Role of ultrasound in characterization of ovarian masses

Background: Ovarian cancer is the second most common malignancy in Pakistani women, accounting for 4% of all cancers in the female population. The aim of this study was to determine sensitivity, specificity, positive and negative predictive values and 95% confidence intervals for ultrasound in characterization of ovarian masses in patients presenting at public and private tertiary care hospitals in Karachi, Pakistan.MATERIALS AND Methods: We adopted a cross-sectional analytical study design to retrospectively collect data from January 2009-11 from medical records of two tertiary care hospitals. Using a non-probability purposive sampling technique, we recruited a sample of 86 women aged between 15 and 85 years fulfilling inclusion criteria with histopathologically proven ovarian masses presenting for an ultrasound examination in our radiology departments.Results: Our retrospective data depicted sensitivity and specificity of ultrasound to be 90.7%, 95%CI (0.77, 0.97) and 91.4%, 95%CI (0.76, 0.98) respectively. Positive predictive value was 93%, 95%CI (0.79, 0.98) and negative predictive value was 89%, 95%CI (0.73, 0.96). A total of 78 ovarian masses were detected, out of which 42 were malignant and 36 were benign.CONCLUSIONS: Results of our study further reinforce the conclusion that ultrasound should be used as an initial modality of choice in the workup of every woman suspected of having an ovarian mass. It not only results in decreasing the mortality but also avoids unnecessary surgical interventions

Ovarian masses: is multi-detector computed tomography a reliable imaging modality?

Background: Ovarian cancer continues to pose a major challenge to physicians and radiologists. It is the third most common gynecologic malignancy and estimated to be fifth leading cancer cause of death in women, constituting 23% of all gynecological malignancies. Multi-detector computed tomography (MDCT) appears to offer an excellent modality in diagnosing ovarian cancer based on combination of its availability, meticulous technique, efficacy and familiarity of radiologists and physicians. The aim of this study was to compute sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of 64- slice MDCT in classifying ovarian masses; 95% confidence intervals were reported.MATERIALS AND Methods: We prospectively designed a cross-sectional analytical study to collect data from July 2010 to August 2011 from a tertiary care hospital in Karachi, Pakistan. A sample of 105 women aged between 15-80 years referred for 64-MDCT of abdomen and pelvis with clinical suspicion of malignant ovarian cancer, irrespective of stage of disease, were enrolled by non- probability purposive sampling. All patients who were already known cases of histologically proven ovarian carcinoma and having some contraindication to radiation or iodinated contrast media were excluded.Results: Our prospective study reports sensitivity, specificity; positive and negative predictive values with 95%CI and accuracy were computed. Kappa was calculated to report agreement among the two radiologists. For reader A, MDCT was found to have 92% (0.83, 0.97) sensitivity and 86.7% (0.68, 0.96) specificity, while PPV and NPV were 94.5% (0.86, 0.98) and 86.7% (0.63, 0.92), respectively. Accuracy reported by reader A was 90.5%. For reader B, sensitivity, specificity, PPV and NPV were 94.6% (0.86, 0.98) 90% (0.72, 0.97) 96% (0.88, 0.99) and 87.1% (0.69, 0.95) respectively. Accuracy computed by reader B was 93.3%. Excellent agreement was found between the two radiologists with a significant kappa value of 0.887.CONCLUSION: Based on our study results, we conclude MDCT is a reliable imaging modality in diagnosis of ovarian masses accurately with insignificant interobserver variability

Comparison of first dorsal metacarpal artery flap done by consultants and residents and guidelines for improving outcome for beginners

Background: Thumb alone constitutes about 40% of hand function and trauma to distal part of thumb will thus affect the overall hand function. The goals of correction of traumatic deformities of distal thumb are to maintain adequate length and sensation along with giving a supple and stable soft tissue cover. Among other options, first dorsal metacarpal artery (FDMA) flap raised from the dorsum of the proximal part of index finger is a simple and widely used flap.Methods: We compared the results of FDMA flap done by residents (M.Ch trainees) and consultants in our institute. Residents operated upon a total of 12 patients and consultants operated upon 16 patients.Results: Among 12 patients operated by residents 3 flaps were lost and 2 flaps had marginal necrosis whereas among the patients operated by consultants 1 flap was lost and 1 had partial necrosis in distal part of the flap.Conclusions: Although there was no statistical difference between the operating time taken by trainees and consultant specialists but the complication rate is higher among the residents. Sticking with the basics of plastic surgery, FDMA flap is an excellent technique for thumb reconstruction and results are excellent as and when more experience is gained

Introducing Team Coordination Framework to Support Globally Distributed Teams for Pakistani Software Industry

Collaborative effort is required in DSD (Distributed Software Development) in order to develop software in manageable components. Immense effort is taking place due to the cultural, geographical and temporal distances among project teams in Pakistani Software Industry to this end. The purpose of this study is to propose a solution during DSD that will help the distributed teams in coordinating their activities. Our solution enhances the management associated activities and assists in optimal usage of team coordination in dispersed settings. The method that we used is single case study type, which involved distributed software business to assess the usefulness and efficiency related to Pakistan’s DSD industries, and has shown strong tendency of participants towards the effectiveness of proposed team coordination framework. Results indicate that the predictable solution will look up the group management, which is considered as a vigorous issue of Pakistani DSD industry. Furthermore, it will assist in resolving the problems of team coordination in distributed situation. One of the most significant current discussion about the proposed solution suggested that it helps in human communication methods team coordination in a distributed environment

