Operative management of patients with non-spinal metastatic bone disease. Does it actually improve quality of life?

Abstract OBJECTIVE: To determine the survival rate and functional outcome of skeletal stabilisation in patients with metastatic bone disease. METHODS: The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised data of patients with non-spinalmetastatic bone disease managed surgically from January 2002 to December 2010. All patients had been managed by experienced orthopaedic, oncology and multidisciplinary teams. Patients managed by non-oncologic orthopaedic surgeons were excluded. The prognostic influence of clinical, pathological and treatment variables on Musculoskeletal Tumour Society score, range of motion, local complications and death rate were measured. SPSS 19 was used for statistical analysis. RESULTS: Of the 49 patients whose records were included in the study, 21(42.9%) males and 28(57.1%) females with an overall median age of 59 years. Most common primary tumour site was breast in 15(3.8%) followed by lungs in 11(22.4%), Open reduction and internal fixation was the mpst commonly used procedure in 18(36.7%) patients. Mean duration of follow-up was 30.20±29.2 SD months (range: 10-48 months). The median patient survival was 23 months. 23% patients have superficial surgical site infection. Mean Musculoskeletal Tumour Society score was 23.73±14.3 SD. CONCLUSIONS: The results confirm the principle that surgery for metastatic disease is done primarily to improve quality of life and ambulation status, and to alleviate pain

Hip reconstruction osteotomy by Ilizarov method as a salvage option for abnormal hip joints

Hip joint instability can be secondary to congenital hip pathologies like developmental dysplasia (DDH) or acquired such as sequel of infective or neoplastic process. An unstable hip is usually associated with loss of bone from the proximal femur, proximal migration of the femur, lower-extremity length discrepancy, abnormal gait, and pain. In this case series of 37 patients coming to our institution between May 2005 and December 2011, we report our results in treatment of unstable hip joint by hip reconstruction osteotomy using the Ilizarov method and apparatus. This includes an acute valgus and extension osteotomy of the proximal femur combined with gradual varus and distraction (if required) for realignment and lengthening at a second, more distal, femoral osteotomy. 18 males and 19 females participated in the study. There were 17 patients with DDH, 12 with sequelae of septic arthritis, 2 with tuberculous arthritis, 4 with posttraumatic arthritis, and 2 with focal proximal femoral deficiency. Outcomes were evaluated by using Harris Hip Scoring system. At the mean follow-up of 37 months, Harris Hip Score had significantly improved in all patients. To conclude, illizarov hip reconstruction can successfully improve Trendelenburg’s gait. It supports the pelvis and simultaneously restores knee alignment and corrects lower-extremity length discrepancy (LLD)

Impact of unplanned excision on prognosis of patients with extremity soft tissue sarcoma

Unplanned excision of soft tissue sarcomas (STSs) outside comprehensive tumor management centers necessitates the need for wide reexcision to achieve adequate margins. We retrospectively reviewed medical records of 135 patients with STS operated at our hospital with the goal of examining outcomes, in terms of local recurrence (LR) and metastasis rate (MR), of reexcision following unplanned excision of STS and comparing results with those of first-time planned surgery. Eighty-four patients had their first-time surgery and 51 patients had come to us following unplanned excision at prereferral hospital. Mean age of all patients was 41.8 ± 21.9 years. The LR and MR was 14.3% and 8.3%, respectively, in patients undergoing first resection, whereas it was 21.4% and 13.7%, respectively, in patients undergoing revision surgery. Average duration from previous unplanned excision was 8 months. Twelve patients were referred immediately after excised specimen revealed STS, while 39 patients presented after evident local recurrence. Wide reexcision was attempted in 48 patients while three patients need amputation. Adjuvant radiotherapy was administered in all patients undergoing limb-sparing surgery. Ten patients needed adjuvant chemotherapy.We conclude that wide reexcision of STS has poorer outcomes compared to planned excision. Therefore, patients with soft tissue masses should be managed by multidisciplinary oncology team at specialized cancer centers

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

Efficacy of exogenous application of 2, 4-Dichlorophenoxyacetic acid (2, 4-D) on growth and yield of mungbean (Vigna radiata L.)

