Outcomes of Portosystemic Shunts in Children with and without Liver Transplantation.

Purpose: Limited data exist regarding outcome and morbidity associated with portosystemic shunts in the pediatric transplant population. Our study assesses the outcomes of pediatric patients who underwent a portosystemic shunt procedure, both with and without liver transplantation (LT). Methods: This study retrospectively reviewed the medical records of pediatric patients aged 0-19 years who underwent shunt placement between 2003 and 2017 at a tertiary care center. The analysis included cases of shunt placement with or without LT. Results: A total of 13 pediatric patients were included in the study with median age of 8.8 years. Among the cases, 11 out of 13 (84.6%) underwent splenorenal shunt, 1 (7.7%) underwent a mesocaval shunt, and another 1 (7.7%) underwent a Modified Rex (mesoportal) shunt. Additionally, 5 out of 13 (38.5%) patients had LT, with 4 out of 5 (80.0%) receiving the transplant before shunt placement, and 1 out of 5 (20.0%) receiving it after shunt placement. Gastrointestinal bleeding resulting from portal hypertension was the indication in all cases. A total of 10 complications were reported in 5 patients; the most common complication was anemia in 3 (23.1%) patients. At the most recent follow-up visit, the shunts were functional without encephalopathy, and no deaths were reported. Conclusion: Shunt placement plays a crucial role in the management of patients with portal hypertension. Our study demonstrates favorable long-term outcomes in pediatric patients who underwent shunt placement. Long term shunt outcomes were similar and unremarkable in patients with LT and without LT.

Revolutionizing sanitation: Valorizing fecal slags through co-digesting food waste at high-solid content and dosing metallic nanomaterials for anaerobic digestion stability.

To achieve the UN Sustainable Development Goals (SDGs) and the China Toilet Revolution on a global scale, it is crucial to implement a decentralized sanitation management system in developing countries. Fecal slags (FS) generated from septic tanks of toilets pose a challenge for remote villages. This study sought to resourcefully utilize FS through co-digesting with food waste (FW) under high-solid anaerobic co-digestion (HSAD). Besides, two metallic nanomaterials, nano-zerovalent iron (nZVI) and magnetite (Fe3O4), were employed to demonstrate the practical improvement of HSAD. The results showed that nZVI-dosed digesters produced the highest cumulative methane of 295.72 mL/gVS, 371.36 mL/gVS, 360.53 mL/gVS and 296.64 mL/gVS in 10%, 15%, 20% and 25% TS content, respectively, which was 1.15, 1.22, 1.16, 1.12 times higher than Fe3O4 dosed digesters. This increment could be ascribed to the simultaneous production of H2 from Fe2+ release from nZVI and the enrichment of homoacetogen. Changes in carbon degradation and methanogenic pathways, which facilitated stability under high TS contents, were observed. At low solid digestion (10% TS), Syntrophomonas cooperated with Methanosarcina and Methanobacterium to metabolize butyrate and propionate. However, due to the buildup of total ammonia nitrogen and volatile fatty acids, acetoclastic methanogens were inhibited in the high-solid digesters (15%, 20% and 25% TS). Consequently, a more resilient and highly tolerant Syntrophaceticus, alongside hydrogenotrophic methanogens such as Methanoculleus and Methanobrevibacter, maintained stability in the harsh environment.

Evolution of Morphology and Distribution of Salt Crystals on a Photothermal Layer during Solar Interfacial Evaporation.

Solar interfacial evaporation (SIE) by leveraging photothermal conversion could be a clean and sustainable solution to the scarcity of fresh water, decontamination of wastewater, and steam sterilization. However, the process of salt crystallization on photothermal materials used in SIE, especially from saltwater evaporation, has not been completely understood. We report the temporal and spatial evolution of salt crystals on the photothermal layer during SIE. By using a typical oil lamp evaporator, we found that salt crystallization always initiates from the edge of the evaporation surface of the photothermal layer due to the local fast flux of the vapor to the surroundings. Interestingly, the salt crystals exhibit either compact or loose morphology, depending on the location and evaporation duration. By employing a suite of complementary analytical techniques of Raman and infrared spectroscopy and temperature mapping, we followed the evolution and spatial distribution of salt crystals, interfacial water, and surface temperature during evaporation. Our results suggested that the compact crystal structure may emerge from the recrystallization of salt in an initially porous structure, driven by continuous water evaporation from the porous and loose crystals. The holistic view provided in this study may lay the foundation for effective strategies for mitigation of the negative impact of salt crystallization in solar evaporation.

