Predictive Factors Associated With Fear Faced by Healthcare Workers During COVID-19 Pandemic: A Questionnaire-Based Study.

Background The coronavirus disease 2019 (COVID-19) since the beginning has been a reason of fear among healthcare workers (HCWs) due to the increased mortality, especially in the HCWs themselves. In this survey study, we aimed to explore the predictive factors associated with fear faced by HCWs during the COVID-19 pandemic and to identify the areas which need to be addressed to reduce it. Methods On May 14, 2020, we conducted an observational, cross-sectional survey using a self-administered questionnaire, consisting of the following two parts: (1) focused on factors associated with HCWs' fear of getting an infection and being a source of carrying the infection to whom they care, and (2) focused on factors associated with HCWs' fear of uncertainty and lack of support from concerned health authorities. Results The mean age of the participants was 40.04 ± 12.92 years with 79.3% being males. More than half (51.1%) of the participants were consultants. The most important factors associated with fear included getting infected (84.8%), quarantined (69.6%), not getting medical treatment (62%), losing a life (56.8%), and infecting family members (94.2%). Another major factor associated with HCWs' fear was lack of support from concerned health authorities, 80.2% thought of solatium, and 71.7% believed that the job should be given to eligible family members of the deceased. More than 82.2% were concerned about health expenses and around 97.6% felt an additional health risk allowance should be given. Conclusion Our results indicate that the risk of getting infection to themselves and their families, along with a lack of support from concerned health authorities, was strongly associated with fear among HCWs. We hope through these findings that the concerned health authorities will take notice and do something in this regard by developing appropriate policies and measures to make sure that HCWs and their families are cared for if they get infected.

Knowledge, Attitude, and Practices of Healthcare Workers Regarding the Use of Face Mask to Limit the Spread of the New Coronavirus Disease (COVID-19).

Introduction Many countries including Pakistan are currently using face masks in their pandemic control plans. Being highly prevalent, the correct use of these masks is particularly important, as an incorrect use and disposal may actually increase the rate of transmission. The purpose of this study was to investigate the knowledge, attitude, and practices of healthcare workers (HCWs) in wearing a surgical face mask to limit the spread of the new coronavirus disease 2019 (COVID-19). Materials and Methods This survey was conducted by interviewing HCWs using a questionnaire consisting of the basic demographic characteristics, and the knowledge, attitude, and practices regarding the use of surgical face mask to limit the new COVID-19 exposure. Each correct answer was scored 1 and each incorrect answer scored 0. The total number of questions was 16, and the final score was calculated and then labeled according to the percentage (out of 16) of correct responses as good (>80%), moderate (60-80%), and poor (<60%). Results A total of 392 participants with a mean age of 42.37 ± 13.34 years (341 males and 51 females) were included in the study. The overall final results were good in 138 (35.2%), moderate in 178 (45.4%), and poor in 76 (19.3%). Around 43.6% of participants knew about the correct method of wearing the masks, 68.9% knew that there are three layers, 53% stated that the middle layer act as a filter media barrier, and 75.5% knew the recommended maximum duration of wearing it. The majority (88.2%) of participants knew that a cloth face mask is not much effective, around 79.8% knew that used face mask cannot be re-used, and 44.8% knew about the yellow-coded bag for disposal. Conclusions Knowledge, attitude, and practice of HCWs regarding the use of face masks were found to be inadequate. Studied HCWs had a positive attitude but moderate-to-poor level of knowledge and practice regarding the use of face mask. HCWs and general public awareness campaigns regarding the proper use of face mask by utilizing all social media available resources would be helpful during this pandemic.

Impact of Ilizarov Fixation Technique on the Limb Functionality and Self-esteem of Patients with Unilateral Tibial Fractures.

