Critical Complications Research Articles

COMPARISON OF LAPAROSCOPIC AND OPEN APPENDECTOMY IN TERMS OF SURGICAL SITE INFECTION

Appendectomy is a common surgical procedure, and the choice between laparoscopic and open approaches has clinical significance. Surgical site infection (SSI) is a critical postoperative complication. This study aimed to compare laparoscopic and open appendectomy in terms of SSI rates. A prospective observational study was conducted at multiple centers including Department of General Surgery, MRHSM Hospital Pabbi Nowshera, Jinnah Teaching Hospital Peshawar and Cat C Hospital Tangi Charsadda, DHQ Hospital Daggar Buner, Khyber Pakhtunkhwa Pakistan in the duration from July, 2023 to December, 2023. The research is involving 320 patients aged 14 to 64 years. Data included demographic information, surgical approach, operative time, hospital stay, and SSI severity using the Southampton grading system. Statistical analysis was performed using SPSS. Laparoscopic (Group A, n=110) and open (Group B, n=210) appendectomies were compared. Group A had a shorter hospital stay (p < 0.05) and similar operative times. SSI rates favored laparoscopic surgery (p < 0.05), with fewer patients developing infections within 10 days post-surgery. Laparoscopic appendectomy demonstrated reduced SSI risk and improved postoperative outcomes. Laparoscopic appendectomy is associated with lower SSI rates, shorter hospital stays, and comparable operative times compared to open appendectomy. These findings support the preference for laparoscopic surgery, especially in low-risk patients, to enhance postoperative outcomes.

Diyabet Aşikar Olmasa da Komplikasyonları Aşikar Olabilir, Prediyabet Hastalarında Nefropatinin Sıklığı

BACKGROUND/AIMS: Prediabetes is considered a risk factor for diabetes mellitus (DM) and cardiovascular diseases. Complications are also detected during diagnosis in 10-40% of diabetes patients. Diabetic nephropathy is one of the critical microvascular complications of diabetes. Studies have shown that prediabetes is associated with the development of glomerular hyperfiltration and albuminuria, as in the early stages of diabetes. Identifying patients before overt DM occurs is important for early diagnosis and treatment of nephropathy and DM. The aim of our study is to investigate the presence and frequency of nephropathy in prediabetes patients. METHODS: Patients who applied to the outpatient internal medicine and endocrinology outpatient clinics and whose random fasting blood sugar was ≥100 mg/dl were evaluated. Oral glucose tolerance test (OGTT) was performed and HbA1C values were measured. 280 patients diagnosed with prediabetes and evaluated for nephropathy were included in the study. RESULTS: Nephropathy was detected in 81 (28.9%) of the patients. The average HbA1C value of the group with nephropathy was 6.28% (sd: 0.52) and the average HbA1C value of the group without nephropathy was 6.05% (sd: 0.29). The average HbA1C value was found to be significantly higher in the group with nephropathy (p=0.000). CONCLUSIONS: The fact that nephropathy was detected in 28.9% of the patients showed once again the seriousness of prediabetes. Therefore, patients with prediabetes, especially those with higher HbA1C values, need to be evaluated more carefully in terms of nephropathy and CKD.

Clinical Outcome of COVID-19 Infection on Chronic Diabetic Complications Patients

Introduction: COVID-19 is an infectious disease resulting from the SARS-CoV-2 virus. The virus targets the respiratory system and leads to a significant number of fatalities worldwide. Consequently, it was officially classified as a pandemic in 2020. The Covid varians is now being monitored by the World Health Organization. Diabetes mellitus is one of the disorders that might deteriorate following an infection. Diabetes mellitus and its associated comorbidities continue to pose a significant health challenge in Indonesia, while it is also a focus of concern of the Sustainable Development Goals (SDGs). The study was aimed to assess the risks and outcomes associated with COVID-19 infection and the long-term consequences of diabetes mellitus.Methods: This was a descriptive study using a retrospective design. Research data were taken from the medical records of patients confirmed positive for COVID-19 infection and also had chronic complications of diabetes mellitus who were treated at Dr Soetomo General Academic Hospital, Surabaya, Indonesia in 2021. There were 156 patients who met the criteria of this research.Results: There were 156 patients (97 males, 59 females). The average age of the patients was 58, while most of the patients (84%) died and the rest of the patients (16%) survived. Most of the patients with fatality (55.8%) were those with critical severity level and complications of microangiopathy, while the patients who survived (10.3%) were those with moderate severity level and complications of microangiopathy. Conclusion: COVID-19 patients with diabetes and comorbidities had a higher mortality rate than those who recovered, while most of the patients with fatality were those with significant COVID-19 and diabetic microangiopathy complications.

