Orthopaedic Specialty Committee Exit Examination Amidst the COVID-19 Pandemic in Malaysia- Experiences and Reflections from the Candidates

@#Introduction: The emergence of the COVID-19 pandemic had affected the Orthopaedic Specialty Committee (OSC) Exit Examination candidates. The objective of this study was to evaluate the impact of this pandemic on the candidates’ teaching and learning, mental well-being, and personal experience during the examinations. Methods: A cross-sectional study was conducted from 1st to 31st January 2021. 103 candidates for the OSC Exit Examination November 2020 were asked to answer a questionnaire. Wilcoxon signed-rank tests were used to compare differences in the frequencies before and during the pandemic. A p-value of less than 0.05 was taken as significant. Results: There was a significant reduction in the number of classes (P-value < 0.001) and examination preparatory courses conducted, reduced number and variety of patients attended and limited exposure in the operation theatre. Most candidates had virtual and physical classes, and agreed virtual clinical teaching was less effective. A majority had increased caffeine intake and smoking habits, decreased time spent with family and sports activities and no impact on sleeping hours, alcohol and analgesic usage. During the examinations, most candidates felt disturbed by the COVID-19 safety protocol and worried about the risk of contracting the infections. Conclusion: The effect of this pandemic on the post-graduate Orthopaedics students teaching and learning is massive. Virtual teaching programmes or applications that can replace the traditional clinical teaching methods should be explored and developed for the benefit of our education system.

Office Exercise Training to Reduce and Prevent the Occurrence of Musculoskeletal Disorders among Office Workers: A Hypothesis

Pain in specific areas of the body (including the lower back, neck, and shoulders) due to extended periods of sitting and inactivity is the most widespread musculoskeletal disorder worldwide and has consequences that are both socio-economic and personal. This condition is particularly prevalent in industrialised countries, affecting roughly 70% to 80% of adults at some point in their lives; approximately 1% of the U.S. population is chronically disabled by this type of pain disorder. A practical way to reduce the prevalence of musculoskeletal pain among office workers would have a significant positive impact. More work is required to develop a package of exercises designed to prevent and treat musculoskeletal pain in office workers. Such a package would be preferable to pharmacological treatments, which can have undesirable side effects. The main objective of this package would be to increase the flexibility and strength of trunk muscles in order to decrease the soreness, pain, and degree of discomfort. In this article, we introduce our proposed package of exercises, which are based on guidelines issued bythe American College of Sports Medicine.

Psychiatric Manifestations in Orthopedic Patients on Celecoxib Therapy

Introduction: The Cyclooxygenase-2 (COX-2) enzyme is responsible for the synthesis of prostaglandin which is responsible for inflammation and pain. Celecoxib a cyclooxygenase-2 inhibitor was first used as a non-steroidal anti-inflammatory drug in 1999. Celecoxib is as effective as NSAIDs but causes less ulceration of the gastrointestinal tract, hence it is commonly used. It has been widely used in patients with osteoarthritis and rheumatoid arthritis. We present 3 cases of temporary psychiatric disorders associated with consumption of celecoxib,two of the patients presented with auditory hallucinations while one was diagnosed to be having depression. None had pre-existing psychiatric disorders or consumed alcohol or substance of abuse. All 3 patients recovered from their temporary psychiatric disorders after stopping celecoxib.Discussion: It is important to be aware of the psychiatric side effects when prescribing the drug for prolonged periods

Chronic nonhealing ulcer of the right thumb with multiple subcutaneous nodules.

A 60-year-old man presented with a 3-month history of nonhealing ulcer over the tip of his right thumb. The ulcer started as a blister over the tip of the thumb that later ruptured and spread proximally to cover the whole pulp area of the thumb. There was no history of trauma, fever, weight loss, or loss of appetite. He is a pensioner and an avid gardener. He has a few cats as pets. The patient initially presented to a private orthopedic surgeon with a nonhealing ulcer of the right thumb. Multiple debridements were unsuccessful in ameliorating the ulcer. Three months after the onset of the initial lesion, multiple painless erythematous nodules had developed on his right arm, and one on the right thigh. All routine blood investigations were nondiagnostic. Swab culture from the ulcer failed to grow any organism and a course of antibiotics did not resolve the problem. Cultures of the biopsy specimen using Sabouraud's dextrose agar and potato carrot medium grew dark brown plaques that microscopically appeared to be branching hyphae. A diagnosis of sporotrichosis of the right upper limb was made and the patient was started on antifungal treatment immediately (T. Itraconazole [Sporanox] 200 mg BD). One month after commencement of antifungal treatment, the ulcer began to dry up and at 3 months all the lesions including the one on the right thigh had healed.