Tackling fat, oil, and grease (FOG) build-up in sewers: Insights into deposit formation and sustainable in-sewer management techniques.

The increasing global demand for fatty products, population growth, and the expansion of food service establishments (FSEs) present significant challenges for the wastewater industry. This is often due to the build-up of fat, oil and grease (FOG) in sewers, which reduces capacity and leads to sanitary sewer overflows. It is crucial to develop economic and sustainable in-sewer FOG management techniques to minimise maintenance costs and service disruptions caused by the removal of FOG deposits from sewers. This study aims to understand the process of FOG deposit formation in both concrete and non-concrete sewers. Compared to fresh cooking oil, disposal of used cooking oil in households and FSE sinks results in the formation of highly adhesive and viscous FOG deposits. This occurs due to hydrolysis during frying, which increases the concentration of fatty acids, particularly palmitic acid, in the used cooking oil. Furthermore, metal ions from food waste, wastewater, and dishwashing detergents contribute to the saponification and aggregation reactions which cause FOG deposition in both concrete and non-concrete sewers. However, the leaching of Ca2+ ions exacerbates FOG deposition in cement-concrete sewers. The article concludes by suggesting future research perspectives and proposes implementation strategies for microbially induced concrete corrosion (MICC) control to manage FOG deposition in sewers. One such strategy involves applying superhydrophobic coating materials with low surface free energy and high surface roughness to the interior surfaces of the sewer. This approach would help repel wastewater carrying FOG deposit components, potentially disrupting the interaction between FOG components, and reducing the adhesion of FOG deposits to sewer surfaces.

Osteoid Osteoma of Retromolar Trigone: Report of a Rare Case.

Osteoid osteoma is a rare benign bone lesion that is often confused with the osteoblastoma. The osteoid osteoma comprises of 3% of all the primary bone tumours usually found in the long bones and vertebrae with the facial skeleton being the most infrequent site. The lesion usually presents with the swelling and pain that resolves with non-steroidal anti-inflammatory drugs (NSAIDs). Here, we report a case of osteoid osteoma of retromolar trigone, the site which has not been reported in the literature, in a 50-year male patient with a complaint of hard swelling on retromolar trigone associated with the mild intermittent localised pain that aggravated at night and on mastication. Excision of the lesion was carried out with chisel and mallet under local anesthesia with uneventful recovery and no recurrence at the 6 months follow-up. Key Words: Benign, Osteoid osteoma, Retromolar trigone.

Semi-solid anaerobic co-digestion of source-separated fecal slag and food waste: focusing on methane production, ecological risk assessment, and quality evaluation as fertilizer.

Toilet revolution is driven by the urgent need for solutions to improve sanitation and access to high-quality organic fertilizer for rural areas, which is tagged "resource recovery from human waste." This study provides a possible solution via semi-solid anaerobic co-digestion (Aco-D) of source-separated fecal slag (SFS) and food waste (FW) (3:1). A comprehensive investigation of Aco-D at different inoculum/substrate ratios (ISR) was conducted. Results revealed that the reactor with ISR of 1:4 reached the highest methane yield (255.05 mL/gVS), which enhanced Methanosaetaceae, Methanomicrobiales, and Syntrophomonas. Additionally, the reactor with low feedstock (ISR of 1:2) showed higher removal efficiency of antibiotics (74.75%). The ecological risk of digestate decreased to an insignificant hazard quotient level, and the contents of nutrients and heavy metals were in line with the standard requirement for fertilizer. This study could serve as an alternative technology to support further research in SFS management and digestate utilization as fertilizer.

Prevalence Of Gustatory And Olfactory Impairment In Different Stages Of Sars-Cov-2 Infected Pateints In Isolation Ward.