A sustainable approach for demand side management considering demand response and renewable energy in smart grids

The development of smart grids has revolutionized modern energy markets, enabling users to participate in demand response (DR) programs and maintain a balance between power generation and demand. However, users’ decreased awareness poses a challenge in responding to signals from DR programs. To address this issue, energy management controllers (EMCs) have emerged as automated solutions for energy management problems using DR signals. This study introduces a novel hybrid algorithm called the hybrid genetic bacteria foraging optimization algorithm (HGBFOA), which combines the desirable features of the genetic algorithm (GA) and bacteria foraging optimization algorithm (BFOA) in its design and implementation. The proposed HGBFOA-based EMC effectively solves energy management problems for four categories of residential loads: time elastic, power elastic, critical, and hybrid. By leveraging the characteristics of GA and BFOA, the HGBFOA algorithm achieves an efficient appliance scheduling mechanism, reduced energy consumption, minimized peak-to-average ratio (PAR), cost optimization, and improved user comfort level. To evaluate the performance of HGBFOA, comparisons were made with other well-known algorithms, including the particle swarm optimization algorithm (PSO), GA, BFOA, and hybrid genetic particle optimization algorithm (HGPO). The results demonstrate that the HGBFOA algorithm outperforms existing algorithms in terms of scheduling, energy consumption, power costs, PAR, and user comfort

Fundus autofluorescence imaging: Fundamentals and clinical relevance.

Fundus autofluorescence (FAF), a relatively new imaging modality, focuses on the fluorescent properties of pigments in the retina to generate images that help us view various disease processes from a different perspective. It aids us in the understanding of the pathophysiology of different retinal disorders. Recently, FAF imaging is being used commonly to help us in the diagnosis, prognosis as well as in determining the treatment response of various retinal disorders. It generates an image based on the distribution pattern of a fluorescent pigment called lipofuscin. Knowing the distribution pattern of lipofuscin in the normal retina is key to understanding an FAF image representing a retinal pathology. Like most other imaging modalities, FAF comes with its own limitations, taking steps to overcome these limitations will be of utmost importance in using this imaging modality to its fullest potential

Negative pressure wound therapy: eleven-year experience at a tertiary care hospital

Background: Management of complicated wounds is a reconstructive challenge. A reconstructive surgeon has to be ready to face new challenges every day. Negative pressure wound therapy has revolutionized the management of complex wounds. We are presenting our experience with this wound care modality in the past 11 years.Methods: It was a prospective study conducted from January 2006 to December 2016 on patients having wounds of varied etiologies, who consented to participate in this study. Custom made low cost NPWT was used till definitive wound closure.Results: A total of 568 patients consented to participate in the study during these 11 years. No major complications were seen. Most of these were males (60.73%) in their 3rd and 4th decade. Trauma was the leading cause of wounds in 38.14%, followed by diabetic foot wounds in 21.5%. Ankle and foot was the most common site of wounds (30.92%) followed by leg (24.01%). A total of 322 small, 218 medium and 97 large size dressings were used. Most of the patients improved with the NPWT.  No major complications were seen.Conclusions: NPWT is safe, effective and has proved to be revolutionary in managing difficult wounds. With the use of customized low cost NPWT the benefit can be extended to underprivileged population in under developed nations too

Closure of anterior palatal fistula using tongue flap: our experience

Background: Palatal fistula is one of the most common complications following cleft palate repair. It occurs mostly due to tip necrosis of palatal flaps. Small palatal fistulas are usually closed by transposition of adjacent tissues, however these local tissues are not sufficient for the closure of bigger fistulas. The tongue flap serves as a reliable and most easily obtainable local flap for closure of large sized palatal fistulas.Methods: This is a prospective study conducted from Aug 2006 to July 2015 in the department of Plastic & Reconstructive Surgery, SKIMS, Srinagar, Jammu Kashmir, India. A total of 25 patients with large anterior palatal fistula were treated using anteriorly based tongue flap. Patients were selected on the basis of size of fistula (> 1x1 cm), scarred local palatal tissue or history of fistula recurrence after previous attempts of closure using local palatal tissues.Results: In present study 25 patients of palatal fistula were treated using tongue flap. Eighty percent patients were in the age group of 3 to 5 years. Male-to-female ratio was 2:3. The largest dimension of treated fistula was 4x3 cm. There was partial dehiscence of flap suture line in two patients while remnant fistula was observed in three patients. None of our patients had flap necrosis.Conclusions: Tongue flap is an excellent and versatile option for closure of large palatal fistulas with high success rate and least morbidity

Chondroblastoma of the cuboid with an associated aneurysmal bone cyst: a case report

We report the case of a young adult who presented with a painful foot due to chondroblastoma associated with an aneurismal bone cyst

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely