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This study examines the effects of blending virgin cotton fibres of selected lengths with a fixed percentage of recycled fibres on yarn quality. By choosing three different lengths of virgin cotton fibres and incorporating 20% recycled fibre, we investigate the resultant yarn properties through detailed statistical analysis. Our research identifies significant enhancements in yarn quality with increased virgin fibre length, offering new insights into effective fibre blending strategies. This investigation supports the textile industry in refining fibre blend ratios for improved yarn qualities while advocating for sustainable practices through the utilization of recycled fibres. It sets the stage for future exploration aimed at optimizing the balance between virgin and recycled fibres to achieve superior yarn characteristics.

The present world is focusing on sustainable products. Most of the natural products collected from are environmentally friendly. In the textile sector the main raw material is fiber. Most textile products are made from the natural cotton fibers. But because of the shortage of this fiber, most of the researchers are looking forwards to other sources of natural fibers. Here in Bangladesh the natural jute fiber is available and the textile industries are making jute products but the jute products are comparatively lower price than cotton products. That's why some factories are making cotton-jute blended yarn to minimise the cost and increase the product's quality and appearance. Here in this research work, it was tried to identify the best cotton-jute blended ratio for producing good quality yarn. 80C-20 J, 60C-40 J and 40C-60 J blended ratios are compared with 100 C and 100 J yarn to analyse the results. The CV m%, Thick/Km +50 %, Neps/Km +200 %, IPI, RKM and Elongation% of blended yarns are evaluated and compared the results between the ratios. After that the yarn quality index (YQI) was calculated to identify the ratio which indicates a relation between yarns strength, elongation% and CVm. The other quality index was fiber quality index (FQI) which indicates a relation between fibers strength, fiber mean length, elongation% and fiber fineness. One way ANOVA was applied to see the significance level between the independent variables. Box plot was applied to see the visual effect of statistical analysis at the same time the regression results show the impact of cotton-jute ratio with an equation, through which it was easy to identify the perfect ratio. It was found that higher percentage of cotton and lower percentage of jute fiber blended yarn shows good results than others. The products which were made from the ratios were shown good results for their different use of purposes.

Abstract Recycling and converting textile waste into value-added products with enhanced functional properties pave the way toward a circular economy for sustainability. This research investigates the utilization of recycled cotton fiber from apparel cutting waste for fabricating high-performance thermal barrier fabrics. The physical characterization of the developed fabrics revealed a regular arrangement of fibers, consequently the uniform thickness of the fabric with no distortion on fiber surfaces due to the recycling operation of cotton waste. The developed fabrics also demonstrated a high softness index and low compression and bending average rigidity compared to the commercial fabric with similar thickness. The heat protection performance revealed an increase in fabric conductive and radiative heat resistance with increasing the amount of recycled cotton fiber in the fabrics. The inherent thermal resistance of cotton fiber and the low inter-fiber spacing because of their uniform orientation in the fabric lead to the high thermal resistance of developed fabrics. In the case of fabric air permeability concerning the clothing thermal comfort, no significant difference in breathability was observed among the test specimens. Besides, the moisture management profile of developed fabrics indicated the capability to create favorable thermal comfort within the clothing-skin microenvironment because of improved liquid transportation and diffusion of perspiration vapor through the fabric.

Gypsum plasterboards are widely used in interior decoration like false ceilings, wall partitioning etc. The main component of this plasterboard is gypsum, which is a mineral material. These boards contain poor mechanical strength with lower durability. The addition of natural fibres in these plasterboards can be useful to achieve better mechanical properties. Since Jute fibre is abundant in Bangladesh and its usability in reinforced composites is well established, for this reason, jute fibre was selected to do the research. The aim of this study was to evaluate the impact of jute fibre on the mechanical properties of the gypsum plasterboard. To make this board, Plaster of Paris and water were thoroughly mixed to make a suspension first. Different fibre loadings of 2, 4, 6, and 8% were incorporated into gypsum composites. Reinforcement of 6% fibre provided the highest tensile properties, but 8% fibre loading showed inferior tensile and flexural properties. Impact test results showed a gradually improving nature with fibre loading, and hardness values showed a decreasing trend in hardness with higher fibre loading. FTIR results and SEM images confirmed that no significant chemical bonding took place in the composites, instead, the composite depended mainly on the mechanical bonding among the reins crystals and between the fibre and gypsum matrix.

Coir is a lignocellulosic natural fiber derived from the coconut's husk, an abundantly found fruit or nut worldwide. This fiber has some unique characteristics, such as its resistance to seawater, microbial attack, high impact, etc. But its low thermal conductivity or high thermal insulating property makes it suitable for being used as insulators in civil engineering sites. On the other hand, the sustainability of a material depends heavily on its environmental impact of the material. For making sustainable materials like biocomposite, there are no options other than using polymers derived from natural renewable sources. Polylactic acid(PLA) is an example of those types of material. And these materials are often being reinforced by fibers like coir for various reasons including improving mechanical properties, reducing the cost of the material, and improving the material's sustainability. Many coir-reinforced sustainable biopolymer composites have already been produced in many pieces of research, which will be discussed in this paper, along with the chemical and physical structure of coir fiber. In addition, this paper will try to focus on the insulating properties of coir and coir-reinforced composites while will also compare some properties of the composites with some commonly used materials based on different parameters to show the suitability of using the coir fiber in heat-insulating applications and to produce sustainable biocomposite materials.

Essentially cell forming and vigorous conjunctive tissues such as skin, joints, ligaments, and bones are expressed as fibril forming the most abundant protein collagen in the human body substantially about one-quarter by weight. Additionally, amongst the biopolymers, the collagen macromolecule is serving humanity in myriad ways. Although it has been used in cosmetics for a long time, nowadays its biological characteristics like nontoxic, biocompatible, biodegradable, structural integrity, cellular affinity and weak antigenicity have encouraged using of it significantly in biomedical and pharmaceutical applications. Its excellent biodegradability and notable bioactivity by endogenous collagenases enzyme convert exogenous collagen for biomedical use. Triple helix 29 collagen composed of three α-chain characteristic variants, type I is the most suitable extracellular matrix (ECM) macromolecule gradually consumed thickness and strength with time being, can be correlated with skin aging phenomena. This review focuses on the sources, structures, extractions, and properties (e.g., bioactive, mechanical, viscoelastic, tensile, etc.) of collagen proteins for use in biomedical applications. The abundance of collagen protein from a natural source can be effectively used in human tissue scaffolds, cardiac implantation, wound healin g, cornea membranes, dental membrane, dermal filler, cosmetic surgery, etc. as highlighted in this review. The application-based advantages and disadvantages of body-suits collagen are also discussed with prospects.

