Treatment and outcomes of soft tissue sarcoma of groin, hip and thigh: A retrospective review from a tertiary care hospital

Objective: To study the frequency of the thigh, hip and groin soft tissue sarcomas and retrospectively analyse the management, treatment results, and outcomes of these uncommon malignant tumours, in a tertiary care hospital of the city of Karachi.Methodology: Data of soft tissue tumours registered from 2017-2018 was retrieved during January 2019 to March 2019 from Aga Khan University Hospital, Karachi bone and soft tissue tumour registry. A retrospective review was performed and all soft tissue tumour cases treated with surgical intervention (with adjuvant /neoadjuvant therapy) or palliative intention were included.Results: Total 119 cases of soft tissue tumours (STS) were identified out of which 85 were malignant cases (sarcomas) while 30 were benign. On presentation 84 (70.6%) were primary cases. On topographical distribution, there were 25 patients who had hip, groin and thigh sarcoma. Of these, 15 were males and 10 were females. As treatment, neo-adjuvant radiation was done in 4 (16%) patients and adjuvant chemo/radio therapy was given to 13 (52%) patients. Wide margin excision was performed in 19 (76%) patients and 4 (16%) had amputation. Reconstruction was offered to 3 (12%) patients. In post-surgical complications, 1 (4%) patient had wound infection. On final surgical histopathology, majority of the sarcomas were liposarcomas, myxofibrosarcoma, synovial sarcoma and Leiomyosarcoma. Post-surgery recurrence occurred in 7 (28%) patients. Overall survival was 76%.Conclusions: In treatment of soft tissue sarcoma, limb salvage is an achievable option and survival results are also good

O papel da justiça organizacional para desenvolver o comportamento de cidadania organizacional: efeito moderador da ética do trabalho islâmico

This paper aims to examine and test the role of organizational justice (distributive, procedural & interactional) to develop and promote organizational citizenship in Pakistani financial institutions under moderation effect of Islamic work ethics on the concepts of social exchange, equity and meta/normative ethics theories. In order to pledge the riven opinion on the relationship of organizational justice and organizational citizenship behavior in the existing literature, Islamic work ethics has been inducted as a moderator. The population of the study is the 19 Financial Institutions of Pakistan and data were collected through a survey based 230 questionnaires. PLS was employed to analyze the data and post analysis; it has been established that all three forms of organizational justice are playing a role in the development of organizational citizenship behavior with varying level of impact and interestingly interactional justice is more dominating. Islamic work ethics has no moderation part in the relationship of organizational justice and organizational citizenship behavior. Islamic work ethics is autonomous character for organizational citizenship behavior development. The study has significant contribution to the existing literature available on all the constructs. The imminent studies may expand its scope.Este documento tiene como objetivo examinar y probar el papel de la justicia organizacional (distributiva, procesal e interactiva) para desarrollar y promover la ciudadanía organizacional en las instituciones financieras pakistaníes bajo el efecto moderador de la ética laboral islámica sobre los conceptos de intercambio social, equidad y teorías de ética meta / normativa. Para garantizar la opinión dividida sobre la relación entre la justicia organizacional y el comportamiento de la ciudadanía organizacional en la literatura existente, la ética laboral islámica ha sido incorporada como moderadora. La población de estudio son las 19 instituciones financieras de Pakistán y los datos se recopilaron a través de una encuesta basada en 230 cuestionarios. PLS se empleó para analizar los datos y el análisis posterior; se ha establecido que las tres formas de justicia organizacional desempeñan un papel en el desarrollo del comportamiento de ciudadanía organizacional con diferentes niveles de impacto y, curiosamente, la justicia interactiva es más dominante. La ética laboral islámica no tiene una parte moderada en la relación entre la justicia organizacional y el comportamiento de la ciudadanía organizacional. La ética laboral islámica es de carácter autónomo para el desarrollo del comportamiento de la ciudadanía organizacional. El estudio tiene una contribución significativa a la literatura existente disponible en todos los constructos. Los estudios inminentes pueden ampliar su alcance.Este artigo tem como objetivo examinar e testar o papel da justiça organizacional (distributiva, processual e interacional) para desenvolver e promover a cidadania organizacional nas instituições financeiras paquistanesas sob efeito moderador da ética do trabalho islâmico nos conceitos de teorias de troca social, eqüidade e ética meta / normativa. . A fim de prometer a opinião distorcida sobre a relação entre a justiça organizacional e o comportamento de cidadania organizacional na literatura existente, a ética do trabalho islâmico foi introduzida como moderadora. A população do estudo é a 19 Instituições Financeiras do Paquistão e os dados foram coletados através de uma pesquisa baseada em 230 questionários. PLS foi empregado para analisar os dados e pós análise, foi estabelecido que todas as três formas de justiça organizacional estão desempenhando um papel no desenvolvimento do comportamento de cidadania organizacional com nível variável de impacto e a justiça interessantemente interacional é mais dominante. A ética do trabalho islâmico não tem parte moderadora na relação entre a justiça organizacional e o comportamento de cidadania organizacional. A ética islâmica do trabalho é um caráter autônomo para o desenvolvimento do comportamento de cidadania organizacional. O estudo tem contribuição significativa para a literatura existente disponível sobre todos os construtos. Os estudos iminentes podem ampliar seu escopo

