Outcomes of HIV-infected Patients on Dialysis: Experience at a Tertiary Care Center.

Background: Human immunodeficiency virus (HIV) infection is a major public health problem. These patients are at an increased risk for end-stage kidney disease. Both hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) are the accepted modalities of treatment. Materials and Methods: In this retrospective study, we included all HIV-positive end-stage kidney disease (ESKD) patients who were on dialysis - HD or CAPD - for at least 1 month. Data were collected from the dialysis charts and analyzed. Results: There were 20 patients in the CAPD group and 76 patients in the HD group. Mean age was 49.6 ± 8.73 years in the CAPD group and 46.28 ± 9.02 years in the HD group. Hypertension and diabetes were the common causes for ESKD. Mean survival was slightly better in CAPD group (20.94 vs. 15.46 months). The HD group had higher mortality within 12 months of dialysis initiation, and infection was the cause for early deaths. Mean infection episodes was 2.1 in HD group and 3.1 in CAPD group. CAPD patients with low albumin (<2.5 g/dl) had higher peritonitis rates. Conclusion: Managing HIV-positive dialysis patients remains challenging. In our study, survival was marginally better in the CAPD group. In both groups, low CD4 count was associated with more infections and low albumin with more peritonitis episodes. A study incorporating more peritoneal dialysis (PD) patients, longer follow-ups, and a matched non-HIV control will throw more light on patient outcomes.

The Lingering Effects of COVID-19: The Psychological State and Quality of Life of Patients with Persistent Loss of Smell and Taste.

The COVID-19 pandemic has resulted in a significant number of individuals experiencing the loss of smell and taste, medically known as anosmia and ageusia, respectively. While many patients recover these senses during the post-acute phase of the illness, a subset of individuals continues to suffer from anosmia and ageusia even after recovering from COVID-19. This article aims to explore the psychological state of COVID patients who have not regained their sense of smell and taste post-recovery, highlighting the potential impact on their mental health and overall well-being. To accomplish this, a comprehensive review of existing literature on the topic has been conducted, analyzing studies and reports that shed light on the psychological consequences of unrecovered anosmia and ageusia in COVID patients.

Clinical Outcomes Following Transcatheter Mitral Valve-in-Valve Replacement Using a Meril Myval Transcatheter Heart Valve.

AIM: Transcatheter mitral valve-in-valve (TMViV) replacement for degenerated surgically implanted bioprosthetic valves has been described by both transseptal and transapical approaches. The balloon-expandable Myval transcatheter valve (Meril Life Sciences, Vapi, India) is commonly used for transcatheter valve-in-valve procedures in India. This study aimed to report in-hospital, 30-day, and 1-year outcomes of Myval patients who underwent TMViV in a single tertiary care centre in India. METHODS: Symptomatic patients with surgical bioprosthetic mitral valve failure with New York Heart Association (NYHA) class III-IV symptoms, despite optimal medical therapy and high or very high risk for redo surgery, were assigned to TMViV following heart team discussions. Data were retrospectively collected and outcomes assessed. RESULTS: Twenty patients were treated, with mean age 64.4 years, 60% were female, and mean Society of Thoracic Surgeons (STS) predicted risk of operative mortality score was 8.1. The failure mechanism was combined stenosis and regurgitation in 60% of patients. Technical success was achieved in 100% of patients. The mean postprocedure and 30-day gradients were 4.6±2.7 and 6.3±2.1, respectively. None of them had significant valvular or paravalvular leaks or left ventricular outflow tract obstruction. All-cause mortality at 1 year was 10%, and all survivors were in New York Heart Association (NYHA) class I or II. CONCLUSION: TMViV replacement with a Meril Myval can be safely performed with high technical success, and low 30-day and 1-year mortality.

Application of density functional theory for evaluating the mechanical properties and structural stability of dental implant materials.

