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Chaubal G, Hatimi H, Nanavati A, Deshpande A, Andankar P, Biradar V, Gupte P, Hanchnale P, Bhalerao S, Tambe S. Pediatric living donor intestine transplant following an atypical complication of COVID-19: A unique case report from India. Am J Transplant 2021; 21:4079-4083. [PMID: 34390165 PMCID: PMC8441672 DOI: 10.1111/ajt.16798] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/13/2021] [Accepted: 08/08/2021] [Indexed: 02/06/2023]
Abstract
Coronavirus disease-19 (COVID-19) infection causing severe gastrointestinal complications is rare. A 9-year-old child after recovering from mild COVID-19 infection developed small bowel gangrene due to superior mesenteric artery thrombosis. He required resection of entire necrotic small bowel along with caecum causing ultra-short bowel syndrome. Reverse transcriptase-polymerase chain reaction (RT-PCR) done on the resected specimen was positive for COVID-19. He was maintained on individualized parenteral nutrition for 3 months. A living donor intestinal transplant was performed using 200 cm of ileum donated by the patient's father. The graft function was satisfactory and was not complicated with thrombosis, infection, reactivation of latent COVID-19 or rejection. He could be weaned off completely from parenteral nutrition by postoperative day 21. The donor had an uneventful recovery. Six month follow-up was satisfactory with the child achieving complete enteral autonomy as well as target goal nutrition. Thrombotic phenomena associated with COVID-19 infection can affect larger vessel-like superior mesenteric artery leading to small bowel gangrene. Intestine transplant could be done safely after 3 months of recovery from COVID-19 without any adverse outcomes. Further studies are required to establish optimal timing and safety of small bowel transplant in this situation.
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Affiliation(s)
- Gaurav Chaubal
- Department of Organ Transplantation, Jupiter Hospital, Mumbai, Maharashtra, India
| | - Hunaid Hatimi
- Department of Organ Transplantation, Jupiter Hospital, Mumbai, Maharashtra, India,Correspondence Hunaid Hatimi, Jupiter Hospital, Thane, Mumbai, Maharashtra, India.
| | - Aditya Nanavati
- Department of Organ Transplantation, Jupiter Hospital, Mumbai, Maharashtra, India
| | - Apoorv Deshpande
- Department of Organ Transplantation, Jupiter Hospital, Pune, Maharashtra, India
| | - Parmanand Andankar
- Department of Organ Transplantation, Jupiter Hospital, Mumbai, Maharashtra, India
| | - Vishnu Biradar
- Department of Organ Transplantation, Jupiter Hospital, Pune, Maharashtra, India
| | - Parijat Gupte
- Department of Organ Transplantation, Jupiter Hospital, Mumbai, Maharashtra, India
| | - Pavan Hanchnale
- Department of Organ Transplantation, Jupiter Hospital, Pune, Maharashtra, India
| | - Suryabhan Bhalerao
- Department of Organ Transplantation, Jupiter Hospital, Pune, Maharashtra, India
| | - Shrinivas Tambe
- Department of Organ Transplantation, Jupiter Hospital, Pune, Maharashtra, India
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Mohanka R, Rao P, Shah M, Gupte A, Nikam V, Vohra M, Kohli R, Shrimal A, Golhar A, Panchwagh A, Kamath S, Shukla A, Patel P, Chattopadhyay S, Chaubal G, Shaikh Y, Dedhia V, Sarmalkar SS, Maghade R, Shinde K, Bhilare P, Nalawade R, As J, Shah S. Acute liver failure secondary to yellow phosphorus rodenticide poisoning: Outcomes at a center with dedicated liver intensive care and transplant unit. J Clin Exp Hepatol 2020; 11:S0973-6883(20)30149-3. [PMID: 33052182 PMCID: PMC7543916 DOI: 10.1016/j.jceh.2020.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/17/2020] [Accepted: 09/28/2020] [Indexed: 12/12/2022] Open
Abstract
Accidental or suicidal poisoning with yellow phosphorus or metal phosphides (YPMP) such as aluminum (AlP) zinc phosphide (Zn3P2) commonly cause acute liver failure (ALF) and cardiotoxicity. These are used as household, agricultural and industrial rodenticides and in production of ammunitions, firecrackers and fertilizers. In absence of a clinically available laboratory test for diagnosis or toxin measurement or an antidote, managing their poisoning is challenging even at a tertiary care center with a dedicated liver intensive care unit (LICU) and liver transplant facility. PATIENTS AND METHODS Patients with YPMP related ALF were monitored using standardized clinical, hemodynamic, biochemical, metabolic, neurological, electrocardiography (ECG) and SOFA score and managed using uniform intensive care, treatment and transplant protocols in LICU. Socio-demographic characteristics, clinical and biochemical parameters and scores were summarized and compared between 3 groups i.e. spontaneous survivors, transplanted patients and non-survivors. Predictors of spontaneous survival and the need for liver transplant are also evaluated. RESULTS Nineteen patients with YPMP related ALF were about 32 years old (63.2% females) and presented to us at a median of 3 (0 - 10) days after poisoning. YPMP related cardiotoxicity was rapidly progressive and fatal whereas liver transplant was therapeutic for ALF. Spontaneous survivors had lower dose ingestion (<17.5 grams), absence of cardiotoxicity, < grade 3 HE, lactate < 5.8, SOFA score < 14.5, and increase in SOFA score by < 5.5. Patients with renal failure need for CVVHDF and KCC positivity on account of PT-INR > 6.5 had higher mortality risk. Patients undergoing liver transplant and with spontaneous recovery required longer ICU and hospital stay. At median follow-up of 3.4 (2.6 - 5.5) years, all spontaneous survivors and transplanted patients are well with normal liver function. CONCLUSIONS Early transfer to a specialized center, pre-emptive close monitoring, and intensive care and organ support with ventilation, CVVHDF, plasmapheresis and others may maximize their chances of spontaneous recovery, allow accurate prognostication and a timely liver transplant.
