Transplant Institute Research Articles

Frequency of Prostate Cancer in Men with Low Percent Free Prostate Specific Antigen in the Serum

Introduction: Prostate cancer is the utmost communal type of cancer in adult men. Assessment of serum total prostate specific antigen (PSA) is broadly cast-off as a screening assistance in the prompt diagnosis of cancer of prostate. Irrespective of the prostate size or patient’s age, 25% cut off value is set or less free PSA level in percentage is suggested for cases with values of PSA amid 4.1 and 10 ng/ml; This helps in detecting prostate cancers in 95% of cases and prevent 20% of unnecessary biopsies. The greater the free PSA percentage, the less jeopardy of cancer. This analysis was designed to evaluate the incidence of prostate cancer in patients with a low percentage of free PSA. If the scale is found to be higher, aggressive strategies and early treatment can lead to good progress. Aim: To determine the frequency of prostate cancer in males with a low percentage of serum free PSA. Study Design: This is a descriptive, cross-sectional study lasting 6 months from July 2020 to December 2020 at the Urology Department of the Sindh Institute of Urology and Transplantation. Subject and method: 149 total individuals with symptoms of lower urinary tract were included in the research. All patients who came to the urology clinic (OPD); free PSA were examined with the same technique as the surgical patient and the result was recorded as proforma. Results: - The prostate cancer Incidence in males with decreased free serum PSA in percentage is noted in 128(85.91%) patients. Conclusions: Our study showed that prostate-specific free antigen plays an important role in the analysis of cancer of prostate. Keywords: Serum prostate specific antigen, Prostate cancer, percentage of free PSA

Holmium: YAG Laser in the Management of Impacted Ureteral Stones HYLe Study

Background: Holmium: yttrium-aluminium-garnet (YAG) laser is considered cost-effective and efficient choice in ureteroscopic lithotripsy on all types of stones. We aim to evaluate the efficacy of Holmium: YAG laser in impacted ureteral stones. Methods: We conducted a prospective case series at the Sindh Institute of Urology and Transplantation (SIUT) Pakistan from 1st October 2016 till 30th September 2017. All adult patients between 18 to 60 years of age with single <20mm ureteral stone impacted for more than one month. The primary outcomes include stone-free and recurrence of ureteric stone during two-year follow-up. Analyses performed using SPSS version 21.0. Results: A total of 117 patients recruited, of which most were males (61,52.14%). The average duration of disease was 7.82±1.79 months, with a stone size of 12.49±3.8 mm. Most of the stones were located in the middle of the ureter (56,47.86%). Holmium: YAG laser for treatment was effective in 99 (84.62%) cases, and efficacy above 80% in all age groups, but the insignificant difference was observed between both gender, location, duration of disease, size of the stone, use of a guidewire and the different catheter. All of the patients were found to be stone-fragment free at six weeks. The ureteral injury was observed (4,3.41%) and recurrence rate in the same ureter was found in a total of 5 (4.27%) patients. Conclusions: Holmium: YAG laser lithotripsy may be considered a safe and effective first-line therapy for impacted ureteral stones, avoiding futile repetition and complication of extracorporeal shock wave lithotripsy (ESWL). Keyword: ureteroscopic lithotripsy, stone-fragment, YAG laser lithotripsy.

COVID-19 vaccine hesitancy among health service providers: A single centre experience from Karachi, Pakistan.

To assess the views of health service providers towards coronavirus disease 2019 vaccination with Cansino, Sinovac and Sinopharm vaccines. The analytical cross-sectional study was conducted at the Sindh Institute of Urology and Transplantation, Karachi, in May and June 2021, and comprised doctors, nurses, technical staff, and medical social officers. Data was collected using a questionnaire, in Urdu and English languages, assessing determinants of hesitancy. Data was analysed using SPSS 19. Of the 331 subjects, 156(47%) were males and 175(53%) were females. Overall, 183(55%) subjects were aged <30 years, and 7(2%) were aged >60 years. Among the responders, 274(83%) were vaccinated, 49(15%) wanted to delay, and 8(2.4%) were outright refusers. Among the hesitant, 43(80%) were women, and 56(98%) were aged <40 years. Age, gender, occupational group and personal experience with the disease had significant correlations with vaccination status (p<0.05). Personal safety 202(74%) followed by the perception of official requirement 162(59%) were the prime reasons for getting vaccinated. No respondent cited religious inhibitions or social media as the reason behind vaccine refusal. A lack of trust in the safety and efficacy data of the available Chinese vaccines appeared as a factor inducing hesitancy. The resistance of younger respondents, especially trainee physicians, was a finding of concern since they form the backbone of the health system in the country.