Traumatic Renal Artery Injuries: A Comprehensive Case Study Analysis

Post-traumatic renal artery injury is a rare yet critical complication following trauma, potentially leading to severe renal damage and functional loss. We present three cases of post-traumatic renal artery injury resulting in renal ischemia due to late diagnosis. Of particular note is that the interval between the first patient and the third is only three months, occurring at a time when such lesions are rarely observed. These cases, all involving young male individuals, highlight the challenges of prompt identification and timely intervention in such injuries. Delayed diagnosis hampered attempts at surgical revascularization in all cases, and our hospital lacked resources for percutaneous revascularization procedures. Despite efforts to manage these injuries conservatively, the success rates of surgical revascularization have been limited, leading to recurrent thrombosis. This has prompted the medical community to reconsider the approach to managing these injuries, with emphasis on non-operative methods and less invasive alternatives, particularly in the presence of a functioning contralateral kidney. However, determining the optimal management strategy remains elusive due to insufficient evidence regarding the efficacy of various approaches. Urgent management of renal artery injuries aims to preserve kidney function and mitigate secondary complications, such as renovascular hypertension. Long-term follow-up revealed varying outcomes among these patients, emphasizing the complex nature of managing post-traumatic renal artery injuries

Sepsis-Induced Coagulopathy

Sepsis, a life-threatening condition resulting from the body’s response to an infection, remains a major global health concern. One of the critical complications associated with sepsis is coagulopathy, characterized by dysregulated blood clotting and a heightened risk of both thrombosis and bleeding. This abstract aims to provide a concise overview of the intricate interplay between sepsis and coagulopathy, shedding light on the underlying mechanisms and clinical implications.

Emergency radiation therapy in modern-day practice: Now or never, or never again ?

Radiation therapy plays a fundamental role in oncological emergencies such as superior vena cava syndrome (SVCS) and metastatic epidural spinal cord compression (MESCC). These are two examples of critical complications of metastatic cancer in terms of pain and functional impact (respiratory and/or neurological). The aim of this review is to explore the current indications, treatment optionsand outcomes for emergency radiotherapy regarding to these complications.Regarding SVCS, studies are mostly retrospectiveand unanimously demonstrated a beneficial effect of radiotherapy on symptom relief. Spinal cord compression remains an indication for urgent radiotherapy, and should be combined with surgery when possible. The innovative stereotactic body radiotherapy (SBRT) showed promising results, however this technique requires small volumes and more time preparation and therefore is often unsuitable for SVCS and MESCC emergencies.This review concluded that radiotherapy has a central role to play within a multimodal approach for SVCS and MESCC treatment. Further prospective studies are needed to confirm the effectiveness of radiation and establish the criteria for selecting patients to benefit from this treatment option.

Hydroxychloroquine in obstetrics: potential implications of the prophylactic use of hydroxychloroquine for placental insufficiency during pregnancy.

Proper placentation during early pregnancy is a key factor for maintaining a healthy pregnancy. Placental insufficiency leads to critical complications such as preeclampsia, fetal growth restriction, and fetal demise. These complications are often associated with pathological findings of restricted remodeling and obstructive lesions of the myometrial spiral arteries, which have high recurrence rates during subsequent pregnancies. Currently, there are no pharmacological interventions other than aspirin for the prevention of preeclampsia. Hydroxychloroquine (HCQ), a well-known antimalarial drug, reduces inflammatory and thrombotic changes in vessels. For decades, the use of HCQ for autoimmune diseases has resulted in the successful prevention of both arterial and venous thrombotic events and has been extended to the treatment of lupus and antiphospholipid antibody syndrome during pregnancy. HCQ reduces the risk of preeclampsia with lupus by up to 90%. Several recent studies have investigated whether HCQ improves pregnancy outcomes in women with a history of poor outcomes. In addition, in vitro and animal studies have demonstrated the beneficial effects of HCQ in improving endothelial dysfunction and alleviating hypertension and proteinuria. Therefore, we hypothesized that HCQ has the potential to attenuate the vascular inflammatory and thrombogenic pathways associated with placental insufficiency and conducted a multicenter clinical trial on the efficacy of combining aspirin with HCQ for pregnancies at high risk for preeclampsia in Korea. This study summarizes the potential effects of HCQ on pregnancies with placental insufficiency and the implications of HCQ treatment in the field of obstetrics.

