K Wire fixation of supra-condylar humerus fractures in children. Is ulnar nerve at risk?

Abstract OBJECTIVE: To compare iatrogenic ulnar nerve injury in lateral entry pin fixation versus medial and lateral entry pin fixation in the treatment of supracondylar fractures of the humerus in children. Measurement of clinical parameters in terms of elbow range of motion and postop radiographic alignment was also targeted. METHODS: The retrospective cohort study was conducted at Aga Khan University Hospital, Karachi, and comprised data of paediatric patients who underwent closed reduction and percutaneous pin fixation for the treatment of displaced extension type supracondylar fractures of the humerus between July 2007 and June 2012. Data regarding socio-demographic status, disease and procedure variables was collected from patient files and was analysed using SPSS 19. RESULTS: There were 71patients; 37(52%) in the lateral entry group and 34(48%) in the medial and lateral entry group. The two groups were similar in terms of mean age, gender distribution, and preoperative displacement, comminution, and associated vascular and nerve status (p\u3e 0.05 each). There were no cases of iatrogenic ulnar nerve injury in either group and no significant differences between groups with respect to the elbow range of motion and radiological parameters (p\u3e 0.05 each). CONCLUSIONS: With the use of the specific techniques employed, both lateral entry pin fixation and medial and lateral entry pin fixation were effective in the treatment of displaced extension type supracondylar humerus fractures in children

Outcomes of internal hemipelvectomy for pelvic tumors: a developing country’s prospective

Introduction: Previously, external hemipelvectomy was the mainstay of treatment for pelvic tumors. However, with technological advancements, limb salvage procedures such as internal hemipelvectomy have emerged as a viable alternative. However, there is limited literature available on long-term outcomes and complications of internal hemipelvectomy, especially from developing countries. Therefore, the objective of this study was to share our experience of internal hemipelvectomy at a tertiary care center in a developing country. Materials and methods: A retrospective review was conducted in which all 24 patients undergoing internal hemipelvectomy from January 1, 2005 to December 31, 2015 at our institution were included. Medical record files were reviewed for intraoperative and early and late postoperative complications, and functional outcomes were assessed by contacting each patient on telephone. Results: Ewing sarcoma was found to be the most common diagnosis, followed by osteosarcoma as the second most common. The mean follow-up period was 18.7 ± 13.9 months. Intraoperatively there were 4 cases of iatrogenic neurovascular injury and 2 cases each of urinary tract injury and dural tear. Four patients developed early wound infections, 7 developed late wound infections, and 2 developed flap necrosis. Three patients developed recurrence, whereas 7 patients developed metastasis postoperatively. The mean survival was calculated to be 28 months and the mean Musculoskeletal Tumor Society score was 19.3 ± 5.2. Conclusions: Outcomes and prevalence of complications shown in this study are comparable to those in the international literature, which suggests that hemipelvectomy is a viable option in developing countries also. However, more such studies are warranted to validate the findings and to identify the challenges and morbidities associated with hemipelvectomy in Asian and developing countries

Rotational mal-alignment after reamed intramedullary nailing for tibial shaft fracture

Abstract Intra-medullary (IM) nailing is standard of care for unstable tibial shaft fractures. Malrotation is very common but it is under-recognised, inpart because of variation in normal anatomy and partly due to difficulty in accurately assessing rotation. This study was planned to evaluate the frequency of rotational mal-alignment after reamed tibia IMnailing. This cross-sectional study was conducted at Aga khan University Hospital, Karachi, and comprised patients with tibia shaft fractures managed with IMnailing from January to December 2014. All the patients were assessed intra-operatively for rotational alignment using the knee and ankle fluoroscopic images. There were 81 patients with a mean age of 38±16.9 years. There were 64(79%) male patients. Overall the incidence of malrotation was in 20(24.7%) cases. Rotational mal-alignment is one of the preventable complications after IMnailing which can be assesed intra-operatively under fluoroscope

Identifying the Processes of Value Co-Creation

This study aimed to address the issues pertaining practicalities of value co-creation from the perspective of Service-Dominant Logic (S-D) of Marketing. Using an interpretive strategy and case study method, this study responds to the call for empirical treatment of Service-Dominant Logic conceptualization. This is done by answering the question “how does integrating resources co-create value?”. A multiple-actor framework of value co-creation is derived from empirical material interpretation incorporating the nature of value realized by actors, resources and actor classifications, nature of interactions, and stages in value co-creation. The outcome of this study suggests that value co-creation is a system where actors engage in dialogues with the aim of improving ‘personal situations’. This system is comprised of various processes at four stages. For instance, resources integration among actors happens at a collaboration stage that co-creates consequences. These consequences are experiences, service offerings, relationships and fluctuations in resources and skills. Resources integration is done through reciprocal co-operative dialogue among actors. These dialogues have four types: initiating, building, sharing and critiquing (IBSC). In the next stage, value is realized in the form of inter-related facets: knowledge, monetary, relationship, functional and experience value. All these value facets together increase or decrease the experience value. Once value is realized, the next stage is the appraisal of the overall experience in the form of positive word of mouth, willingness to participate in the future, innovation, and premium valuation of the service offerings. Positive appraisal results in the improved situations of actors. Improved situations are: increase in resources, actors satisfaction, long-term and sustainable partnerships, and successful service delivery. A negative appraisal recognizes in the co-destruction of value. This framework is significant because in addition to providing implications for marketing theory and future research, 4E’s of value co-creation matrix (Engage, Event Space, Evaluation , Encourage) which are focused on resource integrations and actors, are recommended for value co-creation practices. 4E’s of value co-creation also question the efficacy of marketing mix in framing managerial decisions. 4E’s of value co-creation presents a service dominant perspective on developing marketing strategies

Government’s Brand Image Destroyer: Examining the Driving Factors behind Global Human Trafficking

Human trafficking is fundamentally a human rights issue. Authors have looked at this menace from the perspectives of sociology, economics, education, globalization, criminology, governance, legislation, and racial discrimination. However, most of these models are limited to a conceptual level and little empirical work is done to test the claims made by various theorists. In order to fill the said gap, data of most cited variables in the literature of trafficking are obtained. Results indicate that social progress and response of government against enslavement are negatively related to vulnerability to enslavement, while corruption and population growth rates are positively associated with the outcome

Phytochemical and cytotoxic analysis of Pharthenium hysterophosis selected from District Bannu, Pakistan

Parthenium hysterophorus is a well known medicinal plant widely used traditionally in the treatment of various diseases and as a constituent of various drugs, and in phytotherapy. The current study was designed to investigate the phytochemical screening and cytotoxic capacity of methanolic and n-hexane extract of P. hysterophorus. Quantitative analysis of P. hysterophorus showed maximum quantity of flavonoids in methanolic extract of P. hysterophorus which turned down gradually in n-hexane extract of P. hysterophorus due to the decrease in organic solvents polarity. Similar results were also observed for saponins and tannins during this investigation. The highest quantity of alkaloids was recorded in the methanolic extract of P. hysterophorus when compared to n-hexane extract. The extracts also showed maximum cytotoxic potential in various concentrations of n-hexane and methanolic extract of P. hysterophorus. The results revealed that P. hysterophorus contains a remarkable cytotoxic activity due to the presence of bioactive constituents.Key words: Parthenium hysterophorus, cytotoxic, phytochemical screening