9 research outputs found
Social stigmatisation among COVID-19 patients: addressing a potential source of COVID-19 transmission to healthcare staff in cardiac emergency and cardiac care units
No full textDuring our routine work, we noticed an increased incidence of COVID-19 diagnoses among patients in the cardiac unit, which led to an exponential increase in COVID-19 cases among hospital staff. We found that patients hid their symptoms from the emergency doctors and attributed those symptoms to cardiac or other causes. Social stigmatisation appeared to be the root cause for hiding their symptoms. Hence, we recommended a strategy to introduce psychological counselling of patients who were suspected to be infected with COVID-19, with a normal cardiac workup to overcome social stigmatisation and save our general wards from COVID-19
Experience from Cancer Registry of a Developing Country Regarding Quality of Care and Non-Compliance among Osteosarcoma Patients
No full textAbstract: In this study, we evaluated the level of care given by our institution and to assess the non-compliance along with predictor for
non-compliance among osteosarcoma patients.
Materials and Methods: The included participants were proven for osteosarcoma after biopsy between January 2014 to December 2020.
Records were searched from Departmental Cancer Registry for details regarding treatment plans and follow-ups. The data of outcomes were
compared with the standard guidelines. Patients who did not attend follow-ups, surgery or chemotherapy were termed as non-compliant. The
patients or their next of kins were inquired about the factors behind non-compliance.
Results: 46 participants with 34 (74.9%) males and 12 (26.1%) females and a mean age of 19.7± 9.7 years were included. The prescribed
treatment plan was followed by 11 (23.91%) patients. Neoadjuvant and adjuvant chemotherapy were taken by 18 (39.13%) and 10 (21.74%)
candidates, respectively. Surgery was performed in 22(44.9%). The patients who did not received chemotherapy was attributed to affordability
(P=0.008) and patients’ or next to kins’ choices (P=0.02) while age (P=0.039), patients’ consent not given (78.3%; P=0.05), and stage II
(52.2%; P=0.048) were predictors of surgical non-compliance.
Conclusion: We conclude that the care deferred significantly from the guidelines regarding surgery and chemotherapy. Age, affordability, late
stage, and personal choices are the significant predictors for non-compliance for chemotherapy and surgery
Emergency Management of Metastatic Spinal Cord Compression
No full textMetastatic Spinal Cord Compression (MSCC) is one of the major forms of oncological emergencies. Other common emergency scenarios seen in cancer patients include Neutropenic Sepsis, Hypercalcemia and Superior Vena Cava Obstruction (SVCO). During this brief discussion of MSCC we will be going over the red flag symptoms a patient may present with common malignancies. We shall go through the points that are associated with and the multidisciplinary management of MSCC. A patient presenting to the emergency room with symptoms including recent onset back pain [1, 2], in the extremes of age (i.e. <20 or >55), with a history of weight loss, pyrexia, night sweats, sensory loss, leg weakness, constant pain at night and at rest and/or complains of urinary retention, fecal incontinence should have MSCC considered in differential diagnosis and appropriate work up should be considered
Outcomes of Extended Curettage with and without Bone Allograft for Grade II Giant Cell Tumors around the Knee. A Retrospective Comparative Study
No full textAbstract Objective This is the first study to establish the utility of extended curettage with or without bone allograft for Grade II giant cell tumors GCTs around the knee joint with the aim of exploring postoperative functional outcomes. Methods We retrospectively reviewed 25 cases of Campanacci grade II GCTs undergoing extended curettage between January 2014 and December 2019. The participants were divided into two groups: one group of 12 patients underwent extended curettage with bone allograft and bone cement, while the other group of 13 patients underwent extended curettage with bone cement only. Quality of life was assessed by the Revised Musculoskeletal Tumor Society Score and by the Knee score of the Knee Society; recurrence and complications were assessed for each cohort at the last follow-up. The Fisher test and two-sample t-tests were used to compare the categorical and continuous outcomes, respectively. Results The mean age was 28.09 (7.44) years old, with 10 (40%) males and 15 females (60%). The distal femur and the proximal tibia were involved in 13 (52%) and in 12 (48%) patients, respectively. There was no significant difference in the musculoskeletal tumor society score (25.75 versus 27.41; p= 0.178), in the knee society score (78.67 versus 81.46; p= 0.33), recurrence (0 versus 0%; p= 1), and complications (25 versus 7.69%; p= 0.21). Conclusions Extended curettage with or without bone allograft have similar functional outcomes for the knee without any major difference in the incidence of recurrence and of complications for Grade II GCTs. However, surgical convenience and cost-effectiveness might favor the bone cement only, while long-term osteoarthritis prevention needs to be investigated to favor bone allograft
