Mental health assessment of healthcare workers in the emergency department of a low middle-income country during COVID-19 pandemic.

INTRODUCTION: Emergency department (ED) healthcare workers in Pakistan during the COVID-19 pandemic are facing an acute rise in mental illnesses. In this study, the authors aim to assess the frequency of anxiety and depression among healthcare workers in the ED. METHODS: A cross-sectional online google form-based survey was conducted in the ED of Aga Khan University Hospital, Karachi, Pakistan between July and August 2020. The Hospital Anxiety and Depression (HAD) scale was used for mental illness assessment among ED healthcare workers. Descriptive analysis of grading as per the Likert scale is done through frequencies, means, and standard deviations. Categorical variables were expressed as frequency (%). Mann-Whitney U test was used to compare scores of various groups and sub-groups and the Chi-square test was used to assess the association of depression and anxiety categories among the groups. RESULTS: In the ED, 127 healthcare workers (physicians and nurses) were included in this survey. The median depression score was 8 (IQR 6-10) with 21% (27) falling under depression and 39% (50) under borderline depression. The median anxiety score was 9 (IQR 7-12) with 33% (42) having abnormal, and 38% (48) having borderline anxiety. Healthcare workers working for > 45 h per week have odds of 3.62 [1.374-9.549] of developing depression compared to anxiety with a p-value of 0.009. Similarly, nurses and medical officers develop depression with odds of 2.18 [1.016-4.686] p-value 0.045 and 5.18 [0.197-1.02] p-value 0.002, respectively. CONCLUSION: ED healthcare workers during the COVID-19 pandemic suffered high levels of anxiety and depression, which is a matter of concern. Comprehensive support and training of ED healthcare workers are needed to promote physical and mental well-being and to develop guidelines that should be used during situations that can affect the mental health of healthcare workers.

Does the eversion technique have a lower early postoperative stroke rate than the conventional technique in carotid endarterectomy?

A best evidence topic has been constructed using a described protocol. The three-part question addressed was: In carotid surgery, Does the eversion technique (ECEA) has an early postoperative lower stroke rate, As compared to conventional carotid endarterectomy (CCEA)? The outcome assessed was the stroke rate in the early potoperative period (30 days) in the two techniques. The best evidence confirmed that there is no statistically significant difference between ECEA and CCEA regarding the early postoperative stroke incidence.

Does small bite closure reduce the incidence of incisional hernia compared to standard mass closure for midline laparotomy?

A best evidence topic was constructed using a defined protocol. The three-part question addressed was: in closure of midline laparotomy, which technique had lower incidence of incisional hernia: small bite closure or mass closure? The best evidence demonstrated that small bite technique has lower incidence of hernia.

Stroke incidence between stenting and endarterectomy for asymptomatic carotid artery stenosis.

A best evidence topic has been constructed using a described protocol. The three-part question addressed was: In patients with significant asymptomatic carotid artery stenosis (ACAS), Does Carotid artery stenting (CAS) has a peri-procedural lower Stroke rate, As compared to Carotid endarterectomy (CEA)? The outcomes assessed were the stroke rate in the two management modalities. The best evidence showed no statistically significant difference between CAS and CEA regarding the peri-procedural and the long-term non-procedural stroke incidence. However, in high-risk patients, CAS may be a better option.

The survival rate among endovascular and open surgical repair of abdominal aortic aneurysms.

A best evidence topic has been constructed using a described protocol. The three-part question addressed was: In patients with Infrarenal abdominal aortic aneurysm (AAA), Does endovascular abdominal aortic repair (EVAR), AS compared to open surgical repair (OSR), has higher Survival rates? The outcomes assessed were the overall survival rates in both techniques. The best evidence showed that there is no statistically significant difference between EVAR and OSR in survival rates.

Incidence of secondary rupture after abdominal aortic aneurysms (endovascular vs. open surgical repair).

