Aggressive fibromatosis in pediatric population: A case series

Introduction: Aggressive fibromatosis or Desmoid fibromatosis is a benign tumor which originated form mesenchymal tissues of the body. This tumor has strong potential of recurrence and infiltration but it does not metastasize to other organs of the body. This case series is focused to determine the treatment outcomes for pediatric patients of aggressive fibromatosis. Methodology: It is a retrospective case series conducted on 7 patients presented to section of Orthopedics, department of surgery of our institute in Karachi. We included all the cases of pediatric patients from 1 to 16 years, with biopsy proven fibromatosis from January 2000 to December 2015. Presentation of Cases: Out of 7 pediatric patients, there were 6 (85.7%) males and 1 (14.3%) female patient. The median age was 6 years IQR (5-11) years. Gluteal region was the most common site of disease. Four patients (57.1%) had positive tumor margins while three (42.9%) had negative margins. Out of 7 patients, 4 patients (57.1%) had recurrent disease and they had positive margins. The median Disease Free survival time was 14 months and there was no expiry of patients. Conclusion & Recommendation: The conclusion of our study was that aggressive fibromatosis is more prevalent in children below 15 years of age and disease burden is higher in male gender. Positive margins after surgery indicate a high risk for disease recurrence therefore; primary surgery with negative margins is the treatment of choice for children with AF. However, we recommend that multicenter trials should be conducted in the future to clarify the role of adjuvant treatment for patients with pediatric AF

Process design of onboard membrane carbon capture and liquefaction systems for LNG-fueled ships

This study proposes an onboard membrane carbon capture and liquefaction system for LNG-fueled ships to satisfy the IMO’s 2050 greenhouse gas reduction targets. The exhaust gas from a natural gas ship has a low CO2 fraction (∼3%) and high O2 fraction (∼16%) compared to the flue gas from power plants. Herein, considering the above distinguishing features, a membrane carbon capture and liquefaction system has been proposed that is energy efficient and compact for the application of ships. To ascertain the performance of the proposed membrane-based system, it is compared to an amine-based onboard system in terms of energy consumption and major equipment size. This work evaluates four process configurations by varying the number of membrane stages and associated liquefaction processes at different CO2/N2 selectivity and CO2 permeance. The results show that energy consumption (3.98 GJe/tLCO2) is higher than the amine-based system (3.07 GJe/tLCO2) at the CO2/N2 selectivity of 50, but it can be decreased to 3.14 and 2.82 (GJe/tLCO2) with an improved selectivity of 100 and 150, respectively. The major equipment size decreases to 54%, 28%, and 20% of the amine-based system when the permeance is 1000, 2000, and 3000 GPU, respectively. The results indicate that the new onboard membrane carbon capture and liquefaction system can be a competitive solution for the IMO’s greenhouse gas reduction targets for 2050.Process design of onboard membrane carbon capture and liquefaction systems for LNG-fueled shipsacceptedVersio

Comparison of Efficacy of Above Elbow POP Versus Below Elbow POP in Distal Forearm Displaced Fractures in Children

Background: To compare the efficacy of above elbow versus below elbow POP cast in distal forearm displaced fractures in children.Methods: In this randomized controlled trial 264 patients were selected using consecutive non-probability sampling and were randomized into two groups, one group underwent manipulation under anaesthesia (MUA) and above elbow POP while the other group underwent MUA and below elbow POP. Efficacy was checked at 1 week by X-rays showing presence of re-displacement.Results: Fifty six percent patients were male while 44% patients were female. Bone involvement stood at 14.8%, 54.9% and 30.3% for Ulna only, Radius only and combined Ulna and Radius, respectively. Efficacy was 70.45% in the below elbow group as compared to 52.2% in above elbow group (p=0.002).Conclusion: Below elbow cast is better than above elbow cast in the treatment of displaced distal forearm fractures in children in terms of re-displacement

How innovative climate leads to project success: the moderating role of gender and work culture