Objectives: Aging is one of the most critical stages of human development that has its own characteristics and conditions. One of the most common issues in old age is the mental health whose achievement requires special attention from both health system policymakers and service providers to the elderly. Death anxiety is one of the most common mental health issues in old age, because this period is full of feelings of shortcomings and disabilities. Since death anxiety is a multidimensional factor, it is expected to affect many aspects of the elderly. The present study aims to review and analyze published studies in the field of death anxiety in the elderly in Iran. Methods & Materials: This is a systematic review and meta-analysis conducted on the studies related to the death anxiety of the elderly in Iran published in Persian from 2011 to 2019. A search was conducted in national databases, including SID, IranDoc, MagIran, IDML, and CIVILICA using the keywords: Death anxiety, elderly, and older adult. Initial search yielded 61 articles. After screening, 33 studies that met the entry and exit criteria were selected for the final review. We used Stata v. 14 and SPSS v. 22 applications to perform meta-analysis. Results: In the studies, 40.35% of the participants were older women and the rest were older men with a mean age of 67.80±6.44 years. The mean score of death anxiety was higher in men than in women, and the elderly living in nursing homes had the highest score (11.8). Studies were categorized into three sections: comparison (3 studies), intervention (11 studies), and factors affecting the death anxiety (18 studies). The results of meta-analysis showed no significant relationship between spiritual therapy and reduction of death anxiety in the elderly (P>0.05). In studies with spiritual and behavioral therapies, the heterogeneity was significant and, thus, a significant positive relationship was observed between the reduction of death anxiety and these treatments methods. Conclusion: The death anxiety level of the elderly in Iran is low. Religious beliefs, hopes for the intercession of imams and religious leaders, and hopes for freedom from the hardships of worldly life seem to have contributed to low death anxiety in Iran. Different death anxiety scores have been reported for older men and women in Iran may be due to the effect of culture, religion, and traditions, the difference in the roles of men and women, and even the expression of fear and anxiety. Most of men have less tendency to express their emotions, including fear, while women are more likely to express their feelings. Behavioral and spiritual interventions lead to a decrease in the elderly’s death anxiety through affecting their finding meaning in life.

Abstract This study deals with the determination of new natural fibers extracted from the Corypha taliera fruit (CTF) and its characteristics were reported for the potential alternative of harmful synthetic fiber. The physical, chemical, mechanical, thermal, and morphological characteristics were investigated for CTF fibers. X-ray diffraction and chemical composition characterization ensured a higher amount of cellulose (55.1 wt%) content and crystallinity (62.5%) in the CTF fiber. The FTIR analysis ensured the different functional groups of cellulose, hemicellulose, and lignin present in the fiber. The Scherrer’s equation was used to determine crystallite size 1.45 nm. The mean diameter, specific density, and linear density of the CTF fiber were found (average) 131 μm, 0.86 g/cc, and 43 Tex, respectively. The maximum tensile strength was obtained 53.55 MPa for GL 20 mm and Young’s modulus 572.21 MPa for GL 30 mm. The required energy at break was recorded during the tensile strength experiment from the tensile strength tester and the average values for GL 20 mm and GL 30 mm are 0.05381 J and 0.08968 J, respectively. The thermal analysis ensured the thermal sustainability of CTF fiber up to 230 °C. Entirely the aforementioned outcomes ensured that the new CTF fiber is the expected reinforcement to the fiber-reinforced composite materials.

Political participation is taken into account as one of the main development indicators. If we consider political development as equivalent to “extension of participation and competition of social groups in their political lives”, then undoubtedly political participation would be one of its prerequisites. Therefore, policy makers emphasize the importance of woman participation in the political fields for a comprehensive development. Therefore, it is necessary to examine the features which influence political participation of women. The statistic group consisted of 384 people. Research method was evaluative and questionnaire was used in order to collect data; SPSS was conducted to test the results. The findings show that there is a significant relationship among political confidence, political awareness, and voluntary organizations. Accordingly, increasing awareness of people and getting them involved in their own destiny through non-governmental organizations can increase both their participation and political trust.

The main objective of this research is to predict the mechanical properties of viscose/lycra plain knitted fabrics by using fuzzy expert system. In this study, a fuzzy prediction model has been built based on knitting stitch length, yarn count, and yarn tenacity as input variables and fabric mechanical properties specially bursting strength as an output variable. The factors affecting the bursting strength of viscose knitted fabrics are very nonlinear. Hence, it is very challenging for scientists and engineers to create an exact model efficiently by mathematical or statistical model. Alternatively, developing a prediction model via ANN and ANFIS techniques is also difficult and time consuming process due to a large volume of trial data. In this context, fuzzy expert system (FES) is the promising modeling tool in a quality modeling as FES can map effectively in nonlinear domain with minimum experimental data. The model derived in the present study has been validated by experimental data. The mean absolute error and coefficient of determination between the actual bursting strength and that predicted by the fuzzy model were found to be 2.60% and 0.961, respectively. The results showed that the developed fuzzy model can be applied effectively for the prediction of fabric mechanical properties.