BACKGROUND: Titanium is a commonly used material for dental implants owing to its excellent biocompatibility, strength-to-weight ratio, corrosion resistance, lightweight nature, hypoallergenic properties, and ability to promote tissue adhesion. However, alternative materials, such as titanium alloys (Ti-Al-2 V) and zirconia, are available for dental implant applications. This study discusses the application of Density Functional Theory (DFT) in evaluating dental implant materials' mechanical properties and structural stability, with a specific focus on titanium (Ti) metal. It also discusses the electronic band structures, dynamic stability, and surface properties. Furthermore, it presents the mechanical properties of Ti metal, Ti-Al-2 V alloy, and zirconia, including the stiffness matrices, average properties, and elastic moduli. This research comprehensively studies Ti metal's mechanical properties, structural stability, and surface properties for dental implants. METHODS: We used computational techniques, such as the CASTEP code based on DFT, GGA within the PBE scheme for evaluating electronic exchange-correlation energy, and the BFGS minimization scheme for geometry optimization. The results provide insights into the structural properties of Ti, Ti-Al-2 V, and zirconia, including their crystal structures, space groups, and atomic positions. Elastic properties, Fermi surface analysis, and phonon studies were conducted to evaluate the tensile strength, yield strength, ductility, elastic modulus, Poisson's ratio, hardness, fatigue resistance, and corrosion resistance. RESULTS: The findings were compared with those of Ti-Al-2 V and zirconia to assess the advantages and limitations of each material for dental implant applications. This study demonstrates the application of DFT in evaluating dental implant materials, focusing on titanium, and provides valuable insights into their mechanical properties, structural stability, and surface characteristics. CONCLUSIONS: The findings of this study contribute to the understanding of dental implant material behavior and aid in the design of improved materials with long-term biocompatibility and stability in the oral environment.

Pharmacoeconomic Aspects of Diabetes Mellitus: Outcomes and Analysis of Health Benefits Approach.

Pharmacoeconomics is an important tool for investigating and restructuring healthcare policies. In India, recent statistical studies have shown that the number of diabetic patients is rapidly increasing in the rural, middle and upper-class settings. The aim of this review is to call attention towards the need to carry out pharmacoeconomic studies for diabetes mellitus and highlight the outcome of these studies on healthcare. A well-structured literature search from PubMed, Embase, Springer, ScienceDirect, and Cochrane was done. Studies that evaluated the cost-effectiveness of various anti-diabetic agents for type 2 diabetes were eligible for inclusion in the analysis and review. Two independent reviewers sequentially assessed the titles, abstracts, and full articles to select studies that met the predetermined inclusion and exclusion criteria for data abstraction. Any discrepancies between the reviewers were resolved through consensus. By employing search terms such as pharmacoeconomics, diabetes mellitus, cost-effective analysis, cost minimization analysis, cost-utility analysis, and cost-benefit analysis, a total of 194 papers were gathered. Out of these, 110 papers were selected as they aligned with the defined search criteria and underwent the removal of duplicate entries. This review outlined four basic pharmacoeconomic studies carried out on diabetes mellitus. It gave a direction that early detection, patient counseling, personalized medication, appropriate screening intervals, and early start of pharmacotherapy proved to be a cost-effective as well as health benefits approach.

Impact of structured training program about Hospital Infection Control practices on Knowledge and Perception of nursing students at public and private nursing teaching institute of Northern India- An interventional study.

BACKGROUND: Hospital-acquired infections (HAIs) are a primary cause of illness and death and increased expenditure due to prolonged hospitalization and poor prognosis. HAI is a global safety concern, according to World Health Organization (WHO). This study assesses the current level of knowledge and perception regarding hospital infection control practices among nursing students and evaluates the impact of structured training interventions on their baseline knowledge and perception level. METHODS AND MATERIALS: It was a single group, a pre-post interventional study done on nursing students of one government and one private nursing college in the year 2021. A pretested questionnaire consisting of was used as a study tool. Various statistical tests like one repeated-measure ANOVA, Mauchly's Test of Sphericity, and Greenhouse-Geisser correction were used. RESULTS: The mean knowledge was minimum in the pretest group (Mean = 79.4430, SD = 17.49746) and maximum immediately after the training group (Mean = 96.5443, SD = 25.42322). But after one month, knowledge decreased; however, it was more than pre-training Knowledge (Mean = 84.4937, SD = 22.40313). CONCLUSIONS: Annual educational/training modules help retain knowledge in hospital infection control practices and HAI prevention. All healthcare workers need regular training.

Neurofibrolipoma of Hypopharynx: A Rare Entity.

