Isocitrate Dehydrogenase-1 Mutation as a Prognostic Factor in Recurrent Glioblastoma

Glioblastoma (GBM) is an aggressive form of brain cancer that has a high recurrence rate and very poor prognosis. The prognostic value of various molecular markers (e.g., IDH 1 mutation, MGMT promoter methylation, etc.) and clinical factors (e.g., age, KPS, surgery and chemotherapy) has been studied in GBM after initial diagnosis but not as extensively in the recurrent GBM. Utilizing a retrospective cohort design, based on quantitative data collected through medical chart reviews, and the conceptual framework of outcomes research in oncology, this study evaluated the prognostic value of IDH-1 mutation in recurrent GBM in the context of key predictor variables of age, MGMT promoter methylation, KPS, and surgery and chemotherapy at recurrence. The study specifically evaluated if there was a significant difference in overall survival and progression free survival between rGBM patients with and without IDH-1 mutation and if selected molecular and clinical covariates affected these outcomes. The results of this study indicated, albeit with its limitations, that IDH-1 mutation was not a prognostic factor in recurrent GBM. The prognostic value of IDH-1 mutation from initial diagnosis in this study was inconclusive, consistent with previous reports. The results of this study also indicated that although methylated MGMT promoter was a strong prognostic factor from initial diagnosis as previously reported, it was not a prognostic factor in recurrent GBM. Overall, the results of this study suggest that the prognosis and treatment of GBM may need to be considered differently at initial diagnosis and following disease recurrence. It is anticipated that the results of this study will bring about a positive social change by affecting both patient treatment and health care practice in recurrent GBM

Outcome of Judet\u27s quadricepsplasty for knee contractures and the effect of local infiltration of epinephrine on reducing blood loss

Objective: To evaluate the effectiveness of Judet\u27s quadricepsplasty for treatment of knee contractures and to identify the effect of local infiltration of epinephrine on blood loss associated with this procedure.Methods: A retrospective cohort study was conducted in which all cases of knee contractures managed with Judet\u27s quadricepsplasty from 1st January 2009 to 31st December 2013 were included and were divided into two groups. The epinephrine group included patients who were infiltrated with diluted epinephrine (1:400,000) along with xylocaine, around the operative field 15 min prior to the incision time, while the control group did not receive any infiltration. Judet\u27s outcome, blood loss, drop in hemoglobin and required blood transfusion were noted for all patients and compared between both groups.Results: Most common preceding pathology identified for the development of knee contractures was periarticular fracture while ilizarov application was the most common etiology. Both groups were found similar in all preoperative characteristics except preoperative flexion contracture (p = 0.02). All functional outcome measures including Judet\u27s outcome were similar in both groups. In contrast, duration of surgery (p = 0.01), blood loss (p = 0.02), drop in hemoglobin (p = 0.01) and number of transfusions (p = 0.03) were significantly reduced in epinephrine group.Conclusion: Judet\u27s quadricepsplasty is a useful procedure to increase the range of motion of rigid knees and local infiltration of epinephrine is effective in decreasing the amount of subsequent blood loss and transfusion requirements

Outcome of percutaneous screw fixation of posterior pelvic ring injuries

Objective: To evaluate the clinical outcome of percutaneous fixation for unstable pelvic ring injury.Methods: This retrospective study was conducted at orthopaedics section of Aga Khan University Hospital Karachi, Pakistan from July 2015 to December 2018. Data was retrieved from trauma registry from July 2015 till December 2018, including all patients who underwent percutaneous fixation for pelvic ring injury. Majeed pelvic score was used to determine the functional outcome.Results: A total number of 30 patients were included, 27(90.0%) adults, and 3(10.0%) paediatrics patients. There were 21(70.0%) males and 9(30.0%)females. . Mean age of patients was 37.1±16.1 years. Post op mean Majeed functional pelvic Score was 85.8. Of the 30 patients, 18 (60.0%) had Excellent, 10 (33.3%) good and 02(6.7%) fair scoring.Conclusions: Percutaneous fixation of posterior ring injuries has excellent functional outcome, with minimal blood loss and no soft tissue striping.

Two incision mini open carpal tunnel release- a minimally invasive alternative to endoscopic release

Abstract Surgical techniques for carpal tunnel release are constantly evolving to reduce complications. This retrospective study was planned to identify the outcome and complications associated with a new operating technique for release of carpal tunnel using two incisions. It was conducted at the Aga Khan University Hospital, Karachi, and comprised patients undergoing surgical release of carpal tunnel syndrome (CTS) between January 2011 and December 2014. Of the 54 patients,38(70.4%) cases were of right-sided CTS. The mean operating time was 12.5±4.9 minutes. Complete relief from symptoms was observed in all the patients and the only complication noted was superficial infection in 2(3.7%) patients.The outcomes and complications associated with this technique were comparable with other standard techniques. No major complication (e.g. neurovascular injury) was reported, which showed that this technique was safe and had no additional risks. Therefore, it can be used as an alternative to endoscopic release which is expensive and requires special training and equipment