Post Renal Transplant Infections: A Six Month Follow-Up Study from a Kidney Transplant Institute of North India

Transplantation returns the majority of patients to an improved life-style and an improved life expectancy, as compared to patients on dialysis. Infections are the most prevalent cause of morbidity and mortality in kidney transplant recipients, with more than 80% suffering at least one episode of infection in the first year. The method of data collection in this study was prospective hospital record analysis, all renal transplant recipients were screened pre operatively for the presence of any overt or occult infection. The predominant age group undergoing renal transplantation was between 18 – 29 yrs. Urinary tract infections were the highest and commonest infections observed. The microorganisms involved in the infections were Bacteria (36.4%), Viruses (7.6%), Fungi (3.7%) and Parasites (5.5%). In Urinary tract infection, E. coli followed by Klebsiella pneumoniae were the predominant bacterial isolates. Candida albicans were the commonest fungi isolated. Among the Gastrointestinal tract infections, Cryptosporodium was the commonest Protozoal isolate. Cryptococcus neoformans was isolated in two cases of meningitis. In this study the organisms causing infection during the immediate operative period have been categorized, which will give the treating physician a reasonable idea to suspect the system and cause of infection during the particular post renal transplant period. This study has focused to evaluate the spectrum of infectious complications in post renal recipients in first 6 months of follow up and evaluate the most common type of infection.

Outcome of Renal Transplantation in Children Given Rabbit Anti-Thymocyte Globulin (rATG) as Induction Therapy

BackgroundInduction immunosuppressive therapy is used to prevent rejection and maintain allograft function in transplantation. Rabbit antithymocyte globulin (rATG), a T-cell depleting antibody, is the most commonly used induction agent for kidney transplantation. To date there is still limited data on outcomes of pediatric kidney transplants with rATG as induction therapy. MethodsRetrospective single-center study of first-time kidney transplant recipients ≤18 years old who received rATG induction between 2005 and 2019 at the National Kidney and Transplant Institute. Data were collected up to 1 year post transplant. ResultsEleven patients were included in the study. They received rATG at 1.5 mg/kg/dose (±0.3 mg/kg/dose) once a day for 3 days. Patient survival was 100% at 6 months, and 90.9% at 1 year. Graft survival was 90.9% at 6 months, and 81.8% at 1 year. Four patients (36.4%) had a glomerular filtration rate of <60 at 1 year. One died of sepsis at 7 months. One patient (9.1%) had acute allograft rejection with recurrence of disease, C3 glomerulopathy, on day 13. A total of 3 patients (27.3%) developed leukopenia and 4 patients (36.4%) developed thrombocytopenia. The majority were anemic at baseline (9.7 mg/dL), and a significant increase in the mean hemoglobin was seen at 4 weeks (11.6 mg/dL) to 1 year (13 mg/dL). Incidence of recurrent infections was 9.1% (with culture growth) and 36.4% (no culture growth). Hypertension remained unchanged before and after transplant. ConclusionsInduction with single dose rATG at 1.5 mg/kg/dose (±0.3 mg/kg/dose) for 3 days provided effective and safe outcomes in pediatric kidney transplant patients in this study.

A Scoring Tool to Predict Pulmonary Complications in Severe Leptospirosis with Kidney Failure.