Purpose – In modern times, innovation is considered as a vital component of sustainable competitiveadvantage. The purpose of this paper is to identify how innovation at the individual level [innovative workbehavior (IWB)] and at the organizational level [innovative organizational climate (IOC)] affects the chances ofsuccess of a particular project. Additionally, the moderating effect of gender and work culture on the relationbetween innovative climate and behavior is tested in the study.Design/methodology/approach – Survey technique was used to collect data from 425 employeesworking in project departments at the executive, middle level and senior level management in the paintmanufacturing industry of Pakistan. Multiple regression, as well as Preacher and Hayes (2004) tests, wereapplied to test the hypotheses.Findings – The result of the data analysis showed that IWB acts as a mediator between IOC and projectsuccess (PS), thereby supporting the hypothesized model of innovation and PS. Work culture was supportedas a moderator; however, no moderating effect of gender was validated by the results.Research limitations/implications – The management must make sure that to maximize the rate ofsuccess of projects, innovative work climate within the organizations and departments be given dueimportance. In addition to this, personnel’s individual innovation capabilities must also be enhanced bytaking steps toward improvement through training and development. Originality/value – Though attention has been given to research in innovation in light of other relatedvariables, its relation to PS remains yet to be studied. The effect of gender and work culture on innovation inPakistani paint industry was long over-due which has been addressed by this stud

Early experience of dynamic hip screw with spiral blade and locking side plate for the stabilization of trochanteric fractures.

Abstract OBJECTIVE: To evaluate early experience with helical hip system in osteoporotic elderly patients with per-trochanteric fractures. METHODS: The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised records of patients having low-velocity pertrochanteric fractures who were fixed with spiral blade Dynamic Helical Hip Systemfrom July to December 2014 and were followed up for a minimum of 3 months. Demographic variables and clinical outcomes were noted from the medical records whereas operative details were recorded from the operative note. Radiological variables and outcomes were assessed by viewing appropriate pre-operative, post-operative and follow-up radiographs. RESULTS: Of the 32 patients in the study, 14(44%) were men and 18(56%) were women, with an overall mean age of 77.81±7.04 years and mean body mass index of 25.99±4.13 kg/m2. Of the total, 1(3.13%) patient had implant cut-out, 1(3.13%) had myocardial infarctionand 2(6.2) expired. CONCLUSIONS: The introduction of spiral blade dynamic hip screw manifested favourable results and good clinical and radiological outcomes with low cut-out rates

Oil Price Shock and its Impact on the Macroeconomic Variables of Pakistan: A Structural Vector Autoregressive Approach

This study examines the dynamic effects of the oil price shocks on the key macroeconomic variables of Pakistan. A Structural Vector Autoregressive model is used on yearly data from 1960 to 2014. The impulse response functions indicate that the oil price shocks depress the real gross domestic product while the real exchange rate also experiences depreciation. However, the long-term interest rate and the inflation rate rise as a result of a positive oil price shock. The unanticipated changes in these macroeconomic variables threaten the economic stability of Pakistan; specifically, higher inflation and interest rates hamper the economy's growth rate. Lastly, the variance decomposition analysis illustrates that the oil price shocks have the most impact on the inflation rate of Pakistan. Keywords: SVAR; Oil Price Shocks; Macroeconomic Variable JEL Classifications: C22; E40; E31; E50; Q43

Detailed analysis of allergic cutaneous reactions to spinal cord stimulator devices

