Orthopaedic Practices and Surgeries during COVID-19 in Pakistan - A Survey Based Study

@#Introduction: The study aimed to target the current practices of the orthopaedic community in outpatient (OPD), emergency (ER) and surgical services (OT) during COVID19. Material and method: This study surveyed 303 orthopaedic surgeons from all over Pakistan. The survey had 30 questions targeting the setup of outpatient, emergency and operation services in orthopaedic departments of different hospitals in Pakistan. Result: A total of 302 surgeons were included from 53 cities all over Pakistan. Between 35-48% of the respondents reported lack of availability of standard operating procedures in OPD, ER and in OT. Majority of the respondents noted that their OPD and surgical practice had been affected to some degree and 69% of the surgeons were only doing trauma surgery. This trend was higher in younger consultants of less than 45 years of age (p<0.001). Almost two-third of the surgeons, mostly senior (p=0.03) were using surgical masks as the only protective measure during various practices of OPD, ER and OT, while most of the setups were not assessing patients even for signs and symptoms of COVID. Almost 89% of the orthopaedic community is facing definite to mild stress during this pandemic and this has significantly affected the senior surgeons (p=0.01). Conclusion: Our study highlighted that COVID-19 has resulted in marked changes to the practices of the majority of Pakistani orthopaedic surgeons. Despite a sharp upsurge in the number of cases and mortality due to COVID-19, guidelines were still lacking at most of the settings and a substantial percentage of the orthopaedic community were not following adequate safety measures while attending to patients.

Socioeconomic Impacts of Gluten-Free Diet among Saudi Children with Celiac Disease / 대한소아소화기영양학회지

PURPOSE: To determine the socio-economic impact of gluten free diet (GFD) on Saudi children and their families. METHODS: A cross-sectional study was conducted in which an online questionnaire was sent to all families registered in the Saudi celiac patients support group. We included only children (age 18 years of age and younger) with biopsy-confirmed celiac disease (CD). RESULTS: A total of 113 children were included in the final analysis, the median age was 9.9 years; 62.8% were females. One hundred (88.5%) of the participating families reported that GFD food was not easily available in their areas, 17% of them reported that it was not available at all in their area. One hundred and six (93.8%) reported that the price of GFD food was very expensive and 70 (61.9%) families that the diet was heavily affecting their family budget. Significant social difficulties were reported among the participating families and their children including interference with the child's interaction with other children (49.6%), the families' ability to attend social gatherings (60.2%), the families' ability to eat in restaurants (73.5%), and the families' ability to travel (58.4%). CONCLUSION: There is significant negative socio-economic impact of GFD on children with CD & their families. Health care providers should be aware of these psycho-social difficulties and be well trained to provide a proper education and psychological support for these patients and their families.

Changes in student perceptions after a semester-long interprofessional education activity in Qatar

Objectives: Interprofessional education [IPE] is rapidly becoming integrated into university accreditation standards worldwide. However, the impact of IPE on student learning and practice is largely unknown in the Middle East. This report describes a semester-long IPE coursebased activity and evaluates student perceptions towards professional roles

Methods: Pharmacy and Human Nutrition students from Qatar University completed a 15-week IPE activity that required students to work in groups to complete two assignments after an introductory event. The data were collected during meetings with students and faculty about their overall experience and course assignments. Perceptions regarding professional roles were determined by a pre- and post-reflection questionnaire

Results: After completion of the assignments, fourteen students [37%] noted changed perceptions of themselves, as well as of the other healthcare profession. Twelve of fourteen [86%] noted changes regarding perceptions of the roles of the other healthcare profession, while 2/14 [14%] noted changes regarding perception of their own professional roles. Three of fourteen [21%] reported that their changed perceptions towards IPE were unfavourable. These changed perceptions largely focused on specialised roles of the respective professions

Conclusions: A semester-long IPE experience was deemed beneficial in a Middle Eastern context. Future events and research should focus on fostering collaboration and interprofessional communication to enhance student attitudes and eventual preparation for interprofessional practice

