Extensive porto-mesenteric thrombosis presents a significant challenge in liver transplantation and was previously considered a contraindication. However, advancements in surgical techniques have made liver transplantation feasible. For optimal allograft function, adequate portal flow is crucial, as it generates shear stress that stimulates regeneration. In such cases, portal inflow options include the left renal vein (reno-portal anastomosis; RPA), the inferior vena cava (cavo-portal hemi-transposition; CPHT), any patent splanchnic territory, portal vein arterialization, or multi-visceral transplantation. Among these, CPHT and RPA are the most commonly performed. Generally, CPHT is used in pediatric liver transplantation; however, it is rarely reported in adult living donor liver transplantation (LDLT) due to technical challenges. In this report, we describe our technical modifications to CPHT and present the results in two patients with extensive porto-mesenteric thrombosis who underwent LDLT.

Background: Acute-on-chronic liver failure (ACLF) is associated with high mortality, but transplantation improves survival. Optimizing organ function is time-consuming and can increase infection risk. This study investigated the optimal pretransplant waiting period. Methods: In this retrospective study of patients with ACLF who underwent transplantation between January 2021 and August 2024, perioperative details and morbidity were compared between survival and mortality groups. Receiver operating characteristic (ROC) analysis was used to determine the cutoff for the pretransplant waiting period. Results: Among 112 patients with ACLF under the European Association for the Study of the Liver criteria, 61 (54.5%) underwent living donor liver transplantation (mean age, 41 years; 51 males [83.6%]). The most common etiology was viral infection (44.2%). The median Chronic Liver Failure Consortium (CLIF-C) score was 44 (respiratory failure, 14.7%; renal failure, 16.4%). There were 14 (22.9%) posttransplant deaths. The median waiting period between admission and surgery was longer in the mortality group (8 vs.4 days, P=0.2). The area under the ROC curve for the optimal pretransplant waiting period was 0.723 (P=0.01). A cutoff of 5 days predicted mortality with 71.4% sensitivity and 61.9% specificity. On univariate analysis, survivors and nonsurvivors differed significantly in age, hemoglobin level, warm ischemia time, and postoperative gastrointestinal (GI) bleeding; on multivariate analysis, postoperative GI bleeding independently predicted mortality. During a median follow-up of 17 months, no deaths occurred. Conclusions A pretransplant waiting period of 5 days predicted mortality; furthermore, postoperative GI bleeding was an independent predictor of mortality. Further studies are required to confirm these findings.

INTRODUCTION: The National Institute of Health and Care Excellence (NICE) has defined the terms, 'acute coronavirus disease 2019' (COVID-19), 'ongoing symptomatic COVID-19' and 'post-COVID-19 syndrome', with the latter two described as having persistent symptoms after the onset of COVID-19 symptoms for 4-12 weeks and >12 weeks, respectively. Persistent symptoms can either be due to the after-effects of COVID-19 or new-onset diseases after acute COVID-19. All symptoms observed beyond 4 weeks after the onset of COVID-19 need not be present at the time of onset. Previous studies on persistent post-COVID-19 symptoms have not mentioned new-onset diseases after acute COVID-19, and only a select few studies have discussed such new-onset symptoms. METHODS: Ninety-five patients who attended the post-COVID-19 clinic completed the requisite follow-up till 16 weeks after COVID-19 symptom onset. Data was recorded on a predesigned proforma. Necessary investigations were conducted to rule out any other cause of persistent symptoms. RESULTS: Fatigue (62.1%), breathlessness (50.5%) and cough (27.4%) were the most common symptoms present beyond 4 weeks after the onset of COVID-19 symptoms. Forty-nine (51.57%) patients developed post-COVID-19 syndrome - their severity of symptoms (odds ratio [OR] 17.77) and longer duration of hospital stay (OR 1.095) during acute disease were significantly associated with the development of post-COVID-19 syndrome. During follow-up, 25 patients developed new-onset symptoms, such as diabetes mellitus, hypertension and idiopathic tachycardia. CONCLUSION Patients can have persistent symptoms, new-onset symptoms and new-onset diseases after recovery from acute COVID-19.
Humans ; COVID-19/diagnosis* ; Female ; Male ; Prospective Studies ; Middle Aged ; Adult ; Fatigue/etiology* ; Post-Acute COVID-19 Syndrome ; SARS-CoV-2 ; Aged ; Cough/etiology* ; Dyspnea/etiology*

PURPOSE: Restoring the native patellar thickness after patellar resurfacing provides optimal function of the knee after arthroplasty and minimises complications related to the patellofemoral articulation. The aim of this study was to assess the usefulness of a thin patellar button (6.2 mm) in patients with a patella thickness of less than 20 mm during total knee arthroplasty. MATERIALS AND METHODS: This is a retrospective case control study. A total of 54 female patients with an intraoperative patellar thickness of < 20 mm, resurfaced with a patellar button of 6.2 mm in thickness were identified (group 1). They were matched with 54 patients with a patellar thickness of 20–23 mm, resurfaced with a patellar button of 8 mm (group 2), based on age, sex, body mass index, and deformity. A clinical and radiological evaluation was done at a minimum 2-year follow-up. RESULTS: The preoperative mean patellar thickness was 18.94±1.07 mm and was restored to 19.06±0.79 mm in group 1, as compared to 21.63±0.99 mm and 21.72±0.99 mm in group 2. The mean postoperative range of motion was 122.22°±9.25° in group 1 and 123.52°±8.72° in group 2 (p=0.13). No patellar bone or button related complications were observed in any patient in either group. CONCLUSIONS: The 6.2 mm thin patella is useful to restore the native thickness in patients with a patellar thickness of less than 20 mm without risk of button fracture, loosening or overstuffing.
Arthroplasty ; Arthroplasty, Replacement, Knee ; Body Mass Index ; Case-Control Studies ; Congenital Abnormalities ; Female ; Follow-Up Studies ; Humans ; Knee ; Matched-Pair Analysis ; Patella ; Patellofemoral Joint ; Range of Motion, Articular ; Retrospective Studies

The aim of this study was to develop and validate a simple, sensitive, precise and cost-effective one-level agar diffusion (5t1) bioassay for estimation of potency and bioactivity of Levofloxacin in pharmaceutical preparation which has not yet been reported in any pharmacopoeia. Among 16 microbial strains, Bacillus pumilus ATCC-14884 was selected as the most significant strain against Levofloxacin. Bioassay was optimized by investigating several factors such as buffer pH, inoculums concentration and reference standard concentration. Identification of Levofloxacin in commercial sample Levoflox tablet was done by FTIR spectroscopy. Mean potency recovery value for Levofloxacin in Levoflox tablet was estimated as 100.90%. A validated bioassay method showed linearity (r2 ? 0.988), precision (Interday RSD ? 1.05%, between analyst RSD ? 1.02%) and accuracy (101.23%, RSD ? 0.72%). Bioassay was correlated with HPLC using same sample and estimated potencies were 100.90%and 99.37%, respectively. Results show that bioassay is a suitable method for estimation of potency and bioactivity of Levofloxacin pharmaceutical preparations.