The growth and yield promotion of mungbean in response to the use of 2, 4-Dichlorophenoxy acetic acid (2, 4-D) was investigated through a pot study which was arranged in the wire house of Institute of Soil and Environmental Sciences, University of Agriculture Faisalabad. The study was comprised of five treatments and three replications (control, 0.2 ppm 2, 4-D, 0.5 ppm 2, 4-D, 0.8 ppm 2, 4-D, and 1 ppm 2, 4-D). The suggested dose of Nitrogen, Phosphorus and Potassium (NPK) was applied at the amount of 20, 60 and 25 kg ha-1 added as Urea, DAP and SOP, respectively at sowing time. The data regarding growth (plant height, root and shoot length, root and shoot fresh and dry weight, and total biomass), yield (grain weight, number of grains plant-1) and NPK analysis in plants and soil was recorded and statistically analyzed. The response of exogenous application of 2, 4-D was significant at all levels in improving the performance of all the growth parameters and yield as compared to untreated control treatment. Maximum performance of all the parameters was recorded at 0.8 ppm application of 2, 4-D. As the concentration of 2, 4-D increased the development of plants also showed positive effect but up to 0.8 ppm application after that it started to decrease which showed that at higher concentrations 2, 4-D acts as growth retardant

Autoclaved tumor bone for skeletal reconstruction in paediatric patients: A low cost alternative in developing countries

We reviewed in this series forty patients of pediatric age who underwent resection for malignant tumors of musculoskeletal system followed by biological reconstruction. Our surgical procedure for reconstruction included (1) wide en bloc resection of the tumor; (2) curettage of tumor from the resected bone; (3) autoclaving for 8 minutes (4) bone grafting from the fibula (both vascularized and nonvascularized fibular grafts used); (5) reimplantation of the autoclaved bone into the host bone defect and fixation with plates. Functional evaluation was done using MSTS scoring system. At final followup of at least 18 months (mean 29.2 months), 31 patients had recovered without any complications. Thirty-eight patients successfully achieved a solid bony union between the graft and recipient bone. Three patients had surgical site infection. They were managed with wound debridement and flap coverage of the defect. Local recurrence and nonunion occurred in two patients each. One patient underwent disarticulation at hip due to extensive local disease and one died of metastasis. For patients with non-union, revision procedure with bone graft and compression plates was successfully used. The use of autoclaved tumor grafts provides a limb salvage option that is inexpensive and independent of external resources and is a viable option for musculoskeletal tumor management in developing countries

A Research Review on Tomato Bushy Stunt Virus Disease Complex

Tomato Bushy Stunt Virus (TBSV) was firstly reported on tomatoes by Smith in 1935 in England. The virus belongs to genus Tombusvirus and family Tombusviridae, is a soil-borne virus with isometric particle about 30 nm in diameter. Tomato Bushy Stunt Virus can cause chlorosis, necrosis, stunting, leaf yellowing, leaf mottling, leaf crinkling and fruit setting may be reduced or become zero. These symptoms were depending upon the host morphology. Transmission of this virus is naturally through infected seeds, propagative material and manually by the use of infective cutting tools. A numbers of varieties were affected. But it’s also observed that Lycopersicon pimpinellifolium not susceptible host plant. Gel Electropherotic analysis shows that virus distantly related serologically with several other viral species in the genus Tombusvirus. In phosphotungstic acid, the particles show an angular outline and unresolved surface structure but when mounted in uranyl acetate, they exhibit a rounded outline and somewhat knobby surface and edges. The viral genome is monopartite and TBSV-Ch has been completely sequenced and shown to contain 4,776 nucleotides. The protein shell is constructed by 180 subunits, each subunit contain Mr 41,000 and made icosahedral surface lattice. These subunits show a dimeric clustering on the surface of particles, which give rise to 90 morphological units. These were located on the two-fold axes of the lattice. Each coat protein subunit contains 387 amino acid residues and has four regions. Keywords: Tomato Bushy Stunt Virus, Genus Tombusvirus, Family Tombusviridae, Monopartite, Genome analysis of TBSV

Clinical Study Impact of Unplanned Excision on Prognosis of Patients with Extremity Soft Tissue Sarcoma

