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BACKGROUND This study aims to evaluate the awareness of osteoporosis and related risk factors in elderly Asian patients who present with distal radius fractures. The distal radius fracture is one of the most frequent fractures in the elderly cohort, owing to osteoporosis, and maybe a harbinger for further fractures, however, data is scarce regarding awareness of this condition among these patients. METHOD This cross-sectional study was conducted on patients aged 45 and above that presented in the emergency department with low-energy distal radial fractures in Karachi from January-December 2018. Data were collected via a self-designed questionnaire, assessing the demographic information, knowledge about osteoporosis and its risk factors. The data was analysed using SPSS 20 for statistical significance. RESULTS From a total of 550 patients with a mean age of 70.5 ± 32.82 years, there were 442 (80.36%) females and 108 (19.63%) males. On educational consideration, 243 (44.18%) patients could not read or write and only 110 (20%) of the patients received secondary school education. Only 123 (22.36%) were well informed about osteoporosis, the predominant source of information being their physician. There were 427 (77.63%) patients who were unaware of osteoporosis, 16% of which were smokers, 26% indicated they exercised at least 30 minutes daily, and 2% reported drinking alcohol occasionally. On dietary supplements, 24.27% of patients reported calcium and 17.81% reported vitamin D supplement consumption on regular basis. CONCLUSION We found a positive correlation between a patient's education status and osteoporosis awareness We believe that the role of the physician could be crucial in preventing further fractures in such patients via physician lead educational campaigns to target modifiable risk factors.

Background:Vitamin D deficiency is associated with an increased risk of falls and hip fractures in older adults. Risk factors are suboptimal sunlight exposure and the lower cutaneous synthesis of vitamin D, reduced dietary intake of D2 (ergocalciferol) and D3 (cholecalciferol), impaired intestinal absorption, and impaired hydroxylation in the liver and kidneys. The present study's objective was to determine the frequency of vitamin D levels in females with hip fractures presenting to a tertiary care facility in Karachi, Pakistan. Methodology:A cross-sectional study was conducted at the Orthopaedic Surgery Department of Jinnah Postgraduate Medical Center, Karachi, from 17thMay to 16thNovember 2016. A total of 123 females with Hip fracture of ≤ 4 weeks were included in this study. Patient's age, occupation, education level, and comorbidities like diabetes mellitus (DM), hypertension (HTN), and Vitamin D levels were observed. The patient was labeled with vitamin D sufficiency, insufficiency, and deficiency on the basis of Vitamin D levels. Stratification was done, and the post-stratification Chi-square test was applied. Results:The mean age of study participant was 60.32 ± 9.14 years and the mean duration of fracture was 12.27 ± 5.84 days, Body Mass Index (BMI) was 24.57 ± 2.77 kg/m2, vitamin D level was 18.28 ± 8.10 ng/ml. Only 8.9% were found with sufficient vitamin D levels. Insufficiency was found in 28.5% of patients. Vitamin D deficiency was found in 62.6% of patients. Conclusion:Vitamin D deficiency is common in elderly female patients with hip fractures and is associated with age and DM. This initial work warrants further larger-scale studies of vitamin D variations. Link:http://aeirc-edu.com/ojs14/index.php/IJEHSR/article/view/462/620

Introduction Many young females present with an advanced stage of breast cancer, which has a negative effect on the prognosis. Digital breast tomosynthesis is a new emerging imaging technique that aids in improving the specificity of mammography with subsequent early detection of breast cancer, especially in women with radiographically dense breasts. Tomosynthesis is subjectively preferred to conventional mammography and may offer superior diagnostic accuracy for the evaluation of breast lesions. Method Two breast radiologists retrospectively reviewed asymmetric densities using protocols that were institutional review board-approved in 185 patients aged 18 - 70 years (mean: 48 years) who underwent diagnostic mammography and tomosynthesis. Each asymmetric density was interpreted once with tomosynthesis and once with supplemental mammographic views; both modes included the mediolateral oblique and craniocaudal views in a fully crossed and balanced design by using a five-category Breast Imaging Reporting and Data System (BI-RADS) assessment and a probability-of-malignancy score. If the abnormality persisted and appeared benign or completely disappeared on both modalities, the agreement between additional views and tomosynthesis was determined by calculating Kappa value. If there was a discrepancy between additional views and tomosynthesis, the abnormality was subjected to ultrasound. In our study, 89 asymmetric densities were subjected to ultrasound. Results In a total of 182 cases, 84 (46.15%) were categorized as BIRADS-0; 97 (53.30 %) as BIRADS-I, and one (0.55 %) as BIRADS-II on an additional view. Among the asymmetric densities categorized as BIRADS-0 on additional mammography views, digital breast tomosynthesis categorized 72, six, five, and one patient as BIRADS-0, BIRADS-I, BIRADS-II, and BIRADS-IV, respectively. For densities categorized as BIRADS-I (97) on additional view, digital breast tomosynthesis categorized 10 and 87 densities as BIRADS-0 and BIRADS-I, respectively. No change in the BIRADS category was observed among BIRADS-II and BIRADS-IV. A significant difference was observed with the chi-square test among BIRADS categories assigned by an additional view and digital breast tomosynthesis with a p-value of < 0.001. There was, however, a substantial agreement among additional views and tomosynthesis with a kappa value of 0.767. Conclusion Our study results suggest that tomosynthesis may be equivalent to, if not more equivalent to, additional imaging in the assessment of mammographically-detected asymmetric densities, thus improving BI-RADS classification and patient management.