Cord Compression from Bony Metastasis: An Important Quality of Life Issue which can be Resolved by a Spinal MDT Tumor Board
No full textCancer prevalence is increasing over the past few decades. Spinal osseous metastasis is one of the most common sites of secondary neoplastic disease among cancer patients [1]. Spinal malignancies can broadly be classified into primary spinal cancers and secondary spinal metastasis. Metastatic spinal cancers are more common than primary malignancy of the spine. Metastatic spinal cancers are further subdivided into two parts based on the involvement of the dura mater; metastasis external to dura mater can be termed as metastatic epidural spinal cancers (MESC); metastasis inside the dura mater is called metastatic intradural spinal cancers (MISC) [2]. Bony involvements of vertebrae are common at the presentation of MESC while the involvement of the spinal cord and meninges is a prominent feature of MISC. However, the clinical presentation is quite overlapping and timely-decision making is quite challenging in several cases. Several grading systems have been developed to assess the severity of spinal cancers [3-6]. Such ambiguities require a need for teamwork between different specialties to decide the management plan for better patient care. Multidisciplinary Tumor Boards (MDT) are the practical venue where different specialists are present for the discussion [7]
Unraveling the mystery: A comprehensive review of multidisciplinary strategies for managing giant cell tumor of the bone
No full textThis review article provides a comprehensive overview of the multidisciplinary management of giant cell tumors of the bone (GCTB). GCTB is a rare, intermediate-grade, benign, locally aggressive osteolytic neoplasm that primarily affects the epiphyses of long bones in individuals aged 20–45, with a female predominance. The article discusses the epidemiology, clinical features, and various management approaches for GCTB.The article highlights the importance of GCTB, which can resemble other bone lesions, so an accurate diagnosis is essential. A biopsy is a definitive way to diagnose GCTB. While, radiography includes MRI, PET scans, and bone scans to help diagnose and stage GCTB. The Campanacci grading system, based on radiographic appearance and soft tissue involvement, is commonly used to stage GCTB.Surgical management options for GCTB include intralesional curettage, wide marginal resection, and en-bloc resection, depending on the location and extent of the tumor. In challenging anatomical locations, such as the axial skeleton, intralesional curettage may be the only viable option to preserve function and minimize surgical morbidity. However, it is associated with a high rate of local recurrence. Wide marginal resection is effective in reducing recurrence rates but may result in significant morbidity and require bone defect reconstruction. En-bloc resection is preferred for tumors with soft tissue extension or involvement of expendable bones.In cases where complete surgical resection is not feasible or carries a high risk of morbidity, alternative treatment options such as radiation therapy, arterial embolization, and systemic therapy with bisphosphonates (zoledronic acid) and denosumab are valuable tools in achieving disease control and improving patient outcomes. Radiotherapy is employed for cases where the disease has recurred locally and cannot be removed surgically. Arterial embolization involves interrupting the blood supply to tumors in areas that cannot be operated on. Bisphosphonates are drugs that can be given before or after surgery to reduce the chances of recurrence by inhibiting osteoclast activity.Denosumab, a monoclonal antibody that targets RANKL, has shown promising results in reducing tumor size, facilitating surgical treatment, and improving outcomes. In conclusion, this review provides valuable insights into the epidemiology, clinical features, and multidisciplinary management approaches for GCTB. Accurate diagnosis, appropriate staging, and individualized treatment strategies are essential for optimizing patient outcomes in GCTB management
Effectiveness of Scoliosis Specific Exercises in Improving Cobb’s Angle-A Systematic Review and Meta-Analysis
No full textBackground: Scoliosis is defined as a Three-dimensional deformity that can be diagnosed by measuring the spinal curves. For measuring the curvature, we employ Cobb’s method to calculate Cobb’s angle on the anteroposterior radiograph of the spine. The commonest type of scoliosis is adolescent idiopathic scoliosis (AIS) that is seen in adolescent females. Our literature research revealed a scarcity of systematic reviews regarding the role of Scoliosis specific exercises (SSE) in reducing Cobb’s angle in scoliosis. This review of the literature evaluates the role of SSE compared to the standard treatment practices in reducing Cobb’s angle in scoliosis patients.