Diabetic Keratopathy: Redox Signaling Pathways and Therapeutic Prospects.

Diabetes mellitus, the most prevalent endocrine disorder, not only impacts the retina but also significantly involves the ocular surface. Diabetes contributes to the development of dry eye disease and induces morphological and functional corneal alterations, particularly affecting nerves and epithelial cells. These changes manifest as epithelial defects, reduced sensitivity, and delayed wound healing, collectively encapsulated in the context of diabetic keratopathy. In advanced stages of this condition, the progression to corneal ulcers and scarring further unfolds, eventually leading to corneal opacities. This critical complication hampers vision and carries the potential for irreversible visual loss. The primary objective of this review article is to offer a comprehensive overview of the pathomechanisms underlying diabetic keratopathy. Emphasis is placed on exploring the redox molecular pathways responsible for the aberrant structural changes observed in the cornea and tear film during diabetes. Additionally, we provide insights into the latest experimental findings concerning potential treatments targeting oxidative stress. This endeavor aims to enhance our understanding of the intricate interplay between diabetes and ocular complications, offering valuable perspectives for future therapeutic interventions.

D-box-binding protein alleviates vascular calcification in rats with chronic kidney disease by activating microRNA-195-5p and downregulating cyclin D1.

Vascular calcification (VC) is a critical complication in chronic kidney disease (CKD), where transcription factors (TFs) and microRNAs (miRs) could potentially play a pivotal role in its pathogenesis and progression. To explore the potential molecular mechanism by which the TF D-box-binding protein (DBP) regulates the miR-195-5p/cyclin D1 (CCND1) axis and its impact on aortic VC in CKD rats, we established a rat model of CKD with VC through a 5/6 nephrectomy procedure. This model was treated with lentivirus overexpressing DBP or CCND1 to analyze their roles in aortic VC. Additionally, an in vitro cell model of VC was induced by high phosphorus. This model underwent transfection with lentivirus overexpressing DBP or miR-195-5p mimic/inhibitor to confirm their regulatory roles in aortic VC in vitro. We assessed the interactions between DBP and miR-195-5p, as well as between miR-195-5p and CCND1. Our results indicated that the expression of DBP and miR-195-5p was reduced, while CCND1 levels were elevated in both the rat and cell models. Overexpression of miR-195-5p inhibited VC in vascular smooth muscle cells (VSMCs). Bioinformatics prediction and dual luciferase assays confirmed that DBP could act as a TF to enhance miR-195-5p expression, with Ccnd1 identified as a downstream target gene of miR-195-5p. Overexpression of DBP inhibited aortic calcification in CKD rats, whereas overexpression of CCND1 produced the opposite effect. In conclusion, the TF DBP can inhibit CCND1 expression through transcriptional activation of miR-195-5p, thereby preventing VC in rats with CKD.

Management and Outcomes of Traumatic Liver Injury: A Retrospective Analysis from a Tertiary Care Center Experience.

although liver injuries are one of the most critical complications of abdominal trauma, choosing when to operate on these injuries is challenging for surgeons worldwide. We conducted a retrospective analysis of liver injury cases at our institution from 2016 to 2022 to describe the operative and nonoperative management (NOM) outcomes in patients with traumatic liver injuries. Baseline patient characteristics, liver injury details, treatments, and outcomes were analyzed. Data from 45 patients (male, 77.8%) were analyzed. The mean age was 29.3 years. Blunt trauma was the most common injury mechanism (86.7%), whereas penetrating injuries were 8.9% of cases. Conservative management was associated with 18.9% of complications. The overall complication rate was 26.7%; delirium and sepsis were the most common (13.3%), followed by acute renal failure (4.4%), pneumonia, biliary leaks, and meningitis/seizures. Notwithstanding its limitations, this retrospective analysis demonstrated that NOM can serve as a safe and effective strategy for hemodynamically stable patients with liver trauma, irrespective of the patient's injury grade. Nevertheless, careful patient selection and monitoring are crucial. Further investigations are necessary to thoroughly evaluate the management of traumatic liver injuries, particularly in the context of multiorgan injuries.