Functional outcomes and complications of total hip arthroplasty with dual mobility cup : An audit

Objective: To determine the functional outcomes in total hip arthroplasty with a dual mobility cup, performed in our hospital.Methods: After receiving an exemption from the Ethics review committee of the hospital, data collection for audit was started in January 2019. Records from July 2016 to June 2018 were included. All patients who underwent total hip arthroplasty with dual mobility prosthesis without any age limit were included. A proforma was prepared to collect the required information. Data was entered and analyzed on SPSS v. 21.Results: Two hundred and ten patients were included, 114 females and 96 males. Of the total, 188 patients underwent unilateral surgery while 22 had bilateral hip arthroplasty. The mean postoperative hospital stay was 5.91±3.9 days. . Mean pre-op Harris score was 33.7±7.6 and the post-op mean score was 75.9± 5.34. Eighty-three (39.5 %) patients had the neck of femur fracture, 31(14.8%) had osteoarthritis while 28(13.3%) had avascular necrosis. Post-surgery complications included, wound infection, surgical site haematoma, NSTEMI, and only one patient reported dislocation after use of dual mobility cup.Conclusions: The dislocation rate which was the prime concern, has been reduced with the use of dual mobility implant in total hip arthroplasty patients

Interferon lambda-3 polymorphism and response to pegylated interferon in patients with hepatitis D

Background: Specific single nucleotide polymorphisms (SNPs) near the interferon lambda-3 (IFNλ3) gene (formerly interleukin 28B) influence the response to treatment with interferon in hepatitis C patients. We aimed to investigate such an influence in hepatitis D patients.Methods: The study population consisted of hepatitis D patients who were previously treated with pegylated interferon for one year and who were spontaneous clearers of the virus post recent superinfection. The SNP of IFNλ3, rs12979860, was determined by polymerase chain reaction-restriction fragment length polymorphism protocol.Results: The total number of patients was 64; median age was 30.5 years and 53 were male. The number of patients with sustained virological response 1 year post-treatment was 17, non-responders 29, relapsers 11 and spontaneous clearers post superinfection 7. Cirrhosis was present in 28 (44%). IFNλ3, rs12979860 genotype CC, was present in 41 (64.1%), CT in 21 (32.8%) and TT in 2 (3.1%). There was no difference in the body mass index, baseline alanine aminotransferase, hepatitis B e antigen and HBV DNA status among patients with sustained response and response failure (no response or relapse). The median age of response failures was 33.5 years compared to 26 in responders (P=0.024). They had higher gamma glutamyl transferase levels (P=0.030) and cirrhosis (P=0.003). Genotype CC was present in 29/40 of response failures compared to 9/17 of the responders (P=0.152). Logistic regression analysis showed that cirrhosis was the independent risk factor for failure to have a response (P=0.001). 4/7 patients with spontaneous clearance had genotype CC.Conclusions: IFNλ3 rs12979860 SNP does not have any significant influence on long-term hepatitis D clearance. Presence of cirrhosis may influence the response

