Lack of Diversity in Transplant Hepatology Fellowship Program Directorship.

BACKGROUND: Diversity in medicine has garnered significant attention in recent medical workforce research, as studies consistently reveal the beneficial impact of race-concordant visits on patient outcomes, adherence, and satisfaction. While diversity among residency and fellowship program directors has been studied in other fields, little is known about the diversity within niche fellowship programs such as transplant hepatology. This study aims to investigate the demographic information of program directors in transplant hepatology fellowship programs. METHODS: We identified transplant hepatology fellowship programs and their program directors from the American College of Gastroenterology website. Multiple reviewers compiled demographic and training information from internet searches, which was analyzed using chi-square analysis. In assessing racial diversity, researchers identified perceived race using multiple indicators, including name, physical appearance, and affiliation with identity associations. RESULTS: Our study analyzed data from 72 program directors, with 61.11% being male. Among the program directors, 55.6% appeared non-Hispanic White, 36.11% appeared Asian, while apparent Hispanics and Blacks represented 5.56% and 4.17%, respectively. Our analysis also found that male program directors appeared largely non-Hispanic white (72.72%) and were significantly more likely to be professors (p = 0.045) rather than associate or assistant professors. DISCUSSION: Our findings indicate that transplant hepatology fellowship programs are primarily led by male and non-Hispanic White physicians. To attract underrepresented medical students and residents, it is critical to make meaningful efforts to improve diversity and ensure equitable representation of leaders. Future research should focus on developing strategies to build a more inclusive workforce while addressing existing leadership inequities.

Delayed Splenic Rupture due to an Occult Primary Injury.

Spleen, due to its unique position and relative mobility, is the most vulnerable organ in blunt abdominal injuries. After splenic trauma, hemodynamically unstable patients are treated with splenectomy. Delayed splenic rupture presents 48 to 72 hours after blunt abdominal trauma and is a rare entity. It is usually associated with low-velocity blunt injuries. The sequela is usually a minor trauma that is concealed initially and presents later as subcapsular hematoma, hemodynamic instability, abdominal pain, and positive Kehr's sign in most cases. Computed tomography is the investigation of choice in such cases. We discuss here a case of delayed splenic rupture that presented after eight weeks of a minor abdominal injury due to a fall. The patient presented with a tender left hypochondrium, positive Kehr's sign, and tachycardia. Computed tomography of the abdomen revealed delayed splenic rupture and hemoperitoneum. As the initial imaging is usually normal in these cases, a routine follow-up and close monitoring of trauma patients can help in the early detection of complications. Key Words: Splenectomy, Splenic rupture, Kehr's sign, Hemoperitoneum.

Double Peptic Ulcer Perforation due to Cumulative Effects of Post-surgery Stress and NSAIDs: A Rare Event in Surgical Practice.

Peptic ulcer disease affects a large number of people around the world. Complications occur in 10-20% of patients and perforation develops in 2-14% of the cases. It can either be in the pyloric part of the stomach or in the first part of duodenum. Helicobacter pylori infection and nonsteroidal anti-inflammatory drugs (NSAIDs) abuse and smoking are noted to be the most common risk factors in developing countries. Other risk factors are steroid abuse, post-surgery stress, burns and Zollinger-Ellison syndrome. Although small perforations can be treated conservatively but Graham patch repair is the treatment of choice. Double peptic ulcer perforation is a rare event with only a few cases reported worldwide. This patient presented with double peptic ulcer perforation in emergency due to post-surgery stress. She had cesarean section 10 days earlier with delayed recovery. Key Words: Peptic ulcer disease, Perforation, Graham patch repair, Cesarean section.

Hyperimmune anti-COVID-19 IVIG (C-IVIG) treatment in severe and critical COVID-19 patients: A phase I/II randomized control trial.

BACKGROUND: Hyperimmune anti-COVID-19 Intravenous Immunoglobulin (C-IVIG) is an unexplored therapy amidst the rapidly evolving spectrum of medical therapies for COVID-19 and is expected to counter the three most life-threatening consequences of COVID-19 including lung injury by the virus, cytokine storm and sepsis. METHODS: A single center, phase I/II, randomized controlled, single-blinded trial was conducted at Dow University of Health Sciences, Karachi, Pakistan. Participants were COVID-19 infected individuals, classified as either severely or critically ill with Acute Respiratory Distress Syndrome (ARDS). Participants were randomized through parallel-group design with sequential assignment in a 4:1 allocation to either intervention group with four C-IVIG dosage arms (0.15, 0.20, 0.25, 0.30 g/kg), or control group receiving standard of care only (n = 10). Primary outcomes were 28-day mortality, patient's clinical status on ordinal scale and Horowitz index (HI), and were analysed in all randomized participants that completed the follow-up period (intention-to-treat population). The trial was registered at clinicaltrials.gov (NCT04521309). FINDINGS: Fifty participants were enrolled in the study from June 19, 2020 to February 3, 2021 with a mean age of 56.54±13.2 years of which 22 patients (44%) had severe and 28 patients (56%) had critical COVID-19. Mortality occurred in ten of 40 participants (25%) in intervention group compared to six of ten (60%) in control group, with relative risk reduction in intervention arm I (RR, 0.333; 95% CI, 0.087-1.272), arm II (RR, 0.5; 95% CI, 0.171-1.463), arm III (RR, 0.167; 95% CI, 0.024-1.145), and arm IV (RR, 0.667; 95% CI, 0.268-1.660). In intervention group, median HI significantly improved to 359 mmHg [interquartile range (IQR) 127-400, P = 0.009)] by outcome day, while the clinical status of intervention group also improved as compared to control group, with around 15 patients (37.5%) being discharged by 7th day with complete recovery. Additionally, resolution of chest X-rays and restoration of biomarkers to normal levels were also seen in intervention groups. No drug-related adverse events were reported during the study. INTERPRETATION: Administration of C-IVIG in severe and critical COVID-19 patients was safe, increased the chance of survival and reduced the risk of disease progression. FUNDING: Higher Education Commission (HEC), Pakistan (Ref no. 20-RRG-134/RGM/R&D/HEC/2020).

