Background: Completed treatment of congenital clubfoot deformity using the non-surgical Ponseti method yields very good results. However, many children do not complete the treatment course, potentiating relapse of the deformity, forever compromising independent gait and quality of life. If the factors precipitating 'drop out' from treatment can be averted, more children will complete the Ponseti method of treatment which has low rate of complication and is both economical and highly effective. Children depend on parents to bring them to the clinics, hence we aimed to identify factors obstructing parents and ultimately the children's outcomes. Once identified, barriers to completing treatment may be removed. Aim:To identify the factors obstructing completion of clubfoot treatment.Method: Two of the 32 Walk for Life (WFL) clubfoot clinics in Bangladesh were utilised for participants, who were parents and children (n=72) who had dropped out from completing the clubfoot treatment course four to six years earlier. Bootstrapping was used to improve statistical power (based on 1000 random sample). Validated outcome measures included a specific context drop out questionnaire, the Oxford Ankle Foot questionnaire, the Bangla clubfoot assessment, and the Foot Posture Index. Parent's insights, experiences and recommendations were canvassed both qualitatively and quantitatively.Result: Relapse occurred in 15/72 drop out cases, predicted by problems with the initial casting process. The main reasons for drop out were difficulty with the foot abduction brace (42%), family issues (31%), and other problems with the child's clubfoot treatment (15%). Despite problems and incompletion, the parents were generally satisfied (93%), although many felt sad or ashamed for not completing the treatment course and realizing clubfoot deformity recurrence (96%). Parents who had dropped out, were noted by WFL staff to be regretful, and especially so if their now older child's clubfoot had relapsed to obviously compromise independent gait and mobility. A lack of discernment of postural clubfeet from 'true' clubfeet was identified in some clinicians, indicating variable practice methods despite uniform training, and probably lowering the overall relapse rate with inclusion of 'postural' cases. Conclusion:Relapse was predicted by problems with casting and predicted worse foot posture and reduced physical functioning. Walk for Life adopted appointment reminders, parent support groups, cost sharing, and staff updates.

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Objective: To determine the frequency, risk factors, and management of hepatic arterial thrombosis (HAT) in recipients of living donor living transplantation.

Cerebral phaeohyphomycosis is a fungal brain infection with a high fatality rate. It is caused by dematiaceous fungi and is increasingly recognized as a cause of serious illness in both immunocompetent and immunocompromised patients. We report cerebral phaeohyphomycosis in a liver transplant recipient. He was treated with multiple surgeries and antifungals and made a complete recovery. This report highlights that early and aggressive surgical intervention and extended antifungal coverage can have a positive outcome even in immunocompromised patients. The fungal infection in immunocompromised patients should be considered and treated aggressively.

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