The association between physical activity and burnout among anaesthesia postgraduate trainees in Malaysia.

INTRODUCTION: Burnout is a psychological problem which is becoming more prevalent among medical professionals resulting in various negative outcomes. Physical activity has been found to be an effective method in alleviating burnout. The aim of this study was to determine the association between physical activity and burnout among postgraduate anaesthesia trainees in Malaysia. The study also intended to determine the level of physical activity among trainees, the factors affecting this practice, and the prevalence of burnout among anaesthesia trainees. MATERIALS AND METHODS: An online self-administered questionnaire was sent out to all postgraduate anaesthesia trainees between August 2020 and January 2021 via email and respondents were recruited on a voluntary basis. RESULTS: The prevalence of burnout among postgraduate anaesthesia trainees was high (54%). This prevalence was higher among trainees with low a level of physical activity. Half of the trainees (50.8%) engaged in moderate physical activity while only 12% reported a high level of physical activity. The postgraduate study year was found to be a significant factor affecting the practice of physical activity. CONCLUSION: There is a significant association between physical activity and burnout among postgraduate anaesthesia trainees in Malaysia. Physical activity has the potential to be an essential method of reducing burnout. Hence, measures should be implemented to improve the practice of physical activity among healthcare professionals in order to reduce workplace burnout.

International survey on growth indices and impacting factors in children with food allergies.

BACKGROUND: Elimination diets required for the management of food allergies increase the risk for poor growth in children. Currently, no worldwide data exist on this topic and limited published data exist on the impact of atopic comorbidity, type of allergy and foods eliminated on growth. We therefore set out to perform a worldwide survey on growth and impacting factors in food allergic children. METHODS: A prospective growth survey was performed of children (aged 0-16 years) on an elimination diet with confirmed immunoglobulin (Ig)E and non-IgE mediated food allergies. Data collected included: weight-for-age, weight-for-height, height-for-age, head circumference, body mass index, type of food allergy and eliminated foods, allergic comorbidities and replacement milk/breast milk. Multivariable regression analysis was used to establish factors that affected growth. RESULTS: Data from 430 patients from twelve allergy centres were analysed: median age at diagnosis and data collection was 8 months and 23 months, respectively. Pooled data indicated that 6% were underweight, 9% were stunted, 5% were undernourished and 8% were overweight. Cow's milk elimination lead to a lower weight-for-height Z-scores than other food eliminations and mixed IgE and non-IgE mediated allergy had lower height-for-age Z-scores than IgE mediated allergy. Children with only non-IgE mediated allergies had lower weight-for-height and body mass index. Atopic comorbidities did not impact on growth. CONCLUSIONS: Stunting is more common in children with food allergies than low weight. Children particularly at risk of poor growth are those with non-IgE and mixed IgE and non-IgE mediated allergies, as well as those with cow's milk allergy.

Distally pedicled peroneus brevis muscle flap: a versatile lower leg and foot flap.

INTRODUCTION: The purpose of this study was to evaluate the outcome of our early experience with the distally pedicled peroneus brevis flap in the management of soft tissue defects of the lower leg, ankle and foot. METHODS: This was a non-randomised, retrospective study involving five patients who were treated with the peroneus brevis muscle flap for soft tissue defects over the lower leg. RESULTS: In all five patients, the flaps were viable and successful in providing satisfactory soft tissue coverage for the defects. In one diabetic patient, distal flap necrosis was observed, which was treated successfully with a local rotational skin flap. CONCLUSION: The distally pedicled peroneus brevis muscle flap is an economical, reliable and relatively easy procedure for treating defects of the distal third of the leg, ankle and foot.

Factors affecting the palpability of breast lesion by self-examination.

INTRODUCTION: This study aims to assess the accuracy of detection of breast lesion by breast self-examination and to assess different factors affecting the accuracy. METHODS: All consecutive Chinese female patients, who attended our breast imaging unit in 2001, completed our questionnaire, had retrievable hard copy films, and had more than three years clinical follow-up, were recruited for this study. Different factors, such as age, menopausal status, previous experience of breastfeeding, family history of breast cancer, previous history of mastectomy or lumpectomy, hormonal therapy, oral contraceptive pills and previous history of mammography, were correlated with accuracy in self-detection of breast lesions retrospectively. The nature, size and location of the lesion, and breast size based on imaging, were also correlated with the accuracy in self-detection of breast lesions. RESULTS: A total of 163 questionnaires were analysed. 111 patients detected a breast lesion themselves and 24 of these lesions were false-positives. A total of 173 lesions (27 cancerous, 146 benign lesions) were documented by either ultrasonography and/or mammography, and confirmed by either histology or three-year clinical follow-up. The overall sensitivity in detecting both benign and malignant breast lesions was 71% when number of breast lesions was used as the denominator, and up to 78% sensitivity was achieved when number of patients was used as the denominator. History of mastectomy, and size and nature of the lesions were found to affect the accuracy of self-detection of breast lesions. CONCLUSION: Overall, breast self-examinations were effective in the detection of breast lesions and factors such as size of lesion, nature of the lesion and history of mastectomy affect the accuracy of the detections. Breast self-examination should be promoted for early detection of breast cancer.

Stress fracture of the distal tibia secondary to severe knee osteoarthritis: a case report.

Stress fracture of the tibia secondary to sports-related activities is relatively common, but rarely occurs secondary to osteoarthritis of the knee. Such fractures usually involve the proximal tibia. We report a 61-year-old woman with osteoarthritis and severe varus deformity of the knee who had a stress fracture of the distal tibial shaft. The patient had declined total knee replacement for severe osteoarthritis. She developed a stress fracture that subsequently malunited. The patient presented late and the diagnosis was not made for several months. The pathomechanics, diagnosis, and management options for this patient are discussed.

