Introduction There has been guidance from the government and orthopaedic community on how best to ensure the safety of our patients and colleagues as we recommence elective surgery in the UK. The primary aim was to determine what proportion of patients feel they should proceed with their elective hip and knee arthroplasty surgery during the COVID-19 climate. The secondary aim was to investigate what variables affected this decision. Methods Patient information from a single surgeon's waiting list in a district general hospital were recorded. A standardised telephone discussion was had with all the patients noting the severity of pain and the potential reasons for not wanting to proceed with surgery. Results A total of 70.6% (96/136) of patients wished to proceed with surgery; 29.4% (40/136) did not wish to proceed. The decision to proceed with surgery was not correlated with sex, American Society of Anesthesiologists grade or COVID-19 risk. Those who wished to proceed with surgery had a mean age of 68.5 years while those who did not had a mean age of 72.4 years (P = 0.03). Within the matched subgroups, patients under the age of 70 years were more willing to proceed with primary hip arthroplasty surgery (87.9%) compared with primary knee arthroplasty surgery (57.1%; P = 0.007); 75% of the patients who did not wish to proceed with surgery expressed concerns about perioperative COVID-19 infection. Conclusion There is a significant proportion of arthroplasty patients on waiting lists who would be willing to accept the increased risks associated with COVID-19 to undergo surgery on an urgent basis. The subgroup of younger patients awaiting hip arthroplasty is more willing than those awaiting knee arthroplasty to proceed with surgery.

Background and Aims:There is wide variation in depth of brachial plexus in patient population at supraclavicular region. We plan to find the depth of the corner pocket and correlate it with age, weight, height and body mass index (BMI).Material and Methods:After approval from Ethics Committee, right-sided supraclavicular region of volunteers was scanned. Once an optimal image, which included subclavian artery, pleura, first rib and nerve bundles, was obtained, the corner pocket was kept in the middle of the screen and the image was frozen. Depth of the corner pocket from the skin was measured. Thereafter longest distance (LD) approximating needle trajectory was calculated. The Pearson correlation was used to calculate the relation between these two distances and various predictors such as weight, height, and BMI.Results:Mean shortest distance that is, vertical distance from skin to corner pocket for all volunteers was found to be 1.7 ± 0.8 cm and the mean LD that is, distance traveled by needle entering 1 cm from the edge of foot process to the corner pocket in an in-plane approach was 3.7 ± 0.2 cm. We did not find any significant correlation between age, height versus measured distances. However, significant correlation (0.11) was found between weights, BMI versus two lengths.Conclusion:Prescanning of supraclavicular region for estimating depth of corner pocket should be done before choosing an appropriate size needle. Furthermore, the needle should not be advanced more than the predicted corner pocket depth.

This paper provides a comparative analysis regarding the performance of 17 Libyan banks over the period 2004 up to 2010. According to the relevant literature, there are few studies that combine both the Data Envelopment Analysis (DEA) technique and Tobit model for assessing the efficiency levels and subsequently examining the determinants of efficiency for the banking sector in Libya. For this study, the DEA technique was used to estimate cost, allocative, and technical efficiency of sampled banks by using DEAP software. In the second stage, Tobit regression model was used to identify potential determinants of efficiency by using Stata10 software. The results showed that the specialized banks have exhibited higher mean cost efficiency relative to commercial and private banks. The results of efficiency determinants showed positive relationship between bank efficiency, and return on investment (ROA); risk; and size of operation (SO). This paper concludes with some policy implications of the results.

Neuraxial anaesthesia techniques are routinely used to manage postoperative pain in patients undergoing lower limb orthopaedic surgery. However, neuraxial anaesthesia is contraindicated in patients with a deformed spine or coagulopathy. Researchers recently described the erector spinae plane block—a safe, easy and effective interfascial plane block for managing chronic thoracic pain. Since then, it has been used for providing analgesia in thoracic, abdominal and hip surgery. We report its analgesic use in two patients undergoing knee surgery: one with lumbar scoliosis undergoing above knee amputation, and the other with haemophilia undergoing bilateral knee arthroplasty.

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Introduction: Dietary diversity has been universally identified as a key element of high quality diets. The tendency among undergraduate students with poor dietary patterns is high, due to lack of parental supervision, incorrect knowledge regarding food habits, stress of academic, professional and social life. This study was carried out to assess the diet diversity and eating pattern of undergraduate students of various colleges in India. Methods: This was a descriptive cross-sectional study conducted among 3046 undergraduate students across India by filling the online questionnaire shared through social media. The data on dietary diversity was collected by asking the number of consumed food groups in previous 24hr from the total food groups described by FAO, with anthropometric measurements. Data analysis was done using SPSS version 21. Results: Mean age of participants was 20.7±1.9 years, the majority being females. About 42.2% student's skipped breakfast 1-2 times per week and another 28.5% skipped 3 or more times. About 34.7% had poor DDS (Dietary Diversity Score) whereas 28.5% had good DDS. Higher DDS mean was found in males (3.67) than females (3.23), overall mean being 3.4. Among 869 people with good DDS, 63.1% had normal BMI and 57.1% availed their meals from mess. There is significant distribution of DDS among different regions (p=0.0007), graduation streams (p=0.0014) and source of meals (p<0.001). Conclusion: In this study, the diet diversity of about three-fourth participants was inadequate, showing their improper habit of food consumption and results also indicated their unhealthy eating pattern. Adequate dietary practice is recommended.

A B S T R A C THepatobiliary surgeries are associated with severe pain, and coagulopathy. Adequate pain control is vital and difficult to achieve for these patients. Epidural analgesia is considered the routine standard technique for the management of both somatic and visceral pain from major abdominal surgeries until now. However, it is invasive, blind and carries the risk of dural or vascular puncture. Coagulopathy found in patients posted for hepatobiliary surgery further increases the concerns. We found ultrasound guided erector spinae plane block as a safe, simple yet an effective alternative to epidural analgesia for postoperative pain management of hepatobiliary surgeries.

Introduction: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) causing coronavirus disease 2019 (COVID-19) has led to a global health crisis. Health workforce has been working vigorously in COVID-19 management. So, we have planned this study with an aim to assess the psychological profile of healthcare and allied workers involved in SARS-CoV2 pandemic and to look for associated factors. Methodology: A cross-sectional observational study was planned at All India Institute of Medical Sciences, Patna. Study population comprised of Health care workers and allied health care workers involved in COVID-19 management. Results: Data from 254 study participants have been included in the study. The prevalence of severe and extremely severe depression among study participants was 8.3 and 3.1 percent. Severe and extremely severe anxiety prevalence was found to be 9.4 and 13.8 percent. The prevalence of severe and extremely severe stress was 2.4 and 2.4 percent each. Education till post-graduation, unmarried, occupation of doctor, Comorbidity of headache and occurrence of influenza-like illness in last 3 months had a statistically significant association with high depression score. With high Anxiety score and high-stress score statistically significant association was seen in education till postgraduation, unmarried, occupation of doctor, duration of 1 COVID-19 duty of ≥8 hours. Conclusion: The study highlights high psychological comorbidities in the form of depression, anxiety and stress among health care workers and allied health care workers working in COVID-19 pandemic. Prevalence of psychological morbidity is higher among doctors compared to nurses and allied health workers. COVID-19 duty of ≥8 hours have been found to be hampering mental health.