Role of HLA typing and chimerism analysis in post-liver transplantation GVHD in pediatrics: A systematic review.

BACKGROUND: GVHD is a well-documented complication after liver transplantation. GVHD occurs when donor immune cells mount a destructive immune response against host cells. The rarity of the GVHD complication and the nonspecific presentation of symptoms and histopathological features provide a diagnostic challenge. Therefore, diagnosis and initiation of treatment are often delayed. AIM: In this systematic review, we assessed relevant literature to better understand the utilization of HLA typing and chimerism analysis in liver transplantation. We mainly focused on their importance in diagnosing GVHD incidence after liver transplantation. RESULTS: A total of 18 articles reported 21 cases of GVHD after liver transplantation in pediatrics. Generally, there is a consensus on the advantage of HLA typing and chimerism analysis in confirming the diagnosis of GVHD after liver transplantation. However, there is an inconsistency in the timing and the application of the accurate HLA typing and chimerism analysis. CONCLUSION: Further studies are required to assess the incidence of GVHD post-LT and to determine the impact of HLA typing and chimerism analysis in assessing the risk, early determination of GVHD incidence, and improving outcomes. This systematic review highlights the gap in the field of liver transplantation and calls for revisiting the guidelines to consider HLA typing and chimerism analysis in predicting GVHD before transplantation and diagnosing GVHD incidence after liver transplantation.

Correlation between the estimated GFR and SWRD score in patients with posterior urethral valves at King Abdul-Aziz University Hospital.

OBJECTIVE: The aim was to establish the reliability of the SWRD score as a predictor of both renal and bladder outcomes in posterior urethral valves. This retrospective study included 67 patients with PUVs at King Abdul-Aziz University Hospital. The score was calculated from voiding cystourethrogram before and after the relief of obstruction, and estimated glomerular filtration rates (eGFRs) were calculated as well. RESULTS: Based on Spearman correlations, both baseline eGFRs and SWRD scores can be possible predictors of long-term renal outcomes, as a significant positive correlation between the baseline eGFRs and the last eGFRs was found (p = 0.005). A significant negative correlation was also found between the SWRD score calculated before the intervention and the last eGFRs (p = 0.02). Additionally, the baseline SWRD scores can be possible predictors of short-term bladder outcomes, as the correlation analysis showed a positive relationship between the baseline SWRD scores and the SWRD scores calculated within 2 months after the intervention (p < 0.0001). A significant decrease in SWRD scores and eGFRs was found from before to after the intervention, regardless of the type of intervention. In conclusion, the SWRD scoring system proved to be a potentially promising tool in the anticipation of the clinical outcomes of PUVs.

Doctors' knowledge of the doses and risks of radiological investigations performed in the emergency department.

OBJECTIVES: To assess emergency doctors' knowledge of radiation exposure doses and risks, and the increasing use of radiological investigations in emergency medicine practice is very concerning because of the associated risks of cancer. METHODS: Doctors from different specialties and with different levels of training working in emergency departments of 8 hospitals in Jeddah, Kingdom of Saudi Arabia, filled out a questionnaire. Participants estimated the radiation doses of different imaging modalities and answered questions regarding possible associated risks. Results: One hundred seventy-one doctors returned completed questionnaires. The overall correct dose estimation rate was 20.8%. Doses were more correctly estimated by consultants versus specialists and residents (p=0.007), and by emergency physicians versus doctors from other specialties (p=0.05). The correct answer rate was insignificantly higher among doctors with formal training on radiation protection (p=0.065). The overall correct answer rate was unsatisfactory for 4 questions assessing physicians' knowledge of risks. Questions about the lifetime risk of cancer due to ionizing radiation were more correctly answered by consultants versus residents and specialists (p=0.05). Specialists were more knowledgeable about the risk of imaging on fetuses (p=0.05). Doctors with formal training answered 3 out of 4 questions more correctly than doctors without formal training, but no difference existed between them regarding imaging modalities, that they selected for pregnant patients (p=0.297). Conclusion: Doctors working in emergency departments had poor knowledge about radiation doses and risks. This issue warrants urgent attention.