Low cost reconstructive options after musculoskeletal tumour resection in developing countries: Affordable, effective and durable alternatives

Over the last two, three decades, the overall survival rates for non-metastatic malignant tumours of the bone have dramatically improved. This has become possible due to the recent advances and multidisciplinary approach towards these diseases, specifically the advent of multi-agent chemotherapy and radiotherapy. Limb salvage has now become the norm in the treatment of musculoskeletal tumours without compromising on the overall survival and recurrence of the disease. In the era of metal, prosthetic reconstruction has become the standard procedure specifically in the large tumours which involve the joints as this method of reconstruction helps in joint mobility and early weight-bearing. Considering the costs and resource constraints, multiple cost-effective, stable, durable reconstruction options have evolved over the last decade and these have also shown favourable func tional outcomes without compromising on the amount of resection and risk of local recurrence. The current literature review was planned to discuss various cost-effective, durable reconstructive options and their advantages and disadvantages. These include Van ness rotationplasty, allograft, autograft, devitalised tumour bone and Masqueletor induced membran

Dichlorido(5,10,15,20-tetra­phenyl­porphyrinato-κ4 N)anti­mony(V) hemi{di-μ-chlorido-bis­[trichloridoanti­monate(III)]} dichloro­methane monosolvate

The asymmetric unit of the title complex, [Sb(C44H28N4)Cl2][Sb2Cl8]0.5·CH2Cl2, is composed of a SbV complex cation wherein the Sb atom is hexa­coordinated by four N atoms of the pyrrole rings of the tetra­phenyl­porphyrinate (TPP) ligands and two chloride ions, a half di-μ-chlorido-bis­[trichloridoanti­monate(III)] counter-anion and a dichloro­methane solvent mol­ecule. In the cation, the average Sb—N distance is 2.066 (2) Å, while the Sb—Cl distances are 2.3410 (11) and 2.3639 (12) Å. The central unit of the cation, SbN4C20, is far from being planar, with deviations of atoms from the least-squares plane ranging from −0.110 (4) to 0.124 (4) Å. The Sb—Cl distances in the anion, which is located about an inversion center, lie in the wide range 2.3715 (13)–2.7489 (13) Å, the longest distances being between the Sb and bridging Cl atoms. The crystal structure is stabilized by inter­molecular C—H⋯Cl inter­actions involving the cations, the anions and the solvent mol­ecules. The solvent mol­ecule is disordered over two orientations in a 0.901 (13):0.099 (13) ratio

Infected non-union of tibia treated with ilizarov external fixator: Our experience

Introduction: Tibia is the most common long bone fractured due its vulnerable subcutaneous location and most often associated with acquired complications of delayed union or non-union due to infection. Amongst the various treatment options to treat them, the Ilizarov external fixator application is considered superior due to its multiple advantages. The objective of this study was to analyse the role of Ilizarov fixation in infected tibial non-union, as well as to assess bony union and associated functional outcomes. Materials and Methods: A retrospective review was conducted for the duration between 1st January 2005 to 31st December 2016. Total of fifty-one patients with tibial non-union associated with infection who treated with the Ilizarov fixator were included in the study. Patient records were reviewed for union of bone, bone and functional outcomes and complications. Results: The most common organism for infection was identified to be Staphylococcus Aureus. At the time of final follow-up all patients had achieved union except two, one of whom had to undergo amputation due to non-union and sepsis. Majority of the patients had an excellent score as per ASAMI grading system for bone and function results. The most common complication noted was pin track infections. Conclusion: In our experience, Ilizarov external fixator is better suited for infected non-union of tibia because it can provide a stable mechanical environment, bone transport, correct deformities, and enable weight bearing and hence we recommend its use for the same