Methods: The literature was scrutinized according to PRISMA guidelines where PubMed, Google Scholar, and Cochrane Library were searched for randomized controlled trials in the English language with the search words “Cobb’s angle”, “physiotherapy”, “outcomes”, “scoliosis specific exercises”, “correction of” and “scoliosis” in different combinations published between 2016 to 2022. One group i.e. interventional group consisted of SSE with standard care while the other group i.e. control group did not receive SSE. Mean ± SD was used to measure the change in Cobb’s angle. The difference was pooled by standardized mean difference (SMD) into forest plots. The risk of bias was assessed by the Oxford quality scoring system (OQSS).
Results: The SMD was pooled from five studies where SMD remained -0.717 (-1.142, -0.291) (CI=95%, p-value0.05)
Conclusion: We concluded that SSE produced a decrease in Cobb’s angle compared to the group without SSE. However, good quality randomized controlled trials with larger sample sizes and longer follow-ups are needed to strengthen the role of SSE.
Keywords: Low Angle Scattering, Physical Therapy Modalities, Scoliosis
Current Trends Regarding Perioperative Pharmacological Anticoagulation in Lower Limb Surgeries among Orthopedic Surgeons of Pakistan- A Critical Survey
No full textAbstract: Perioperative anticoagulation has been recommended by AAOS, AACP, and ASH during orthopedic procedures of the lower limb.
Guidelines show a difference of opinion regarding the optimum duration and drug of choice giving a way to use different methods of
anticoagulation. This survey assessed the differences in preferences for pharmacological anticoagulation in lower limb surgeries among
orthopedic surgeons of Pakistan.
Materials & Methods: Orthopedic surgeons (n=632) were invited to fill in the questionnaires. A total of 85 orthopedic surgeons responded
completely. An electronic eight-question survey was designed which included questions about demographics of surgeons, the drug of choice,
perioperative duration, preferred surgeries, and average incidence of thromboembolism per year.
Results: 12.9% surgeons use anticoagulation for all surgeries while 82.3% of orthopedic surgeons use anticoagulants in selective surgeries.
LMWH (94.1%) and Rivaroxaban (17.6%) were the drug of choice for most surgeons. 70.6% of respondents never used anticoagulation
preoperatively. 17.7% used it three days preoperatively. 28.24% of surgeons prescribed anticoagulation for 3 days postoperatively while 17.7%
of surgeons prescribed anticoagulation for 2 weeks postoperatively. 10.6% of surgeons never used anticoagulation postoperatively.
Arthroplasty (71.7%), trauma (55.3%), and pelvis and acetabulum (54.1%) were the subspecialties with routine anticoagulation. 81.2% and
17.7% of surgeons reported less than 1% and 1% to 3% incidence of thromboembolism, respectively. No surgeon reported any incidence of
thromboembolism above 5%.
Conclusion: Use of anticoagulation is prevalent among orthopedic surgeons in Pakistan. However, significant differences are observed
regarding the perioperative duration. The surgeons need to prescribe DOAC such as Rivaroxaban and Dabigatran as agents of choice while
extended postoperative pharmacological anticoagulation of 28-35 days needs to be adopted
Efficacy of drug-coated balloon versus uncoated balloon for dysfunctional dialysis access: a systematic review and meta-analysis
No full textBackground: Dysfunctional vascular access is a major cause of morbidity and mortality in patients undergoing hemodialysis, affecting both arteriovenous fistulas and grafts. The most optimal strategy to restore long-term patency has not been established. This meta-analysis compares drug-coated balloon (DCB) versus uncoated balloon (UCB) angioplasty for dysfunctional vascular access. Methods: We performed a systematic literature search across multiple databases from inception to June 2024. Randomized-controlled trials (RCTs) comparing DCB and UCB in dialysis patients with dysfunctional vascular access were included. Risk ratios were pooled using a random-effects model. Results: Twenty-seven RCTs (2645 patients) were included. Target lesion patency (TLP) at 6 months was significantly superior in the DCB group (RR 1.22, 95% CI 1.07–1.39, p = 0.003). The two regimens were comparable for TLP at 3 months (RR 1.14, p = 0.24) and 12 months (RR 1.14, p = 0.10). The two regimens were comparable in terms of circuit patency rate, target-lesion revascularization, and all-cause mortality. Conclusion: DCB has significantly superior TLP and a comparable risk of mortality to UCB. Further research is warranted to identify factors affecting outcomes following DCB angioplasty for dysfunctional dialysis access. © The Author(s), under exclusive licence to Japanese Society of Nephrology 2025