A best evidence topic has been constructed using a described protocol. The three-part question addressed was: In patients with Infrarenal abdominal aortic aneurysm (AAA), Does endovascular abdominal aortic repair (EVAR), AS compared to open surgical repair (OSR), has lower secondary rupture rates? The outcomes assessed were the secondary rupture rate in both techniques. The best evidence showed that The OSR has statistically significant lower secondary rupture rates than the EVAR.

Re-intervention rate in endovascular vs open surgical repair for abdominal aortic aneurysms.

A best evidence topic has been constructed using a described protocol. The three-part question addressed was: In patients with Infrarenal abdominal aortic aneurysm (AAA), Does endovascular abdominal aortic repair (EVAR), AS compared to open surgical repair (OSR), has lower re-intervention rates? The outcomes assessed were the re-interventional rates in both techniques. The best evidence showed that the OSR has lower statistically significant difference rates in re-intervention rates than the EVAR.

Incidence of anal incontinence among patients with anal fissure treated with Botox injection versus lateral sphincterotomy.

A best evidence topic has been constructed using a described protocol. The three-part question addressed was: In patients with anal fissure, which technique has a lower of incidence anal incontinence: Botox injection or lateral sphincterotomy? The best evidence showed that Botox injection has lower incidence of incontinence.

Infraclavicular arterio-arterial prosthetic loop is a safe and effective vascular access technique for haemodialysis in frail patients: a prospective observational study.

Vascular access failure causes significant morbidity among end stage renal failure patients. With the increased life expectancy and frailty of those patients, maintaining vascular access became a great challenge. In this study, we assess the short and midterm outcomes of infraclavicular arterio-arterial prosthetic loop (IAAPL) as vascular access for haemodialysis in frail patients who have exhausted conventional vascular access methods. A prospective observational study of 43 patients undergoing IAAPL was conducted in a single centre between May 2017 and March 2020. Primary, assisted primary and secondary patency rates were recorded in addition to complications and patient compliance with access. The achieved primary, assisted primary and secondary patency rates at 6 months are 87.5%, 95%, 97.5% respectively, at one year, corresponding rates were 75%, 83.3%, 94.4% and at 18 months they were 68.6%, 77.1%, 85.7% respectively. There was no procedure related mortality and life-threatening complications during the study period. So we can assume that infraclavicular AAPL is a safe and effective method of obtaining alternative vascular access for hemodialysis in frail patients for whom the conventional vascular access for hemodialysis is not suitable or contraindicated.

Effects of longitudinal pavement edgeline condition on driver lane deviation.

Single vehicle crashes, particularly those classified as run-off-the-road, are very common on two-lane rural highways. One method to potentially reduce such crashes is to provide additional driver information in the form of wider longitudinal edgeline pavement markings. However, since these markings deteriorate over time, the primary objective of this research was to study the effects of longitudinal edgeline pavement markings with varying deterioration levels and widths and to assess a driver's ability to maintain lane position. The University of Idaho's driving simulator was used to examine these effects by incorporating different marking deterioration percentages and roadway geometries on a two-lane rural highway environment. Two different pavement marking widths (4 and 6 inch) and four different deterioration levels (0%, 25%, 50%, and 75%) were assessed in daytime and nighttime conditions as part of this study. The results determined that while wider 6-in longitudinal edgeline pavement markings compared with standard four inch edgeline markings did not cause any significant changes in driver lane deviation during the day, statistically significant differences were observed in nighttime driving conditions. Drivers consistently maintained a lane position that slightly favored the edgeline side throughout the study and increasingly shifted away from the centerline as edgeline deterioration worsened.

Knowledge, attitude and perceptions of Muslim cancer patients regarding cancer treatment during Ramadan: Results from a tertiary care hospital Karachi.