The genetic relationships between immune cell traits, circulating inflammatory proteins and preeclampsia/eclampsia.

Preeclampsia/eclampsia (PE), a critical complication during pregnancy, has been suggested to correlate with immune cell phenotypes and levels of circulating inflammatory proteins. Our study aimed to employ a two-sample mendelian randomization (MR) analysis to assess the potential causal effects of immune cell phenotypes and circulating inflammatory proteins on the onset of PE. We utilized summary-level data from genome-wide association studies (GWAS). This included statistics for 371 immune cell phenotypes from 3,757 individuals in the Sardinian founder population, and data on 91 circulating inflammatory proteins from 14,824 European ancestry participants. Additionally, genetic associations related to PE were extracted from the FinnGen consortium, involving 1,413 cases and 287,137 controls. We applied inverse variance weighting (IVW) and supplementary methods like MR-Egger, weighted median, and weighted mode to comprehensively assess potential causal links. Our analysis revealed significant causal associations of several immune cells type and inflammatory proteins with PE. Out of the immune cell phenotypes analyzed, six immune phenotypes emerged as significant risk factors (p <0.01), mainly include CD4 on activated and secreting CD4 regulatory T cells, CD28 on CD39+ CD4+ T cells, CD127- CD8+ T cell absolute cell (AC) counts, HLA DR on HLA DR+ CD8+ T cell, CD66b on CD66b++ myeloid cells, and HLA DR on dendritic cells. And ten were identified as protective factors (p <0.01). Such as CD45 on CD33br HLA DR+ CD14-, CD33+ HLA DR+ AC, CD33+ HLA DR+ CD14- AC, CD33+ HLA DR+ CD14dim AC, CD27 on CD24+ CD27+ B cell, CD20- CD38- %B cell, IgD- CD24- %B cell CD80 on plasmacytoid DC, CD25 on CD4+ T cell, and CD25 on activated & secreting CD4 regulatory T cell. Furthermore, among the inflammatory proteins studied, five showed a significant association with PE, with three offering protective effects mainly include that C-X-C motif chemokine 1, tumor necrosis factor ligand superfamily member 14, and C-C motif chemokine 19 and two exacerbating PE risk such as STAM-binding domain and Interleukin-6 (p <0.05). Our study highlights the pivotal roles played by diverse immune cell phenotypes and circulating inflammatory proteins in the pathophysiology of PE. These findings illuminate the underlying genetic mechanisms, emphasizing the criticality of immune regulation during pregnancy. Such insights could pave the way for novel intervention strategies in managing PE, potentially enhancing maternal and neonatal health outcomes.

Comprehensive Management of Ovarian Tumour-related Torsion: A Case Report

Ovarian tumours are diverse and lead to rare yet critical complications such as torsion. The ovary twists on its own axis and compromises blood flow. Ovarian torsion is uncommon and has considerable risk in women of reproductive age. The present case report elucidates the intricate nature of ovarian tumours, particularly emphasising the rare yet critical complication of torsion, where the ovary twists, compromising blood flow. The presented case involves a 35-year-old multiparous woman with acute abdominal pain, vomiting, and elevated Cancer Antigen 125 (CA-125) levels, leading to the diagnosis of a left ovarian cyst with torsion via Ultrasonography (USG). The subsequent surgical intervention, involving exploratory laparotomy, successfully confirmed and addressed the issue, resulting in detorsion and cystectomy. Histopathological examination further identified a benign serous cystadenoma. The present case underscores the diagnostic challenges associated with ovarian tumour-related torsion, highlighting the importance of symptom analysis and diagnostic imaging for early recognition. It also emphasises the effectiveness of surgical intervention, showcasing varied treatment options, from cystectomy to detorsion, contingent on individual circumstances. The present case report stresses the imperative of a multidisciplinary approach involving gynaecologists, radiologists and surgeons for optimal outcomes in managing this complex condition.

