Osteoid osteoma is a benign bone-forming tumor with hallmark of tumor cells directly forming mature bone. Osteoid osteoma accounts for around 5% of all bone tumors and 11% of benign bone tumors with a male predilection. It occurs predominantly in long bones of the appendicular skeleton. According to Musculoskeletal Tumor Society staging system for benign tumors, osteoid osteoma is a stage-2 lesion. It is classified based on location as cortical, cancellous, or subperiosteal. Nocturnal pain is the most common symptom that usually responds to salicyclates and non-steroidal anti-inflammatory medications. CT is the modality of choice not only for diagnosis but also for specifying location of the lesion, i.e. cortical vs sub periosteal or medullary. Non-operative treatment can be considered as an option since the natural history of osteoid osteoma is that of spontaneous healing. Surgical treatment is an option for patients with severe pain and those not responding to NSAIDs. Available surgical procedures include radiofrequency (RF) ablation, CT-guided percutaneous excision and en bloc resection.

Covid-19 has adversely impacted the health care organizations by over burdening with Covid patients and suspending the elective surgeries and clinics. Hospitalization during pandemic may increase health cost of patients for elective and emergency procedure due to extra cost of covid testing and isolation. A single center retrospective study was conducted to quantify losses due to postponement of elective surgeries and extra cost for procurement of PPEs. The secondary objective was to see the effect of Covid −19 on the total costs of inpatient care during Covid era. Patient and method We included all the patients admitted in orthopedic section for operative intervention of fractures and elective procedures from January 1, 2020 to May 31, 2020. We divided this period into two halves; the first half was from January first to March 15 named as PreCovid Era and second half was from March 16, to May 31, 2020, termed as Covid Era. The total number of trauma procedures and elective procedures were compared in both eras. We compared six procedures each from upper and lower limit for cost analysis and length of stay. We also analyzed the extra cost for procurement of PPEs. Results A total 625 patients were admitted during study period; 417 in precovid and 208 in covid era. There was 50% reduction in patients admissions during Covid era. There was no statistically significant difference in age and gender of both groups. A total of 840 (591in preCovid era and 251 in Covid era) procedures were performed on these 625 patients. Elective and emergency procedures were significantly reduced in Covid era. There was 55.7% drop in the collective revenue generated in covid era as compared to that of Precovid era. The average length of stay was decreased in Covid era. No statistically significance difference was found in inpatient hospital charges of both groups except for two procedures ankle and proximal humeral fractures; that was significantly reduced in Covid era. There was significantly increase in use of PPE in covid era Conclusion The financial income of our service decreased more than 55% due to postponement of elective work. The number of elective and procedures related to musculoskeletal trauma also decreased. The cost for inpatient care did not increase during covid era. There was significant reduction in inpatient hospital stay during covid era. The hospital management had to spent additional expenses on procurement of PPEs.

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IntroductionBrain tumor resection under awake settings may cause significant psychological stress, which may lead to perioperative anxiety and depression. We conducted a prospective study to compare postoperative depression in patients undergoing awake craniotomy (AC) for tumor resection and compare it with patients undergoing tumor resection under general anesthesia (GA). MethodsWe conducted a prospective study at a tertiary care hospital. Non-probability consecutive sampling was performed, and patients with a preoperative diagnosis of depression or with any other medical comorbidities that could precipitate depression were excluded. Two separate questionnaires, the Patient Health Questionnaire-9 (PHQ-9) Scale and the Karnofsky Performance Score (KPS), were used to screen depression and assess functional status, respectively. ResultsNinety-six patients met the inclusion criteria and were included in the study. Out of these, 37 (38.1%) had undergone awake craniotomy and 59 (60.8%) had undergone conventional craniotomy (CC) (under general anesthesia) for brain tumor resection. To standardize our method, we ensured that the demographic variables, including mean age, gender, educational status, marital status, and socioeconomic conditions, were comparable between both groups. Postoperative functional status fared better in patients who underwent awake craniotomy (p = 0.03). The total number of patients suffering from postoperative clinical depression, according to the PHQ-9 Scale, was 41 (42.7%), of which 12 (12.5%) were in the awake craniotomy group and 29 (30.2%) were in the conventional craniotomy group. The median PHQ-9 Scale score in the awake craniotomy group was 6 (range: 3-10), which was less than the median score in the conventional craniotomy group, which was 9 (range: 4-12). This difference, however, was not statistically significant (p = 0.06). ConclusionResection of brain tumors under awake conditions is not likely associated with any additional incidence of postoperative depression when compared with resection of tumors under general anesthesia.

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