Managing soft tissue sarcomas in a developing country: Are prognostic factors similar to those of developed world?

Background: Managing soft tissue sarcomas (STS) in a developing country with limited financial resources and a poor health referral system is a challenge. Presenting late, these extremity STS are prone to recurrence despite apparently complete resection. This study aimed to explore and compare the impact of clinico-pathological factors on recurrence and survival in Pakistan with the corresponding figures quoted from the developed world. Methods: An institutional review was performed on all patients with primary STS of the extremities operated on between 1994 and 2008. The prognostic influence of clinical, pathologic, and treatment variables on local recurrence free survival (LRFS), metastasis free survival (MFS) and overall survival (OS) were analyzed by univariate and multivariate Cox regression analysis and Kaplan Meier survival curves. Results: A total of 84 patients with a mean age of 41.8 ± 21.9 years were included in the study. The local recurrence rate was 14.3% after a median of 6 (mean 7.4) months. Metastases occurred in 7 patients (8.3%) and 65 patients were alive without evidence of disease after a mean follow-up of 52.6 ± 39.8 months. Tumor size \u3e 5 cm, grade 3 tumors and margin \u3c 10 mm significantly increased local recurrence rates. A margin ≥ 10 mm and age \u3c 45 years significantly enhanced cumulative survival. Significant multivariate risk factors for metastases were margin \u3c 10 mm and tumor grade G3. Conclusions: Despite a poor health referral system in our country, our results are no different from those reported from the developed world. Surgical margins and tumor grade prognostically influenced LRFS, MFS and OS

CENTRAL NERVOUS SYSTEM RELAPSE OF MULTIPLE MYELOMA

Multiple myeloma (MM) is a plasma cell disorder primarily involving bone marrow. Extramedullary involvement is less common, with central nervous system (CNS) myelomatosis being a rare entity and such presentation carries extremely dismal prognosis. We present case of a 40 years old male with MM who was initially treated with 6 cycles of Cyclophosphamide, Thalidomide and Dexamethasone resulting in complete response. 2 years later he presented with CNS myelomatosis and scrotal involvement and was initially treated with Bortezomib and dexamethasone, cranial irradiation and intrathecal Methorexate, Cytarabine, Hydrocortisone (TRIO IT), along with radical orchiectomy and testicular radiation during the course of treatment. However, after initial response his disease showed clinical and radiological progression after 4 months of therapy. He was switched to high dose Methotrexate (HD-MTX) with TRIOITand later Lenalidamide and dexamethasone (Len/dex) was added to the above regimen. He continued to show good clinical response but his cytology remained persistently positive, therefore, HD-MTX was discontinued in the later course of treatment. Subsequently he was started on best supportive care only, when his neurological status deteriorated further. He survived almost 9 months after a diagnosis of CNS myelomatosis. Patients with multiple myeloma, presenting with neurological symptoms should always be investigated for the possibility of CNS MM. CNS relapse is a fatal disease with poor prognosis. Recommended treatment must include a systemic anti-MM regimen that crosses the BBB (ideally Immunomodulatory drugs (IMiDs) IMiDs-dexamethasone based therapy), CNS irradiation and intrathecal chemotherapy.Key words: Multiple myeloma, central nervous system myelomatosis, therap

How Customer Loyalty Model Be Operative? A study of Cellular Phone Service Providers in Pakistan

The idea of this study is raised because of tough competition in cell phone industry of Pakistan. In this scenario, every organization after retaining customer tries to make him/her loyal. The loyalty, which has rigorously investigated, empirically tested with different combination of variables, which collectively help in making the customer loyal. Data were collected through 508 questionnaires. Respondents were pre-paid cell phone customers. Data was analyzed via factor loading and reliability of variables. Structural Equation Modeling (SEM) technique was used for the testing of hypotheses. Loyalty model was found significantly responsive for cellular phone services in Pakistan. Perceived service quality, satisfaction, trust and image have chained link of positive affects, which leads to loyalty of customers in the telecom sector of Pakistan. Customers do not take effect of perceived service quality. However, it is service quality, which satisfies customer through image of the organization. This loyalty model is more preferably applicable in the industry where competition is tough and switching rate is high. In future researches, this model can be tested across the culture. Moreover, more variables can be added to strengthen the loyalty model

The genetics associated with Primary Congenital Glaucoma

Glaucoma is a progressive optic neuropathy; increased intraocular pressure (IOP) is a modifiable risk factor for primary congenital glaucoma (PCG). Increase IOP causes retinal and optic nerve compression and leads to gradual and irreversible loss of eyesight if left untreated. It is the second most leading cause of blindness. PCG mainly affects children up to the age of three years, and symptoms include epiphora, photalgia, swollen eyes, opaque corneas, blepharospasm, rupture in the retina and ocular nerve damage due to IOP. Early detection, management, and treatment are the keys to preventing vision loss from glaucoma. Many mutations have been discovered in Cytochrome P450 1B1 (CYP1B1) gene to be responsible for causing PCG, and there are still a lot of mutations to be discovered. In this review, we will discuss the genetic aspects of PCG and the most frequent mutations responsible for PCG in Pakistani children. PCG can be handled by decreasing IOP either by medication or by surgery. Genetic counselling plays a significant role in the establishment of proper management of PCG.Keywords: Primary Congenital Glaucoma; IOP; Cyp1b1; Mutation