Background: New guidelines propose a minimum 5-year survival of 60% for hepatocellular carcinoma (HCC) with living donor liver transplantation (LDLT). This study aimed to evaluate the 5- and 10-year survival rates after transplantation for the expanded criteria for HCC., Methods: This single-center retrospective cohort study included 208 patients who underwent LDLT for the expanded criteria (the largest tumor diameter of ≤10 cm, any tumor number, and alpha-fetoprotein [AFP] level of <1000 ng/mL) and analyzed 5- and 10-year overall survival (OS) and recurrence risk (RR) rates., Results: With a median follow-up of 65.1 months (IQR, 19.1-80.2), the 5- and 10-year OS and RR rates were 67.0% and 61.0% and 20.5% and 22.5%, respectively. The largest tumor diameter of >6 cm (hazard ratio [HR], 3.7; 95% CI, 1.7-8.2; P = .001) and AFP level of >400 ng/mL (HR, 4.0; 95% CI, 1.8-9.0; P = .001) were predictors of recurrence. Patients outside the Milan criteria (MC) were grouped into low- and high-risk HCC based on tumor size and AFP level. For low-risk HCC (tumor size of <6 cm, any tumor number, and AFP level of <400 ng/mL), the 5-year RR was comparable to the MC and increased the transplant pool by 35.7% (P > .5). The median number of tumors and the rate of microvascular invasion in the high-risk group, low-risk group, and MC were 2.0 (1.0-3.2), 4.0 (2.0-5.0), and 1.0 (1.0-2.0) (P < .001) and 72.2% (13/18), 44.0% (22/50), and 22.8% (32/140) (P < .001), respectively., Conclusion: The expanded criteria met the benchmark for 5-year survival. LDLT for the low-risk HCC in the expanded criteria was associated with an acceptable RR., (Copyright © 2024 Society for Surgery of the Alimentary Tract. Published by Elsevier Inc. All rights reserved.)

A neurogenic dumbbell tumour is a rare occurrence in which the tumour has an extension through an intervertebral foramen, acquiring an hourglass shape. Surgical strategies to resect these tumours are rapidly evolving, and there is no definite consensus on the approach, stages, and plan of surgery. Here, we present a case report on a dumbbell tumour that was successfully resected via laminectomy and video-assisted thoracoscopic surgery (VATS) approach. A 53-year-old lady had an incidental finding of a mediastinal mass from chest radiography. Computed tomography (CT) and magnetic resonance imaging (MRI) studies showed a neurogenic mass with extension into the posterior mediastinum via the T1/2 neural foramina. A multi-disciplinary operation was planned for the patient, starting with neurosurgery resecting the intraspinal portion via laminectomy. The posterior mediastinal portion of the mass was resected via the right VATS approach and was successfully resected entirely. Her operation was complicated with a cerebrospinal fluid (CSF) leakage, requiring a revisit surgery. She was subsequently discharged well. Histopathology examination of the resected mass confirmed the diagnosis of schwannoma. Surgical resection of a dumbbell tumour is challenging because it involves both the thoracic and neurosurgical fields. There is currently no consensus on the best way to approach a tumour. Multiple articles have discussed various approaches, such as single-stage versus two-stage surgery, VATS versus open incisions, and the plan or sequence of the surgery. Dumbbell tumours need to be assessed on a case-by-case basis, and a multidisciplinary approach involving both neurosurgery and cardiothoracic surgery in deciding the best surgical approach could ensure a successful resection., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ng et al.)

Despite the promising role of renal replacement therapy (RRT) in acute liver failure (ALF), high-risk patients need liver transplantation and remain at risk for death due to cerebral complications. The objective of this study was to report outcomes of living donor liver transplantation (LDLT) for ALF with perioperative RRT. This was a single-center retrospective cohort study. Out of 1167 LDLTs, 24 patients had ALF and met the King's College criteria for transplantation. They were categorized into no-RRT ( n = 13) and RRT ( n = 11) groups. We looked at 1-year posttransplant survival in these patients. The median serum ammonia level at the time of transplant in the no-RRT and RRT groups was 259.5 mcg/dL (222.7-398) and 70.6 mcg/dL (58.1-92.6) ( p = 0.005). In the RRT group, serum ammonia level < 100 mcg/dL was achieved in all patients. Seven (53.8%) patients in the no-RRT group and 11/11 (100%) in the RRT group were extubated and regained full consciousness after LDLT ( p = 0.013). The 90-day mortality was 6/13 (46.1%) and 2/11 (18.1%) ( p = 0.211). There was no brainstem herniation-related mortality in the RRT group, that is, 5/13 (38.4%) and 0/11 (0%) ( p = 0.030). The 1-year posttransplant survival was also significantly higher in the RRT group ( p = 0.031). The use of RRT lowers serum ammonia levels and might reduce posttransplant mortality due to brainstem herniation., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Abu Bakar Hafeez Bhatti et al.)

Coronary artery bypass grafting (CABG) utilizing saphenous vein grafts (SVGs) stands as a fundamental approach to surgically treating coronary artery disease. However, the long-term success of CABG is often compromised by the development of intimal hyperplasia (IH) and subsequent graft failure. Understanding the mechanisms underlying this pathophysiology is crucial for improving graft patency and patient outcomes. Objectives : This study aims to explore the potential of an ex vivo model utilizing SVG to investigate IH and re-endothelialization. Methods : A thorough histological examination of 15 surplus SVG procured from CABG procedures at Hospital Canselor Tuanku Muhriz, Malaysia, was conducted to establish their baseline characteristics. Results : SVGs exhibited a mean diameter of 2.65 ± 0.93 mm with pre-existing IH averaging 0.42 ± 0.13 mm in thickness, alongside an observable lack of luminal endothelial cell lining. Analysis of extracellular matrix components, including collagen, elastin, and glycosaminoglycans, at baseline and after 7 days of ex vivo culture revealed no significant changes in collagen but demonstrated increased percentages of elastin and glycosaminoglycans. Despite unsuccessful attempts at re-endothelialization with blood outgrowth endothelial cells, the established ex vivo SVG IH model underscores the multifaceted nature of graft functionality and patency, characterized by IH presence, endothelial impairment, and extracellular matrix alterations post-CABG. Conclusions : The optimized ex vivo IH model provides a valuable platform for delving into the underlying mechanisms of IH formation and re-endothelialization of SVG. Further refinements are warranted, yet this model holds promise for future research aimed at enhancing graft durability and outcomes for CAD patients undergoing CABG.

Pulmonary metastases in soft tissue, such as sarcoma and osteosarcoma, are associated with a poor prognosis. A complete surgical resection has been proven to prolong survival. We report four cases of sarcoma with pulmonary metastases, all with differing progressions, prognoses, and management. This highlights the challenging nature of managing sarcoma with pulmonary metastases. Surgical metastatectomy remains the mainstay treatment for sarcoma with pulmonary metastases. Studies have demonstrated a significant survival benefit with complete surgical resection. There is currently no consensus on the size of the metastasis or the number of lesions for considering a patient inoperable. Surgical metastatectomy provides improved survival for sarcoma patients with pulmonary metastases. Management strategy is rapidly evolving with the emergence of new treatment methods. A case-by-case assessment and MDT approach are paramount in deciding the best course of action., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ng et al.)