Functional and radiological outcomes of atypical femur fractures among elderly in Karachi, Pakistan

Objective: To assess the functional and radiological outcomes in a unique class of fractures i.e. atypical femur fractures and to assess the effects of osteoblastic agents in healing.Methods: It is a retrospective observational study conducted at Aga Khan University Hospital, Karachi, Pakistan. All patients with atypical femur fractures who were surgically managed with intramedullary nailing from January, 2013 to June, 2017 and with a follow-up till December 2019, were included in the study. Radiological outcomes were expressed as mean healing time and functional outcomes were recorded as mean Short Musculoskeletal Functional Assessment (SMFA) score.Results: A total of twenty-four patients were included in this study. Mean age of patients was 65.8 ± 8 years. Mean healing time was 10 ±3.2 months post operatively. Two patients underwent redo procedures. No other complications like paresthesia or weakness was observed in any patients. All the patients reported a good score on SMFA ranging from 19% to 31%.Conclusion: Intra-medullary nailing shows a promising result in treatment of atypical femur fractures. Use of post-operative osteoblastic supplements showed statistically significant results with early healing time (p=0.008 [95% CI])

Proximal femur locking plate for sub-trochanteric femur fractures: Factors associated with failure

Introduction: Proximal femur locking compression plates (PF-LCP) have gained popularity since their inception due to superior biomechanical stability and durability but clinical experience has shown conflicting results including implant failure.Objective: To study the incidence of implant failure in patients with sub-trochanteric fractures managed with proximal femoral locking compression plate and identify potential risk factors associated with the failure.Materials & Methods: Fifty patients with sub-trochanteric fractures, operated upon with titanium PF-LCP were included in the study from January 2012 to December 2014. These plates were of two designs including one five 5.0 mm proximal locking screws (implant A) and other with three 6.5 mm proximal locking screws (implant B). Fractures were classified according to AO/OTA and Seinsheimer classification. Patients had regular follow-up visits for at least a year, allowing for clinical and radiological assessment of union and implant-related complications.Results: A total of 13 out of 50 (26%) plates failed of which 7 were implant fractures, 3 screw breakage and 3 screw cut outs. 70% of the failures occurred in elderly females. Overall implant failure was significantly more common in patients \u3e50 years (p 0.04). Comparing the two different designs of implants used, implant A was more likely to fail at a plate screw density of 0.8 or more (p 0.02), whereas implant B was associated with significant failure when less than 4 proximal screws were used (p 0.03).Conclusion: This study revealed a high failure rate (26%) of this implant. Attention to the neck shaft angle difference, number of proximal screws and plate screw density may help reduce failure rates, particularly in elderly osteoporotic females

Frequency of angular malalignment after intramedullary nailing for femur shaft fractures - A cross-sectional study

Objective: To determine the frequency of angular malalignment of femur in patients undergoing Intra Medullary nailing for femur shaft fracture by measuring axis on immediate postoperative plain radiographs.Methods: A cross-sectional study was conducted at the Section of Orthopaedics, Department of Surgery, Aga Khan University Hospital, Karachi from 1st January 2019 till 30th June 2019. All patients between the ages of 15 to 80 years who underwent IM nailing for femur shaft fractures were included. Angulation was measured on immediate post-operative X-ray films and an angle of ≥5° on AP and/or lateral views was defined as malalignment.Results: A total of 65 patients were enrolled in the study with a mean age of 39.9 ± 16.5 years. Majority of the patients,49 (75.4) were males and road traffic accidents were found to be the most common mechanism of injury. Malalignment after surgery was encountered in 6(9.2%) patients. Proximal femur fractures were noted to be significantly associated with malalignment with a p-value of 0.014.Conclusions: This shows that frequency rate of malalignment after IM nail for femoral shaft fractures in a developing country like Pakistan is comparable to internationally reported literature and proximal femur fracture is a risk factor for malalignment

Outpatient percutaneous release of trigger finger: A cost effective and safe procedure

Introduction: Trigger finger is a common cause of pain and disability of the hand. Percutaneous release results in earlier functional recovery and patient satisfaction. This is a rapid and cost-effective method which saves a surgical procedure and results in better functional outcome.Materials and Methods: This is a prospective observational study conducted on fifty-two fingers and thumbs in 52 patients treated from 1st July 2014 till 31st December 2014, in the Orthopaedic Section, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan. All the baseline characteristics of the patients, like demographics, symptoms, Quinell\u27s criteria and functional outcome were recorded. The patients were treated at our hospital with trigger finger, managed with percutaneous release using an 18 gauge needle and followed up for a minimum period of three months. The follow-up information included range of motion scoring, patient satisfaction and overall outcome of the procedure in terms of patient acceptance. The data was analyzed to determine the functional outcome at three months.Results: There was complete release of A1 pulleys in 52 out of 52 digits (100%) in the patients undergoing percutaneous release and significant patient satisfaction. No recurrence was observed.Conclusion: Percutaneous release of trigger finger with needle was not only associated with excellent functional outcome and recovery in terms of patient satisfaction and range of finger motion three months post-procedure but also was found to be cost effective