Management of Postgastric Bypass Jejuno-jejunal Anastomotic Leak: A Multicenter Retrospective Study

Abstract Introduction: Anastomotic leakage is one of the most critical complications following gastric bypass surgery. Leakage from jejuno-jejunal (JJ) anastomosis after Roux-en-Y gastric bypass occurs infrequently, and so there are fewer studies on its management. The JJ anastomotic leak (AL) has high morbidity and mortality; hence, early detection and timely management are critical to optimizing outcomes. Aims and Objectives: We evaluated all the treatment options for the patients experiencing JJ anastomosis leaks to propose an algorithm-based practical management guideline for these patients. Materials and Methods: During the early postoperative period, retrospective analysis using clinical findings, blood parameters, and contrast computed tomography scans were carried out, and patients were classified into various categories such as leak with/without septicemia and leak with or without extravasation of contrast. All the patients were managed differently based on the category they belonged to. Results: Over a period of 3 years, out of 1393 cases of gastric bypass, 11 patients (0.78%) were diagnosed with postoperative JJ AL within 6 weeks of the postoperative period. The earlier cases were extensively treated with diagnostic laparoscopy along with local lavage, insertion of a feeding jejunostomy tube, leakage site drainage, proximal drainage, and nasogastric decompression with or without intensive care, causing considerable hospital stay and increased morbidity. With experience, we realized that all patients with leaks do not require extensive management. We have eventually determined an algorithm to manage JJ ALs depending on clinical and radiological parameters. Conclusion: Our individualized and effective algorithm-based management protocol results in quicker recovery, optimizes the intervention, and minimizes hospital stay, morbidity, and mortality after postoperative JJ AL. It can potentially mitigate the cost burden in India while ensuring a better outcome. This retrospective pilot study can be a practical guideline for the optimal management of JJ ALs after gastric bypass.

Comprehensive Management of Ovarian Tumour-related Torsion: A Case Report

Ovarian tumours are diverse and lead to rare yet critical complications such as torsion. The ovary twists on its own axis and compromises blood flow. Ovarian torsion is uncommon and has considerable risk in women of reproductive age. The present case report elucidates the intricate nature of ovarian tumours, particularly emphasising the rare yet critical complication of torsion, where the ovary twists, compromising blood flow. The presented case involves a 35-year-old multiparous woman with acute abdominal pain, vomiting, and elevated Cancer Antigen 125 (CA-125) levels, leading to the diagnosis of a left ovarian cyst with torsion via Ultrasonography (USG). The subsequent surgical intervention, involving exploratory laparotomy, successfully confirmed and addressed the issue, resulting in detorsion and cystectomy. Histopathological examination further identified a benign serous cystadenoma. The present case underscores the diagnostic challenges associated with ovarian tumour-related torsion, highlighting the importance of symptom analysis and diagnostic imaging for early recognition. It also emphasises the effectiveness of surgical intervention, showcasing varied treatment options, from cystectomy to detorsion, contingent on individual circumstances. The present case report stresses the imperative of a multidisciplinary approach involving gynaecologists, radiologists and surgeons for optimal outcomes in managing this complex condition.

Symptomatic Intracranial Hemorrhage after Mechanical Thrombectomy - the Difference between Iso-Osmolar and Low-Osmolar Contrast Media.

Symptomatic intracranial hemorrhage (SICH) after mechanical thrombectomy (MT) is generally considered a critical complication. Hemorrhagic transformation after ischemic stroke has also been associated with contrast media administration. The objective of our study was to evaluate correlations between contrast media type and incidence of SICH after MT. Ninety-three consecutive patients (41 men; mean age, 80.2 years; range, 44-98 years) underwent MT reperfusion (expanded thrombolysis in cerebral infarction score, 2a-3) for acute large-vessel occlusion ischemic stroke within 8 h after symptom onset between April 2020 and July 2023 were retrospectively reviewed. Correlations between contrast media type (iso-osmolar or low-osmolar medium) and incidence of SICH were assessed. Contrast media were iso-osmolar in 60 cases or low-osmolar in 33 cases. The overall incidence of SICH was 5.5%. The frequency of SICH was significantly lower in the iso-osmolar group (1.7%) than in the low-osmolar group (12.1%; P = 0.033). Iso-osmolar contrast media was associated with a lower incidence of SICH compared with low-osmolar contrast media in patients after MT.

Making Neuroendovascular Therapy for Cerebrovascular Disease Using Distal/Trans-radial Artery Access Safer.