Sternal osteomyelitis and mediastinitis are rare yet severe complications post-cardiac surgery, often associated with significant morbidity and mortality. Fungal etiologies, particularly those caused by Rhizopus spp., are infrequent but can lead to aggressive infections. Here, we present the case of a 68-year-old male who developed sternal osteomyelitis and mediastinitis caused by Rhizopus spp. two weeks following coronary artery bypass grafting surgery. Debridement and pectoralis flap reconstruction were performed following clinical identification and confirmation with microbiological examinations and a CT scan. Prompt recognition, aggressive surgical intervention, and targeted antifungal therapy were crucial for successful management. This case underscores the importance of considering fungal pathogens, such as Rhizopus , in the differential diagnosis of post-cardiac surgery infections, as well as aggressive treatment to improve outcomes for affected patients., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Tiew et al.)

Background: Long-term medical and quality of life (QOL) outcomes in voluntary liver donors remain under investigated. The objective of the current study was to report long-term medical outcomes and re-evaluate QOL in living liver donors., Methods: This was a single-center retrospective cohort study of donors who underwent donor hepatectomy between 2012 and 2018. We investigated long-term outcomes in 7 domains. These include medical problems, surgical procedures, work-related issues, pregnancy outcomes, psychiatric interventions, willingness to donate again, and long-term mortality. QOL was evaluated using short-form 36., Results: The median follow-up time was 61.4 months (53.3-83.7). Among 698 donors, 80 (11.5%) experienced medical problems, 4 (0.6%) had work-related issues, and 20 (2.9%) needed psychiatric assistance. Surgery was performed in 49 donors (7%), and females were more likely to have undergone incisional hernia repair (5.8% vs 1.9%, P = .006). There were 79 postdonation pregnancies including 41 normal vaginal deliveries (51.9%), 35 cesarean sections (44.3%), and 3 miscarriages (3.8%). Willingness to donate again was reported by 658 donors (94.3%). Donors whose recipients were alive were more likely to donate again (95.5% vs 90.5%, P = .01). There were 3 deaths (0.4%) in the long-term. The mean physical composite score at initial and follow-up evaluation was 86.7 ± 13.9 and 76.5 ± 20.9 (P = .001), and the mean mental composite score at initial and follow-up evaluation was 92.1 ± 13.5 and 80.7 ± 16 (P = .001)., Conclusion: The overall long-term outlook in living liver donors is promising. QOL parameters might deteriorate over time and frequent re-evaluation might be considered., (Copyright © 2024 Society for Surgery of the Alimentary Tract. Published by Elsevier Inc. All rights reserved.)

Introduction: There is no consistency in current practice pertaining to the prescription and progression of upper limb resistance exercise following cardiac surgery via median sternotomy. The aim of this study is to investigate whether less restrictive sternal precautions with the addition of early-supervised resistance training exercise improves upper limb function and facilitates recovery following median sternotomy., Methods and Analysis: This is double-blind randomised controlled trial, with parallel group, concealed allocation, blinding of patients and assessors, and intention-to-treat analysis. 240 adult participants who had median sternotomy from eight hospitals in Malaysia will be recruited. Sample size calculations were based on the unsupported upper limb test. All participants will be randomised to receive either standard or early supervised incremental resistance training. The primary outcomes are upper limb function and pain. The secondary outcomes will be functional capacity, multidomain recovery (physical and psychological), length of hospital stay, incidence of respiratory complications and quality of life. Descriptive statistics will be used to summarise data. Data will be analysed using the intention-to-treat principle. The primary hypothesis will be examined by evaluating the change from baseline to the 4-week postoperative time point in the intervention arm compared with the usual care arm. For all tests to be conducted, a p value of <0.05 (two tailed) will be considered statistically significant, and CIs will be reported. The trial is currently recruiting participants., Ethics and Dissemination: The study was approved by a central ethical committee as well as the local Research Ethics Boards of the participating sites (UKM:JEP-2019-654; Ministry of Health: NMMR-50763; National Heart Centre: IJNREC/501/2021). Approval to start was given prior to the recruitment of participants commencing at any sites. Process evaluation findings will be published in peer-reviewed journals and presented at relevant academic conferences., Trial Registration Number: International Standard Randomised Controlled Trials Number (ISRCTN17842822)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: The treatment of Plasmodium vivax malaria with 8-aminoquinolines is contraindicated in glucose-6-phosphate dehydrogenase (G6PD) deficient individuals due to the risk of acute haemolytic anaemia. Effective G6PD screening is paramount to avoid adverse drug reactions. This study aimed to evaluate the performance of novel quantitative point-of-care (POC) tests as a new screening method for G6PD deficiency in Malaysia., Materials and Methods: A total of 153 neonatal cord blood, 99 peripheral blood of older children aged between 1 month to 12-years old, and 62 peripheral adult blood were screened for G6PD deficiency using two quantitative POC tests, CareStartTM biosensor (Carestart) and CareStartTM Biosensor 1 (S1). The results were compared with OSMMR2000D kit as a reference assay. Two statistical analyses were performed in this study to evaluate the POC test performances, the Spearman's correlation test and the Cohen's kappa method., Results: Both Carestart and S1 tests showed significant positive correlations to OSMMRS000D with r 2 = 0.7916 and r 2 = 0.7467. Their measurement of agreement showed a kappa (κ) value of 0.805 (p<0.001, 95% CI), and 0.795 (p<0.001, 95% CI), respectively. Analysis of the area under the Receiver Operating Curve (ROC) at 60% cut-off illustrated that the Carestart had 90.2% sensitivity, 98.9% specificity, 98.3% positive predictive value (PPV), and 93.8% negative predictive value (NPV). The corresponding values for the S1 were 95.2%, 100%, 100%, and 96.8%, respectively., Conclusion: This study showed that the Carestart and S1 biosensors have high-performance reliability for screening of G6PD deficiency, which can guide safe prescriptions of anti-malaria medications and hence, eradication of Plasmodium vivax malaria.

Backgrounds/aims: Locally advanced gallbladder cancer (GBC) is associated with survival limited to a few months. Extended resections (ER) are occasionally performed in this group and outcomes remain inconclusive. This study assessed outcomes after ER for locally advanced GBC., Methods: Patients who underwent ER for GBC between 2011 and 2020 were reviewed. ER was defined as a major hepatectomy alone (n = 9), a pancreaticoduodenectomy (PD) with or without minor hepatectomy (n = 3), a major hepatectomy with PD (HPD) (n = 3) or vascular resection and reconstruction (n = 4). We assessed 30-day morbidity, mortality, and 2-year overall survival (OS)., Results: Among 19 patients, negative margins were achieved in 14 (73.6%). The 30-day mortality was 1/9 (11.1%) for a major hepatectomy, 0/3 (0%) for a minor HPD, 2/3 (66.7%) for a major HPD, and 1/4 (25.0%) for vascular resection. All short term survivors (< 6 months) (n=8) had preoperative jaundice and 6/8 (75.0%) underwent a major HPD or vascular resection. There were five (26.3%) long term survivors. The median OS in patients with and without preoperative jaundice was 4.1 months (0.7-11.1 months) and 13.7 months (12-30.4 months), respectively ( p = 0.009) (2-year OS = 7% vs. 75%; p = 0.008). The median OS in patients who underwent a major hepatectomy alone or a minor HPD was 11.3 months (6.8-17.3 months) versus 1.4 months (0.3-4.1 months) ( p = 0.02) in patients who underwent major HPD or vascular resection (2 year OS = 33% vs. not reached) ( p = 0.010) respectively., Conclusions: In selected patients with GBC, when ER is limited to a major hepatectomy alone, or a minor HPD, acceptable survival can be achieved.

Background: Intrapleural fibrinolytic therapy (IPFT) is one of the treatment options for complex pleural effusion. In this study, the IPFT agent used was alteplase, a tissue plasminogen activator (t-PA). This study aims to determine the difference in the outcome of patients with complex pleural effusion between IPFT and surgery in terms of radiological improvement, inflammatory parameters, length of stay, and post-intervention complications., Methods: A retrospective review of patients with complex pleural effusion treated at Universiti Kebangsaan Malaysia Medical Center from January 2012 to August 2020 was performed. Patient demographics, chest imaging, drainage chart, inflammatory parameters, length of hospital stay, and post-intervention and outcome were analyzed., Results: Fifty-eight patients were identified (surgical intervention, n = 18; 31% and IPFT, n = 40, 69%). The mean age was 51.7 ± 18.2 years. Indication for surgical intervention was pleural infection (n = 18; 100%), and MPE (n = 0). Indications for IPFT was pleural infection (n = 30; 75%) and MPE (n = 10; 25%). The dosages of t-PA were one to five doses of 2-50 mg. The baseline chest radiograph in the IPFT group was worse than in the surgical intervention group. (119.96 ± 56.05 vs. 78.19 ± 55.6; p = 0.029) At week 1, the radiological success rate for IPFT and surgical intervention were 27% and 20%, respectively, and at weeks 4-8, the success rate was 56% and 80% respectively. IPFT was associated with lesser complications; fever (17.5%), chest pain (10%), and non-life-threatening bleeding (5%)., Conclusion: IPFT was comparable to surgery in radiological outcome, inflammatory parameters, and length of stay with lesser reported complications., (© 2022. The Author(s).)

Purpose: Textbook outcome (TO) is a composite measure of outcome and provides superior assessment of quality of care after surgery. TO after major living donor hepatectomy (MLDH) has not been assessed. The objective of this study was to determine the rate of TO and its associated factors, after MLDH., Methods: This was a single center retrospective review of living liver donors who underwent MLDH between 2012 and 2021 (n = 1022). The rate of TO and its associated factors was determined., Results: Among 1022 living donors (of whom 693 [67.8%] were males, median age 26 [range, 18-54] years), TO was achieved in 714 (69.9%) with no donor mortality. Majority of donors met the cutoffs for individual outcome measures: 908 (88.8%) for no major complications, 904 (88.5%) for ICU stay ≤ 2 days, 900 (88.1%) for hospital stay ≤ 10 days, 990 (96.9%) for no perioperative blood transfusion, 1004 (98.2%) for no 30-day re-admission, and 1014 (99.2%) for no post-hepatectomy liver failure. Early donation era (before streamlining of donor operative pathways) was associated with failure to achieve TO [OR 1.4, CI 1.1-1.9, P = 0.006]. TO was achieved in 506/755 (67%) donors in the early donation era versus 208/267 (77.9%) in the later period (P = 0.001)., Conclusion: Despite zero mortality and low complication rate, TO was achieved in approximately 70% donors. TO was modifiable and improved with changes in donor operative pathway., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Rapid deployment of COVID-19 vaccines is challenging for safety surveillance, especially on adverse events of special interest (AESIs) that were not identified during the pre-licensure studies. This study evaluated the risk of hospitalisations for predefined diagnoses among the vaccinated population in Malaysia., Methods: Hospital admissions for selected diagnoses between 1 February 2021 and 30 September 2021 were linked to the national COVID-19 immunisation register. We conducted self-controlled case-series study by identifying individuals who received COVID-19 vaccine and diagnosis of thrombocytopenia, venous thromboembolism, myocardial infarction, myocarditis/pericarditis, arrhythmia, stroke, Bell's Palsy, and convulsion/seizure. The incidence of events was assessed in risk period of 21 days postvaccination relative to the control period. We used conditional Poisson regression to calculate the incidence rate ratio (IRR) and 95% confidence interval (CI) with adjustment for calendar period., Results: There was no increase in the risk for myocarditis/pericarditis, Bell's Palsy, stroke, and myocardial infarction in the 21 days following either dose of BNT162b2, CoronaVac, and ChAdOx1 vaccines. A small increased risk of venous thromboembolism (IRR 1.24; 95% CI 1.02, 1.49), arrhythmia (IRR 1.16, 95% CI 1.07, 1.26), and convulsion/seizure (IRR 1.26; 95% CI 1.07, 1.48) was observed among BNT162b2 recipients. No association between CoronaVac vaccine was found with all events except arrhythmia (IRR 1.15; 95% CI 1.01, 1.30). ChAdOx1 vaccine was associated with an increased risk of thrombocytopenia (IRR 2.67; 95% CI 1.21, 5.89) and venous thromboembolism (IRR 2.22; 95% CI 1.17, 4.21)., Conclusion: This study shows acceptable safety profiles of COVID-19 vaccines among recipients of BNT162b2, CoronaVac, and ChAdOx1 vaccines. This information can be used together with effectiveness data for risk-benefit analysis of the vaccination program. Further surveillance with more data is required to assess AESIs following COVID-19 vaccination in short- and long-term., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Maintaining standards of living donor liver transplantation (LDLT) can be a challenge during the corona virus disease 2019 (COVID-19) pandemic. Center-specific protocols have been developed and transplant societies propose limiting elective LDLT. We have looked at outcomes of LDLT during the pandemic in an exclusively LDLT center., Methods: Patients were grouped into pre-COVID (January 2019-February 2020) (n = 162) and COVID (March 2020-January 2021) (n = 53) cohorts. We looked at patient characteristics, 30-day morbidity, and mortality. Outcomes were also assessed in donors and recipients who underwent surgery after recovery from COVID-19., Results: The average number of transplants reduced from 11.5/month to 4.8/month. Fewer patients with MELD > 20 underwent LDLT in the COVID cohort (41.3% versus 24.5%, P = 0.03). Out of nine patients with a positive pretransplant COVID-19 PCR, there were 2 (22.3%) deaths on the waiting list. Seven patients underwent LT after recovery from COVID-19 with one 30-day mortality due to biliary sepsis. Three donors with positive COVID-19 PCR underwent uneventful donation after testing negative for COVID-19. No significant difference in 30-day survival was observed in the pre-COVID and COVID cohorts (93.2% versus 90.6%) (P = 0.3). Out of two recipients who developed COVID-19 pneumonia within 30 days after LT, there was one mortality. The 1-year survival for the entire cohort with a MELD cutoff of 20 was 90% and 84% (P = 0.2)., Conclusion: Despite comparable outcomes, fewer sick patients might undergo LDLT during the pandemic. Individuals recovered from COVID-19 might be safely considered for donation or transplantation., (© 2021. The Society for Surgery of the Alimentary Tract.)

