Diagnosis and management of pediatric acute liver failure: consensus recommendations of the Indian Society of Pediatric Gastroenterology, Hepatology, and Nutrition (ISPGHAN).

Timely diagnosis and management of pediatric acute liver failure (PALF) is of paramount importance to improve survival. The Indian Society of Pediatric Gastroenterology, Hepatology, and Nutrition invited national and international experts to identify and review important management and research questions. These covered the definition, age appropriate stepwise workup for the etiology, non-invasive diagnosis and management of cerebral edema, prognostic scores, criteria for listing for liver transplantation (LT) and bridging therapies in PALF.

Role of splenic hepatic elastography ratio in differentiating non-cirrhotic portal fibrosis and chronic liver disease in children and adolescents.

Background: Differentiation of Non-cirrhotic Portal Fibrosis (NCPF) from chronic liver disease (CLD) in children and adolescents with portal hypertension (PHT) is challenging especially in cases where liver stiffness measurement (LSM) and hepatic venous pressure gradient are higher. This objective of the current study was to evaluate the diagnostic accuracy of the splenic stiffness measurement (SSM)/LSM ratio in the diagnosis of NCPF.

Methods: From January 2019 to December 2023, consecutive children and adolescents of 6 months to 18 years of age with PHT (CLD and NCPF) were prospectively enrolled.

Hydroxyapatite ceramic-coated femoral components in younger patients followed up for 27 to 32 years.

Aims: This study reports the results of 38 total hip arthroplasties (THAs) in 33 patients aged less than 50 years, using the JRI Furlong hydroxyapatite ceramic (HAC)-coated femoral component.

Methods: We describe the survival, radiological, and functional outcomes of 33 patients (38 THAs) at a mean follow-up of 27 years (25 to 32) between 1988 and 2018.

Results: Of the surviving 30 patients (34 THAs), there were four periprosthetic fractures: one underwent femoral revision after 21 years, two had surgical fixation as the stem was deemed stable, and one was treated nonoperatively due to the patient's comorbidities.

Hepatic visceral larva migrans: A radiological case report.

Visceral larva migrans (VLM) occurs due to migration of the second stage of larvae of nematodes through human viscera. It is an underdiagnosed entity which commonly affects the liver as eosinophilic abscesses and appears as coalescing, conglomerated cavities on imaging. This case report details the sonographic and CT features of an 8 year old female patient with right upper quadrant pain and peripheral eosinophilia on laboratory reports, diagnosed as a case of VLM on biopsy.

Prognostic markers in hepatitis A-related pediatric acute liver failure and validation of the Peds-hepatitis A virus prognostic model.

Objectives: Hepatitis A virus (HAV) is the commonest cause for pediatric acute liver failure (PALF) in India. The objective of the study was to identify the predictors of mortality and to evaluate the utility of Peds-HAV model in a cohort of non-LT HAV-PALF.

Methods: The study included HAV-related PALF from two non-transplant centers.

Investigating electrochemical corrosion at Mg alloy-steel joint interface using scanning electrochemical cell impedance microscopy (SECCIM).

Developing strategies to prevent corrosion at the interface of dissimilar metal alloys is challenging because of the presence of heterogenous distribution of galvanic couples and microstructural features that significantly change the corrosion rate. Devising strategies to mitigate this interfacial corrosion requires quantitative and correlative understanding of its surface electrochemical reaction. In this work, scanning electrochemical cell impedance microscopy (SECCIM) was employed to study location-specific corrosion in the interfacial region of dissimilar alloys, such as AZ31 (magnesium alloy) and DP590 (steel) welded using the Friction-stir Assisted Scribe Technique (FAST) processes.

Treatment of intractable cholangitis in children with biliary atresia: Impact on outcome.

Objectives: To evaluate the response and outcome with prolonged intravenous antibiotics including home-based intravenous antibiotics in children with intractable cholangitis (IC) after Kasai portoenterostomy (KPE) for biliary atresia (BA).

Methods: A retrospective review of treatment and outcome of children with IC post KPE (no resolution after four weeks of antibiotics) was done between 2014 and 2020. A protocol-based antibiotic regimen was used based on sensitivity and hospital antibiogram.

Splenic Stiffness Is the Best Predictor of Clinically Significant Varices in Children With Portal Hypertension.