Background: The objective of our study is to assess the impact of COVID-19 pandemic on clinical practice as well as psychological impact on orthopedic surgeons of Pakistan.Method: An online survey involving orthopedic surgeons through social media platforms like WhatsApp and Facebook and also through email, to assess the impact of COVID-19 pandemic. Our survey also aims to evaluate their state of mind and physical as well as emotional wellbeing in the wake of COVID-19 pandemic.Results: Among 77 respondents, mostly 31 (40.3%) were consultant and mostly 28 (36.4%) having experience in field of orthopedics was between 5-10 years. This data revealed 48 (62.3%) respondents did not received any specific training or recommendations about COVID pandemic from their institute and only 37 (48.1%) reported they are well informed on latest COVID guidelines. Interestingly, this data revealed the willingness of orthopedic surgeons 30 (39%) to take care of COVID-19 positive patients in ICU.67 (87%) feel anxious, stressed, furious, angry or depressed due to pandemic and most common fear among them was to infect their family members followed by getting infected and loss of their life and health. 40 (51.9%) did not think their institute is well equipped to deal COVID pandemic.Conclusions: Orthopedic community nevertheless have to play an important role in the face of an increasing psychological and emotional stress which comes from working in a post COVID era. The dread of getting infected while treating and the sinking feeling of spreading the contagion to their loved ones has put a massive toll on the emotional well-being and needs to be addressed through open and fair discussion.

Background: To determine the prevalence and association of hyperuricemia with genetic factors, dietary and alcohol consumption, metabolic syndrome, diuretic use and chronic renal disease in patients presenting with joint pain in the outpatient department (OPD) at a tertiary care hospital of Karachi, Pakistan and to establish a significant correlation between concentration of serum creatinine and triglyceride with uric acid concentration statistically.Methods: This study was conducted on 2200 patients. The data included age, gender, occupation, genetic factors (family history), dietary and alcohol consumption, metabolic syndrome, hypertension, obesity, diuretic use and chronic renal disease. Serum uric acid concentration of 2.4-6.0 mg/dl (female) and 3.4-7.0 mg/dl (male) labelled as normal values. All participants’ serum uric acid concentration compared with serum creatinine and triglyceride concentration.Results: Overall prevalence of 30.1% (662 patients) hyperuricemia in patients presenting with joint pain. Majority of the patients belonged to age group 30-34 and highest average uric acid value (7.7±2.01) was found to be in the age group of 65 and above. Hyperuricemia was related to increased age (56.25%), genetic factors 159 (24.01%), dietary 370 (55.89%) and alcohol consumption 33 (4.98%), metabolic syndrome (hypertension 146 (22.05%), obesity 121 (18.27%), diuretic use 215 (32.47%) and chronic renal disease 53 (8.00%). On laboratory investigations, hyperuricemia was directly related to serum creatinine and triglyceride.Conclusions: This study emphasized the high prevalence of hyperuricemia in patients presenting with joint pain and it is directly proportional to the age. Increased serum uric acid levels with increasing age might be secondary to impaired renal function, use of diuretics, and hypertension as commonly seen among elderly patients. Early diagnosis, management of risk factors and treatment will prevent adverse effects on health.

