To compare the effect of abdominal binder versus no binder after major abdominal surgery and cesarean section on various post-operative recovery parameters.

Antiphospholipid syndrome (APS) is an acquired prothrombic state with recurring thromboembolic and obstetric complications in the presence of antiphospholipid antibodies. Isolated skin manifestation especially symmetrical peripheral gangrene (SPG) in postpartum phase is reported rarely. To highlight this unusual presentation of APS with SPG we present a case of young female who developed SPG on her third postpartum day. Postpartum period runs a high risk of sepsis but development of such extensive and rapid ischemic changes in APS is seen uncommonly.

Background: Hemophilia B is a rare entity than other coagulation disorders. It is an X-linked disorder characterized by a deficiency of functionally active coagulation factor IX (FIX), resulting in spontaneous or trauma-induced bleeding primarily in joints, muscles, and soft tissues. Case Presentation: We report a case of a female who presented with a surgical problem. She had a history of massive transfusion many years back. She bled perioperatively and then we investigated her and luckily found the deficiency of FIX. She was managed and discharged home well. Conclusion: Surgeons rarely comes across this rare coagulation disorder, so this was an intriguing case in view of the unusual presentation, initial diagnostic dilemma, and challenges in management.

Objective: To assess the pain relief after denosumab use in grade III giant cell tumor of bone (GCT-B). Study Design: Retrospective Cohort study. Setting: Department of Orthopedic Surgery Dow University of Health Sciences / Dr Ruth KM Pfau Civil Hospital Karachi. Period: 2018 May to 2020 June. Material & Methods: Total 27 patients were included in the study with diagnosis of grade III GCT-B. Patients with Stage I & II excluded from study. Results: After the first dose of Denosumab, 24 (88.9%) patients reported no pain relief while the other 3 (11.1%) patients had mild pain. A second dose of Denosumab was given to these patients. After the second dose, 3 (11.1%) patients scored mild pain and 24 patients had a score of ≥4 on VAS. The pain severity reduced significantly after administration of 2nd dose of Denosumab (p=0.019). Pain severity was remeasured after the third dose of Denosumab where they had VAS of 0 to 6, with inconsistent use of simple analgesics. The pain severity reduced significantly after administration of 3rd dose of Denosumab (p=0.001). Conclusion: We conclude that denosumab have excellent analgesic effect in grade III giant cell tumor of bone. We recommend the use denosumab in perioperative therapy for grade III GCT-B bone and we found analgesic effect as additional one. It may gain some time for patient specially in developing nations where oncology surgery centers are limited. It also reduces the use of NSAIDS during window period of definitive surgery.