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

Power-Efficient and Highly Scalable Parallel Graph Sampling using FPGAs

Energy efficiency is a crucial problem in data centers where big data is generally represented by directed or undirected graphs. Analysis of this big data graph is challenging due to volume and velocity of the data as well as irregular memory access patterns. Graph sampling is one of the most effective ways to reduce the size of graph while maintaining crucial characteristics. In this paper we present design and implementation of an FPGA based graph sampling method which is both time- and energy-efficient. This is in contrast to existing parallel approaches which include memory-distributed clusters, multicore and GPUs. Our strategy utilizes a novel graph data structure, that we call COPRA that allows time- and memory-efficient representation of graphs suitable for reconfigurable hardware such as FPGAs. Our experiments show that our proposed techniques are 2x faster and 3x more energy efficient as compared to serial CPU version of the algorithm. We further show that our proposed techniques give comparable speedups to GPU and multi-threaded CPU architecture while energy consumption is 10x less than GPU and 2x less than CPU

Malignant distal femur tumors management in children, low cost innovations with affordable care in a tertiary care hospital, a cross sectional study

Introduction: Malignant musculoskeletal tumors in children are mostly comprised of Osteosarcoma and Ewing\u27s sarcoma and distal femur is the most common site for primary bone tumors. This study examined the surgical management outcomes of pediatric patients (\u3c18 years) presented in our setup with malignant distal femur tumors.Methodology: We retrospectively reviewed the medical records of patients diagnosed with malignant sarcomas of distal femur and younger than 18 years of age who underwent limb salvage surgery during June 2009-June2017.Results: There were 31 pediatric patients who had distal femur malignant tumors and out of them 20 patients were selected who underwent limb salvage as a primary surgery. The mean age (range) of patients was 11.90 (6-17) years. Seventeen had osteosarcoma and three had Ewing\u27s sarcoma. In surgery all patients were offered reconstruction. Post-operative complications were observed in (50%) patients while other 50% patients had no complications. Wound infection, flap necrosis, broken plates with non-union and recurrence of disease were the reported complications. Revision surgery was performed in 10 patients out of 20 patients.Conclusion: Salvage was the primary option in our surgery and revision surgery was performed in the cases due to complications. Small sample size was the limitation of the study

Our experience of mega-prosthesis in bone tumours: A retrospective cross-sectional study in a tertiary care hospital

Objective: To evaluate the oncological and functional outcomes of bone tumour patients who underwent reconstruction with mega prosthesis.Methodology: A retrospective study was conducted in the department of Orthopaedics Aga Khan University Hospital, Karachi. All the paediatric and adult age group patients diagnosed with malignant, benign and metastatic bone tumours and meeting the inclusion criteria were selected and analysed. Retrospective data was collected from January 2008-January 2018.Results: Sixty-two patients, 30 (48.4%) females and 32 (51.6%) males. were included in the study. Of these 57 (92%) cases had involvement of the lower limb. The mean age was 36.95±19.1 years with a range of 9-81 years. The duration of patients follow up was from 1-124 months (mean 32.7±36.43 months). There were 29 (47%) malignant cases. The most commonly occurring tumour site was distal femur and proximal femur. There were 53 (85%) primary surgeries (first time conducted surgeries) while 9(15%) revision surgeries were done. Major complications were encountered in 19 (30.6%) patients and 13 (20.9%) had minor complications. Post-surgery local recurrence occurred in 2 (3.2%) patients while 7 (11.2%) had distant metastasis. In functional outcomes the mean MSTS score of our patients was 72.09±26.43. The survival rate was 69.8% with 45 patients recovered.Conclusions: With a good patient selection, adherence to the principles of tumour surgery and an adequate applied knowledge of mega prosthesis insertion, a good functional outcome was achieved

Beneficial Effects of Artocarpus Lakoocha Extracts in Rat Models Suffering from Atherosclerosis

Objective: To evaluate the anti-inflammatory effects of A. lakoocha extracts by utilizing the rat models with induced hyperlipidemia.Methodology: Twenty-four well-fed rats (Wistar breed), were selected for the current study, weighing average 150-250 grams each and divided into three groups; GROUP I served as healthy control group, fed with normal diet composed of carbohydrates, proteins and fats. Group II were hyperlipidemic rats, with atherosclerosis, and considered as disease group. They were fed with high fat diet. Group III rats were fed with extracts of A. lakoocha, extending from day 20 up to day 60 of this experiment.Results In the disease group, significantly decreased (P < 0.001) expression levels of IL-5 were found in (14.76 ± 2.65) compared with control group (26.54 ± 3.98). IN the group treated with A. lakoocha extracts (22.01 ± 4.53) significantly enhanced (P < 0.01) the expression levels of IL-5 were observed. In addition, plasma IL-6 levels were significantly enhanced (P < 0.05) in the disease group (44.19 ± 10.90) compared with the control group (32.59 ± 4.51). Treatment of rats with A. lakoocha extract (20.22 ± 2.75) caused significant reduction (P < 0.001) in the expression levels of IL-6 as compared with the disease group. Significantly raised (P < 0.01) expression levels of TNF-α within the disease group (31.78 ± 4.71) compared with the control group (23.34 ± 2.25) group. Moreover, A. lakoocha extracts (24.60 ± 4.26) significantly reduced (P < 0.05) the expression of TNF-α levels, compared with the disease group.  Conclusion: Current study demonstrates that A. lakoocha extracts significant protective and anti-inflammatory properties in selected rat models, subsequently leading to atherosclerosis. The present study highlighted the down-regulation of inflammatory cytokines such as IL-6, TNF-α, IL-6 and NF-кB, while simultaneously up-regulating the plasma levels of IL-15, in rat models treated with extracts of A. lakoocha

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

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