Improved outcomes of ABO incompatible living donor liver transplant with biologically related donors.

INTRODUCTION: Liver transplantation is considered to be the only curative treatment in decompensated liver disease. Shortage of liver allografts is a major impediment for widespread application of this procedure. ABO-incompatible grafts have been used successfully thereby increasing the LDLT donor pool. However, ABO-I liver transplantation is associated with complications like acute liver rejection, hepatic artery thrombosis and higher biliary stricture rates leading to transplant failure, re-transplantations or sepsis-related complications. Various desensitization strategies have been adopted which have improved outcomes. Biologically-related donor-recipient pairs have theoretical advantage of favourable HLA match. We have analysed the outcomes of ABO-incompatible LDLT and compared the results of HLA-matched (biologically-related) and HLA-unmatched (biologically-unrelated) donor-recipient pairs. Retrospective data of 90 cases of ABO-I liver transplant recipients: HLA matched (n=35) and HLA un-matched (n=55) for comparison of pre-operative and post-operative data. RESULTS: Peak bilirubin level in HLA-unmatched recipients were higher. Platelets count were lower than HLA-matched recipients (7.3 mg/dL vs 8.9 mg/dL). No significant difference in days-to-normal bilirubin, peak INR, hospital stay and discharge-day from transplant between both groups. Post-operatively, HLA-unmatched recipient required more pulse-steroids therapy than HLA-matched - 21/55 (38.2%) vs 11/35 (31.4%). Biliary complication and intervention were more in HLA-unmatched group (12/55, 21.8%) than HLA-matched (4/35, 11.4%). Renal complications requiring post-operative haemodialysis was more in HLA-unmatched group than HLA-matched group 9/55 (16.4%) vs 3/35 (8.6%). The incidence of vascular complications was similar. CONCLUSION: ABO-I LDLT is an effective and safe method for increasing the donor pool in absence of ABO-C liver donor. Long term outcomes of recipients with biologically-related donors are marginally better than biologically-unrelated ABO-I LDLT recipient. However, incidence of antibody-mediated graft rejection and biliary complications are more in biologically-unrelated ABO-I liver recipient.

A Prospective Study of the Incidence of Chronic Xerostomia and the Quality of Life in Patients Undergoing Radiotherapy for Head and Neck Malignancies with IMRT or VMAT Techniques.

BACKGROUND: Radiation therapy in Head and neck cancers often leads to xerostomia which often leads to a decline in quality of life. The aim of the study was to compare xerostomia among cancer patients undergoing IMRT and VMAT techniques for head and neck malignancies and follow them up via quality of life assessment. METHODOLOGY: It was a hospital based prospective study with follow up at 0, 3 and 6 months among total 80 patients divided in 2 groups of VMAT and IMRT respectively. Patients were assessed using a quality of life questionnaire. Data analysis was done using SPSS 25.0 Results: It was observed that there was no significant difference between the two groups for xerostomia and quality of life over the follow up period. However, there was improvement of symptoms over time in both groups. DISCUSSION: Similar results were observed in other international studies as well with respect to the quality of life. CONCLUSION: It was found that both technologies were similar when it came to treatment related xerostomia in patients undergoing radiotherapy for head and neck malignancies with either technique.

Phase encoded quantum key distribution up to 380 km in standard telecom grade fiber enabled by baseline error optimization.

Phase encoding in quantum key distribution (QKD) enables long-distance information-theoretic secure communication in optical fibers. We present a novel theoretical model characterizing errors from various sources in practical phase encoding-based QKD systems, namely the laser linewidth, detector dark counts, and channel dispersion. This model provides optimized optical pulse parameters and less distortion in pulses, which eliminates system imperfections and leads to a reduced quantum bit error rate (QBER) for practical QKD scenario. This analysis is applicable to various fiber-based phase and time encoding protocols. In particular, we implement this to a differential phase shift (DPS) QKD scheme operating at a 2.5 GHz clock, which produces a secure key rate of 193 bits/s at a fiber length of 265 km and an unprecedented QBER < 1[Formula: see text] up to 225 km length with standard telecom components. We show that by adjusting the quantum efficiency and dark count rates of detectors, proposed system can establish secure keys up to 380 km distance using standard telecom grade fiber with a QBER of 1.48%. Moreover, the system is compatible with existing optical fiber networks and capable of establishing a secure key exchange between two cities 432 km apart using ultra-low-loss (ULL) specialty fiber.

Primary malignant melanoma of the gastroesophageal junction: A rare and unusual disease.

Malignant melanoma, an aggressive tumor of skin, is also seen rarely in extra cutaneous sites like the gastrointestinal tract (GIT). Primary melanoma of the GIT by itself is a rare tumor; often metastatic at presentation and if found non-metastatic, it is rarely resectable. We are reporting a histopathologically confirmed case of primary malignant melanoma affecting the 'gastroesophageal junction', which we operated on.

A study on outcome of binding pancreaticogastrostomy following pancreaticoduodenectomy: A prospective observational study.