Rapid identification of patients likely to develop pulmonary complications in severe leptospirosis is crucial to prompt aggressive management and improve survival. The following article is a cohort study of leptospirosis patients admitted at the National Kidney and Transplant Institute (NKTI). Logistic regression was used to predict pulmonary complications and obtain a scoring tool. The Kaplan–Meir method was used to describe survival rates. Among 380 patients with severe leptospirosis and kidney failure, the overall mortality was 14%, with pulmonary hemorrhage as the most common cause. In total, there were 85 (22.4%) individuals who developed pulmonary complications, the majority (95.3%) were observed within three days of admission. Among the patients with pulmonary complications, 56.5% died. Patients placed on mechanical ventilation had an 82.1% mortality rate. Multivariate analyses showed that dyspnea (OR = 28.76, p < 0.0001), hemoptysis (OR = 20.73, p < 0.0001), diabetes (OR = 10.21, p < 0.0001), renal replacement therapy (RRT) requirement (OR = 6.25, p < 0.0001), thrombocytopenia (OR = 3.54, p < 0.0029), and oliguria/anuria (OR = 3.15, p < 0.0108) were significantly associated with pulmonary complications. A scoring index was developed termed THe-RADS score (Thrombocytopenia, Hemoptysis, RRT, Anuria, Diabetes, Shortness of breath). The odds of developing pulmonary complications were 13.90 times higher among patients with a score >2 (63% sensitivity, 88% specificity). Pulmonary complications in severe leptospirosis with kidney failure have high mortality and warrant timely and aggressive management.

Comparison of Outcomes among Chronic Kidney Disease V Patients with COVID-19 at the National Kidney and Transplant Institute: A Retrospective Cohort Study.

Background There is very little published data on outcomes of COVID-19 among chronic kidney disease (CKD) patients. We compared the outcomes of COVID-19 in a tertiary care renal hospital among CKD V patients on hemodialysis (HD), peritoneal dialysis (PD), and dialysis initiation, in terms of duration of hospitalization, in-patient mortality, and 30-day mortality. Methods A total of 436 CKD V patients, on either HD, PD, or dialysis initiation, with COVID-19 who were admitted at the National Kidney and Transplant Institute (NKTI) from March 13, 2020, to August 31, 2020, were included. Kaplan–Meier survival analysis was performed. Comparison of probability of mortality by group was performed using Log-Rank test. p values ≤0.05 were considered statistically significant. Results Among 436 CKD V patients, 298 (68%) were on HD, 103 (24%) were on PD, and 35 (8%) required dialysis initiation. Overall in-hospital mortality was 34%; 38% were on HD, 20% on PD, and 37% on dialysis initiation. Total 30-day mortality was 27%; 32% were on HD, 26% on PD, and 16% on dialysis initiation. Median follow-up was 24 days. Among the 137 deaths recorded, total median time to death was 10 days; 8.5 days, 15.5 days, and 9 days for HD, PD, and dialysis initiation groups, respectively. Probability of mortality was significantly higher in HD patients versus PD patients (p < 0.00001) and in the dialysis initiation group compared to PD patients (p=0.0234). Mortality probability, however, was not significantly different in HD patients versus the dialysis initiation group (p=0.63). Conclusion Among CKD V patients diagnosed with COVID-19 at the NKTI, those on HD and on dialysis initiation had significantly higher in-hospital and 30-day mortality, compared to patients on PD.

Oбеспечение баланса интересов участников отношений в развитии института трансплантации органов и тканей в Российской Федерации

The article deals with issues related to the development of the Institute of Human Organ and Tissue Transplantation. The issues of transplantation currently cause numerous discussions both in the theory of law and in practice, in connection with which the main task of developing relations is to ensure a balance of interests of the persons involved in these relations. The authors seek to dwell not only on the issues of the genesis of the institution under consideration, but also to show the importance of further development of the legal regulation of the aspects raised in the study

Recurrent Urinary Tract Infections in Renal Transplant Recipients: Risk Factors and Outcomes in Low-resource Settings.

Recurrent urinary tract infections (UTIs) after kidney transplantation are a common problem adversely affecting graft outcomes. This retrospective study aimed to report the frequency and risk factors of recurrent UTI and their impact on graft and patient outcomes in kidney transplant recipients at the Sindh Institute of Urology and Transplantation, Karachi, Pakistan, in January-December 2015. Five-year graft and patient survival rates were compared among different groups using Kaplan-Meier analysis. Of the 251 recipients, 67 developed one episode of UTI. Of these 67, 29 had 76 episodes of recurrent UTI. Out of the 76 episodes of recurrent UTI, Escherichia coli was the most common pathogen in 32 cases. Organisms causing recurrent UTI showed resistance to carbapenem in 19 cases versus 2 in the non-recurrent UTI group (P = 0.006). The estimated glomerular filtration rate at 1 year was 57.8 ± 16.23 mL/min/1.73 m2 in the recurrent UTI group vs. 61.9 ± 15.7 mL/min/1.73 m2 in the non-recurrent UTI group (P = 0.001). Graft survival in the recurrent UTI group at 5 years was significantly lower (76%) than in the non-recurrent UTI (95%) and no UTI groups (93%) (log-rank P = 0.006), with no significant effect on patient survival in these groups (P = 0.429). The presence of double-J stent (P = 0.036) and cytomegalovirus infections (P = 0.013) independently predicted recurrent UTI. Recurrent UTIs are common in low-resource settings and adversely affect graft outcomes. Appropriate prophylaxis and treatment are important to reduce recurrent UTI to improve graft outcomes.