The use of computer navigation in performing minimally invasive surgery for intertrochanteric hip fractures--The experience in Singapore.

OBJECTIVE: Intertrochanteric hip fractures are very common and early mobilisation correlates with a better outcome. The ideal surgical procedure should protect the soft tissue envelope, thereby preserving blood supply and reducing blood loss. Furthermore, occupational exposure to fluoroscopy that is used in hip fracture fixation remains a concern amongst orthopaedic surgeons. Computer-aided surgery can help to reduce reliance on fluoroscopy. We therefore combined the principles of minimally invasive plate osteosynthesis (MIPO) and computer navigation to describe a new procedure. We also present our results using this technique of minimally invasive computer-navigated dynamic hip screw fixation (navMIS-DHS), and compare it to computer-navigated open DHS fixation (nav-DHS) and to conventional open DHS fixation (conv-DHS). MATERIALS AND METHODS: This paper has three parts. In the first part, we describe the procedure of navMIS-DHS in detail. In the second part, we present our initial retrospective pilot series of 35 cases. Amongst them we performed 5 navMIS-DHS, 3 nav-DHS and 27 conv-DHS. There were also two cases of conv-DHS deliberately performed with a mini-incision in an attempt to see if we could duplicate the 5 cm incision that we achieved with navMIS-DHS. All patients were followed up for a minimum of 6 months. In the third part, we performed a single surgeon prospective evaluation of navMIS-DHS versus conv-DHS involving 43 fractures in two arms. RESULTS: We were able to achieve reduction in fluoroscopy time. There was also reduction in opiate requirement post-operatively in the minimally invasive procedure. The incision sizes were also smaller. The prospective study also showed less wound-related complications in navMIS-DHS and a shorter time to ambulation. Implant positions were acceptable but we have also described how it may be improved. CONCLUSIONS: Navigated MIS-DHS, by virtue of less pain, better healing, earlier rehabilitation and potentially shorter hospital stay, would benefit both the patients and reduce the economic strain on the health care system. It is a safe and reproducible procedure. Technical difficulties are present and these need to be addressed with further modifications of technique, and instrumentation.

Piriformis pyomyositis: a rare cause of sciatica.

A 30-year-old Thai woman with piriformis pyomyositis presented with sciatica. Computed tomography showed swelling and enhancement of the right gluteus medius and piriformis muscles. She made a complete recovery after a course of intravenous antibiotics. This condition has only been reported three other times and is often diagnosed with difficulty. It could be erroneously dismissed as a lumbar disc prolapse. If untreated, it could lead to prolonged hospital stay and death. A high index of suspicion, early diagnosis and appropriate antibiotic or surgical treatment leads to full recovery.

Management of intraparotid facial nerve schwannomas.

BACKGROUND: The purpose of the present paper was to review the management of intraparotid facial nerve schwannoma so as to discuss its clinical presentation, evaluate the various possible diagnostic investigations, and compare the various surgical options and outcome. METHODS: Case series was undertaken of five (1.3%) patients with facial nerve schwannoma out of 400 consecutive parotidectomies at Singapore General Hospital. RESULTS: There were three men and two women with an age range of 29-65 years. Three patients presented with painless parotid lumps while two had painful parotid swellings. None had facial nerve paresis. Only one patient had preoperative diagnosis suspicious of schwannoma by fine-needle aspiration cytology (FNAC). Diagnoses were made intraoperatively. Four patients had excision with cable grafting of the nerve defect. achieving facial nerve grade II-IV (House-Brackmann scale). One patient who underwent enucleation of tumour with nerve preservation achieved grade II. CONCLUSIONS: Preoperative diagnosis is difficult but it is important for discussion of the extent and options of surgery. Fine-needle aspiration cytology holds promise in making a preoperative diagnosis. Enucleation with nerve preservation where possible seems to offer better facial function whereas nerve excision with cable graft can give satisfactory results.

Clinics in diagnostic imaging (38). Post-ESWL perinephric haematoma.

A 57-year-old man presented with urosepsis related to urinary calculi. He underwent multiple sessions of ESWL and developed a perinephric haematoma that was treated conservatively and monitored by serial imaging. However, the haematoma became infected, necessitating percutaneous drainage 2 months after the initial ESWL. The risk factors and sequelae of post-ESWL perinephric haematoma, as well as its diagnosis and imaging, are discussed.

The involvement of phosphohydrolases in mineralization: studies on enzymatic activities extracted from red deer antler.

The process of growth of red deer antler "bone" is very similar to the endochondral growth of long bones. The growth zones of the antler are temporally organized from the tip, in a proximal direction, permitting sequential aspects of antler development to be followed in serial transverse sections from the tip to the base. The activities of alkaline phosphatase (ALKPase, phosphodiesterase I, nucleoside triphosphate pyrophosphohydrolase, and 5'-nucleotidase were measured in extracts of antler mineralizing tissue at different distances from the tip, and compared with mineralization, which peaked at ca. 60 mm. The activities of ALKPase and phosphodiesterase I were maximal at ca. 30 and 60 mm, respectively, suggesting that these enzymes are involved in different phases of mineralization. The patterns of distribution were similar to those determined from equivalent quantitative histochemical analyses, confirming the validity of both methods of assessment. The distribution of nucleoside triphosphate pyrophosphohydrolase also suggested that this enzyme is involved in mineralization, but the pattern of distribution was not as reproducible as for the other enzymes. 5'-Nucleotidase activity was distributed differently than the others and showed relatively constant levels at all distances. The results suggest that each of the four phosphohydrolases may have a different role in the process of mineralization. A tentative model suggesting functions for these phosphohydrolases and ATPases is presented and discussed.