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

Performance Analysis of Hardware Protection & System Security in Different Operating Systems

The intention of article is to protect the hardware, which includes protecting CPU, I/O, and memory. This article portrays and relates the security in different operating systems. Therefore, helping us to choose the best. We can evaluate the security in different operating systems like Windows, UNIX, Linux to secure over all data to access unauthorized users

Antibacterial, cytotoxic studies and characterization of some newly synthesized symmetrical N 3, N 3 ′ -bis(disubstituted)isophthalyl- bis(thioureas) and their Cu(II) and Ni(II) complexes

A series of some novel ,-bis(disubstituted)isophthalyl-bis(thioureas) compounds with general formula [C6H4 {CONHCSNHR}2], where R = 2-ClC6H4S (L1), 3,5-(Cl)2C6H3 (L2), 2,4-(Cl)2C6H3 (L3), 2,5-(Cl)2C6H3 (L4), and 2-NH2C6H4 (L5), and their Cu(II) and Ni(II) complexes (C1–C10) have been synthesized. These compounds (L1–L5) and their metal(II) complexes (C1–C10) have been characterized by elemental analysis, infrared spectroscopy, 1H NMR and 13C NMR spectroscopy, magnetic moments, and electronic spectral measurements. The ligands are coordinated to metal atom in a bidentate pattern producing a neutral complex of the type [ML]2. These compounds (L1–L5) and their metal(II) complexes (C1–C10) were also screened for their antibacterial and cytotoxic activities

Unicameral bone cysts: Current concepts

Unicameral bone cysts (UBC) or simple/solitary bone cysts are benign fluid filled cavities that enlarge over time, resulting in thinning of the bone. Usually these cysts are reported in the metaphyseal areas of long bones with open physes. 85% of UBCs occur almost exclusively in children and adolescents. UBCs are more aggressive in the first decade of life and correspondingly the recurrence rate for these patients is four times that for adolescents. The proximal humerus and femur account for almost 90% of these cases. UBCs are classified as active when they are within 1 cm of the physis and latent as they progress to a diaphyseal location. Differential diagnoses for UBC include aneurysmal bone cyst, fibrous dysplasia, enchondroma, and intraosseous ganglia. By the time of skeletal maturity most UBCs tend to resolve. Nonoperative treatment may be a viable option for many patients with small or symptomatic lesions. Interventions include steroid injection, open curettage and bone grafting, decompression and percutaneous injection of marrow or graft substitutes

ERBM-SE: Extended Restricted Boltzmann Machine for Multi-Objective Single-Channel Speech Enhancement

Machine learning-based supervised single-channel speech enhancement has achieved considerable research interest over conventional approaches. In this paper, an extended Restricted Boltzmann Machine (RBM) is proposed for the spectral masking-based noisy speech enhancement. In conventional RBM, the acoustic features for the speech enhancement task are layerwise extracted and the feature compression may result in loss of vital information during the network training. In order to exploit the important information in the raw data, an extended RBM is proposed for the acoustic feature representation and speech enhancement. In the proposed RBM, the acoustic features are progressively extracted by multiple-stacked RBMs during the pre-training phase. The hidden acoustic features from the previous RBM are combined with the raw input data that serve as the new inputs to the present RBM. By adding the raw data to RBMs, the layer-wise features related to the raw data are progressively extracted, that is helpful to mine valuable information in the raw data. The results using the TIMIT database showed that the proposed method successfully attenuated the noise and gained improvements in the speech quality and intelligibility. The STOI, PESQ and SDR are improved by 16.86%, 25.01% and 3.84dB over the unprocessed noisy speech

Effect of Diabetes Mellitus on Tuberculosis Treatment Outcome and Adverse Reactions in Patients Receiving Directly Observed Treatment Strategy in India: A Prospective Study

Despite successful implementation of directly observed treatment, short course (DOTS) in India, the growing number of diabetes mellitus (DM) patients appears to be a cause in the increasing tuberculosis (TB) incidence, affecting their management. In this regard, a prospective study was conducted on DOTS patients in three primary health care centers in urban slum region of South Delhi, India, to evaluate the effect of DM on sputum conversion, treatment outcome, and adverse drug reactions (ADR) due to anti-TB treatment. Eligible TB patients underwent blood glucose screening at treatment initiation. Disease presentation, clinical outcome, and ADRs were compared between patients of TB with and without DM. Out of 316 patients, the prevalence of DM was found to be 15.8%, in which 19.4% and 9.6% were PTB and EPTB patients, respectively. DM patients have observed higher sputum positivity (OR 1.247 95% CI; 0.539-2.886) at the end of 2-month treatment and poor outcome (OR 1.176 95% CI; at the completion of treatment compared with non DM patients. Presence of DM was significantly associated (OR 3.578 95% CI; 1.114-11.494, = 0.032) with the development of ADRs. DM influences the treatment outcome of PTB patients in our setting and also on the ADR incidence