Outcomes of Allogeneic Hematopoietic Stem Cell Transplantation in Myelodysplastic Syndromes with Trisomy 8 and/or Monosomy 7

The study assessed the outcomes of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in 34 patients with cytogenetically verified variants of myelodysplastic syndrome (MDS) with trisomy 8 and/or monosomy 7, who were treated at the RM Gorbacheva Scientific Research Institute of Pediatric Oncology, Hematology and Transplantation from 2013 to 2020. Both adult and pediatric MDS were analyzed without excluding the variants with two additional chromosomal abnormalities or complex karyotype. The study revealed that а) allo-HSCT should be performed in the treatment of both MDS variants; b) the outcomes of trisomy 8 treatment appeared to be better; c) children with monosomy 7 showed a higher rate of toxic complications in allo-HSCT.

The role of pneumocysts in the etiology of bronchopulmonary complications in patients with orthotopic heart transplantation

Objective. To study the prevalence of pneumocystosis among heart recipients (persons awaiting heart transplantation), persons with heart transplantation (patients with orthotopic heart transplantation) and to determine the role of pneumocysts in the etiology of bronchopulmonary complications in them. Materials and Methods. The paper presents an analysis of the results of a study of 94 samples of blood sera of patients who were treated at the Shumakov Institute of Transplantation and Artificial Organs of the Ministry of Health of Russia (Moscow). As a comparison group, samples were taken from 90 donors aged 18 to 60 years. Results. The detection of various markers of pneumocystosis made possible to establish the total number of infected among the examined and determine the stage of the disease in them. Total antibodies were found in a significant number of examined patients (donors, heart recipients, patients with OTTS. They were 2.1 times more often detected in patients with OTT (53.5%) than in the comparison group (23.3%). The indicators of heart recipients did not differ much from those of blood donors, and amounted to 25.0%. Active pneumocystis infection was most often detected in patients with OTT, which in 27.9% of cases was due to primary acute infection, in 2.3% – reactivation and in 3.5% – convalescence. Active pneumocystosis was diagnosed 2.7 times less frequently in OTT recipients than in patients after heart transplantation. All cases of pneumocystosis in them are associated with primary acute infection. It should be noted that the incidence of pneumocystosis among donors is practically absent, active infection was 2.2%, all cases are due to primary acute infection. Conclusions. The identification of such a significant number of cases of active pneumocystosis in patients after heart transplantation gives grounds to carry out laboratory diagnostics on a regular basis, which will prevent the development of pneumocystis pneumonia.

The Effect of Neuro-Linguistic Programming on Depression, Anxiety and Stress in Liver Transplant Patients

Aim: This study was conducted using a prospective randomized single-blind clinical trial model to examine the effect of neuro-linguistic programming (NLP) on depression, anxiety, and stress in liver transplant patients.Materials and Methods: This study was conducted with liver transplant patients at a university’s Liver Transplant Institute between June 2021 and December 2021. The sample size of the study was determined as 84 (Experimental group: 42, control group: 42). Personal information form and Depression, Anxiety, and Stress Scale (DASS-21) were used to collect data. The data obtained from the research were evaluated with SPSS 25.Results: In the experimental group, the mean score of DASS-21 was found to be 38.95 ± 11.96 before the NLP application and 25.21 ± 5.43 after the NLP application. It was found statistically significant that the value obtained in the second measurement was lower than the value obtained in the first measurement (p&amp;lt;0.05). It was determined that NLP application significantly decreased all parameters of depression, anxiety, and stress (p&amp;lt;0.05). In the control group, the mean score of DASS-21 was determined as 51.05 ± 7.53 in the first measurement and 52.57 ± 7.92 in the second measurement. It was found statistically significant that the value obtained in the second measurement was higher than the value obtained in the first measurement (p&amp;lt;0.05).Conclusion: This study found that NLP reduced depression, anxiety, and stress in liver transplant patients. In line with this result, it can be suggested that nurse’s benefit from NLP practice and receive training on NLP in managing the depression, anxiety, and stress experienced by liver transplant patients.