A Large pedunculated neurofibrolipoma involving the hypopharynx is a very rare entity. Patient with hypopharyngeal polyp usually presents with progressive dyaphagia, sensation of persistent lump in throat and difficulty in breathing. Regurgitation of the mass into the airway can led to fatal asphyxiation on several occasions and may rarely cause death also if not evaluated and treated timely. Malignant degeneration of these large polyps occurs infrequently. We encountered a case with similar complaints in our outpatient department. After complete clinical examination, radiological investigations and anaesthetic evaluation; patient was taken for elective tracheostomy first and subsequently followed by successful transoral endoscopic excision of hypopharyngeal polypoidal mass. The histopathological examination of mass revealed it to be a neurofibrolipoma.

Advances in mesenchymal stem/stromal cell-based therapy and their extracellular vesicles for skin wound healing.

Wound healing is a dynamic and complicated process containing overlapping phases. Presently, definitive therapy is not available, and the investigation into optimal wound care is influenced by the efficacy and cost-effectiveness of developing therapies. Accumulating evidence demonstrated the potential role of mesenchymal stem/stromal cell (MSC) therapy in several tissue injuries and diseases due to their high proliferation and differentiation abilities along with an easy collection procedure, low tumorigenesis, and immuno-privileged status. MSCs have also accelerated wound repair in all phases through their advantageous properties, such as accelerating wound closure, improving re-epithelialization, elevating angiogenesis, suppressing inflammation, and modulating extracellular matrix (ECM) remodeling. In addition, the beneficial therapeutic impacts of MSCs are largely associated with their paracrine functions, including extracellular vesicles (EVs). Exosomes and microvesicles are the two main subgroups of EVs. These vesicles are heterogeneous bilayer membrane structures that contain several proteins, lipids, and nucleic acids. EVs have emerged as a promising alternative to stem cell-based therapies because of their lower immunogenicity, tumorigenicity, and ease of management. MSCs from various sources have been widely investigated in skin wound healing and regeneration. Considering these features, in this review, we highlighted recent studies that the investigated therapeutic potential of various MSCs and MSC-EVs in skin damages and wounds.

Computational evaluation of transport parameters and logic circuit designing of L-Lysine amino acid stringed to Au, Ag, Cu, Pt, and Pd electrodes.

The integrants of proteins, i.e., amino acids, have grossed exceptional recognition for their applications towards designing imminent switching devices. Among 20 amino acids, L-Lysine (i.e., positively charged) has the highest number of CH2 chains, and such chains affect the rectification ratio in several biomolecules. Towards molecular rectification, we investigate the transport parameters of L-Lysine in conjunction with five different coinage metal electrodes, i.e., Au, Ag, Cu, Pt and Pd to form five distinct devices. We deputize the NEGF-DFT formulism for computing conductance, frontier molecular orbitals, current-voltage, and molecular projected self-Hamiltonian calculations using a self-consistent function. We focus on the most widely used electron exchange correlation combination, i.e., the PBE version of GGA with DZDP basis set. The molecular devices under inquisition exhibit phenomenal rectification ratios (RR) in conjunction with negative differential resistance (NDR) regimes. The nominated molecular device offers a substantial rectification ratio of 45.6 with platinum electrodes and a prominent peak to valley current ratio of 1.78 with copper electrodes. We deduce from these findings that L-Lysine based molecular devices would implicit in future bio-nanoelectronic devices. The OR and AND logic gates are also proposed hinged on highest rectification ratio of L-Lysine-based devices.

Exploring various novel diagnostic and therapeutic approaches in treating diabetic retinopathy.

Diabetic retinopathy is regarded as a common manifestation of diabetes mellitus, being a prominent cause of visual impairment and blindness. This microvascular complication is marked by the appearance of microaneurysms, elevated vascular permeability, capillary blockage, and proliferation of neovasculature. The etiology behind retinopathy is ambiguous and the efficacy of current treatment strategies is minimal. Early diagnosis of this complication using a biomarker with high sensitivity and specificity is very essential for providing better therapeutic strategies. The current available therapeutic options are limited with various adverse effects. Laser treatment is not beneficial in all the situations, economic constraints being the major challenge. Surgical interventions are employed when pharmacotherapy and laser treatment fail. New pharmacological treatments are becoming a necessity for treating the condition. This review highlights the use of various diagnostic tools, emerging biomarkers for early detection of diabetic retinopathy, pathological mechanisms associated with the disease, current therapeutic approaches used and future strategies for more enhanced treatment options and more potent pharmacological actions.

Elevated serum PAR-1 levels as an emerging biomarker of inflammation to predict the dengue infection severity.

The present study was designed to check the serum levels of protease-activated receptor (PAR-1) in patients during different phases of dengue severity. Moreover, a correlation between serum PAR-1 levels and hematological parameters, inflammatory cytokine levels, and liver functional changes was also determined. Based on the World Health Organization criteria, the study population was divided into: nonsevere dengue fever (DF; n = 30), severe dengue hemorrhagic fever (DHF; n = 19), and severe dengue shock syndrome (DSS; n = 11). The platelet count (PLT) and hematocrit (HCT) were analyzed using an automated hematology analyzer and liver function enzymes aspartate transaminase (AST), alanine transaminase (ALT), and alkaline phosphate (ALP), bilirubin were checked by auto-analyzer using diagnostic kits. Moreover, the levels of inflammatory mediators C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-17 (IL-17), and PAR-1 were determined using respective ELISA kits. The HCT levels were elevated and platelet count decreased significantly during dengue complications (DHF and DSS) compared to the DF patients, while the levels of liver functional biomarkers AST, ALT, ALP, and bilirubin remained elevated in DHF and DSS groups than in the corresponding DF group. Similarly, the inflammatory cytokine levels of CRP, TNF-α, IL-6, and IL-17 in DHF and DSS subjects were markedly increased when observed against DF subjects. Notably, the PAR-1 levels were significantly elevated in DHF and DSS groups than in the DF group and positively correlated with changes in HCT levels, inflammatory biomarkers, and liver enzymes. Our findings conclude that PAR-1 levels persistently increased with the severity of the dengue infection and are strongly associated with various clinical manifestations. Thus, PAR-1 levels can be used as a diagnostic marker for assessing dengue severity.

Is #SDG13 Trending Online? Insights from Climate Change Discussions on Twitter.

Anthropogenic activities over the past few decades have led to increased vulnerability of environmental and ecological stability on this planet. Accelerated climate change is one such subset of the environmental problems that threatens the very existence of humankind in twenty first century. Governments, United Nations (UN) and other humanitarian agencies across the globe have developed and devised strategies for climate action that requires grater public awareness and actions. Social media has played a vital role in information dissemination and raising public awareness of climate change in the digital era. To this aid, an upsurge has been documented in recent times regarding discussions over climate change with #SDG13 (Sustainable Development Goals) at its epicenter. Following the principles of Actor Network Theory (ANT) we analyzed a large volume of Twitter data to understand general citizens' perception and attitude towards climate change. Our findings unveil people's opinion on causes and concerns related to barriers of adopting a more sustainable consumption and lifestyle practice. There is also a growing apathy towards sluggish government actions that makes little difference. People were also found to exchange innovative concepts and measures towards mitigating the effects of climate change.

Evaluation of the Outcome of Pyeloplasty in Children with Poorly Functioning Kidneys due to Unilateral Ureteropelvic Junction Obstruction.

Aim: To analyze the outcome of upfront pyeloplasty in kidneys of children with unilateral ureteropelvic junction obstruction (UPJO). Materials and Methods: Thirty-three consecutive cases with split renal function (SRF) of ≤20% on dynamic renal scintigraphy (DRS) underwent upfront pyeloplasty with a nephrostomy tube and trans-anastomotic stent. Outcome was analyzed based on symptomatic relief, nephrostomy output, surgical complications and changes noted in pre-and post-operative findings on renal ultrasound (US), and DRS. Results: The most common symptom was abdominal lump in <5-year age group (79%) and abdominal pain in >5-year age group (93%). Postoperatively, symptoms were relieved in all (100%), parenchymal thickness (PT) on US improved in 82% and SRF improved significantly (>5%) in 75.8% of patients. The improvement was more significant in patients with abdominal lump and large kidneys. The mean nephrostomy output showed an inverse relationship with age at pyeloplasty and a direct correlation with the change in PT and SRF. The degree of improvement in SRF also was inversely related to the age at pyeloplasty with a significantly better outcome in <2-year-age. Although age at pyeloplasty, nephrostomy output and change in PT individually showed significant correlation with change in SRF, multiple regression analysis showed PT as the only significant factor. Conclusion: Upfront pyeloplasty should be the first option in children with poorly functioning kidneys as it has a favorable outcome in almost all the cases with a very low incidence of complications. The degree of improvement in SRF can be predicted by the nephrostomy output and improvement in PT on US.