Our experience of treating adult bone lymphoma, a retrospective cross-sectional study in a tertiary care center, Aga Khan University hospital, Karachi

Objective: To determine the experience at the Aga Khan University Hospital in diagnosing and treating adult patients with primary lymphoma of bone.Methodology: All patients with Primary lymphoma of bone (PLB) that were diagnosed and/or treated at Aga Khan University Hospital, Karachi from 2005 to 2019 were included as part of this study.Results: There were 17 patients with PLB including 13 (76.5%) males and 4 (23.5%) females with a mean age of 44 ± 16.5 years. Nine patients were between 30-59 years of age at diagnosis. The mean follow-up time of patients was 80±46.7 months. Six patients had tumours of pelvic bone followed by tibia (5) and femur (4). Four patients had a pathological fracture at the time of presentation whereas 2 (11.8%) required surgical fixation of the pathological fracture. The stage of the tumour was based on Ann Arbor classification. Nine (52.9%) cases had Stage 1 disease, 7 (41.2%) had stage IV disease with metastasis in extra nodal tissues. As for treatment, every patient received chemotherapy whereas 5 (29.4%) received adjuvant radiotherapy. Complete remission in the size of the tumour was seen in 11 (64.7%) patients while 6 (35.3%) had partial remission. Post-treatment, 4 (23.5%) patients expired. The mean Overall Survival (OS) time was 80.18 ± 46.71months with a survival rate of 76.5.Conclusions: Primary lymphoma of the bone can be treated with medical regime and good prophylactic surgeries to avoid pathological fracture such as intramedullary nailing

Study of Debris Flow Impact on Bridge Pier

The destructive nature of debris has ability to transport large boulders and wooden material along with the flow whose impact can pose serious safety risks to a bridge. In this study an effort has been made to study the impact of varying debris densities on a bridge pier.  The experimentation was carried out in Hydraulics Laboratory, Civil Engineering Department, University of Engineering and Technology Taxila. Hexagonal wooden pier model was used. Wooden sticks of uniform size and mass were used to act as debris in flow. Respective discharges were determined against different flow velocities. Dial gauge was installed carefully beside the bridge pier in a way that deflections were easily measurable. This debris of masses 189, 253, 316, 379 and 442 grams was floated on water for five trials at discharges of 10.3, 12.8, 16, 23.8 and 28.9 liters per second. Debris hit the pier and caused a deflection in it. These deflections were measured by a dial gauge. The results show that with increasing debris mass and intensity of flow velocity, the impact on the pier bridge in term of deflection increased. A hydraulic structure's health can be monitored using the findings of the current study

In vitro shoot regeneration of fenugreek (Trigonella foenum-graecum L.) using different cytokinins

Fenugreek (Trigonella foenum-graecum L.) is an important vegetable, spice and medicinal legume plantused as fresh and dried leaves and seeds in many parts of the world. Fenugreek seeds contain polysaccharide galactomannan and different saponins and have anti-microbial activity. The study presents an efficient shoot regeneration protocols from 8 - 10 days old in vitro grown cotyledon node explants cultured on Murashige and Skoog (MS) medium supplemented with 0.05 - 0.80 mg/l kinetin, 0.25 - 1.0 mg/l 6 benzyladenine (BA) with 0 and 0.20 mg/l α naphtalene acetic acid (NAA) and 0.05 - 0.80 mg/l thidiazuran (TDZ) with 0 and 0.10 mg/l indole 3 butyric acid (IBA). All culture mediums were solidified with 0.22% gelrite. Maximum shoot regeneration and number of shoots per explant were recorded on MS medium supplemented with TDZ with or without IBA. Maximum of 22.21 shoots per explant were recorded on MS medium containing 0.40 mg/l TDZ. Presence of auxins in the culture medium positively increased the mean shoot length. Regenerated shoots were transferred to rooting media containing 0.1 - 1.0 mg/l IBA or NAA.Key words: Fenugreek , cotyledon node, hypocotyl, shoot regeneration