Costing of Haemodialysis and Continuous Ambulatory Peritoneal Dialysis Procedures Performed at National Institute of Nephrology, Dialysis &amp; Transplantation, Sri Lanka

<strong>Introduction: </strong>Chronic Kidney Disease(CKD) is a rising epidemic. It is estimated that annually 1000 patients of End Stage Renal Failure are newly diagnosed. They require dialysis therapy, until kidney transplantation. Haemodialysis(HD) is the widely practiced dialysis method used today. The Continuous Ambulatory Peritoneal Dialysis(CAPD) is the other dialysis option. There are studies done on costing of HD, no such studies are available for CAPD in Sri Lanka. <strong> </strong> <strong>Objective: </strong>To compare the provider cost of HD and CAPD. performed at National Institute of Nephrology, Dialysis and Transplantation (NINDT) during the month of February 2016. <strong> </strong> <strong>Methodology: </strong>A descriptive cross sectional retrospective study, conducted among patients who underwent HD and CAPD for one month. Step down approach was used to calculate the costs. <strong> </strong> <strong>Results: </strong>Study reveals that the cost for a patient who undergoes HD for one month is Rs. 102,420. Cost for CAPD procedure for a patient during the 1st month was Rs 87,485 including the five day training. From the second month home based CAPD cost per month is Rs. 77,520. Most Asian countries adopt ‘CAPD first policy’ for Renal Replacement Therapy (RRT). With the increasing number of ESRF patients in Sri Lanka a need of rationalizing RRT exists. According to the study the annual cost for a HD patient is Rs1,229,040 and the same for CAPD patient is Rs 940,205. <strong> </strong> <strong>Conclusion: </strong>CAPD is 25% less costly than HD. <strong> </strong> <strong>Recommendation: </strong>Increase the facilities available for CAPD at more hospitals.

Portal vein reconstruction with cryopreserved vascular grafts: A two-edged sword.

Portal vein anastomotic complications related to size discrepancy are important causes of morbidity and mortality in pediatric liver transplantation. Interposed vascular grafts in portal vein anastomosis can solve this problem. The aim of this study is to evaluate the results of pediatric liver transplantations performed using cryopreserved interposed vascular grafts between graft portal vein and superior mesenteric vein (SMV)-splenic vein (SpV) confluence. Twenty-nine pediatric patients received liver transplantation using cryopreserved venous grafts in our Liver Transplant Institute between 2013 and 2020 were included in this study. Demographic, clinical, and operative characteristics and postoperative follow-up were analyzed. Sixteen patients (55.2%) had portal hypoplasia and five patients (17.2%) had portal vein thrombosis. In total, six patients (20.6%) suffered portal vein thrombosis in the early postoperative period. Three patients (10.3%) experienced portal vein thrombosis in the late postoperative period. Late portal vein thrombosis rate was significantly higher in patients with early portal vein thrombosis (3/6 patients [50%] versus 0/23 patients [0%]; p=.034). Lack of portal flow was significantly higher in patients with both early (50% versus 0%; p=.002) and late portal vein thrombosis (66.7% versus 6.7%; p=.03). Preoperative portal vein thrombosis and insufficient flow are important factors affecting success of liver transplant in children. The use of interposed vein grafts in problematic portal anastomoses can overcome portal flow problems.