Neuroendovascular therapy using distal/trans-radial artery access (d/TRA) has attracted attention as a less invasive procedure. We have selected dTRA or TRA in all cases of carotid artery stenting (CAS). In recent years, TRA has been actively selected for mechanical thrombectomy for acute ischaemic stroke (MT for AIS) and Onyx embolisation for arteriovenous malformations. We compared the patient background, surgical strategy, perioperative complications, and outcome in 41 patients who underwent CAS in the first period (Apr 2017-Feb 2019) and 12 patients in the second period (Apr 2020-Feb 2022) avoiding trans-femoral artery access (TFA) as possible. We compared the patient background, surgical strategy, perioperative complications, and outcome in 46 patients who underwent MT for AIS via TFA from Apr 2022 to Dec 2022 as the first period and five patients who underwent MT for AIS via TRA from Jan 2023 to Sep 2023 as the second period. Concerning CAS, the second period included significantly more symptomatic cases, with a higher rate of edaravone use to prevent hyperperfusion and a significantly smaller sheath diameter. In the second period, CAS was performed in severe conditions; nevertheless, there was no significant difference between the two groups in terms of either the ratio of cases detected by postoperative diffusion-weighted imaging positive or the ratio of cases with puncture site-related complications (PSCs). Concerning MT for AIS, there were no significant differences between the two groups with the patient backgrounds. The percentage of effective reperfusion, time from puncture to recanalisation, and outcome in the second period were all non-inferior to those in the first period when conventional MT for AIS was performed. Even though we introduced d/TRA in patients with cognitive decline and inability to remain at rest during the perioperative period, we completely avoided PSCs via d/TRA. In particular, cerebral hyperperfusion syndrome after CAS and ischaemia-reperfusion injury or re-occlusion after MT were rare but critical perioperative complications, and near-infrared spectroscopy (NIRS) may be used to monitor these problems. We introduced intensive evaluation by NIRS if we had time to spare.

Impact of anterior component separation technique on lowering the incidence of abdominal wall dehiscence and incisional hernia after emergent laparotomy: a feasibility study

Introduction Abdominal wall dehiscence is one of the critical postoperative complications following abdominal surgeries. Emergency surgery highly contributes to the incidence of a burst abdomen due to a lack of proper preoperative preparation and the presence of intraabdominal sepsis. Anterior component separation was primarily evolved in abdominal wall reconstruction in the open abdomen and huge ventral hernia repair. Methods This prospective study included 50 patients operated by midline laparotomy for non-traumatic abdominal emergencies. Anterior component separation technique was randomly applied in 25 patients before laparotomy closure, the other 25 patients were closed using the traditional midline closure method. Preoperative patient’s demographics, operative time, and different postoperative complications were reported. Incidence of burst abdomen in both groups was reported. Results Preoperative patient’s demographic data showed no significant difference between both groups; the mean age of the patients was 53.69±7.34. Operative time was significantly longer in the Anterior Components Separation (ACS) group (P&lt;0.001). The incidence of abdominal wall dehiscence after ACS technique (4.3%) was significantly less than after traditional technique (24%). Postoperative seroma and hematoma were the common postoperative complications after ACS however the incidence was not statistically significant. Incisional hernia was detected in (13.04%) in ACS group and in (32%) in traditional group. Conclusion Application of ACS technique during laparotomy closure in abdominal emergencies seems to lower the incidence of abdominal wall dehiscence with no increase in different postoperative complications.

Histopathological Spectrum of Liver Allograft Biopsies and Association with Clinical and Pathological Parameters in Transplant Patients: A Cross-sectional Study