Higher albumin levels on admission predict better prognosis in patients with confirmed COVID-19.

BACKGROUND: Research surrounding COVID-19 (coronavirus disease 2019) is rapidly increasing, including the study of biomarkers for predicting outcomes. There is little data examining the correlation between serum albumin levels and COVID-19 disease severity. The purpose of this study is to evaluate whether admission albumin levels reliably predict outcomes in COVID-19 patients. METHODS: We retrospectively reviewed 181 patients from two hospitals who had COVID-19 pneumonia confirmed by polymerase chain reaction (PCR) testing and radiologic imaging, who were hospitalized between March and July 2020. We recorded demographics, COVID-19 testing techniques, and day of admission labs. The outcomes recorded included the following: venous thromboembolism (VTE), acute respiratory distress syndrome (ARDS), intensive care unit (ICU) admission, discharge with new or higher home oxygen supplementation, readmission within 90 days, in-hospital mortality, and total adverse events. A multivariate modified Poisson regression analysis was then performed to determine significant predictors for increased adverse events in patients with COVID-19 pneumonia. RESULTS: A total of 109 patients (60.2%) had hypoalbuminemia (albumin level < 3.3 g/dL). Patients with higher albumin levels on admission had a 72% decreased risk of developing venous thromboembolism (adjusted relative risk [RR]:0.28, 95% confidence interval [CI]:0.14-0.53, p<0.001) for every 1 g/dL increase of albumin. Moreover, higher albumin levels on admission were associated with a lower risk of developing ARDS (adjusted RR:0.73, 95% CI:0.55-0.98, p = 0.033), admission to the ICU (adjusted RR:0.64, 95% CI:0.45-0.93, p = 0.019), and were less likely to be readmitted within 90 days (adjusted RR:0.37, 95% CI:0.17-0.81, p = 0.012). Furthermore, higher albumin levels were associated with fewer total adverse events (adjusted RR:0.65, 95% CI:0.52-0.80, p<0.001). CONCLUSIONS: Admission serum albumin levels appear to be a predictive biomarker for outcomes in COVID-19 patients. We found that higher albumin levels on admission were associated with significantly fewer adverse outcomes, including less VTE events, ARDS development, ICU admissions, and readmissions within 90 days. Screening patients may lead to early identification of patients at risk for developing in-hospital complications and improve optimization and preventative efforts in this cohort.

Impaction of Phytobezoar at Meckel's Diveticulum.

Small bowel obstruction secondary to phytobezoars is a rare presentation in surgery. These are masses of undigested food and vegetables, which obstruct the narrowest part of gut. We discuss a case of a young patient presenting in emergency department with history of acute abdominal pain, distension and constipation. Diagnosis of acute intestinal obstruction was made on the basis of history, examination, and initial investigations. Exploratory laparotomy revealed a phytobezoar at the origin of Meckel's diverticulum, which was an incidental finding. He underwent wedge resection with primary closure and removal of phytobezoar. The change in dietary habits, decreased fiber intake, and psychiatric evaluation can prevent recurrence.

Comparative study of two bacteriocins produced by representative indigenous soil bacteria.

The aim of this research work was to identify and characterized the bacteriocins produced by soil-associated bacteria. Bacillocin from Bacillus brevis Bb and pyocin from Pseudomonas aeruginosa Pa were found bioactive only against gram-positive bacteria tested. Maximum production of both the bacteriocins was observed at 32 degrees C in BHI medium. Production of both the bacteriocins started in the early exponential growth phase while the maximum production was observed during the stationary phase. Bacillocin Bb remained stable during 1-9 pH while pyocin Pa remained stable at pH 1-11. Both of the bacterocins were found resistant to high temperature (100 degrees C for 30 min), detergents (1% solutions of EDTA, Tween 20, Tween 80 and SDS) and organic solvents (1% solutions of Ethanol, Butanol, Methanol, Propanol, Chloroform, and Acetone). Activity of both was completely lost after proteinase K treatment suggesting their protein nature. Titre of bacillocin Bb was estimated to be 5280 AU/mL while the titre for pyocin Pa was calculated as 640 AU/mL. Both of the bacteriocins showed bacteriolytic mode of action against the indicator Bacillus strain BC31 and were found <10 KDa in their molecular mass.