Background And Aims: We studied splenic stiffness measurement (SSM) by transient elastography (TE) and portal hemodynamics parameters (PHDp) on Doppler as predictors of clinically significant varices (CSV) in children.

Methods: All children of 6 months to 18 years of age with portal hypertension (PHT) (chronic liver disease, CLD and non-cirrhotic portal hypertension, NCPH) were enrolled. TE for spleen (SSM) and liver (liver stiffness measurement, LSM) and PHDp by Doppler ultrasonography were measured.

Incidence and Predictors of Relapse After Stopping Antiviral Therapy in Pediatric Chronic Hepatitis B.

Background: There are no definite end-points for stopping therapy in pediatric chronic hepatitis B (CHB). The study objective was to evaluate the incidence of relapse after stopping antiviral therapy and to identify its predictors.

Methods: All hepatitis B surface antigen (HBsAg) positive children presenting to our hospital, who had been on antivirals for at least 2 years with undetectable hepatitis B virus-deoxyribonucleic acid (HBV-DNA) and normal alanine aminotransferase (ALT) on 3 consecutive occasions over last 12 months were included.

The missing piece of the trauma armoury-medial femoral condyle plate.

Fixation of distal femoral fractures is often challenging due to the fracture configuration and associated poor bone quality. Dual plating (lateral and medial) has become an acceptable option to provide improved stability versus a single plate fixation. Though there are several commercially available anatomically designed plates for the lateral femoral condyle, there is no anatomic plate available in UK specifically for medial fixation of distal femur fractures.

Interfacial reaction during friction stir assisted scribe welding of immiscible Fe and Mg alloy system.

We report on interfacial characteristics and chemistry of bonded Mg-Fe interfaces welded using friction stir assisted scribe technique (FaST). Two pairs of dissimilar joints: (AZ31-DP590) and (Pure Mg-DP590) were studied to shed light on joining mechanisms responsible for bonding of "immiscible" pairs of Mg and Fe. We present first direct experimental evidence of presence of oxide layer, Al segregation by atom probe tomography and nano steel grains close to interface by transmission electron microscopy study.

Short or long intramedullary devices for hip fracture? A systematic review of the evidence.

Trochanteric hip fractures may be fixed with either sliding hip screws or intramedullary devices. Current UK guidance is that intramedullary fixation should be used for AO/OTA 31A3 fractures but does not stipulate length of nail. We present a systematic review comparing short and long nails for these injuries in older patients.

Modified functionally generated path technique to develop occlusal scheme in single complete denture.

Single maxillary denture often represents vigorous challenge to the practicing dentists. The difficulty arises when the maxillary dentures are set to fit the occlusion of natural mandibular teeth. The functionally generated pathway technique registers occlusal pathways of the posterior teeth in functional wax and is described as the "three-dimensional static expression consists of dynamic tooth movement.

External fixators in the treatment of midshaft clavicle non-unions: a systematic review.

Non- or mal-union of the clavicle is reported to occur in up to 15 % of conservatively treated fractures: the purpose of this systematic review is to examine the evidence for the use of external fixation in the treatment of clavicular non-union. We performed a search of MEDLINE and Embase, including all papers using external fixators for the treatment of clavicular non-union. Four papers satisfied our eligibility criteria: three case series and one case-control study.

Minimally invasive forefoot surgery: a cadaveric study.

Background: Minimally invasive surgery (MIS) aims to improve cosmesis and minimize soft tissue disruption by using small skin incisions. When using MIS in the forefoot, there is concern about iatrogenic neurovascular and tendon damage. The aim of this anatomical study was to assess the risk of iatrogenic injury while performing MIS techniques.

Role of hypertonic saline and mannitol in the management of raised intracranial pressure in children: A randomized comparative study.

Objective: To compare the efficacy and side effects of 3% hypertonic saline and mannitol in the management of raised intracranial pressure in children.

Design: Prospective randomized study.

Setting: Pediatric intensive care unit (PICU) in a tertiary care hospital.

The use of warfarin as thromboprophylaxis for lower limb arthroplasty.

Introduction: Most orthopaedic surgeons in the UK use some form of prophylaxis against venous thromboembolic events. Warfarin has been recommended as one of the preferred methods to use. The period of in-hospital postoperative rehabilitation has reduced significantly since lower limb arthroplasty was introduced.