Objective: Pregnant women with bacterial vaginosis due to Gardnerella vaginalis (GV) infection presents with a wide-ranging disease symptomatology. We speculate this may be due to interaction that varies between host immune response and the pathogen. We studied the oxidative burst in polymorphonuclear leukocytes (PMNL)s from maternal blood (MB) and cord blood (CB) upon phagocytosis of GV and compared against E. coli and Group B Streptococcus (GBS)., Results: The PHAGOBURST™ assay detects fluorescence from oxidized dihydrorhodamine during oxidative burst. The average percentage of PMNL showing oxidative burst was almost two-fold greater with GBS (99.5%) and E. coli (98.2%) than GV (56.9%) (p  < 0.01) in MB, but a similar proportion of PMNL with burst activity was seen in CB (84.7%). The mean fluorescence intensity (MFI) of oxidative burst in MB PMNL with GV was lower compared to E. coli but comparable to GBS. The MFI of CB PMNL (1580 ± 245.8) was significantly higher than MB PMNL (1198 ± 262.1) with GV, p  = 0.031. The live-cell imaging showed neutrophil oxidative burst upon phagocytosis of GV produces hypochlorous acid (HOCl). Overall, the HOCL-mediated microbicidal activity against GV is more variable and less robust than E. coli and GBS, especially in maternal than CB PMNL., (© 2021. The Author(s).)

Low temperature CO 2 methanation is a favorable pathway to achieve high selectivity to methane while increasing the stability of the catalysts. A Ba promoted Ni/Sm 2 O 3 catalyst was investigated for CO 2 methanation at atmospheric pressure with the temperature ranging from 200-450 °C. 5Ni-5Ba/Sm 2 O 3 showed significant enhancement of CO 2 conversion particularly at temperatures ≤ 300 °C compared to Ni/Sm 2 O 3 . Incorporation of Ba into 5Ni/Sm 2 O 3 improved the basicity of the catalysts and transformed the morphology of Sm 2 O 3 from random structure into uniform groundnut shape nanoparticles. The uniformity of Sm 2 O 3 created interparticle porosity that may be responsible for efficient heat transfer during a long catalytic reaction. Ba is also postulated to catalyze oxygen vacancy formation on Sm 2 O 3 under a reducing environment presumably via isomorphic substitution. The disappearance of a high temperature (∼600 °C) reduction peak in H 2 -TPR analysis revealed the reducibility of NiO following impregnation with Ba. However, further increasing the Ba loading to 15% formed BaNiO 3 -BaNiO 2.36 phases which consequently reduced the activity of the Ni-Ba/Sm 2 O 3 catalyst at low temperature. Ni was suggested to segregate from BaNiO 3 -BaNiO 2.36 at high temperature thus exhibiting comparable activity with Ni/Sm 2 O 3 at 450 °C., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Objectives: To investigate the specific clinical features of pain following cardiac surgery and evaluate the information derived from different pain measurement tools used to quantify and describe pain in this population., Methods: A prospective observational study was undertaken at two tertiary care hospitals in Australia. Seventy-two (72) adults (mean age, 63±11 years) were included following cardiac surgery via a median sternotomy. Participants completed the Patient Identified Cardiac Pain using numeric and visual prompts (PICP), the McGill Pain Questionnaire-Short Form version 2 (MPQ-2) and the Medical Outcome Study 36-item version 2 (SF-36v2) Bodily Pain domain (BP), which were administered prior to hospital discharge, 4 weeks and 3 months postoperatively., Results: Participants experienced a high incidence of mild (n=45, 63%) to moderate (n=22, 31%) pain prior to discharge, which reduced at 4 weeks postoperatively: mild (n=28, 41%) and moderate (n=5, 7%) pain; at 3 months participants reported mild (n=14, 20%) and moderate (n=2, 3%) pain. The most frequent location of pain was the anterior chest wall, consistent with the location of the surgical incision and graft harvest. Most participants equated "pressure/weight" to "aching" or a "heaviness" in the chest region (based on descriptor of pain in the PICP) and the pain topography was persistent at 4 weeks and 3 months postoperatively. Each pain measurement tool provided different information on pain location, severity and description, with significant change (p<0.005) over time., Conclusion: Mild-to-moderate pain was frequent after sternotomy, improved over time and was mostly located over the incision and mammary (internal thoracic) artery harvest site. Persistent pain at 3 months remained a significant problem in the community within this surgical population., (Copyright © 2021 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). All rights reserved.)