BACKGROUND: To evaluate the prevalence of gustatory and olfactory impairment and its correlation with the severity of SARS-Cov-2 infection as per WHO guidelines. METHODS: A total of 241 patients of both gender having age from 15-80 years were included in the study. It was cross Sectional study conducted at SARS-COV-2 Isolation wards of Pakistan institute of medical science Islamabad from 15thSeptember 2020 to 15th January 2021. Convenient sampling technique was used to collect data. A proforma was designed for this purpose. Participants were divided into 3 groups on the basis of age. Group-1 (15-30 years), group-2 (31-50 years) and group 3 (51-80 years). Further the participants were graded into mild, moderate and severe stages of Sars-Cov-2 infection according to WHO guidelines. Statistical analysis was performed by using SPSS version 20. RESULTS: In this study 66% were male and 34% population were the female. Regarding the age groups 72% population were from the group-3. Results of study shows 47% in mild stage, 45% in moderate stage and 8% severe stage. The results regarding the Gustatory and Olfactory impairment showed that 126 had gustatory impairment while 130 patients had olfactory impairment. CONCLUSIONS: We found strong relationship of olfactory and gustatory changes associated with SARS-COV-2 patients. It is premature to conclude that taste and smell changes are strongly linked to SARS-COV-2 diagnosis. Further multi center researches are required to find out possible pathophysiological mechanism.

A 17-Year-Old Girl with a Recent History of Marijuana Use Presented with Pneumomediastinum and Pneumopericardium and Tested Positive for SARS-CoV-2 Infection on Hospital Admission.

BACKGROUND Pneumomediastinum and pneumopericardium have been reported to occur in people who regularly smoke marijuana and have also been reported in patients with COVID-19 pneumonia due to infection with SARS-CoV-2. This report is of a 17-year-old girl with a history of marijuana use who presented with pneumomediastinum and pneumopericardium and was found to be positive for SARS-CoV-2 infection on hospital admission by Abbott ID NOW testing. CASE REPORT A 17-year-old girl presented to the emergency room with a 3-day history of abdominal pain, nausea, and vomiting and a 1-day history of diarrhea. She had a history of daily marijuana use and lived with her grandmother who was presumed to be positive for COVID-19, based on symptoms. Her admission laboratory results were unremarkable except for pyuria, which was suspicious for urinary tract infection. The patient's nasopharyngeal swab was positive for SARS-CoV-2 infection. Owing to abdominal pain, a computed tomography (CT) scan of the abdomen and pelvis was obtained, which was concerning for pneumomediastinum and pneumopericardium. A CT scan of the thorax confirmed the findings. A contrast-enhanced barium esophagogram was performed and was unremarkable. The patient was admitted to the pediatric intensive care unit for observation and supportive care. CONCLUSIONS This report shows the importance of current testing for SARS-CoV-2 infection in patients of all ages who present acutely to the hospital. It also highlights the importance of obtaining a full social and medical history so that symptoms and signs from causes other than SARS-CoV-2 infection are not missed.

Peripheral Giant Cell Granuloma of Posterior Maxilla in a 9-Year Child.

Peripheral giant cell granuloma is a relatively uncommon benign reactive gingival lesion of the oral cavity. A 9-year boy presented with a painless, slow-growing, reddish-blue, soft tissue lesion on attached gingiva adjacent to maxillary right first and second premolars, which was interfering with eating. A periapical radiograph demonstrated focal alveolar bone loss and slight teeth displacement adjacent to the lesion. Diagnosis of peripheral giant cell granuloma was made through clinical and radiographic evaluation, by its typical presentation and correlation with histopathologic findings. Complete excision was carried out down to the underlying bone. A follow-up visit was scheduled after 7 days and deep scaling was performed. There was no recurrence three months post-excision. Timely detection and excision of this lesion is important to avoid future dentoalveolar problems. Key Words: Giant cell granuloma, Benign, Peripheral, Child.

Glycogen Storage Disease Type IX due to a Novel Mutation in PHKA2 Gene.

We report a case of a 17-month-old male with a history of developmental delay with poor muscle control, hepatomegaly, and transaminitis. Ultrasound of abdomen revealed hepatomegaly with a liver span of 13 cm, homogeneous parenchyma, and normal spleen size. Liver and muscle biopsies were obtained: the liver biopsy revealed distended hepatocytes with excessive glycogen accumulation and fine septate fibrosis. Biopsy of the right vastus lateralis muscle showed focal swollen glycogen containing mitochondria. For the developmental delay, a chromosomal microrarray was ordered. The chromosomal microarray revealed the patient to have 1q21 duplication syndrome and 16p11.2 deletion syndrome. Given the liver and muscle biopsy findings, a glycogen storage disease panel was sent which identified the patient to be hemizygous for a variant of uncertain significance denoted as p.Gly 131Val, c.392G > T in the PHKA2 gene. PKHA2 gene encodes the alpha subunit of hepatic phosphorylase kinase. This change in the PHKA2 gene was in a highly conserved region and had been reported in another patient with decreased enzymatic activity of the phosphorylase kinase and who had symptoms of GSD IX. Based on this, the patient was started on treatment for GSD IX, and his family met with a dietician.