Lean manufacturing culture: The role of human perceptions of standardized work

The final publication is available at IOS Press through http://dx.doi.org/10.3233/978-1-61499-902-7-523.Lean implementation and its sustainability are strongly coupled with organizational culture and consequently the culture defines success. Organizational culture is strongly linked with organizational dynamics. Work standardization is one of the lean tools whose role in terms of organizational performance improvement has been claimed in the literature; however, its implications in terms of employee's perceptions are still controversial. This study aims at investigating the effect of position on employee's perception about the standardized work. Four textile manufacturing companies in Pakistan were selected for the purpose of data collection, where the implementation level of the tool and organizational maturity towards lean adoption were initially measured. A questionnaire was administered to 326 employees from these organizations. The overall data sample was divided into two categories (white-collar and blue-collar). Data analysis was by F-tests (for identifying significance levels) and separate regression analyses (for identifying variables associated with negative perceptions of employees). A significant difference was found between white-collar employees, who were generally positive about the standardization of work, and the blue-collar employees that had negative perceptions. Moreover, the study concluded that positive perceptions about standardized work are directly linked with job satisfaction and inversely linked with job stress

Stock market trend prediction using supervised learning

© 2019 Association for Computing Machinery. The stock trend prediction has received considerable attention of researchers in recent times. It is an important application in machine learning domain. In this work, we propose a machine learning based stock trend prediction system with a focus on minimizing data sparseness in the acquired datasets. We perform outlier detection on the acquired dataset for dimensionality reduction and employ K-nearest neighbor classifier for predicting stock trend. Results obtained show the effectiveness of the proposed system, when compared with baseline studies

Effect of sodium lactate /sodium diacetate in combination with sodium nitrite on physiochemical, microbial properties and sensory evaluation of cow sausage

Sodium nitrite has been always considered as one of the common additives due to its antibacterial effects on Clostridium botulinum and meat products' color, however it produces cancer creating nitrosamine. Recently, organic acids and their salts such as lactates have been employed as antimicrobial compounds. Lactates also improve organileptic properties including color, texture and taste and antioxidant properties. Sodium lactate causes to more reduction of anaerobic spore former bacteria than nitrite, inhibits botulin produced by Clostridium botulinum. Sodium lactate produces a permanent reddish pink color through reduction of deoxymygloboline and producing deoxymyoglobuline. In this study, the decrease of sodium nitrite amount from 120ppm to 15ppm by adding sodium lactate / sodium diacetate led to achieve an acceptable product. The best results revealed through adding 3.0625% of sodium lactate / sodium diacetate in combination with 30ppm sodium nitrite. Results also exhibited more reduction of pathogens' growth than nitrite, enhanced flavor slightly, but unable to produce reddish pink color as produced by nitrite. Results also exhibited  that sodium lactate / diacetate cause to retard in microbial growth, reducing chemical change, enhance sensory properties, partially improvement in taste and texture. Although inappropriate color demonstrated sodium lactate / diacetate's inability in red pink color production in 4th sample (contains 15 ppm nitrite), its synergy effect in combination with sodium nitrite on nitroso myoglobuline production has been proven, led to sodium nitrite reduction in sausages

Operational Risk Management in Corporate and Banking Sector of Pakistan

This paper is to examine the current status of operational risk management in Pakistan concerning corporate and banking sector and explore the reasons for the adoption or lack of adoption of integrated approach to operational risk management. It identifies the imperatives for implementation of comprehensive risk management solutions leading to enterprise risk management (ERM).The mode of research is qualitative. The paper shows that effective risk management can enhance organizational performance but appropriate infrastructure is not available in companies.  This paper highlights the fact that knowledge of risk management in corporate sectors of Pakistan is insufficient and sample companies hesitate to respond thinking that it may reflect inefficiencies and in banking sectors the concept of operational risk management can be seen up to some extent. Keywords: Operational risk management, corporate and banking, integrated approach, Enterprise risk management, organizational performanc

Antibiotic susceptibility profiling and virulence potential of Campylobacter jejuni isolates from different sources in Pakistan