Comparative Study of the Effects of the Retrocrural Celiac Plexus Block Versus Splanchnic Nerve Block, C-arm Guided, for Upper Gastrointestinal Tract Tumors on Pain Relief and the Quality of Life at a Six-month Follow Up

BACKGROUND: The celiac plexus and splanchnic nerves are targets for neurolytic blocks for pain relief from pain caused by upper gastrointestinal tumors. Therefore, we investigated the analgesic effect of a celiac plexus block versus a splanchnic nerve block and the effects of these blocks on the quality of life six months post-intervention for patients with upper GIT tumors. METHODS: Seventy-nine patients with inoperable upper GIT tumors and with severe uncontrolled visceral pain were randomized into two groups. These were Group I, for whom a celiac plexus block was used with a bilateral needle retrocrural technique, and Group II, for whom a splanchnic nerve block with a bilateral needle technique was used. The visual analogue scale for pain (0 to 100), the quality of life via the QLQ-C30 questionnaire, and survival rates were assessed. RESULTS: Pain scores were comparable in both groups in the first week after the block. Significantly more patients retained good analgesia with tramadol in the splanchnic group from 16 weeks onwards (P = 0.005, 0.001, 0.005, 0.001, 0.01). Social and cognitive scales improved significantly from the second week onwards in the splanchnic group. Survival of both groups was comparable. CONCLUSIONS: The results of this study demonstrate that the efficacy of the splanchnic nerve block technique appears to be clinically comparable to a celiac block. All statistically significant differences are of little clinical value.

Clinical Characteristics of Celiac Disease and Dietary Adherence to Gluten-Free Diet among Saudi Children / 대한소아소화기영양학회지

PURPOSE: To describe the clinical characteristics of celiac disease (CD) among Saudi children and to determine the adherence rate to gluten free diet (GFD) and its determinant factors among them. METHODS: A cross-sectional study was conducted, in which all the families registered in the Saudi Celiac Patients Support Group were sent an online survey. Only families with children 18 years of age and younger with biopsy-confirmed CD were included. RESULTS: The median age of the 113 included children was 9.9 years, the median age at symptom onset was 5.5 years and the median age at diagnosis was 7 years, the median time between the presentation and the final diagnosis was 1 year. Sixty two of the involved children were females. Ninety two percent of the patients were symptomatic at the diagnosis while eight percent were asymptomatic. The commonest presenting symptoms included: chronic abdominal pain (59.3%), poor weight gain (54%), abdominal distention, gases, bloating (46.1%) and chronic diarrhea (41.6%). Sixty percent of the involved children were reported to be strictly adherent to GFD. Younger age at diagnosis and shorter duration since the diagnosis were associated with a better adherence rate. CONCLUSION: CD has similar clinical presentations among Saudi children compared to other parts of the ward; however, the adherence to GFD is relatively poor. Younger age at diagnosis and shorter duration since the diagnosis were associated with a better adherence rate.

Absent abdominal muscles, nephro-urologic abnormalities, and severe neurologic damage in an infant with 3 chromosomal duplications: a novel syndrome?

Absent abdominal muscles, cryptorchidism, and hydroureteronephrosis are known to occur in the prune belly syndrome [PBS]. We present a male with absent abdominal muscles, severe neurologic damage, with global developmental delay, hydroureteronephrosis, and cryptorchidism. The patient also had arthrogryposis multiplex congenital, low set ears, short neck, micrognathia, bilateral total ptosis, and bilateral clubfeet. Genetic testing [CGH array] revealed 3 novel duplications of unknown clinical significance at 7qll.23, 9q22.32 [PTCH 1 gene], and 12q21.32 [CEP 290 gene]. We feel that our patient represents a novel entity, henceforth not described in the literature

Another hazard to laboratory workers

Needle-stick injuries, unfortunately, are a common occurrence during blood extraction and handling of specimens in the laboratory, which often lead to the contraction of blood-borne viral diseases. Mycobacterium tuberculosis infection also poses a threat to healthcare workers, especially laboratory workers in areas with endemic levels of tuberculosis infections. We present in this report, a case of primary inoculation of tuberculosis of the skin transmitted following a needle-stick injury, which was successfully treated. Reports of such an occurrence are few, and our report further underlines the need to take greater precautions against these accidents. In addition, our case draws attention to the possibility of prophylactic anti-tuberculous treatment in high-risk patients to prevent the progression of an overt illness

Congenital familial erythrocytosis: a case report with literature review

Familial erythrocytosis is a heterogeneous group of hereditary conditions with an increased total red blood cell volume. The disease occurs in a familial pattern and follows a relatively benign course. The absence of leukocytosis and thrombocytosis differentiates it from polycythemia vera. The best characterized primary erythrocytosis is the autosomal dominant primary familial and congenital polycythemia. In most families, erythrocytosis is due to abnormal hemoglobin with increased oxygen affi nity. In other families, erythrocytosis is caused by an autonomous production of erythropoietin [EPO]. EPO receptor gene mutations are also responsible for erythrocytosis when no secondary causes are apparent. Presented herein is a family with familial erythrocytosis possibly due to high autonomous production of EPO, which as per the literature is the fi rst of its kind in the Indian context

Experimental Investigation on Rabbits Following Peritoneal Injection of Bacteria Isolated from Human Keratitis.

Aim: This work was aimed at studying the pathogenicity of bacteria causing infectious keratitis through experimental infection using different groups of rabbits that were inoculated with clinical isolates and assessed through biochemical and histopathological investigations. Study Design: This study was carried out on Rabbits. Place and Duration of the Study: this experiment was carried out at Med. Labs. Dept, Qassim Univ., in April 2013. Methodology: The isolated bacteria, Pseudomonas aeruginosa and Staphylococcus aureus from clinical corneal scraping swabs of patients suffering from infectious keratitis were experimentally inoculated through intraperitoneal injection in different groups of Original Research Article Article British Journal of Medicine & Medical Research, 4(26): 4470-4481, 2014 4471 rabbits (2.0-2.5kg) and were subjected to serum biochemical and histopathological examinations. Results: The experimental rabbits showed alterations in both liver and kidney function parameters that varied with the type of bacteria injected. The level of urea was nonsignificantly increased to a higher extent in rabbits within 3 and 7 days of infection. There was no marked change in the levels of uric acid and creatinine in all groups of rabbits. Alanine aminotransferase (ALT) and Aspartate aminotransferase (AST) showed variable increased values but seemed also within limits of reference in all the groups of rabbits injected with either S. aureus or P. aeruginosa. Histopathologically, the internal organs (liver and kidneys) of the experimental rabbits showed inflammatory reactions with degenerative changes and/or necrosis while the cornea revealed oedema and leukocytic infiltration. The microscopic findings were varied in severity according to the type of the bacteria. Conclusion: Pseudomonas aeruginosa and Staphylococcus aureus experimentally induced infections revealed histopathologic lesions and disturbances in the functions of liver and kidneys of experimental rabbits together with proliferation of corneal epithelium and polymorphonuclear leukocytes infiltration in the corneal stroma. Therefore, strict measures are recommended to control and treat infectious keratitis to avoid visual complications and systemic disturbances among infected patients.

Association of NOD2/CARD15, DLG5, OCTN1 and toll-like receptor 4 gene polymorphisms with inflammatory bowel disease: a university hospital experience

Background: Both genetic and environmental factors play major roles in the development of inflammatory bowel disease [IBD]. Recent studies have identified a number of genetic susceptibility loci for Crohn's disease [CD] and ulcerative colitis [UC]

Objectives: The present study aimed at examining the association of nine polymorphisms in four different genes with the development of CD and UC in a sample of Saudi patients with IBD

Materials and Methods: All gene polymorphisms were identified by polymerase chain reaction and by direct sequencing. Allele and genotype frequencies of polymorphisms of NOD2/CARD15 [R702W, G908R, L1007finsC], Toll-like receptor 4 [TLR4] [D299G, T399I], OCTN promoter [C1672, G207C] and DLG5 [G113A, C4136A] genes were determined in Saudi subjects with CD [51], UC [26] and in 75 normal controls