Efficacy of Low-Level Laser Therapy in Management of Temporomandibular Joint Pain: A Double Blind and Placebo Controlled Trial.

Background: Stomatognathic system is an interaction of the muscles of mastication, dentition, neural component, and temporomandibular joint. Any dysfunction in this system may lead to temporomandibular disorders (TMDs). Various non-surgical modalities have been employed for treating TMDs. Aim and objectives: The aim of the study was to objectively evaluate the effects of low-level laser therapy (LLLT) in treatment of patients with TMDs. Materials and Methods: Sixty individuals diagnosed with TMDs were divided randomly into two groups (Group I-placebo and Group II -LLLT). A series of 20 sessions of LLLT applied both in closed mouth and maximum mouth opening position were given over a period of 08 weeks. Assessment was done in terms of improvement in mouth opening, pain, clicking, and deviation of mandible. The data collected were analyzed statistically. Results: The results showed improvement in the pain reduction, improvement in the maximum mouth opening, reduction in deviation, and clicking in both groups but better treatment outcome in the low-level laser group. Conclusion: Though conservative measures improved the symptoms in TMD but LLLT has shown better results in comparison with the placebo group. Being non-surgical can be employed in combination with other modes for effectively treating such disorders. Keywords: Pain, Dysfunction, Temporomandibular joint disorders (TMDs), Low-level laser therapy (LLLT).

Serum protease-activated receptor (PAR-1) levels as a potential biomarker for diagnosis of inflammation in type 2 diabetic patients.

BACKGROUND: Inflammation is a prominent clinical manifestation in type 2 diabetes mellitus (T2DM) patients, often associated with insulin resistance, metabolic dysregulation, and other complications. AIM OF THE STUDY: The present study has been designed to check the serum levels of PAR-1 and correlate with various clinical manifestations and inflammatory cytokines levels in type 2 diabetic subjects. MATERIAL AND METHODS: The study population was divided into two groups, healthy volunteers (n = 15): normal glycated hemoglobin (HbA1c) (4.26 ± 0.55) and type 2 diabetic subjects (n = 30): HbA1c levels (7.80 ± 2.41). The serum levels of PAR-1 (ELISA method) were studied in both groups and correlated with demographic parameters age, weight, body mass index (BMI), and conventional inflammation biomarkers like C-reactive protein (CRP), interleukin 6 (IL-6), interleukin 8 (IL-8), and tumour necrosis factor-alpha (TNF-α). RESULTS: The demographic variables including the body weight (77.38 ± 10.00 vs. controls 55.26 ± 6.99), BMI (29.39 ± 3.61 vs. controls 25.25 ± 4.01), glycemic index HbA1c (7.80 ± 2.41 vs. controls 4.26 ± 0.55) were found to be statistically increased in T2DM subjects than the healthy control group. The levels of various inflammatory biomarkers and PAR-1 were significantly elevated in T2DM groups in comparison to healthy volunteers. The univariate and multivariate regression analysis revealed that elevated PAR-1 levels positively correlated with increased body weight, BMI, HbA1c, and inflammatory cytokines. CONCLUSION: Our findings indicate that the elevated serum PAR-1 levels serve as an independent predictor of inflammation in T2DM subjects and might have prognostic value for determining T2DM progression.