1377. Impact of Pre-Transplant Infectious Diseases Wellness Visit on Vaccine Uptake in Solid Organ Transplant Candidates

BackgroundDespite published guidelines, vaccine uptake in solid organ transplant candidates (SOTc) remains suboptimal. We established an Infectious Disease pre-transplant clinic (IDPT) to perform a wellness visit for all SOTc. The visit was conducted by a nurse practitioner (NP) primarily and included pre-transplant assessment and optimization of vaccinations. We report the preliminary results of this pilot project on vaccine uptake in SOTc.MethodsRetrospective review was done on all SOTc referred to the IDPT from January 2020 to February 2021 at Henry Ford Transplant Institute in Detroit, MI. SOTc were patients listed for different types of transplants. Sociodemographic data, comorbidities, vaccination status for influenza, pneumococcus, hepatitis B, Tdap, Td, and varicella zoster were assessed from electronic medical records and the Michigan Care Improvement Registry that includes vaccination records. Follow up was at least 3 months after IDPT visit. Binomial analysis was performed comparing vaccine uptake in a previous institutional cohort of 530 SOTc from January 2015 to December 2016 in which there was no IDPT visit. Data was analyzed using EpiInfo ver. 7.2.4.0.ResultsA total of 183 SOTc were evaluated in IDPT. Baseline characteristics are shown in Table 1. Median age was 57 years, mean Charlson Comorbidity Index was 4.1. Majority of IDPT visits were done by the NP and most were video visits given the COVID-19 pandemic. Vaccine uptake improved post IDPT for all vaccines and most notably for hepatitis B, varicella zoster and pneumococcal 13V vaccines (Table 2). Of the SOTc, 38 (20.8%) received their vaccines during the IDPT visit or shortly after. Compared to the prior cohort, all vaccines rates improved with the post IDPT visit (p< 0.001) (Table 3). IDPT and vaccines - ID week 2021 - Table 1 IDPT and vaccines - ID week 2021 - Table 2 IDPT and vaccines - ID week 2021 - Table 3ConclusionIDPT clinic visits significantly improved vaccine uptake in SOTc at our institution. Approximately one in five SOTc had vaccines administered at the time of IDPT visit or shortly after. Implementation of an Infectious Diseases wellness visit as a requirement for all SOTc can provide opportunities to greatly optimize vaccine completion before transplantation. Disclosures All Authors: No reported disclosures

Spirometric lung age for predicting the risk of pulmonary complications after thoracic surgeries

Annotation. Surgical interventions for diseases of the thoracic cavity are one of the most invasive surgical procedures, which are often accompanied by postoperative complications, which increase mortality, prolong hospital stays, require additional costs and correlate with poor long-term survival. However, respiratory complications remain the most common of non-surgical complications and their frequency varies from 13 to 38%. So far, several studies have shown that respiratory dysfunction is an independent risk factor for postoperative pneumonia. The aim – investigate whether it is possible to use spirometric lung age to predict the occurrence of postoperative pneumonia after thoracic surgeries. The study was performed on 192 patients with diseases of the thoracic cavity (esophagus, lungs, mediastinum), underwent surgery in the thoracoabdominal department of the Shalimov’s National Institute of Surgery and Transplantation. Statistical software EZR v.1.54 was used for statistical calculations (graphical user interface for statistical software R version 4.0.3, R Foundation for Statistical Computing, Vienna, Austria). We found a very strong association between the risk of developing pulmonary complications and the age of the lungs, AUC=0.97 (95% confidence interval from 0.94 to 0.99). When choosing the optimal point for predicting the risk of pulmonary complications obtained: Lung age critical = 99.6 years. Thus, at Lung age &gt;99.6 years, the development of postoperative pulmonary complications is predicted. At Lung age &lt;99.6 years, the absence of postoperative pulmonary complications is predicted. When choosing this decision point, the sensitivity is 93.5% (82.1-98.6%), specificity – 95.9% (91.3-98.5%). Therefore, spirometric age of the lungs was associated with the incidence of postoperative pulmonary complications in patients undergoing surgery for thoracic disease. This parameter deserves attention as a predictor of the probability of developing postoperative pneumonia after thoracic surgeries and can help in assessing the state of respiratory function of patients.

Outcome of Rirs for Renal Pelvic Stones 1.5 to 2.0 cm using Semi-Rigid Uretero-Renoscopy