Introduction: Transplantation is vital for acute and terminal irreversible liver conditions. While imaging and functional measurements are valuable for evaluating post-transplant hepatocellular or biliary issues, liver allograft biopsies are used to determine the underlying causes of these changes. Long-term Immunosuppression (IMS), complex clinical circumstances, and de novo complications present challenges in transplant pathology, necessitating a multidisciplinary approach. Aim: To conduct a histopathological assessment of allograft liver biopsies for differential diagnosis, timing (postoperative day), and prevalence of post-transplantation complications, including identifying the causes of graft damage. Materials and Methods: This retrospective cross-sectional study was conducted between January 2019 and June 2022 at Vayalil Parambath Shamsheer (VPS) Lakeshore Hospital, Kochi, Kerala, India. A total of 45 post-transplant needle biopsy samples were analysed, examining histological characteristics and clinical data extracted from hospital records. Over 3.5 years, 45 post-liver transplant biopsies were performed. All clinical records and biopsy findings were examined using staining, and immunohistochemical analysis was performed. The Banff Working Group’s criteria were used to grade rejection based on a semiquantitative index, the Rejection Activity Index (RAI), into indeterminate (Score 1, 2); mild (Score 3, 4); moderate (Score 5, 6); and severe (&gt;6). The classic histologic findings are characterised by predominant portal-based lesions, including a classical triad of mixed inflammatory cell infiltrates, venous endothelial inflammation, and inflammatory infiltration of bile ducts. Results: Among 38 patients, a total of 45 needle biopsies were performed. The first specimen was collected within a few hours of transplantation, and the final specimen was collected after 770 days. Notably, T-Cell-Mediated Rejection (TCMR) was diagnosed in 9 out of 45 (20.00%) specimens. Other complications included Intrahepatic Cholestasis (IHC) in 11 out of 45 (24.44%) cases, biliary obstruction in 5 out of 45 (11.11%) patients, Herpes Simplex Virus (HSV) hepatitis in 3 out of 45 (6.67%) specimens, Plasma Cell-Rich Rejection (PCRR) in 2 out of 45 (4.44%), and Isolated Central Perivenulitis (ICP), Dengue Haemorrhagic Fever (DHF), and veno-occlusive-like disease in 2 out of 45 (4.44% each) specimens. One patient had ethanolinduced liver injury (1 out of 45, 2.22%). Conclusion: Post-transplant liver biopsies are essential for accurate and timely diagnosis of rejection and other complications, guiding therapeutic interventions. This study offers insights into the types, prevalence, and timing of critical complications following liver transplantation (LTx).

The Influence of Low-Dose Radiotherapy on Paraoxonase-1 and Inflammatory Biomarkers in COVID-19 Pneumonia Patients

The COVID-19 pandemic will be remembered for its significant health and economic impact worldwide. Severe pneumonia could often progress to acute respiratory distress syndrome (ARDS), this being a critical complication characterised by an exaggerated inflammatory response, known as cytokine-release syndrome (CRS). Amid debates regarding the efficacy of conventional treatments, low-dose Radiotherapy (LDRT) has emerged as a potential therapy due to its anti-inflammatory effects. LDRT modulates immune responses by polarizing macrophages towards an anti-inflammatory phenotype and reducing oxidative stress. While studies investigating LDRT for COVID-19 pneumonia have shown promising results, conflicting data has been published and challenges persist in patient selection and treatment timing. Biomarkers such as paraoxonase-1 activity hold promise for predicting treatment outcomes. LDRT presents an alternative approach to modulating the immune response in COVID-19 pneumonia, offering hope for improved clinical outcomes. Further research is warranted to validate its efficacy and elucidate underlying mechanisms. This article provides summary of the radioimmunological mechanisms and the results of biomarkers research in this context.

Reasonable Risk Ratio of Palate Surgery: A New Critical Analysis.

A new critical complication risk analysis, the reasonable risk ratio (RRR or R3) for palate surgeries in obstructive sleep apnea patients. Analysis from published meta-analyses, systematic reviews on success rates, and complications encountered for 3 palate surgeries, expansion sphincter pharyngoplasty (ESP), barbed repositioning pharyngoplasty (BRP) and modified uvulopalatopharyngoplasty (mUPPP), over 20 years. The RRR is derived from a ratio of the percentage of each respective complication over the success rate of that particular surgical procedure. The benchmark RRR of tonsillectomy is set at 0.035 to 0.078. An RRR below this benchmark value is more favorable as tonsillectomy is a widely accepted ENT procedure with risks to benefit well accepted. The RRR for foreign body (FB) sensation (BRP) ranged from 0.03 to 0.23 (mean RRR of 0.14), FB sensation (ESP) 0.01, FB sensation (mUPPP) ranged from 0.33 to 0.55 (mean RRR of 0.44). The RRR for swallowing difficulties (BRP) ranged from 0.04 to 0.23 (mean RRR of 0.11), mUPPP, was 0.37; no reported swallowing difficulties with the ESP. The RRR for velopharyngeal insufficiency (VPI) (BRP) ranged from 0.009 to 0.18 (mean RRR of 0.07), and RRR VPI (mUPPP) was 0.14. The RRR (BRP) for dry throat was 0.06 and the mUPPP was 0.35, with no reported VPI or dry throat for ESP. The overall RRR for the BRP was 0.09, ESP was 0.01 and mUPPP was 0.29. RRR provides a summarized data-driven, statistical guide to aid decision-making, and helps in patient counseling. BRP and ESP have been shown to have less complications compared to mUPPP.Level of evidence: IV.