INTRODUCTION: The type of anastomosis of the pancreas following pancreaticoduodenectomy is often attributed to the reason for pancreatic leak. Results of various randomized trials comparing pancreaticojejunostomy and pancreaticogastrostomy are conflicting one suggesting advantage over the other and vice versa. In this study we intend to critically analyze a novel technique of binding pancreaticogastrostomy following pancreaticoduodenectomy. AIMS AND OBJECTIVES: The aim of this study is to see the outcome of binding pancreaticogastrostomy by evaluating the technical aspects of binding PG and study the incidence of post-operative complications. MATERIALS AND METHODS: The study included all patients who had undergone binding pancreaticogastrostomy from Mar 2012 to Mar 2016 at a tertiary care hospital. Patients' data, including patients demographics, type of procedure performed, complications, mortality, hospital stay, postoperative interventional procedures or reoperations were all documented. RESULTS: There were 60 men and 37 women (mean age was 55.4 ±â€¯11.6 years) with a mean BMI of 22.6 Kg/M2. 16% of the patients had evidence of cholangitis and 14 of them had to be stented preoperatively. Ninety-four percent of the patients were operated for malignant cause of obstructive jaundice. The mean operative time was 283 min s and average blood loss during surgery was 352 ml. 36% of the patients were operated by the senior residents undergoing training in Gastro intestinal surgery with the assistance of the available faculty. 60% of the patients had a pancreatic duct diameter less than 3 mm. 72% of the pancreatic stump were soft in consistency. In our study we had 3% patients with pancreatic leak. The most frequent complication was DGE, which was seen in 22% patients. The mean duration of DGE was 13.5 ±â€¯2.6 days. We had 2 deaths within 30 days of surgery of which one was due to massive intraabdominal bleed due to pancreatic leak. None of the parameters like pre-operative and operative parameters like age, bilirubin, total leucocyte count, preoperative stenting, pancreatic duct diameter, texture of pancreas and surgery performed by residents were found to be responsible for pancreatic leak. CONCLUSION: This novel method of binding PG is simple, secure, and reproducible. It possesses several advantages over the conventional PG: it is very easy to perform, it is less traumatic to the pancreatic stump, can be performed in all types of pancreatic stump irrespective of the texture and diameter of the pancreatic duct without any statistically significant adverse outcomes.

The effect of laparoscopic sleeve gastrectomy (LSG) on glycemic control in morbidly obese patients.

INTRODUCTION: Bariatric procedures have become popular in treating not only the morbid obesity but also the metabolic derangements. Sleeve Gastrectomy has recently become popular as a standalone procedure and its usefulness as a metabolic procedure especially glycemic control is still under investigation. One of the most commonly used measure of insulin resistance is statistically derived 'Homeostatic model assessment of insulin resistance (HOMA-IR). AIM: The effect of Laparoscopic Sleeve Gastrectomy (LSG) on clinical and measurable change in glycemic control as seen by reduction of insulin resistance ie HOMA-IR levels in morbidly obese patients. MATERIAL AND METHODS: All the patients with BMI ≥35 kg/m(2) with co morbidities and BMI ≥40 kg/m(2) even without co morbidities were included in the study. The period of the study was from Feb 2013 to Sep 2014. Fasting (FBS), post prandial blood sugar (PPBS) and Insulin levels were checked before the surgery, 1month and 3 month after the surgery. We also recorded BMI and diabetic status. HOMA-IR was calculated and trends were recorded. STATISTICAL ANALYSIS: Statistical analysis was carried out using SPSS 16.0. RESULTS: Out of 28 patients 8 were males and 20 were females. The mean age was 43 yrs. 11 (39%) patients were diabetic and mean BMI was 44 kg/m(2) and a range of (35-61.3) kg/m(2). 11 patients had BMI > 45 kg/m(2). The HOMA-IR values decreased significantly after the surgery both in diabetics and non diabetics. CONCLUSION: LSG results in improvement in glycemic control in both diabetics and non diabetics.

Clinical evaluation of analgesic activity of guduchi (tinospora cordifolia) using animal model.

INTRODUCTION: Pain is a very well-known signal of ill health and analgesics are the drugs that are used to relieve pain. The main problem with these drugs remains that of side effects. Safer alternatives are natural herbs. Guduchi (Tinospora cordifolia) is one such plant with analgesic potential but few studies are there. OBJECTIVE: To evaluate the analgesic activity of commercially available extract of Guduchi (T. cordifolia). MATERIALS AND METHODS: For this purpose commercially available extract of Guduchi (T. cordifolia) by Himalaya Drug Company, Bangalore was used. Albino rats were divided randomly in three groups of six rats each. Group 1 (control) received distilled water orally, group 2 (test) received T. cordifolia extract in dose of 300 mg/kg orally and group 3(standard) received Pentazocine in dose 10mg/kg intraperitoneally. Analgesic activity was evaluated using hot plate and abdominal writhing method. All the observations were analysed statistically using student's t-test. OBSERVATION AND RESULTS: T. cordifolia extract significantly (p<0.05) increased the response time and decreased the number of writhes in hot plate method and abdominal writhing method respectively, on comparison with the control group. CONCLUSIONS: The above findings suggest that this commercially available extract of Guduchi (T. cordifolia) possess analgesic activity. This analgesic activity probably involves peripheral as well as central mechanisms as the extract showed analgesic activity in both hot plate and abdominal writhing method.

Tuberculosis of breast: unusual manifestation of tuberculosis.

Tuberculosis affects almost every organ of the body, and the breast is no exception. However, tuberculosis of the breast is rare, and the varied presentation requires a high index of suspicion, especially in middle-aged women for whom a clinical diagnosis of malignancy is likely to be made. We report two cases of primary tuberculosis of breast with different manifestations. One case presented as tuberculous mastitis and the other presented with a lump masquerading as breast carcinoma. The diagnosis in both cases was based on demonstration of acid-fast bacilli on histopathological examination. Resolution was complete with antitubercular therapy, and major surgical intervention was not necessary.