OBJECTIVE: To assess the knowledge and attitude of Muslim cancer patients regarding cancer treatment during Ramadan. METHODS: This cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, from July to August 2015, and comprised cancer patients. .Adult Muslim cancer patients receiving active oncological treatment or on surveillance were included. Patients on only supportive treatment were excluded. SPSS 19 was used for data analysis. RESULTS: Of the 265 patients, 87(32.8%) were males and 178(67.2%) were females. The overall mean age was 49±13.87 years. Besides, 184(70.9%) patients belonged to the middle class. Breast cancer was the most common cancer 106(40.6%). Overall, 153(57.9%) patients had stage II disease. Further, 201(80%) patients had 0-1 performance status. Moreover, 180(72%) patients were receiving different forms of chemotherapeutic agents. It was found that 113(54.3%) patients sought advice regarding fasting. Most of the patients who observed fast, i.e. 214(81%), had an early stage disease and 19(7.1%) were on hormonal therapy. Patients who did not fast mostly attributed this to fatigue 69(26.3%). Conclusion: Only half of the patients sought advice on fasting and those having early disease more. CONCLUSIONS: Only half of the patients sought advice on fasting and those having early disease more frequently observed fast.

Cystic Adenomatoid Odontogenic Tumor.

Adenomatoid Odontogenic Tumor (AOT) is a well-established benign epithelial lesion of odontogenic origin. Rightfully called "the master of disguise," this lesion has been known for its varied clinical and histoarchitectural patterns. Not only does AOT predominantly present radiologically as a unilocular cystic lesion enclosing the unerupted tooth (which is commonly mistaken as a dentigerous cyst) but the lesion also presents rarely with a cystic component histopathologically. We present one such unusual case of cystic AOT associated with an impacted canine, mimicking a dentigerous cyst. The present case aims to highlight the difference between cystic AOT and dentigerous cyst radiographically. The exact histogenesis of AOT and its variants still remains obscure. An attempt has been made to hypothesize the new school of thought regarding the origin of AOT.

Potential crash reduction benefits of shoulder rumble strips in two-lane rural highways.

This paper reports the findings from a study aimed at examining the effectiveness of shoulder rumble strips in reducing run-off-the-road (ROR) crashes on two-lane rural highways using the empirical Bayes (EB) before-and-after analysis method. Specifically, the study analyzed the effects of traffic volume, roadway geometry and paved right shoulder width on the effectiveness of shoulder rumble strips. The results of this study demonstrate the safety benefits of shoulder rumble strips in reducing the ROR crashes on two-lane rural highways using the state of Idaho 2001-2009 crash data. This study revealed a 14% reduction in all ROR crashes after the installation of shoulder rumble strips on 178.63miles of two-lane rural highways in Idaho. The results indicate that shoulder rumble strips were most effective on roads with relatively moderate curvature and right paved shoulder width of 3 feet and more.

Long-term outcome of transobturator suburethral tape procedure for treatment of female stress urinary incontinence.

OBJECTIVE: The aim is to evaluate the long-term safety and efficacy of transobturator tape (TOT) procedure in the treatment of women with stress urinary incontinence (SUI) by subjective and objective measures. PATIENTS AND METHODS: A total 48 women with SUI underwent the TOT procedure during the period from December 2005 to February 2008. The follow-up period ranged between 60 and 84 months (mean 71 months). Mean age was 44.21 ± 7.52 (range: 30-58). Preoperative and early postoperative data were retrieved from the patient's medical files. Follow-up evaluation was carried out every 3 months during the 1(st) year and yearly afterwards by history taking (including incontinence and quality-of-life questionnaire), clinical examination, urine analysis, abdominopelvic ultrasonography, and urodynamic studies when indicated. RESULTS: At 12-month follow-up, the cure, improvement, and failure rates were 39 patients (81.25%), 5 (10.42%) and 4 (8.33%), respectively. The corresponding rates at the last follow-up were 38 (79.15%), 5 (10.42%) and 5 (10.42%) respectively. The postvoid residual urine and peak flow rates did not differ significantly between the preoperative values and at the last follow-up. The complication rates after a mean 71-month included one patient with voiding difficulty and two patients with de novo urgency. No case was recorded with retention of urine or erosion. CONCLUSIONS: Transobturator tape procedure appeared to be effective minimally invasive procedure for SUI with low rate of complication and good long-term outcome.

Role of immunoglobulin E and gastro-esophageal reflux disease in the development of otitis media with effusion.