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Key Words
- AKI, Acute kidney injury
- ALF, acute liver failure
- Acute Liver Failure
- CVVHDF, Continuous Veno-Venous Hemodiafiltration
- Continuous Veno-Venous Hemodiafiltration
- DDLT, Deceased donor liver transplant
- IEH, Ingestion to encephalopathy interval
- KCC, King College criteria
- LDLT, living donor liver transplant
- Liver Transplant
- MELD, Model for end-stage liver disease
- MOF, Multi-Organ Failure
- Multi-Organ Failure
- Plasmapheresis
- Rodenticide
- SIRS, systemic inflammatory response syndrome
- SOFA, sequential organ failure assessment
- YPMP, yellow phosphorus or metal phosphides
- Yellow Phosphorus
- Zinc Phosphide
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Affiliation(s)
- Ravi Mohanka
- Department of Liver Transplantation and HPB Surgery, Global Hospital, 35, Dr. E Borges Road Opp. Shirodkar High School, Parel, Mumbai, Maharashtra, 400012, India
| | - Prashantha Rao
- Department of Liver Transplantation and HPB Surgery, Global Hospital, 35, Dr. E Borges Road Opp. Shirodkar High School, Parel, Mumbai, Maharashtra, 400012, India
| | - Mitul Shah
- Department of Liver Transplantation and HPB Surgery, Global Hospital, 35, Dr. E Borges Road Opp. Shirodkar High School, Parel, Mumbai, Maharashtra, 400012, India
| | - Amit Gupte
- Department of Hepatology, Global Hospital, 35, Dr. E Borges Road Opp. Shirodkar High School, Parel, Mumbai, 400012, Maharashtra, India
| | - Vinayak Nikam
- Department of Liver Transplantation and HPB Surgery, Global Hospital, 35, Dr. E Borges Road Opp. Shirodkar High School, Parel, Mumbai, Maharashtra, 400012, India
| | - Mihir Vohra
- Department of Hepatology, Global Hospital, 35, Dr. E Borges Road Opp. Shirodkar High School, Parel, Mumbai, 400012, Maharashtra, India
| | - Ruhi Kohli
- Department of Liver Intensive Care, Global Hospital, 35, Dr. E Borges Road Opp. Shirodkar High School, Parel, Mumbai, 400012, Maharashtra, India
| | - Anurag Shrimal
- Department of Liver Transplantation and HPB Surgery, Global Hospital, 35, Dr. E Borges Road Opp. Shirodkar High School, Parel, Mumbai, Maharashtra, 400012, India
| | - Ankush Golhar
- Department of Liver Transplantation and HPB Surgery, Global Hospital, 35, Dr. E Borges Road Opp. Shirodkar High School, Parel, Mumbai, Maharashtra, 400012, India
| | - Ameya Panchwagh
- Department of Liver Transplant Anesthesia, Global Hospital, 35, Dr. E Borges Road Opp. Shirodkar High School, Parel, Mumbai, 400012, Maharashtra, India
| | - Saurabh Kamath
- Department of Liver Transplant Anesthesia, Global Hospital, 35, Dr. E Borges Road Opp. Shirodkar High School, Parel, Mumbai, 400012, Maharashtra, India
| | - Akash Shukla
- Department of Hepatology, Global Hospital, 35, Dr. E Borges Road Opp. Shirodkar High School, Parel, Mumbai, 400012, Maharashtra, India
| | - Priyesh Patel
- Department of Hepatology, Global Hospital, 35, Dr. E Borges Road Opp. Shirodkar High School, Parel, Mumbai, 400012, Maharashtra, India
| | - Somnath Chattopadhyay
- Department of Liver Transplantation and HPB Surgery, Global Hospital, 35, Dr. E Borges Road Opp. Shirodkar High School, Parel, Mumbai, Maharashtra, 400012, India
| | - Gaurav Chaubal
- Department of Liver Transplantation and HPB Surgery, Global Hospital, 35, Dr. E Borges Road Opp. Shirodkar High School, Parel, Mumbai, Maharashtra, 400012, India
| | - Yasmin Shaikh
- Department of Liver Transplantation and HPB Surgery, Global Hospital, 35, Dr. E Borges Road Opp. Shirodkar High School, Parel, Mumbai, Maharashtra, 400012, India
| | - Vidhi Dedhia
- Department of Liver Transplantation and HPB Surgery, Global Hospital, 35, Dr. E Borges Road Opp. Shirodkar High School, Parel, Mumbai, Maharashtra, 400012, India
| | - Shivali S. Sarmalkar
- Department of Liver Transplantation and HPB Surgery, Global Hospital, 35, Dr. E Borges Road Opp. Shirodkar High School, Parel, Mumbai, Maharashtra, 400012, India
| | - Ravikiran Maghade
- Department of Hepatology, Global Hospital, 35, Dr. E Borges Road Opp. Shirodkar High School, Parel, Mumbai, 400012, Maharashtra, India
| | - Kavita Shinde