Unplanned excision of soft tissue sarcomas (STSs) outside comprehensive tumor management centers necessitates the need for wide reexcision to achieve adequate margins. We retrospectively reviewed medical records of 135 patients with STS operated at our hospital with the goal of examining outcomes, in terms of local recurrence (LR) and metastasis rate (MR), of reexcision following unplanned excision of STS and comparing results with those of first-time planned surgery. Eighty-four patients had their first-time surgery and 51 patients had come to us following unplanned excision at prereferral hospital. Mean age of all patients was 41.8 ± 21.9 years. The LR and MR was 14.3% and 8.3%, respectively, in patients undergoing first resection, whereas it was 21.4% and 13.7%, respectively, in patients undergoing revision surgery. Average duration from previous unplanned excision was 8 months. Twelve patients were referred immediately after excised specimen revealed STS, while 39 patients presented after evident local recurrence. Wide reexcision was attempted in 48 patients while three patients need amputation. Adjuvant radiotherapy was administered in all patients undergoing limb-sparing surgery. Ten patients needed adjuvant chemotherapy. We conclude that wide reexcision of STS has poorer outcomes compared to planned excision. Therefore, patients with soft tissue masses should be managed by multidisciplinary oncology team at specialized cancer centers

Bacterobilia in acute cholecystitis: bile cultures\u27 isolates, antibiotic sensitivities and antibiotic usage. a study on a Pakistani population.

Abstract Acute cholecystitis is one of the most common acute surgical conditions. Laparoscopic cholecystectomy remains the mainstay of treatment. In patients managed non-operatively, antibiotics play an important role in the treatment of cholecystitis. The current retrospective observational study was conducted at a tertiary care hospital in Karachi, and comprised medical records of patients admitted between 2008 and 2014with acute cholecystitis and in whom bile cultures were obtained. Of the 509 patients with a mean age of 51.15 ± 13.4years, early laparoscopic cholecystectomy (within 72hours) was performed on 473(92.9%) cases, while the rest underwent percutaneous cholecystostomy. Bile cultureswere positive in 171(33.6%) patients. Predominantly gram-negative organisms were isolated among a total of 137(27%), with E.coli 63(46%) being the most commonly isolated organism. Of the gram-positive organism, enterococcus 11(8%) was the most common. Antibiotic sensitivities were determined.Based on our findings gram-negative coverage alone should be sufficient in our segment of the population

Personalized Medicine; a Potential Therapy for Cystic Fibrosis

Cystic Fibrosis (CF) is an inherited disorder caused by mutations in CFTR gene that codes for Cystic Fibrosis Transmembrane-conductance Receptor anion channel. It is an autosomal recessive disease which affects the cells that secrete sweat, mucous and digestive juice, making these fluids thick and sticky, thus plugging ducts and tubes of various organs. The CF mutations are classified into various classes (class I, II, III, IV, V and VI) based on the cellular phenotype and complexity of mutants. The knowledge and understanding of biology and mechanisms of defects that underlie Cystic fibrosis paved a way to the development of different therapeutic approaches for these mutation classes. Ivacaftor first CFTR potentiator (FDA approved in 2012) is mostly used for Class III and IV mutations. Trials in patients with homozygous F508del mutation, a most common type of CF mutation that involves protein processing defects, showed no improvement with Ivacaftor alone, therefore, a double-combination therapy involving potentiator-corrector i.e., Ivacaftor-Lumacaftor got approval in 2015 to treat patients homozygous for F508del mutation. Then Ivacaftor-Tezacaftor (corrector) combination therapy was approved in 2018 which showed improved tolerability as compared to lumacaftor. In 2019, Trikfta, a triple combination therapy, came into light. It increases CFTR activity and is substantially considered to work more effectively in patients homozygous for F508del mutation. Studies and clinical trials reveal the outperformance of Trikafta in other available therapies in terms of respiratory symptoms, lungs functionality and quality of life on a whole.Keywords: Cystic Fibrosis (CF); Cystic Fibrosis Transmembrane Conductance regulator (CFTR); Ivacaftor; Lumacaftor; Tezacaftor; Trikafta