Results: Out of the nine polymorphisms studied in four loci, only two polymorphisms in two different loci were found to have increased in patients compared with the control subjects. The CT genotype of TLR4 T3991 was over represented in patients with CD or UC compared to that in controls [odds ratios [OR], 5.63:95% confident interval [CI], 1.19-26.69; P = 0.03]. In addition, the GA genotype of DLG5 G113A was over represented in patients with CD or UC compared with that in controls [OR, 4.72:95% CI 2.30-9.66; P = 0.0001]. However, there were no significant associations found between all other polymorphisms studied and the susceptibility of CD or UC found in the Saudi population

Conclusion: Our finding indicates that association of IBD with nine gene polymorphisms was only significant in two of these polymorphic variants

Early prevention of childhood caries with maternal xylitol consumption

To evaluate the effect of maternal xylitol consumption on children's salivary mutans streptococci [MS] level, caries activity, and plaque accumulation in contrast with maternal fluoride varnish in a group of mother-child pairs. In this randomized controlled trial, the study subjects were 60 mother-child pairs recruited from the pediatric dentistry clinic and the hospital well baby clinic at King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. The sample was recruited on the basis of maternal high salivary MS levels, and a child aged 10-36 months. The subjects were randomly assigned to experimental and control groups. Mothers in the experimental group chewed xylitol gum, 1.8 gram [66% xylitol by weight], 3 times/day for 3 months. Mothers in the control group received fluoride varnish. Both groups received oral hygiene instructions, dietary counseling, and restorative treatment. Children were examined after 6, 12, and 24 months from the initiation of the study to evaluate salivary MS levels, caries, and plaque accumulation. There was an increase in MS levels in the experimental and control children at 24 months, which was non-significant in the experimental group, and significantly higher in the control group when compared with the baseline [p=0.008]. The decayed, missing, filled scores of the children in the experimental group showed no change after 24 months, contrary to the controls that showed a significant increase [p=0.001]. Plaque scores revealed no differences over time or between the 2 groups. Compared with fluoride varnish, maternal xylitol consumption provided preventive outcomes on salivary MS and caries levels in children

Gastroesophageal reflux disease in children: a 2013 update

Gastroesophageal reflux [GER] refers to the passage of gastric contents [acid, pepsin, etc] in the esophagus. It is a worldwide physiologic condition most common in infants. This physiologic condition [GER] should be differentiated from the pathologic reflux called gastroesophageal reflux disease [GERD]. The distinction between GER and GERD is based on severity of the reflux episodes.[1,2] The most common mechanism of reflux is transient lower esophageal sphincter relaxation [TLESR] and less commonly low resting LES pressure. [3] GER presents with regurgitation and occasional vomiting only without effects on growth and development whereas GERD usually has additional presentations. The objective of this review is to provide update on recent developments in the diagnosis and management of this condition

Menetrier's disease in a Saudi child

Menetrier's disease is a rare form of acquired gastropathy that presents mostly during adulthood, but is extremely rare in children. It is a clinicopathological diagnosis that typically presents with abdominal pain, vomiting, and edema secondary to hypoalbuminemia. Endoscopy usually shows giant gastric mucosal folds, and gastric biopsy shows foveolar hyperplasia and decreased oxyntic glands. Here, we describe a 5-year-old boy from Saudi Arabia with typical presentation of Menetrier's disease and serological evidence of acute cytomegalovirus infection

Isotope effects of neodymium in different ligands exchange systems studied by ion exchange displacement chromatography

The isotope effects of neodymium in Nd-glycolate ligand exchange system were studied by using ion exchange chromatography. The separation coefficients of neodymium isotopes, epsilon's, were calculated from the observed isotopic ratios at the front and rear boundaries of the neodymium adsorption band. The values of separation coefficients of neodymium isotopes, epsilon's, for the Nd-glycolate ligand exchange system were compared with those of Nd-malate and Nd-citrate, which indicated that the isotope effects of neodymium as studied by the three ligands takes the following direction Malate > Citrate > Glycolate. This order agrees with the number of available sites for complexation of each ligand. The values of the plate height, HETP of Nd in Nd-ligand exchange systems were also calculated

