Prophylaxis against heterotopic ossification after elbow and acetabular fractures — do we really need it

Abstract OBJECTIVE: To compare the efficacy and safety of prophylactic modalities for heterotopic ossification prevention after elbow and acetabular surgeries. METHODS: The retrospective chart review was conducted at the Aga Khan University Hospital and comprised record of patients who underwent open reduction and internal fixation for elbow and acetabular fractures between 2010 and 2013. Data was classified into three groups: Group A patients had received single dose of radiotherapy; Group B patients had received indomethacin, and Group C patients had not received any prophylaxis. Outcome variables included time-to-fracture healing, heterotopic ossification, non-union and wound infection. RESULTS: Of the 104patients 70(67.3%) had elbow fractures and 34(32.7%) had acetabular fractures. Out of the 70patients with elbow fractures, 28(27%) were in Group A, 24(23%) in Group B, and 18(17%) in Group C. In Group A, 4(22%) patients had wound infection compared to 1(5.5%) patient in Group C (p=0.131). One (4%) patient in Group B and 1(5.5%) in Group C developed heterotopic ossification (p=0.486). Non-union occurred in 1(4%) patient in Group B and 1(5.5%) in Group C. Out of the 34 patients with acetabular fractures, 11(32.3%) were in Group A, 10(29.4%) in Group B, and 13(38.2%) in Group C. In Group A, 2(18.2%) patients developed wound infection. Only 1(7.6%) patient in Group C developed heterotopic ossification. CONCLUSIONS: No role of radiotherapy or indomethacin was detected in the prevention of heterotopic ossification

Clinic based biopsy vs. theatre biopsy of bone and soft tissue extremity tumours: comparable diagnostic modalities

Abstract OBJECTIVE: To compare the diagnostic accuracy of clinic-based biopsy versus theatre biopsy against final histopathology in patients presenting with extremity tumours. METHODS: The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised record of patients who underwent biopsy procedure of extremity tumours from January 2008 to December 2011. Data regarding socio-demographic status, disease-related and procedure-related variables were collected from the files. Histopathology report of biopsy was compared with the final histopathology after definite procedure of the tumour for concordance. RESULTS: Of the 87 patients whose records were reviewed, 42(48%) had undergone biopsy in theatre and 45(52%) in clinic. The overall median age was 29 years (Inter-quartile range: 18-58 years). As compared to final histopathology after the definite procedure, diagnostic accuracy of theatre and clinic-based biopsy was 97.7% vs. 95.5% respectively. Surgical site infection was observed in 2(5%) in theatre and in 1(2.2%) in clinic. CONCLUSIONS: Clinic-based biopsy was accurate and safe with diagnostic accuracy comparable to theatre-based biopsy. Clinic-based biopsy, being cost-efficient along with low morbidity, should be preferred in patients with extremity tumour

Analysis of customer satisfaction in services industry: A case study of private universities in Karachi, Pakistan

The purpose of this study is to analyze which factors have influence on the satisfaction of customers in service sector which can ultimately affects organization’s profitability. This study attempts to examine the relationship between students’ satisfaction and others variables such as service quality, empathy and customer relationship management. The investigation is conducted both from a theoretical and empirical point of view after conducting a pilot study, the instrument was administered to 100 under graduate and postgraduates who were selected based on random sampling from the four private universities of Karachi, Pakistan. The analysis started with descriptive analysis followed by regression, correlation and reliability analyses. The empirical results of the relationships in this study provide support for the Hishamuddin study (2008), which identified the factors contributing to the satisfaction of students. The results verify that service quality and empathy has significant impact on the students’ satisfaction level, while female were found to be more satisfied. The outcomes of the study also showed positive relationship among all the three explanatory variables and dependent variable

The in vitro a-glucosidase inhibition activity of various solvent fractions of Tamarix dioica and 1H-NMR based metabolite identification and molecular docking analysis