Introduction Tibial fractures with nonunion are frequently managed with Ilizarov external fixation. Living with an external frame has some psychological impact which is readily neglected from the literature. We conducted a study to evaluate the status of limb functionality in patients managed with the Ilizarov external ring fixator technique and assess their self-esteem while living with the frame. Materials and methods This is a prospective observational study conducted in the Orthopedic Department of Dr. Ruth KM Phau Civil Hospital, Karachi, Pakistan, from June 2018 to June 2019. A total of 26 patients consecutively managed with Ilizarov external fixation for infected nonunion, with unilateral tibial fractures, were included. To assess the postoperative functionality status, lower extremity functional scale (LEFS) was used. To assess and evaluate the impact of the external frame application on the self-esteem of these patients, Rosenberg's self-esteem (RSE) scale was used. For each patient, LEFS and RSE scales were administered at the time of hospital discharge, after six months of frame application, and at the time of removal of the frame. Results The mean duration of hospital stay was 4.11 ± 1.23 weeks. The mean LEFS scores increased by 47% from hospital discharge until the time of frame removal. The differences were highly significant (p < 0.001). There was a 12% decline in the mean score of self-esteem from the time of discharge till the time of removal of the Ilizarov frame and these differences were highly significant (p < 0.001). Conclusion Ilizarov technique improves the limb functionality status significantly in participants with a unilateral tibial fracture. However, it also reduces their self-esteem during the period of frame application. Psychological support is recommended for participants living with an external fixation frame to protect their self-esteem.

Ilizarov External Fixation: Percutaneous Gigli Saw Versus Multiple Drill-hole Osteotomy Techniques for Distraction Osteogenesis.

Introduction Many different methods and variations have been employed to perform osteotomy for deformity correction, bone lengthening, and segmental bone transport. Currently, multiple drill-hole (MDH) and Gigli saw osteotomies are the two most preferred ones, being favoured over other techniques. Our objective is to compare the modified healing index (mHI) of these two commonly used procedures. Methodology This retrospective study was conducted at the department of Orthopedics, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan. The study population consisted of all skeletally mature patients who underwent tibial bone osteotomy for bone lengthening or bone transport using Ilizarov circular fixator from June 2016 to September 2018. We excluded patients with metabolic bone disease and patients who underwent osteotomy for deformity correction. Preoperative and operative patients' demographics and clinical data were gathered through a review of medical record and mHI was calculated to compare the effectiveness of osteotomy techniques. Results A total of 50 patients, 74% males and 26% females 26% with a mean age of 33.14 ± 12 years were included in the study. Of the 50 patients, 23 (27 osteotomies) had undergone MDH osteotomy (group I), whereas 27 patients (37 osteotomies) had a Gigli saw osteotomy (group II). The overall mHI of both groups was 1.60 ± 0.34 month/cm (range 1.0-2.5 month/cm). When we compared the mHI of both techniques, the mean mHI was 1.72 ± 0.33 month/cm (range 1.2 - 2.5 months/cm) in MDH group and 1.54 ± 0.36 month/cm (range 1.0-2.5 month/cm) in the Gigli saw group. The healing index was significantly lower in the Gigli saw group. None of our patients showed nonunion at the osteotomy site. However, the problems of incomplete osteotomy in two cases and bone fractures in four cases were seen in MDH osteotomy. Conclusion According to our results, percutaneous Gigli saw osteotomy technique by two small incisions minimizes the local soft tissue trauma and periosteal disruption around the osteotomy more than the multiple drill holes osteotomy, resulting in better consolidation following distraction osteogenesis.

Outcome of Percutaneous Release for Trigger Digits in Diabetic and Non-diabetic Patients.

