enrolled. 85.6% (80 in low-dose and 81 in standard-dose) participants completed the study period. 14.4% discontinued thalidomide due to various reasons. The mean Hb and baseline transfusion requirement were 8.6 ± 0.98 g/dl and 35.91 ml/kg in the preceding 12 weeks. The overall response rate was 55.9%. There was no statistically significant difference in the response rates in 2 groups (63% in low-dose vs 48% in standard-dose) (p:0.135). Good, moderate, and minimal responses were seen in 19.3%, 36.6 %, and 44.1% of the participants respectively. Response rate was not affected by age, sex, transfusion requirement or serum ferritin at baseline. The commonest adverse events were somnolence (n=40), constipation (n=29), weight gain (n=25), reversible cytopenia's (n=22), and peripheral neuropathy (n=14). 3.7% participants experienced Grade 2/3 events. There were no grade 4 events. Conclusions: The low-dose thalidomide was as efficacious as the standard dose in reducing transfusion requirements. Thalidomide is well tolerated and can be considered as an adjunct to optimal transfusion-chelation regimen under close monitoring in a resource constrained setting.

Background: We performed a prospective longitudinal study to report the mid-term follow-up of arch vessel angioplasty in patients with Takayasu’s arteritis following the use of self-expanding stents (SES) or balloon-expandable stents (coronary drug-eluting stents [DES] or peripheral bare metal stents). Methods: Eighteen consecutive Takayasu’s arteritis patients with arch vessel involvement undergoing angioplasty were included in the study. Ostial lesions were treated with DES; other lesions were treated with SES. Twelve patients were treated with 15 SES and eight patients were treated with 14 DES. Lesions were quantified by quantitative angiography before and after the procedure and during check-up angiography at 6 months to compare lumen dimensions with the immediate post-procedural results. Check-up angiography was performed in 10 patients with 13 SES and in six patients with DES. Results: SES had an immediate mean (±SD) lumen gain of 2.95 ± 1.1 mm. At 6 months, although there was a lumen loss of 2.01 ± 1.13 mm, there was a persistent mean lumen gain of 0.94 ± 1.16 mm. Similarly, DES resulted in an immediate mean lumen gain of 2.01 ± 1.13 mm, with a lumen loss of 1.6 ± 0.8 mm, but a persistent mean lumen gain of 0.40 ± 1.26 mm, at 6 months. Conclusion: We showed that both SES and DES may be used to treat patients with arch vessel involvement, with comparable results at the 6-month follow-up, and could provide these patients with significant and persistent symptom relief.