Background and Objective: Biliary atresia (BA) is a fibro-obliterative cholangiopathy and the leading indication for liver transplantation (LT) in children. This study compared one-year survival following primary and salvage LT, along with perioperative course and post-operative complications. Methodology: We retrospectively reviewed children younger than 15 years with BA who underwent LT at PKLI & RC, Lahore, from January 2020 to May 2025. Recipients were divided into two groups based on prior KPE. Demographic, clinical, perioperative and postoperative data were compared. Patient and graft survival were assessed using Kaplan-Meier analysis. Results: Twenty-four children were included in the study. Ten (41.7%) underwent primary LT (pLT) and 14 (58.3%) underwent salvage LT (sLT). pLT recipients were significantly younger, smaller, and had higher PELD scores at LT (p<0.05). ICU stay, duration of mechanical ventilation and hospital stay were comparable between the groups. Infection was the most common early post-LT complication while cholangitis was the most frequent long-term complication. Vascular thrombosis was significantly more frequent in pLT recipients than in sLT recipients (40% vs 0% p=0.020). Oneyear patient and graft survival was higher in the pLT group as compared to sLT group (80% vs 64.3%) although the difference was not statistically significant(p=0.528). Conclusion: pLT demonstrated a trend toward improved survival compared to sLT, despite greater disease severity at transplantation. Individualized treatment regimens, strict infection control and vigilant vascular surveillance are essential to optimizing outcomes.
Background & Objective: Effective teamwork is vital for coordinated decisions to ensure patient safety. This study assessed the effectiveness of a structured Team-STEPPS workshop in improving residents' teamwork attitudes. Methodology: A randomized controlled trial was conducted at Ayub Teaching Hospital, Abbottabad, over a six month period. A total of 75 trainee medical officers from three obstetrics and gynecology units of Ayub Teaching Hospital were included in the sampling frame. Each participant was assigned a unique serial number (1-75). Participants were first stratified by clinical unit to ensure balanced representation. From each unit, random subsets were generated using a computer-based simple randomization process; 18 residents from Unit-A, 16 from Unit-B, and 16 from Unit-C were selected. Within each subset, block randomization was used to assign participants to two groups: experimental and control. This resulted in nine experimental and nine control participants from Units A and eight experimental and eight control participants from Units B and C. The final sample size of 50 participants was determined a priori using a formal sample-size calculation based on the anticipated effect size, significance level, and statistical power specified in the study protocol. The experimental group attended a two-hour Team-STEPPS workshop; the control group continued routine duties. Teamwork Attitudes (T-TAQ) and Perceptions (T-TPQ) questionnaires were administered at baseline, immediately after training, and two months later. Data were analyzed with ANOVA in SPSS v26 (p <= 0.05). Results: At baseline, there were no significant differences in perception (mean = 134.44 +/- 13.64 vs. 127.08 +/- 19.38, p = 0.137) or attitude scores (121.40 +/- 9.46 vs. 126.72 +/- 9.67, p = 0.766) between groups. In the intervention group, perception scores increased from 127.08 +/- 19.38 at pre-test to 144.24 +/- 19.56 immediately post-intervention and remained significantly higher at two-month follow-up. Pairwise analysis showed significant improvement from pretest to post-test (mean difference 17.20, p=0.005) and from pre-test to two-month follow-up (mean difference 32.88, p<0.001). Attitude scores increased from 126.72 +/- 9.67 to 129.64 +/- 9.54 immediately post-intervention, but the difference was not significant (mean difference 2.92, p=0.929). At two-month follow-up, attitude scores were significantly higher than both pre-test (mean difference 12.60, p<0.001) and immediate post-test (mean difference 9.68, p=0.002). Conclusion: The Team-STEPPS intervention was found effective in improving teamwork attitudes and perceptions among obstetrics and gynecology residents.
Lung cancer ranks as the second most commonly diagnosed malignancy worldwide and remains the leading cause of cancer-related mortality. This case report is of a 77 years old male smoker admitted to Affiliated Hospital of Hebei University on July 22, 2024, presented with a three-month history of cough and white sputum, unresponsive to multiple antibiotic regimens. Chest computed tomography showed bilateral interstitial changes and right upper lobe consolidation initially interpreted as pneumonia. Despite sequential anti-infective therapy with cefoperazone/ sulbactam, levofloxacin, meropenem and caspofungin, radiological findings worsened. Next-generation sequencing of bronchial aspirates detected Stenotrophomonas maltophilia, Burkholderia cepacia and Candida albicans, but targeted antimicrobials provided only transient symptom relief. One month after discharge, recurrent cough prompted transbronchial cryobiopsy, which confirmed adenocarcinoma (CK7+, TTF-1+, p40-, Ki-67-10%). This case illustrates that pneumonic-type lung adenocarcinoma can mimic refractory pneumonia. When pulmonary opacities fail to respond to adequate anti-infective therapy, especially in elderly patients with chronic productive cough and mildly elevated tumor markers, early histopathological evaluation is essential to avoid diagnostic delay.
We report a 35-year-old man with Fabry disease coexisting with Hepatitis-B virus (HBV)-associated IgA nephropathy who had been treated for "rheumatism" for many years. He presented with severe burning pain in his extremities, microscopic hematuria and nephrotic-range proteinuria, while kidney function was preserved. Autoimmune tests were negative, but HBV markers were positive. Renal biopsy showed IgA-dominant mesangial proliferative glomerulonephritis with mesangial HBsAg deposits, and electron microscopy revealed myelin-like inclusions in podocytes and tubules. Markedly reduced alpha-galactosidase A activity, elevated lyso-GL-3 and a splice-site GLA mutation confirmed Fabry disease. Treatment with renin-angiotensin blockade, entecavir and enzyme replacement improved pain and proteinuria and stabilized renal function. This case illustrates that Fabry disease coexisting with HBV-associated IgA nephropathy is uncommon and easily underdiagnosed, and that persistent neuropathic pain with proteinuria should prompt consideration of metabolic and genetic renal disorders.
Going into 2026, dentistry faces significant challenges in meeting the demand for dental appointments, with approximately 13 million people in the UK reporting unmet dental and oral health needs.1 Access inequalities and affordability issues mean many patients avoid appointments until they become urgent. In response, the government and regulatory boards have introduced reforms aimed at expanding capacity and transitioning toward a preventative care model.