Introduction Trigger finger (TF) is a common cause of hand pain, swelling, and limited motion. It is common in women and in the thumb. Diabetes mellitus (DM) increases the risk of TF. Individuals with DM who develop TF are resistant to both medical and surgical interventions. The aim of this study is to compare the outcomes of percutaneous trigger release in diabetic and nondiabetic patients. Methods Fifty diabetic and 50 non-diabetic patients with a clinical diagnosis of TF were included after informed consent. Percutaneous trigger release was performed in all of them. Follow-ups for pain and/or neurovascular complications were taken after one week, one month, and six months. Data were entered and analyzed using SPSS v. 22 (IBM Corp., Armonk, NY, US). Results In the diabetic group, 86% of patients had TF of grade III or above and in the non-diabetic group, 76% of patients had TF of grade III or above. At the one-week follow-up, 79.2% diabetic patients still had mild to severe pain and 60.4% non-diabetic patients had mild to severe pain. By one month, 40% patients in the diabetic group still reported mild to moderate pain, however, all patients in the non-diabetic group reported no pain. By six months, nine (20%) diabetic patients reported mild pain. There was no incidence of infection or neurovascular damage at any follow-up in the non-diabetic group, and in the diabetic group, 4.2% of patients had an infection on the one-week follow-up. Conclusion Percutaneous trigger finger release is a safe, reliable, time-saving, and cost-effective procedure for the management of trigger finger in both diabetic and non-diabetic patients.

Surgical Fixation of Atypical Femur Fractures in Bisphosphonate-treated Patients.

Objective To evaluate the outcomes of the surgical fixation of atypical femoral fractures in bisphosphonate-treated patients with an intramedullary device. Materials and methods This multicentric study was carried out at the department of orthopedics, Dr. Ruth Phau Civil Hospital and Medicare Hospital, Karachi, Pakistan, between 2013 and 2018. In this retrospective observational study, we reviewed 10 bisphosphonate-treated patients, fixed surgically with an intramedullary nail after presenting with radiologically characteristic atypical femur fractures identified according to the American Society for Bone and Mineral Research criteria. We excluded patients with fractures sustained by high-energy trauma, road traffic accidents, fall from a height, and those associated with underlying malignancy. Results A total of 11 atypical femoral fractures in 10 patients were included, all of whom were females with a mean age of 68.6 (range 57-82) years. Out of 11 fractures, 81.8% (n=9) were located in the subtrochanteric region and two were located in the femoral shaft. The mean bisphosphonate use was 58.3 months. All patients were treated with intramedullary devices; an intramedullary interlocking nail in two cases and proximal femoral nail antirotation in nine cases. The mean follow-up duration was 12 months. All fractures were united in an average time of 9.9 months (range 6 - 16 months). Implant failure and/or nonunion were not observed, whereas delayed union was noted in five patients. Conclusion Intramedullary fixation is a reliable method for the treatment of atypical femur fractures in bisphosphonate-treated patients owing to its intramedullary placement. These devices act as an internal splint and can provide much more axial stability, reducing the risk of implant fatigue failure due to a delay in fracture healing from prolonged bisphosphonate use.

Fixation of Metacarpal Fractures Using Intramedullary Headless Compression Screws: A Tertiary Care Institution Experience.

Introduction Metacarpal fractures account for the majority of hand fractures. Inadequate management can cause functional deficit which can lead to loss of fine hand movements. Adequate management has proven to give good outcomes. The use of intramedullary screws has given better results than the use of Kirschner wires (K-wires). Method This study was conducted at Dr. Ruth Phau Civil Hospital, Karachi (CHK) between August 1, 2018 and January 31, 2019. A total of 32 patients presented with metacarpal fractures. They were surgically managed with intramedullary headless screw fixation. Post-operatively, grip strength, range of motion, and presence of any disabilities were recorded. Patients were followed up to three months. Results Out of 32 patients, six were females. Mean age was found to be 29.1 ± 10.5 years. Post-operatively the mean grip strength was found to be 37.8 ± 7.3 kilograms. The mean total active range of motion was found to be 242.8 ±14.5 degrees. The mean days to return back to work were 25 ± 5.4 days. The mean patient satisfaction score was 8.1 ± 0.79. Three patients developed post-operative stiffness of the joint. Conclusion Patients with intramedullary screw fixation have good post-operative results with early return to work.