Machine-Learning-Enabled Obesity Level Prediction Through Electronic Health Records

Obesity is a critical health condition that severely affects an individual’s quality of life and well-being. The occurrence of obesity is strongly associated with extreme health conditions, such as cardiac diseases, diabetes, hypertension, and some types of cancer. Therefore, it is vital to avoid obesity and or reverse its occurrence. Incorporating healthy food habits and an active lifestyle can help to prevent obesity. In this regard, artificial intelligence (AI) can play an important role in estimating health conditions and detecting obesity and its types. This study aims to see obesity levels in adults by implementing AI-enabled machine learning on a real-life dataset. This dataset is in the form of electronic health records (EHR) containing data on several aspects of daily living, such as dietary habits, physical conditions, and lifestyle variables for various participants with different health conditions (underweight, normal, overweight, and obesity type I, II and III), expressed in terms of a variety of features or parameters, such as physical condition, food intake, lifestyle and mode of transportation. Three classifiers, i.e., eXtreme gradient boosting classifier (XGB), support vector machine (SVM), and artificial neural network (ANN), are implemented to detect the status of several conditions, including obesity types. The findings indicate that the proposed XGB-based system outperforms the existing obesity level estimation methods, achieving overall performance rates of 98.5% and 99.6% in the scenarios explored

Interferon lambda-3 rs12979860 variants and response to pegylated interferon in chronic hepatitis-c genotype-3

Objective: To assess the role of single nucleotide polymorphisms (SNPs) near the interferon lambda-3 (IFNλ3) (formal IL-28B) gene rs12979860 in predicting sustained virologic response (SVR) in hepatitis-C virus genotype-3 (HCV-3). Study Design: Descriptive, analytical study. Place and Duration of Study: Department of Medicine, The Aga Khan University Hospital, Karachi, from July 2012 to June 2014. Methodology: Patients with HCV-3 were classified as sustained virologic response (SVR), relapsers and non-responders. SNP rs12979860 was determined by PCR-RFLP protocol. Differences between categorical variables were assessed by chi-square or Fisher\u27s exact test, while those between continuous variables were evaluated using the Mann-Whitney U-test. Binary logistic regression analysis by forward conditional method was performed by using significant variables with p-values less than 0.05 as the criteria for model inclusion. Results: Out of 115 patients, rs12979860 genotype-CC, CT, TT was found in 37 (32.2%), 70 (60.9%), and 8 (7%) patients. 72 patients were male with median age of 45 years. Cirrhosis was present in 32 patients. Patients with response failures (no response and relapse, n=36 and 29, respectively) had higher baseline gamma glutamyl transferase (GGT) level (p \u3c 0.001), higher alanine aminotransferase (p=0.027) and cirrhosis (p=0.001) than patients with SVR. Genotype-CC was present in 16/65 in response failures compared to 21/50 who achieved SVR (p=0.048). Rapid virologic response (RVR) (p \u3c 0.001), low GGT (p=0.001) and absence of cirrhosis (p=0.039) were the independent predictive factors for SVR. In patients who could not achieve RVR and in patients with cirrhosis, SVR was seen more in with genotype-CC (p=0.007 and 0.038). Conclusion: In patients infected with HCV-3, IFNλ3 rs12979860, SNP has less impact on SVR