Objective To assess the prevalence, nature of trauma, reason(s) behind these trauma and first-aid care provided during transportation to hospital in Karachi Pakistan. Study also presents the framework of a national trauma registry and comparatively analyzes data between other registries. Method This cross sectional observational/descriptive study was conducted from July 2015 to Dec 2015. An informed verbal consent was taken and preformed questionnaire was filled. Patient brought dead and who did not give consent were excluded. Results The study conducted on 1500 patients includes 1030 males (68.7%) and 470 females (31.3%). Mean age was 45 SD 28.69 Maximum injuries occurred in age group of 11–20 year. By occupation most were found to be students and children 350 (23.3%). Most traumas occurred on road 919 (61.3%) and other occurred in home 349 (22.7%). Road traffic accidents are found to be major cause of injuries 730 (48.7%) and rest was due to other causes 630 (42.0%).The vehicle involved in majority of cases was motorcycle 340 (22.7%). In most of the cases emergency medical service 72148.0% was used for the transportation of the patients. During transportation (100%) of victims were not provided with first aid, breathing care/bleeding care/iv fluids and splints/slabs. Severity at emergency room of patients was mainly moderate (52.7%) while severe condition was suffered by (32.0%) of patients and mild (14.7%). Conclusion This study concluded that the transport accidents are the major health problems especially in young population. For better transportation of patients it is needed to upgrade facilities of ambulances and other emergency medical services. Emergency medical care facilities establishment at district level, sub-divisional level are needed to provide good and quality care to trauma patients. Improvement in trauma care depends on the establishment of functioning trauma care systems, of which a trauma registry is a crucial component.

Objective This study aims to describe the crash characteristics and injury patterns for Qingqi rickshaw occupants and other road users hit by Qing-qi rickshaw in Karachi, Pakistan. Method An Observational/Descriptive study was conducted at Accident and Emergency and Orthopaedic Surgery Department ,Jinnah Post Graduate Medical Center, Karachi Pakistan from July 2014 to June 2015.All patients who came with Qing-qi rickshaw accident in A and E of JPMC were included. Crash characteristics, details of injuries, injury severity parameters and outcome were documented in detailed interviews. Results 486rickshawrelated injuries were noted in road traffic accidents by Qing-gi rickshaw. Age range was 2 to 85 years, mean age was 43.5 (SD 58.68). 350 injured victims were males and 136 were females. By occupation most victims were laborers and daily wageworkers (45%) and students (21%). Overloading of vehicle with more than two passengers was found in (28.5%). The most common cause of injury was collision with a moving vehicle (56%), followed by fall from rickshaw. The most common contributing factor was the overloading of rickshaw and roll over on turning(61%). Injury severity on arrival were mild (49%), moderate were (32%), and severe were (19%). Injuries related to head and neck (26%), face (14%), thorax and abdomen (5%), lower extremity and pelvic girdle (31%) and upper extremity (23%) were observed. Conclusion This study concluded that Qing-qi rickshaw injuries are common and these vehicles are vulnerable to road traffic accidents. Occupants and road users are both at risk of injuries. Urgent preventive measures targeted towards this group are needed to reduce injuries involving rickshaws which results in increasing morbidity and mortality. The need for improved understanding of the risk characteristics of Qing-qi rickshaw is emphasized. The option of a safe, accessible and dignified mass transit system for the city of Karachi should be explored at the earliest.

Background: The objective of the study was to determine association of inadequacy of vitamin D level with low energy fractures of distal radius and its predictors in young patients in Karachi Pakistan.Methods: Cross-sectional study was conducted on 220 young patients, visited hospital with low energy fracture of distal radius. A questionnaire was designed and filled after taking consent includes details regarding age, gender, occupation, area of skin and sun exposure duration, dietary habits, type of clothing and residence used. Serum Vitamin D3 levels were determined and compared with serum calcium levels, serum phosphorus and alkaline phosphatase levels. Results: Among 220 patients ranging from 12-45 years, mean 28±23.33 SD. Female were 172 (78.18%). Mostly have history of fall 127 (57.72%) and RTA 63 (28.63). Sun exposure duration in majority of participant was 1-2 hour/day 132 (60%). Variable coloured clothes used by majority participant 135 (61.36%) and variable fabric 102 (46.36%). 202 (91.8%) patients had deficiency of vitamin D and correlated with duration of sunlight exposure significantly, also with exposure of large skin area, dietary consumption of vitamin D rich food and worn variable clothing colours. Serum phosphorus level and serum alkaline phosphatase level were negatively correlated with vitamin D significantly whereas positively correlated with serum calcium.Conclusions: Prevalence of vitamin D deficiency is very high in low energy fracture of distal radius in young population and sun exposure duration found to be most common predictor of inadequate D levels. A national food fortification program and campaign of public awareness to increase sunlight exposure and increase intake of vitamin D rich food are urgently needed.