INTRODUCTION: The role of allergy in chronic otitis media with effusion (OME) is controversial. AIM OF THE WORK: To study the role of allergy and gastroesphogeal reflux diseases in the etiology of OME. MATERIALS AND METHODS: It is a prospective study that was done on 43 cases; 30 patients suffer from OME with mean age 6.8 years and 13 control child with mean age 8.3 years. Blood sample were taken from patients and control children for assay of total Immunoglobulin E (IgE) and serum pepsinogen 1 (PG1). Effusion fluid samples were taken from middle ear of the patients during myringotomy and ventilation tube insertion; IgE and PG1 were assayed in the effusion samples. Total IgE and PG1 were assayed by enzyme-linked immunosorbent assay. RESULTS: Our results showed that, there is a correlation between serum IgE and Effusion IgE in the patients group, there is a significant negative correlation between PG1 in the effusion and serum of the studied patients. CONCLUSION: Allergy is a possible risk factor for the development of OME. The level of PG1in the effusion is one tenth of its level in the serum of the patients.

An atypical presentation of Pindborg tumor in anterior maxilla.

Pindborg tumor, the eponymous counterpart of calcifying epithelial odontogenic tumor (CEOT), is a rare benign odontogenic neoplasm that was first described by a Dutch pathologist Jens Jorgen Pindborg in 1955 and accounts for approximately 1% of all odontogenic tumors. Its origin as well as its malignant potential is controversial. This neoplasm is possibly of stratum intermedium origin and occurring predominantly in the mandible of adults. We hereby report a case of Pindborg tumor arising in the premaxilla which is seldom (9 out of 200 cases) documented in the scientific literature.

One month outcome of ocular related emergencies in a tertiary hospital in Central Saudi Arabia.

OBJECTIVE: To investigate the number and characteristics of patients attending the Accident/Emergency (A/E) Department of a tertiary care hospital in Riyadh, and to determine their route of referral, and pattern of ocular emergency cases. METHODS: A retrospective study was carried out using the records and history of all patients attending the A/E at King Abdulaziz University Hospital (KAUH) in Riyadh, Kingdom of Saudi Arabia in July 2010. Data collected included time of arrival, age, gender, source of referral, principal diagnosis, attending doctor, action taken, and discharge plan. RESULTS: A total of 1,412 patients were recruited in our study with an average daily attendance of 47 patients. A total of 863 (61%) patients were male, and their mean age was 28.2 years. The most frequent diagnosis in patients was trauma (382, 27%), followed by conjunctivitis (211, 14.9%), lids and lacrimal system (133, 9.4%), retina problems (51, 3.6%), glaucoma (30, 2.1%), neuro-ophthalmology (22, 1.6%), keratitis (20, 1.4%), uveitis (10, 0.7%), and episcleritis (5, 0.35%). Most cases (77.5%) seen were self-referrals. Additionally, 712 (50.4%) of cases were considered as non-emergency, which are visiting the A/E for dry eye, chalazion, blepharitis, and allergy. CONCLUSION: Most cases seen at our ophthalmic A/E had non-urgent conditions that could be managed satisfactorily by trained ophthalmic assistants under supervision of an ophthalmologist.

Regional odontodysplasia: An unusual case report.

Regional odontodysplasia is an uncommon developmental anomaly affecting a localized area of dentition, with distinctive clinical, radiographic, and histological findings. This article reviews a case of a 14-year-old female who reported with unerupted maxillary anterior teeth. This case was rare in that it involved maxillary dentition with unerupted maxillary anterior teeth on the right side, but the left central incisor was missing. The molars on the right side were showing some amount of abnormality. Radiographically, the affected teeth had a 'ghostly' appearance, showing a marked reduction in radiodensity. Both enamel and dentin appeared to be very thin, the pulp chamber was exceedingly large, and the roots were short with wide open apices. All the characteristics were consistent with the diagnosis of regional odontodysplasia. The care and treatment of this patient required a multidisciplinary approach. The unerupted maxillary anterior teeth were surgically removed, following which temporary prosthetic restoration was provided to improve esthetics and to restore the function.