Thoracoscopic debridement and/or decortication for thoracic empyema: a comparative study with open decortication

To compare between thoracoscopic debridement and/or decortication versus open decortication in the management of thoracic empyema. This retrospective study was conducted out at King Hussein Medical Center, during the period of December 2006 and November 2011. Fifty-five patients with the diagnoses of stage two or three thoracic empyema were included in this study. The patients were divided in two groups. Group A included patients who underwent thoracoscopic debridement and/or decortication and group B included patients who underwent open decortication. Efficacy of the procedure, operative time, and postoperative blood loss, the need for ventilator support, postoperative complications, postoperative hospital stay and mortality were compared in both groups. Males constituted 61.8% [n=34] of the studied patients. Twenty-nine patients [52.7%]; underwent thoracoscopic debridement and /or decortication while 26 patients [47.3%] underwent open decortication. Mean age [range] was 36.55 +/- 16.47 [16-70] years for group A, and 37.70 +/- 14.28 [17-67] years for group B. There was no statistical significant difference between both groups regarding postoperative hospital stay [P=0.1012] and duration of air leak [P=0.1515]. Duration of the procedure was 209.29 +/- 20.93 minutes for group A patients, while it was 97.86 +/- 38.06 minutes for group B patients [P<0.001]. Three out of the 26 patients [11.5%] who underwent open decortication died in the postoperative period though the fatality was zero in group A patients. Thoracoscopic debridement and/or decortication should be considered as the first surgical option in the management of stage two and three thoracic empyema.

Regional variation in prevalence of overweight and obesity in Saudi children and adolescents

There are limited data on regional variation of overweight and obesity in the Kingdom of Saudi Arabia. Therefore, the aim of this report is to explore the magnitude of these variation in order to focus preventive programs to regional needs. Community-based multistage random sample of representative cohort from each region. the study sample was cross-sectional, representative of healthy children and adolescents from 2 to 17 years of age. Body mass index [BMI] was calculated according to the formula [weight/height[2]. The 2000 center for disease control reference was used for the calculation of prevalence of overweight and obesity defined as the proportion of children and adolescents whose BMI for age was above 85[th] and 95[th] percentiles respectively, for Northern, Southwestern and Central regions of the Kingdom. Chi-square test was used to assess the difference in prevalence between regions and a P value of <0.05 was considered significant. The sample size was 3525,3413 and 4174 from 2-17 years of age in the Central, Southwestern and Northern regions respectively. The overall prevalence of overweight was 21%, 13.4% and 20.1%, that of obesity was 9.3%, 6% and 9.1% in the Central, Southwestern and Northern regions respectively indicating a significantly-lower prevalence in the Southwestern compared to other regions [P<0.0001]. This report revealed significant regional variations important to consider in planning preventive and therapeutic programs tailored to the needs of each region

Sutureless large incision cataract extraction: indications and results from two teaching hospital eye departments in the United Kingdom

To highlight the role of Sutureless Large Incision Cataract Extraction [SLICE] in the United Kingdom for the treatment of cataracts at high risk for intra- or postoperative complications. Two University Hospitals in the United Kingdom. Retrospective case note review of planned SLICE performed over a 12-month period. SLICE was performed on 11 eyes of 11 patients [mean age, 79 years] having preoperative vision of hand motions [10 eyes] with very dense or mobile cataracts and high risk for phacoemulsification. Mean follow up was 12 weeks, with no operative or postoperative complications. Nine patients [without ocular or systemic comorbidity] achieved best corrected vision of 0.3 LogMAR [20/40] or better. SLICE is safe and effective for dense or mobile cataracts and can play a role in patients where conventional phacoemulsification carries higher risks of complications

Application of ventilator care bundle and its impact on ventilator associated pneumonia incidence rate in the adult intensive care unit