Chronic Kidney Disease and COVID-19: Outcomes of hospitalised adults from a tertiary care centre in North India.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a novel disease caused by the SARS-CoV-2 virus and has emerged as a deadly pandemic affecting countries all over the world. Here we share our experience of managing adults with chronic kidney disease (CKD) and concomitant COVID-19 infection jointly managed by pediatric and adult nephrology teams. METHODS: This retrospective study was done on patient admissions (>18 years) between 20th June- 30th October 2020 with previously diagnosed CKD and hospitalised with COVID-19 infection. The demographic details, underlying comorbidities, clinical presentation, medications, laboratory, radiological profile and outcomes were studied. RESULTS: A total of 213 adults (62% males) with CKD were admitted during this period with a median (IQR) age of 52 (42, 60) years; 75 (35.2%) had associated diabetes mellitus, 83.1% hypertension, 5.2% hypothyroidism and 7% coronary artery disease. 165 (77.5%) were on maintenance haemodialysis (MHD), and 72.8% had arteriovenous fistula as vascular access at presentation. Most (84.5%) patients were symptomatic for COVID-19, and about 2/3 diarrhoea had moderate to severe disease. Oxygen therapy was needed in 62.9%, and medications used were hydroxychloroquine in 84.5%, azithromycin in 21.6%, ivermectin in 82.6%, steroids in 63.8% and Low molecular weight heparin in 59.2%. A further comparison of patients with CKD5D and CKDND revealed similar parameters except for a higher incidence of diarrhoea, acute kidney injury (AKI) and a shorter period to RTPCR negativity (12.5 vs 15 days; P = 0.038) in CKDND. The overall mortality was 24.4%, with similar mortality rates in both groups (P = 0.709) and 20.7% needed ICU transfer. CONCLUSIONS: Adults with CKD especially on haemodialysis, are prone to more severe COVID-19 infection and take a longer time for viral clearance (>2 weeks); the mortality too is higher in these patients.

Nutrient requirement equations for Indian goat by multiple regression analysis and least cost ration formulation using a linear and non-linear stochastic model.

An elaborate multiple regression analysis was done to arrive a nutrient requirement equation for goat including dry matter intake, DMI (kg/day), total digestible nutrient, TDN (g/day) and crude protein, CP (g/day) based on animal body weight (BW) (kg) and average daily gain (ADG)(g/day). The derived equations were highly significant (p < 0.001) and had high R2 (0.99) values. The estimated values of TDN, CP and DMI are compared with NRC (1981), Kearl (Nutrient Requirements of Ruminants in Developing Countries, All Graduate Theses and Dissertations, 1982), as well as ICAR (Livestock Management, 2013). The estimated total TDN and CP requirements at different body weights and ADG are close to the values of recommended feeding standards of Mandal et al. (Small Ruminant Res., 58, 2005, 201). The estimated DMI values are close to the values of ICAR (Livestock Management, 2013) but lower (26.5%-43.8%) as compared to NRC (1981). Regressed values are used to develop a linear programming (LP) model and a stochastic model (SM) for least-cost ration formulation for the Indian goat breed, whose average BW is about 45 kg and ADG is 130 (g/day), and which is solved using LP simplex and Generalised Reduced Gradient (GRG) nonlinear of Microsoft Excel. The models satisfy the nutrient requirement calculated by regression equations with minimum specified level of variation (usually 5%-10%) in CP and TDN. Both methods adequately meet the nutritional requirements. Therefore, an electronic sheet is developed in Excel to calculate DMI, TDN and CP for different body weights, ADG and formulate the ration by LP and stochastic model.

Intravitreal dexamethasone implant use as first-line therapy for cancer-associated retinopathy.

We present a 65-year-old female smoker who presented with acute bilateral blurred vision. Investigations led to an endobronchial ultrasound-guided fine-needle aspiration resulting in an early diagnosis of limited stage small cell lung cancer. Positive recoverin antibodies supported the diagnosis of cancer-associated retinopathy (CAR). CAR was the first manifestation of systemic malignancy in our patient and early diagnosis enabled curative intent systemic treatment with chemotherapy and radiotherapy. Ocular-specific treatment is required in CAR, although no standardised treatment exists. Current treatment options include steroids and immunosuppressive agents. Our patient was administered bilateral intravitreal dexamethasone implants, resulting in significant visual field and electroretinogram improvement at 8 weeks post-intervention. To our knowledge, this represents the first reported successful use of intravitreal dexamethasone implants as first-line therapy, in conjunction with chemoradiotherapy. Intravitreal dexamethasone implants therefore may provide an effective and safe treatment for CAR by reducing intraocular inflammation without systemic effects.

Simultaneous Detection of Biliary Injury and Vascular Infarct using 99mTc-HIDA Scintigraphy in a Patient with Trauma.

A 45-year-old male with a history of trauma was referred to the department of nuclear medicine to identify site of a biliary leak, which could not be identified in ultrasound and exploratory laparotomy. Contrast-enhanced computed tomography (CT) was able to identify lacerations in the right lobe of the liver, but the extent of injury to the biliary pathways and vessels was unclear. 99mTc-HIDA scintigraphy with single-photon emission CT/CT was not only able to identify the site of leak but also the extent of infarcted area.