The Tamarix dioica (T. dioica) is widely used medicinal plant to cure many chronic ailments. T. dioica is being used to manage diabetes mellitus in traditional medicinal system; however, very little scientific evidence is available on this plant in this context. The current study involves the fractionation of crude methanolic extract of T. dioica using n-hexane, ethyl acetate, chloroform, and n-butanol. The screening for antioxidant activity using 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay was carried out. The in vitro antidiabetic potential was assessed by measuring α-glucosidase inhibition. Total phenolic and flavonoid contents were also determined for each fraction. The metabolites were identified using highly sensitive and emerging 1H-NMR technique. The results revealed the ethyl acetate fraction as the most potent with DPPH scavenging activity of 84.44 ± 0.21% and α-glucosidase inhibition with IC50 value of 122.81 ± 2.05 µg/mL. The total phenolic and flavonoid content values of 205.45 ± 1.36 mg gallic acid equivalent per gram dried extract and 156.85 ± 1.33 mg quercetin equivalent per gram dried extract were obtained for ethyl acetate fraction. The bucketing of 1H-NMR spectra identified 22 metabolites including some pharmacologically important like tamarixetin, tamaridone, quercetin, rutin, apigenin, catechin, kaempferol, myricetin and isorhamnetin. Leucine, lysine, glutamic acid, aspartic acid, serine, and tyrosine were the major amino acids identified in ethyl acetate fraction. The molecular docking analysis provided significant information on the binding affinity among secondary metabolites and α-glucosidase. These metabolites were most probably responsible for the antioxidant activity and α-glucosidase inhibitory potential of ethyl acetate fraction. The study ascertained the ethnomedicinal use of T. dioica to manage diabetes mellitus and may be a helpful lead towards naturopathic mode for anti-hyperglycemia

Exhaust emission profiling of fatty acid methyl esters and NOx control studies using selective synthetic and natural additives

The present study was focused on the optimized biodiesel production using Moringa oleifera (M. oleifera) and rice bran oils, characterization, and comparative evaluation of the exhaust emission profile using artificial and natural additives resulting from synthesized biodiesel. Furthermore, various biodiesel blends (B10, B20, B50, and B100) of Moringa oleifera (M. oleifera) and rice bran oils were studied in a four-cylinder, direct injection engine at different engine speeds (1800–3000 rpm). The optimal yields (%) for both the M. oleifera and rice bran oil-based biodiesel were found to be 87 ± 2.0 and 93 ± 2.6%, respectively, using sodium methoxide as the catalyst. The optimized reaction parameters involved in the transesterification of the M. oleifera and rice bran oils were revealed to be catalyst concentration (1.25%), methanol-to-oil molar ratio (9:1), reaction temperature (60 °C), and reaction time (90 min). The fuel properties of the M. oleifera and rice bran oil-based biodiesel were found to be in compliance with ASTM D6751 and EN 14214. The exhaust emission levels of the synthesized biodiesel and its blends with conventional diesel showed a significant reduction in the particulate matter and carbon monoxide levels comparative to the fossil fuel-based diesel combustion, whereas an increasing trend was observed in case of the oxides of nitrogen (NOx) emission. The results of the engine performance test indicated that the brake power in all of the samples had approximately similar values for each load and the enriched blends showed a distinct improvement in brake-specific fuel consumption. The effect of antioxidants on the NOx emission levels resulting from the combustion of the biodiesel and its blends showed that the synthetic additives (butylated hydroxyl anisole (BHA), butylated hydroxyl toluene (BHT), t-butyl hydroquinone (TBHQ), and propyl gallate (PG)) were more effective than the natural methanolic antioxidant extracts (extract of P. pinnata (EPPL), extract of A. lebbeck (EPPL), extract of P. guajava (EPG), and extract of M. azedarcah (EMA) for reduction in the NOx emission level

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Gender-based barriers to primary health care provision in Pakistan: the experience of female providers

In common with several countries in South Asia, the Pakistan government health system has introduced cadres of community-based female health and family planning workers as a response to gender-based constraints on women’s access to services. However, the recruitment, training and retention of such female workers has been difficult. This finding points to the obvious but neglected fact that female health workers must operate within the same gender systems that necessitate their appointment in the first place. The present study used qualitative methods to increase our understanding of the experience of female staff working at the community level and in particular the gender-based constraints that they face. Important problems identified include: abusive hierarchical management structures; disrespect from male colleagues; lack of sensitivity to women’s gender-based cultural constraints; conflict between domestic and work responsibilities; and poor infrastructural support. The findings highlight the interconnectedness of women’s public and private lives and the interplay of class and gender hierarchies in the patterning of women’s employment experiences. The study’s conclusions suggest ways in which the organizational functioning of the government health services might be modified to better facilitate the work of female staff.</p