Background: Asymptomatic severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections are well documented. Healthcare workers (HCW) are at increased risk of infection due to occupational exposure to infected patients. We aim to determine the prevalence of SARS-CoV-2 antibodies among HCW who did not come to medical attention., Methods: We prospectively recruited 400 HCW from the National Public Health Laboratory and two COVID-19 designated public hospitals in Klang Valley, Malaysia between 13/4/2020 and 12/5/2020. Quota sampling was used to ensure representativeness of HCW involved in direct and indirect patient care. All participants answered a self-administered questionnaire and blood samples were taken to test for SARS-CoV-2 antibodies by surrogate virus neutralization test., Findings: The study population comprised 154 (38.5%) nurses, 103 (25.8%) medical doctors, 47 (11.8%) laboratory technologists and others (23.9%). A majority (68.9%) reported exposure to SARS-CoV-2 in the past month within their respective workplaces. Adherence to personal protection equipment (PPE) guidelines and hand hygiene were good, ranging from 91-100% compliance. None (95% CI: 0, 0.0095) of the participants had SARS-CoV-2 antibodies detected, despite 182 (45.5%) reporting some symptoms one month prior to study recruitment. One hundred and fifteen (29%) of participants claimed to have had contact with known COVID-19 persons outside of their workplace., Interpretation: Zero seroprevalence among HCW suggests a low incidence of undiagnosed COVID-19 infection in our healthcare setting during the first local wave of SARS-CoV-2 infection. The occupational risk of SARS-CoV-2 transmission within healthcare facilities can be prevented by adherence to infection control measures and appropriate use of PPE., Competing Interests: None of the authors have any conflict of interest, (© 2021 The Author(s).)

Background: In deceased donor liver transplantation (DDLT), transplant eligibility for T3-T4 HCC requires successful downstaging (DS). Living donor liver transplantation (LDLT) can be considered selectively in these patients without DS, but its role is not defined. The objective of the current study was to assess outcomes of LDLT for HCC based on UNOS staging with no prior DS. Materials and Methods: Patients who underwent LDLT for HCC ( n = 262) were staged based on modified UNOS TNM staging. High-risk factors were identified and 5-year recurrence free survival was compared in patients with T2-T4 HCC. Results: Median follow-up was 30.2 (16.4-46.3) months. Recurrence rate in T1, T2, T3, T4a, and T4b HCC was 0, 10.1, 16.1, 5.9, and 37.5% ( P = 0.02), respectively. On multivariate analysis, AFP > 600 ng/mL [HR:11.7, P < 0.001] and T4b HCC (macrovascular invasion) [HR = 5.6, P = 0.03] were predictors of recurrence. After exclusion of AFP > 600 ng/mL, 5-year RFS for T2, T3, and T4a HCC was 94, 86, and 92% ( P = 0.3). Rate of microvascular invasion between T2 and T3 HCC was 24.3 vs. 53.6% ( P = 0.005), and between T2 and T4a HCC was 24.3 vs. 36.7% ( P = 0.2). Overall, 26 (19.4%) patients were overstaged and 23 (17.1%) were understaged on preoperative imaging. The 5-year RFS in patients with identical preoperative and histopathological staging was 94, 87, and 94% ( P = 0.6). Conclusion: LDLT without prior DS leads to comparable survival for UNOS T2, T3, and T4a HCC as long as AFP is < 600 ng/mL., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Bhatti, Waheed and Khan.)

Objective: The aim of this study was to investigate the psychometric properties of the shortened version of the Functional Difficulties Questionnaire (FDQ)., Design: This is a multisite observational study., Setting: The study was conducted in four tertiary care hospitals in Australia., Subjects: A total of 225 participants, following cardiac surgery, were involved in the study., Intervention: Participants completed the original 13-item FDQ and other measures of physical function, pain and health-related quality of life., Method: Item reduction was utilized to develop the shortened version. Reliability was evaluated using intraclass correlation coefficients (ICCs), the smallest detectable change and Bland-Altman plots. The validity and responsiveness were evaluated using correlation. Anchor and distribution-based calculation was used to calculate the minimal clinical important difference (MCID)., Results: Item reduction resulted in the creation of a 10-item shortened version of the questionnaire (FDQ-s). Within the cohort of cardiac surgery patient, the mean (SD) for the FDQ-s was 38.7 (19.61) at baseline; 15.5 (14.01) at four weeks and 7.9 (12.01) at three months. Validity : excellent internal consistency (Cronbach's α  > 0.90) and fair-to-excellent construct validity (>0.4). Reliability : internal consistency was excellent (Cronbach's α > 0.8). The FDQ-s had excellent test-retest reliability (ICC = 0.89-0.92). Strong responsiveness overtime was demonstrated with large effect sizes (Cohen's d  > 1.0). The MCID of the FDQ-s was calculated between 4 and 10 out of 100 (in cm)., Conclusion: The FDQ-s demonstrated robust psychometric properties as a measurement tool of physical function of the thoracic region following cardiac surgery.

Purpose: Occasionally, a recipient's native hepatic arteries are not suitable for reconstruction in living donor liver transplantation (LDLT). The use of the great saphenous vein (GSV) conduits in such patients is seldom practiced since arterial conduits from deceased donors are available. Here, we share our experience with a significantly large group of LDLT recipients who underwent arterial reconstruction with GSV conduits., Methods: We reviewed patients who underwent LDLT between 2012 and 2017. Patients who had arterial reconstruction using native hepatic arteries (group 1)(n = 452) were compared with those who had GSV interposition conduits for reconstruction (group 2)(n = 21). We compared hepatic artery thrombosis (HAT) rate, allograft dysfunction, morbidity, mortality, and actuarial 5-year survival in the two groups., Results: HAT was seen in 0/452 (0%) versus 1/21(4.7%) patients (P = 0.04). Allograft dysfunction was seen in 89/423 (21%) versus 6/19(31.5%) (P = 0.2) patients. Overall mortality was 81/452 (17.9%) versus 8/21(38%) (P = 0.02). Death after a biliary complication was seen in 24/452 (5.3%) versus 4/21 (19%) patients (P = 0.02). Actuarial 1- and 5-year overall survival was 85% versus 67% and 79% versus 58% (P = 0.008)., Conclusion: GSV conduits are a suboptimal alternative for establishing hepatic arterial inflow in LDLT, but remain valuable in ominous situations.