Background Retrograde Intrarenal Surgery (RIRS) is among the recommended treatment modality for stones located in renal pelvis and is of less than 2 cm. Renal Stones with Hounsfield units more than 1000 have low stone free rate with ESWL. Objective To determine the outcome of retrograde intrarenal surgery using semirigid ureteroscope in fragmentation of renal pelvic stone. Methods Patients with 1.5-2.0 cm stone located in renal pelvis of more than 1000 HU who underwent retrograde intrarenal surgery as primary procedure at Sindh Institute of Urology And Transplantation were included. Stone fragmentation was achieved with holmium-yttrium aluminum garnet laser. Secondary procedure was performed if complete stone fragmentation was not achieved. Statistical analysis was performed by SPSS version 20. Result Total 82 patients with mean size of pelvic renal stones 1.7 ± 0.53 cm were included. The mean operating time was 32.1±12.9 mins. The stone clearance rate at six weeks after the first procedure was 79.3%. Minor complications including flank pain, fever and hematuria were reported. Conclusion Retrograde intrarenal surgery performed with semi rigid ureteroscope in renal pelvic stones of more than 1000 HU is a technically safe and effective procedure. Keywords: Retrograde intrarenal surgery; Pelvic stone; Flexible ureteroscopy and holmium laser.

Liver Transplantation in Malaysia: Needs, Obstacles, and Opportunities.

Liver Transplantation in Malaysia: Needs, Obstacles, and Opportunities.

De Novo Malignancies After Liver Transplantation: Experience of a High-Volume Center.

Patient care, newer immunosuppressive medications, and advances in surgical technique, have resulted in significant prolongation of survival after liver transplantation in recent years. However, as life expectancy increased and the early mortality rates have decreased, different problems have evolved due to chronic immunosuppressive therapy. The aim of the present study is to evaluate patients who were transplanted and then developed de novo malignancies, in terms of the type of malignancies and the follow-up period. The study was conducted on 2814 patients who received liver transplantation between 2008 and 2020 in Inonu University Liver Transplant Institute. In total, the data of 23 patients were evaluated retrospectively. Non-melanoma skin cancer was the most common de novo malignancy (21.7%), followed by gynecological cancers (17.3%). The interval between the time of transplantation until the development of de novo malignancy was 36 (6-75) months. The median follow-up period after the diagnoses of the de novo malignancies was 4.11years. One, 3-, 5-year survival rates of patients after the diagnoses of de novo malignancies were 69.6%, 56.5%, and 41.9%; respectively. Non-melanotic skin cancers were the most common de novo cancers in liver transplant recipients. A strict surveillance program is very important in the follow-up of liver transplant recipients.

High Fluorescence Lymphocyte Count and Immature Platelet Fraction; “Can these Two Parameters Reliably Distinguish between Dengue and ITP?”

Abstract: Objective: Thrombocytopenia is a frequent finding in Dengue fever. Immune Thrombocytopenia (ITP) is a diagnosis of exclusion and is not associated with febrile illness. Ignoring fever, low platelet count and clinical signs may be similar in both conditions. Peripheral film finding in Dengue fever shows many reactive lymphocytes. Enumeration of these reactive lymphocytes as high fluorescence lymphocyte count (HFLC) and computing immature fraction of platelets (IPF) may be useful in differentiating these two disorders as soon as the blood sample is analyzed on XN-1000 hematology analyzer. Materials and Methods: A cross-sectional study was conducted at National Institute of Blood Disease and Bone Marrow transplantation from January to July 2019 during (Dengue season); blood samples from emergency room were analyzed on XN-1000 hematology analyzer for complete blood count and IPF. Samples with thrombocytopenia were checked for IPF count and HFLC from the extended research parameter data of the analyzer. Patients presenting with fever, had Dengue NS-1 tested. Detailed history &amp; examination was recorded from the patients. Results: Out of the 124 patients, 62 (50%) patients of Dengue and ITP respectively. Male to female ratio was 2:1. Mean age in Dengue was 25.52±10.46 years while 34.44 + 20.82 years in ITP group. Mean platelet count was significantly higher in dengue than ITP patients (120.59 ± 80.28 x109/L versus 41.84 ±38.62 x109/L) (p&lt;0.001). HFLC was 11.71± 7.17% in Dengue fever while 0.198±0.25% in ITP patients whereas IPF in ITP group was 21.91 ± 16.09% while 8.79± 4.39%in Dengue patients were found to be significant i.e. (p&lt;0.001). Conclusion: Excluding fever, thrombocytopenia, presence of increased number of HFLC and low or normal IPF can reliably a predictor of a diagnosis in Dengue season. Keywords: High fluorescence lymphocyte counts, Immature platelet functions, Dengue, Immune thrombocytopenia, Resource constraint Laboratories, Research parameters.