- Department of Liver Intensive Care, Global Hospital, 35, Dr. E Borges Road Opp. Shirodkar High School, Parel, Mumbai, 400012, Maharashtra, India
| | - Priyanka Bhilare
- Department of Liver Transplantation and HPB Surgery, Global Hospital, 35, Dr. E Borges Road Opp. Shirodkar High School, Parel, Mumbai, Maharashtra, 400012, India
| | - Rohini Nalawade
- Department of Liver Transplantation and HPB Surgery, Global Hospital, 35, Dr. E Borges Road Opp. Shirodkar High School, Parel, Mumbai, Maharashtra, 400012, India
| | - Jacob As
- Department of Liver Intensive Care, Global Hospital, 35, Dr. E Borges Road Opp. Shirodkar High School, Parel, Mumbai, 400012, Maharashtra, India
| | - Samir Shah
- Department of Hepatology, Global Hospital, 35, Dr. E Borges Road Opp. Shirodkar High School, Parel, Mumbai, 400012, Maharashtra, India
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Bansal VK, Rajan K, Sharma A, Paliwal P, Chaubal G, Jindal V, Misra MC, Kucheria K. Prospective Case-Control Study to Evaluate the Role of Glutathione S Transferases (GSTT1 and GSTM1) Gene Deletion in Breast Carcinoma and Its Prognostic Significance. Indian J Surg 2014; 77:1067-72. [PMID: 27011512 DOI: 10.1007/s12262-014-1152-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Accepted: 07/22/2014] [Indexed: 11/24/2022] Open
Abstract
Breast cancer is the most common cause of cancer death in women with the incidence rising in young women. GST gene polymorphisms are significant because of their role in the detoxification of both environmental carcinogens and also cytotoxic drugs used in therapy for breast cancer. The present study has been designed to identify the role of polymorphisms in GSTT1 and GSTM1 genes in the risk of development of breast cancer, in the prognostication of breast cancer, and in the prediction of response towards chemotherapy. Ninety-nine patients with breast cancer and 100 healthy controls with no history of cancer were taken from blood donors after informed consent. Epidemiological and clinical data was collected from participants and 5 ml of peripheral venous blood was collected for genotype analysis. Null genotype of GSTT1 was detected in 51.04 % of the controls in comparison to 20.2 % of patients with carcinoma breast, which was found to be statistically significant (OR 4.18; 95 % CI 2.01-8.75; P = 0.0001). GSTM1 gene deletion was also significantly more common among controls (60 %) than in patients with breast cancer (33 %) (OR 4.57; 95 % CI 2.20-9.51; P = 0.0001). Tumors more than 5 cm in size had greater tendency for GSTM1 gene expression (P value = 0.019), but other clinicopathological parameters did not show any correlation. GSTT1 and GSTM1 genes status did not show any association with response to chemotherapy. The results indicated the null genotype of both GSTT1 and GSTM1 to be protective for the development of carcinoma breast. None of the known etiological factors have any correlation with GSTT1 and GSTM1 gene deletion. Patients with small tumor size expressed GSTM1 gene deletion. Other tumor characteristics and clinicopathological parameters did not have any correlation with gene deletion.
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Affiliation(s)
- Virinder Kumar Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5021, 5th Floor Teaching Block, New Delhi, India
| | - Karthik Rajan
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5021, 5th Floor Teaching Block, New Delhi, India
| | - Arundhati Sharma
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India
| | - Preeti Paliwal
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India
| | - Gaurav Chaubal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5021, 5th Floor Teaching Block, New Delhi, India
| | - Vikas Jindal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5021, 5th Floor Teaching Block, New Delhi, India
| | - Mahesh C Misra
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5021, 5th Floor Teaching Block, New Delhi, India
| | - Kiran Kucheria
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India
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