Burnout Among Orthopedic Surgeons and Residents in Pakistan.

Objective Burnout is exceptionally pervasive among medical professionals, especially surgeons, and is considered the main indicator of surgeons' fulfillment with career choice. Our objectives are to discover the extent of orthopedic specialist burnout in Pakistan and to explore the clinical impact of burnout. The efficacy of surgeons may be enhanced by implementing burnout prevention and treatment plans. Data collection This observational study was conducted from April 2018 to May 2018 in various tertiary care hospitals in Pakistan and includes post-graduate trainees and consultants. Those who agreed to be part of this study were asked to complete a self-structured questionnaire about demographics and burnout. The questionnaire had 28 questions based on a standard questionnaire from the American Public Welfare Association. Results In our study, 15% (n=15) of respondents had advance burnout, 22% (n=22) had early burnout, and 43% (n=49) had a fair chance of burnout. All 15 participants suffering from advance burnout were consultants. Of participants suffering from early burnout, 36.3% (n=8) were consultants, and 63.7% (n=14) were post-graduate trainees. Conclusion Compared to other countries, the burnout rate is higher among Pakistani orthopedic surgeons. Special care and attention should be paid towards the stress and workload of surgeons.

Post-football Gonathrosis: Injuries and Surgeries are A Risk.

Football is one of the most popular sports in the world. Many studies have shown there is a high incidence of gonarthrosis in football players. The reason for this increase is said to be injuries to the meniscus, the anterior cruciate ligament (ACL) and the resulting surgeries. The incidence is significantly increased in players with knee injuries. The knee is also the most commonly injured site in football and the most common cause of surgery in football players. Together these injuries, particularly of the ACL or meniscus and the resulting surgeries, increase the risk of developing gonarthrosis in post-football years.

Pattern of Infecting Microorganisms and Their Susceptibility to Antimicrobial Drugs in Patients with Diabetic Foot Infections in a Tertiary Care Hospital in Karachi, Pakistan.

Diabetes mellitus is a universal health problem, with its prevalence in Pakistan making it among the top 10 countries in the world. Approximately 13.9 million people in Pakistan will have developed diabetes by 2030. Diabetic foot ulcer (DFU) is one of the more serious complications of diabetes. If not treated properly, patients may develop diabetic foot osteomyelitis leading to gangrene and amputation. These infections are usually polymicrobial, with Staphylococcus aureus (S. aureus), Proteus, Pseudomonas, and Escherichia coli (E. coli) being among the more common organisms isolated from DFU. This survey of patients with DFU in a tertiary hospital in Karachi, Pakistan found 68.5% of patients had peripheral neuropathy, 57% had chronic osteomyelitis, and 37% and 49% had Wagner grades 2 and 3, respectively. Infections were polymicrobial in 83% of patients, E. coli was isolated from 63%, and S. aureus from 58%. Of the isolated organisms, 95% were sensitive to meropenem and 81% to linezolid.

Sleep Abnormalities Among Patients With and Without Diabetes Using Pittsburg Sleep Quality Index and Epworth Sleepiness Scale.

Introduction Diabetes has a great influence on sleep patterns. Several hormonal mechanisms are disrupted in patients with diabetes and, hence, affect their sleep patterns. Sleep disturbances further worsen the state of the disease itself. Method In this cross-sectional study, we collected data from 50 healthy adults and 50 patients diagnosed with type 2 diabetes mellitus without comorbidities. Study participants were asked to complete the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) surveys. Results The mean PSQI score was 8.64 ± 3.96 for patients with type 2 diabetes and 4.24 ± 2.72 for patients without diabetes. The mean Epworth Sleepiness score was 6.3 ± 5.29 among patients with diabetes and 1.94 ± 2.34 for patients without diabetes. Conclusion The early diagnosis and management of sleep problems can help maintain target blood glucose levels and may help impede the future development of complications.