The use of spinal cord stimulation (SCS) devices to treat chronic, refractory neuropathic pain continues to expand in application. While device-related complications have been well described, inflammatory reactions to the components of these devices remain underreported. In contrast, hypersensitivity reactions associated with other implanted therapies, such as endovascular and cardiac rhythm devices, have been detailed. The purpose of this case series is to describe the clinical presentation and course of inflammatory reactions as well as the histology of these reactions. All patients required removal of the entire device after developing inflammatory reactions over a time course of 1–3 months. Two patients developed a foreign body reaction in the lead insertion wound as well as at the implantable pulse generator site, with histology positive for giant cells. One patient developed an inflammatory dermatitis on the flank and abdomen that resolved with topical hydrocortisone. “In vivo” testing with a lead extension fragment placed in the buttock resulted in a negative reaction followed by successful reimplantation of an SCS device. Inflammatory reactions to SCS devices can manifest as contact dermatitis, granuloma formation, or foreign body reactions with giant cell formation. Tissue diagnosis is essential, and is helpful to differentiate an inflammatory reaction from infection. The role of skin patch testing for 96 hours may not be suited to detect inflammatory giant cell reactions that manifest several weeks post implantation

A methodology for flexibility analysis of pipeline systems

Pipeline systems serve a crucial role in an effective transport of fluids to the designated location for medium to long span of distances. Owing to its paramount economic significance, pipeline design field have undergone extensive development over the past few years for enhancing the optimization and transport efficiency. This research paper attempts to propose a methodology for flexibility analysis of pipeline systems through employing contemporary computational tools and practices. A methodical procedure is developed, which involves modeling of the selected pipeline system in CAESAR II followed by the insertion of pipe supports and restraints. The specific location and selection of the inserted supports is based on the results derived from the displacement, stress, reaction, and nozzle analysis of the concerned pipeline system. Emphasis is laid on the compliance of the design features to the leading code of pipeline transportation systems for liquid and slurries, ASME B31.4. The discussed procedure and approach can be successfully adjusted for the analysis of various other types of pipeline system configuration. In addition to the provision of systematic flow in analysis, the method also improves efficient time-saving practices in the pipeline stress analysis

Does Performing Endoscopy Sooner Have an Impact on Outcomes in Patients With Acute Nonvariceal Upper Gastrointestinal Hemorrhage? A Systematic Review.

Background Endoscopy is the cornerstone for the diagnosis and treatment of nonvariceal upper gastrointestinal bleeding. Regarding the management of nonvariceal bleeding, the administration of crystalloid solution and proton pump inhibitors before endoscopy is well established, but the optimal timing of endoscopy has been a matter of debate and a subject of many investigational studies. The need for urgent endoscopy arises to provide prompt redress to acute bleeding, decrease the length of stay, and lower mortality from ongoing bleeding. Objective This study aimed to determine if endoscopy performed within 24 hours of presentation improves outcomes in terms of mortality, hospital length of stay, and rebleeding in individuals presenting with nonvariceal upper gastrointestinal bleed with any risk. Methodology We performed a systematic review of two large databases (PubMed and Google Scholar) to incorporate all studies published after 2000. We included studies with nonvariceal upper gastrointestinal bleeding and excluded those reporting variceal gastrointestinal hemorrhage. Results We reviewed eight studies that qualified after meeting our inclusion and exclusion criteria. We divided these studies into three separate groups based on the timing of endoscopy. Only two studies found a difference in mortality that was statistically significant in patients who underwent endoscopy within 24 hours of presentation. One study showed lower mortality in a patient who underwent urgent endoscopy, but it did not reach statistical significance. Other studies did not show any statistical difference in mortality, hospital length of stay, and rebleeding rates. The studies showed conflicting evidence on the amount of blood transfusion, though urgent endoscopy was found to be difficult in few studies due to blood obscuring the lesion. Conclusions While data suggest that there is a potential benefit in performing endoscopy sooner, there is no concrete evidence to point to a particular time range. Before performing endoscopy, the American Society for Gastrointestinal Endoscopy (2012) recommends adequate resuscitation with crystalloid solutions, blood transfusions, and antisecretory and prokinetic agent therapy. More investigational studies are needed to formulate a time-sensitive flow sheet to approach endoscopy in patients with nonvariceal upper gastrointestinal bleeding. A strict criterion is also needed to delineate patients into low-risk and high-risk groups. Doing so would provide a systematic approach to help with mortality, rebleeding, and healthcare resource utilization