To reduce ventilator associated pneumonia [VAP] incidence rate, lessen the cost of care, and correlate VAP bundles compliance with VAP incidence rate. This study was a prospective longitudinal study conducted on adult intensive care unit [ICU] patients at Hera General Hospital, Makkah, Kingdom of Saudi Arabia from January to December 2010. The following Institute for Healthcare Improvement VAP prevention bundle was applied: head-of-bed elevation; daily "sedation-vacation" along with a readiness-to-wean assessment; peptic ulcer disease [PUD] prophylaxis; and deep venous thrombosis [DVT] prophylaxis. Among a total of 2747 patients, the bundle compliance rate in January 2010 was 30%, and reached to 100% in December 2010, while the overall rate was 78.9%. The individual bundle compliance rates were as follows: head-of-bed elevation - 99.9%; daily sedation vacation - 88.9%; PUD prophylaxis - 94.9%; and DVT prophylaxis - 85.7%. At the beginning, VAP rate was 2.5/1000 ventilator days, and reduced to 0.54 in the next month. The overall VAP incidence rate in 2010 was found to be 1.98 with a reduction of 1.41 by comparing with the same data of year 2009 collected retrospectively. The total reduction cost in one year was $154,930. A significant correlation was found between the VAP rate and its bundle compliance [p=0.001]. Most frequent pathogens found were Pseudomonas aeruginosa [30.8% of all isolates] followed by Acinetobacter baumannii [27.7%], and methicillin-resistant Staphylococcus aureus [15.4%]. Application of VAP prevention bundle reduced the VAP incidence rate and lowered the cost of care

Presenting features of childhood-onset inflammatory bowel disease in the central region of Saudi Arabia

To investigate the presenting features of childhood-onset inflammatory bowel disease [IBD] in the central region of Riyadh, Saudi Arabia and to compare with those reported in the literature. This is a retrospective review of medical records of children below 18 years of age at onset of symptoms with confirmed diagnosis of IBD for age, gender, family history, presenting clinical and laboratory findings in the Divisions of Pediatric and Adult Gastroenterology, King Khalid University Hospital [which provides free health care] and the Department of Gastroenterology Al Mofarreh Poly Clinic, Riyadh, Saudi Arabia, between January 1993 and December 2010. Two hundred and eighteen children diagnosed with IBD with predominance of males in Crohn's disease [CD] [56%] and females in ulcerative colitis [UC] [59%]. There was no significant difference between UC and CD regarding age of onset of symptoms [p=0.347]; however, the difference in the age at presentation and age at final diagnosis were significant [p=0.027 and p=0.008]. There was a significant increase of IBD diagnosis from the period 1993-2001 to 2002-2010 [p<0.0001]. The family history was positive in 15.3%. The presenting clinical features and laboratory abnormalities are similar to those reported in other populations. Further studies are needed to establish the incidence and prevalence

Prevalence of short stature in Saudi children and adolescents

Data on stature in Saudi children and adolescents are limited. The objective of this report was to establish the national prevalence of short stature in Saudi children and adolescents. Community-based, cross-sectional study conducted over 2 years [2004, 2005] The national data set of the Saudi reference was used to calculate the stature for age for children and adolescents 5 to 18 years of age. Using the 2007 World Health Organization [WHO] reference, the prevalence of moderate and severe short stature was defined as the proportion of children whose standard deviation score for stature for age was less than -2 and -3, respectively. In addition, the 2000 Center for Disease Control [CDC] and the older 1978 National Center for Health Statistics [NCHS]TWHO references were used for comparison. Using the 2007 WHO reference, sample size in the Saudi reference was 19372 healthy children and adolescents 5 to 1 7 years of age, with 50.8% being boys. The overall prevalence of moderate and severe short stature in boys was 11.3% and 1.8%, respectively; and in girls, 10.5% and 1.2%, respectively. The prevalence of moderate short stature was 12.1%, 11% and 11.3% in boys and 10.9%, 11.3% and 10.5% in girls when the 1978 WHO, the 2000 CDC and the 2007 WHO references were used, respectively. The national prevalence of short stature in Saudi children and adolescents is intermediate compared with the international level. Improvement in the socioeconomic and health status of children and adolescents should lead to a reduction in the prevalence of short stature