AbstractObjectiveTo determine antibiotic resistance patterns and virulence potential of Campylobacter jejuni (C. jejuni) isolates from clinical human diarrheal infections, cattle and healthy broilers.MethodsAntibiotic sensitivity patterns of C. jejuni isolates were determined by Kirby Bauer Disc Diffusion assay. These isolates were then subjected to virulence profiling for the detection of mapA (membrane–associated protein), cadF (fibronectin binding protein), wlaN (beta–l,3–galactosyltransferase) and neuAB (sialic acid biosynthesis gene). Further C. jejuni isolates were grouped by random amplification of polymorphic DNA (RAPD) profiling.ResultsA total of 436 samples from poultry (n=88), cattle (n=216) and humans (n=132) from different locations were collected. Results revealed percentage of C. jejuni isolates were 35.2% (31/88), 25.0% (54/216) and 11.3% (15/132) among poultry, cattle and clinical human samples respectively. Antibiotic susceptibility results showed that similar resistance patterns to cephalothin was ie. 87.0%, 87.1% and 89%among humans, poultry and cattle respectively, followed by sulfamethoxazole+trimethoprim 40.0%, 38.7% and 31.0% in humans, poultry and cattle and Ampicillin 40%, 32% and 20% in humans, poultry and cattle respectively. Beta–lactamase activity was detected in 40.00% humans, 20.37% cattle and 32.25% in poultry C. jejuni isolates. CadF and mapA were present in all poultry, cattle and human C. jejuni isolates, wlaN was not detected in any isolate and neuAB was found in 9/31 (36%) poultry isolates. RAPD profiling results suggested high diversity of C. jejuni isolates.ConclusionsDetection of multidrug resistant C. jejuni strains from poultry and cattle is alarming as they can be potential hazard to humans. Moreover, predominant association of virulence factors, cadF and mapA (100% each) in C. jejuni isolates from all sources and neuAB (36%) with poultry isolates suggest the potential source of transmission of diverse types of C. jejuni to humans

Diabetic ketoacidosis associated with tacrolimus in solid organ transplant recipients

Diabetic ketoacidosis in patients receiving tacrolimus in the post-transplant setting is rare. We describe two such cases in solid-organ transplant recipients. The first patient, a 17-year-old male, presented with severe diabetic ketoacidosis and was managed with intravenous fluids and insulin infusion. He was a known case of Laurence-Moon-Bardet-Biedl syndrome and had received a renal transplant 2 years ago and was receiving tacrolimus since then. Although diabetic ketoacidosis resolved in 24 hours, large doses of subcutaneous insulin (upto 130 units per day) were needed to keep serum glucose within the normal range. Substitution of tacrolimus with cyclosporine obviated the need for insulin or oral hypoglycaemics. The second patient, a 55-year-old woman, presented with a history of polyuria for 3 days. She had received a hepatic transplant 2 years ago and tacrolimus was being used since then. Mild diabetic ketoacidosis was managed with fluid resuscitation and subcutaneous insulin. Her insulin requirement after an uneventful recovery has been 54 - 70 units per day. Clinicians should be cognizant of the possibility of hyperglycaemic crisis presenting as sudden onset of diabetic ketocidosis in patients receiving tacrolimus. Use of an alternative calcineurin inhibitor may provide a safer solution to minimize future morbidity in such patients

Lower-limb alignment and posterior tibial slope in Pakistanis: a radiographic study

Abstract PURPOSE: To assess the lower-limb alignment and posterior tibial slope in Pakistanis. METHODS: 40 male and 19 female healthy Pakistanis aged 20 to 45 years were recruited. A full weight-bearing anteroposterior radiograph of the entire lower limb of each subject was obtained. The axial alignment was measured based on the centres of the femoral head, knee, and ankle. The tibiofemoral (TF) angle, knee joint line obliquity angle (angle J), and posterior tibial slope were determined. RESULTS: The mean TF angle was more varus in men than women (178.4 degrees vs. 180.0 degrees, p\u3c0.001). The mean angle J was more medially inclined in men than women (93.4 degrees vs. 91.4 degrees, p=0.007). The mean medial tibial slope was greater in women than men (16.0 degrees vs. 12.5 degrees, p\u3c0.001). The posterior tibial slope was greater in women than men (14.1 degrees vs. 12.5 degrees, p=0.02), and was greater than the 5 degrees to 10 degrees commonly reported. CONCLUSIONS: Knee alignment and geometry vary in different population subsets. With regard to total knee arthroplasty, the more medially inclined angle J in Pakistani men suggests that an anteroposterior cut of the distal femur should be in increased external rotation, compared with Pakistani women. Whereas the greater posterior tibial slope in Pakistanis suggests that a proximal tibial cut with a greater posterior tibial slope may reduce the chance of tibial loosening and increase postoperative knee range of motion, especially when using posterior cruciate ligament-retaining designs