Background: As a quality assessment tool, failure to rescue (FTR) has been employed in various surgical specialties. However, its role in liver transplantation has only recently been explored. To the best of our knowledge, role of FTR in living donor liver transplant (LDLT) has not been assessed previously. The objective of the current study was to determine failure to rescue (FTR) rate and it's predictors in an LDLT center., Materials and Methods: We reviewed a prospectively maintained database of patients who underwent LDLT at our center between 2012 and 2016. Patients who experienced grade 3B or above complications on Clavien-Dindo grading were included in this study. Primary outcome of interest was FTR rate in these patients. FTR was defined as a preventable major complication followed by death within one year after transplantation. We also looked at independent predictors of FTR in our patients and a multivariate analysis was performed., Results: Median age was 48.4(18-73) years. Male to female ratio was 3.3:1. Median MELD score was 17(6-42). The FTR rate in the current study was 52/131 (39.6%). Infectious complications were more common in the FTR group i.e. 22/32(68.8%) versus 10/32 (31.2%) (P < 0.0001). Biliary complications were more common in the non-FTR group i.e. 49/62 (79.1%) versus 13/62 (20.9%) (P < 0.0001). On multivariate analysis, there was a 60% increase in mortality following a major complication in the presence of early allograft dysfunction (Hazard ratio: 1.6, Confidence interval; 1.2-2.2, P = 0.002). A 40% reduction in FTR was seen in patients with a biliary complication versus other complications (Hazard ratio: 0.6, Confidence interval = 0.4-0.8, P = 0.009)., Conclusion: Early allograft dysfunction and biliary complications are independent predictors of FTR in LDLT., (Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.)

Objective: To determine the outcome of living-donor liver transplant (LDLT) donors from the first liver transplant program in Pakistan., Study Design: Cohort study., Place and Duration of Study: Shifa International Hospital, Islamabad, from April 2012 to August 2014., Methodology: A total of 100 live donors who underwent hepatectomy were included. Demographics, etiologies, graft characteristics and operative variables were retrospectively assessed. Outcome was assessed based on morbidity and mortality., Results: Median donor age was 28 (17 - 45) years and median body mass index (BMI) was 24 kg/m2 (15 - 36). Male to female ratio was 1.5:1. Hepatitis B and C were the most common underlying etiologies and accounted for 79/100 (79%) of LDLT&#039;s. Overall, 93/100 (93%) donors donated a right lobe graft. Median estimated graft weight to recipient body weight (GW/BW) ratio was 1.03 (0.78 - 2). Standard arterial anatomy was present in 56% donors. The 90-day morbidity was 13/100 (13%) and overall morbidity was 17/100 (17%). Bile leak was encountered in 3 (3%) patients. There was no donor mortality., Conclusion: Acceptable short-term donor outcomes were achieved in an LDLT program in Pakistan with careful donor selection and planning.

Introduction: Safety of extended lymphadenectomy (EL) ± vascular resection in patients undergoing pancreaticoduodenectomy (PD) in resource limited settings is not well established. The objective of this study was to report outcomes of PD resection with EL ± vascular resection from Pakistan and review national literature., Methods: Data of patients who underwent PD between 2011 and 2014 was reviewed. A total of 66 patients were included in the study. Primary outcome was 90 day morbidity and mortality. Secondary objective was 2 year overall survival., Results: Median age was 57 (32-82) years. Majority patients had locally advanced (pT3/T4) tumors and nodal involvement i.e. 44 (71%) and 42 (67.8%). Mean number of excised lymph nodes and positive lymph nodes was 28.2 ± 12.8 (range 3-62) and 4.8 ± 6.9 (range 0-27) respectively. There were 13 vascular resections including 3 arterial resections. Overall 90 day morbidity was 31.8% and mortality was 3%. No difference in complication rate was observed in patients who did and did not undergo vascular resection i.e. 18% versus 34.5% (P = 0.1). Similarly, median survival was 11 (3-24) months and 11 (1-36) months and not significantly different (P = 0.5)., Conclusion: In developing countries, extended lymphadenectomy with vascular resection can be safely performed with pancreaticoduodenectomy in specialized hepatobiliary units., (Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.)

Living donor liver transplantation (LDLT) is the only treatment option for patients with end-stage liver disease (ESLD) where cadaveric donors are not available. In developing countries, the inception of LDLT programs remains a challenge. The first successful liver transplantation program in Pakistan started transplantation in 2012. The objective of this study was to report outcomes of 100 LDLT recipients in a developing country and to highlight the challenges encountered by a new LDLT program in a resource-limited setting. We retrospectively reviewed recipients who underwent LDLT between April 2012 and August 2014. Demographics, etiology, graft characteristics, and operative variables were assessed. Outcome was assessed on the basis of morbidity and mortality. All complications of ≥ 3 on the Clavien-Dindo grading system were included as morbidity. Estimated 1-year survival was calculated using Kaplan-Meier curves, and a Log-rank test was used to determine the significance. Outcomes between the first 50 LDLTs (group 1) and latter 50 LDLTs (group 2) were also compared. Median age was 46.5 (0.5-72) years, whereas the median MELD score was 15.5 (7-37). The male to female ratio was 4:1. ESLD secondary to hepatitis C virus was the most common indication (73% patients). There were 52 (52%) significant (≥ grade 3) complications. The most common morbidities were bile leaks in 9 (9%) and biliary strictures in 14 (14%) patients. Overall mortality in patients who underwent LDLT for ESLD was 10.6%. Estimated 1-year survival was 87%. Patients who underwent transplantation in the latter period had a significantly lower overall complication rate (36% versus 68%; P = 0.01). Comparable outcomes can be achieved in a new LDLT program in a developing country. Outcomes improve as experience increases., (© 2015 American Association for the Study of Liver Diseases.)