Cirrhosis in a Young Child Due to Fatty Liver; Importance of Early Screening: A Case Report and Review of the Literature.

BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is the presence of chronic hepatic steatosis in the absence of infections, steatogenic medication use, metabolic/genetic disorders, malnutrition, or ethanol consumption. NAFLD encompasses a spectrum of liver damage varying from non-alcoholic fatty liver (NAFL) on the most clinically benign end of the spectrum to cirrhosis on the opposite extreme, where most liver-related morbidity and mortality occurs. CASE REPORT We report a case of a 9-year-old boy with history of obesity (BMI 32.1 kg/m² - 99th percentile) and non-alcoholic fatty liver disease, who was referred to our pediatric gastroenterology clinic with a 1-week history of vomiting and right upper-quadrant abdominal pain. A review of the past medical history revealed transaminitis for the last 4 years and a dietary regimen for the last 2 years with poor compliance and follow-up. An extensive workup revealed an SGPT of 327 unit/L, SGOT 186 unit/L, and triglycerides of 208 mg/dL; infectious, metabolic, genetic, and autoimmune etiologies were ruled-out. The median liver stiffness measured by Fibroscan was 14 kPa, consistent with F4 fibrosis, and the cap median value was 271 dB/mW, reflective of S2 steatosis. An ultrasound-guided core liver biopsy revealed steatohepatitis with bridging and encircling fibrosis consistent with early/evolving cirrhosis. CONCLUSIONS Although cirrhosis is rarely seen in pediatric patients with NAFLD, it should always be considered. Secondly, Fibroscan, a non-invasive imaging procedure, is a useful tool to assess the level of fibrosis and steatosis in patients with NAFLD; early evaluation of our patient could potentially have limited the progression to cirrhosis.

Successful venoarterial extracorporeal membrane oxygenation for prolonged hepatopulmonary syndrome following pediatric liver transplantation: A case report and review of the literature.

HPS is a major complicating feature of end-stage liver disease. Diagnosis is clinical, and LT is the only definitive treatment. While the general impression is that HPS improves quickly after transplantation, it may not always be the case. We describe the smallest reported child with HPS prior to LT and requiring prolonged venoarterial extracorporeal membrane oxygenation after LT; especially as it is a rare occurrence, physician managing such cases should be aware of the circumstances under which HPS may require specific treatment.

Comparison of once a day rifaximin to twice a day dosage in the prevention of recurrence of hepatic encephalopathy in patients with chronic liver disease.

BACKGROUND: Rifaximin has been used for prevention of recurrence of hepatic encephalopathy in twice a day dosage. The drug is expensive and lower dising may be possible. OBJECTIVE: To determine the efficacy of rifaximin once a day dose in the prevention of hepatic encephalopathy (HE) in patients with liver cirrhosis as compared with twice daily dose of rifaximin. METHODS: This Randomized control trial was carried out at the Department of Gastroenterology and Hepatology, Shifa International Hospital, Islamabad, Pakistan from November 2012 to February 2014. Patients with known chronic liver disease with at least one episode of HE in the past were randomized to group A (rifaximin 550 mg OD) and group B (rifaximin 550 mg BD), after fulfilling the inclusion criteria. Each patient was followed for 6 months for any episode of HE. Patients in each group were identified for any breakthrough episode of encephalopathy during this period. Data were analyzed using SPSS version 16. Chi-squared test and t-test were applied where required to determine the significant difference between the two groups. RESULTS: There were a total of 306 patients: 128 patients in Group A while 178 in group B. Majority of patients (75.81%) had hepatitis C virus with mean age of 52.30 ± 9.92, MELD score 13.58 ± 8.3, and 55.22% were in Child-Pugh B. Eighty-one patients had an episode of HE during the study period. There were 27 patients in group A and 54 patients in group B with breakthrough episode of HE (P = 0.088). CONCLUSION: This study suggests that there is no significant difference in rifaximin once a day or twice daily dose in preventing HE.