The prevalence of LBP among nurses at HGH is high and should be actively addressed, however, it was not a major cause of sick leave. Preventive measures should be taken to reduce the risk of lower back pain, such as arranging proper rest periods, educational programs to teach the proper use of body mechanics and sports activity programs.

BackgroundThe aim of this study was to describe the pattern of traumatic injuries and determine the predictors of inhospital mortality in patients admitted to the emergency department.Patients and methodsThis is a retrospective cohort study of 3,786 patients with traumat injuries admitted to the emergency department of King Abdulaziz Medical City, Riyadh, Saudi Arabia, between January 2012 and December 2014. Data on patient characteristics, trauma characteristics and outcomes were extracted from medical records. A negative binomial regression model was utilized to identify significant predictors of inhospital mortality.ResultsOf all injured patients, 77.5% were male, 29.8% were aged 15–25 years and 25.7% were aged 26–45 years. Blunt trauma was the main mechanism of injury, including motor vehicle crashes (MVCs) in 52.0% and falls in 25.8% of patients. Most patients had injuries to the extremities (61.3%), followed by the head (32.2%), chest (16.9%) and abdomen (8.9%). Injuries were mild in 49.7% of patients, moderate in 30.2% and severe in 20.1%. The sex of the patients was significantly associated with the mechanism of injury (p<0.001), severity (p<0.001), anatomical site of injury (p<0.001), admission to the intensive care unit (p<0.001), need for trauma team activation (p<0.001) and type of transportation to hospital (p<0.001). The predictors of inhospital mortality were age (rate ratio [RR] for each 10-year increase=1.174; p<0.001), falls and burns (RR=2.337 and 1.728; p<0.001) and moderate and severe injuries (RR=6.438 and 181.780; p<0.001).ConclusionOur results suggest different patterns of trauma injuries according to patient age and sex. MVCs were the leading cause of injuries, but falls and burns had the highest inhospital mortality. This suggests the need for a comprehensive national education and prevention programs that address all causes of injuries.

Aim. To assess the knowledge and practice of PHC physicians toward the detection and management of hypertension (HTN) and other CVD risk factors. Methods. A cross-sectional study of all primary health care physicians of the FHU of three rural districts of Egypt was conducted. Each physician was subjected to a prevalidated interview questionnaire on the WHO-CVD risk management package for low and medium resources, and a checklist of observation of daily practices. Results. Hypertension was a priority problem in about two-thirds (62.9%) of physicians, yet only 19% have guidelines for HTN patients. Clinical history recording system for HNT was available for 50% of physicians. Levels of knowledge varied with regard to definition of HTN (61.3%, fair), procedures for BP measurement (43.5%, poor), indications for referral (43.5%, poor), patient counseling (61.3%, fair), patient treatment (59.8%, fair). Availability of clinical history recording system for HNT was a significant predictor for physician's level of knowledge (P = 0.001). Overall level of practice was fair (68.5%). Conclusion. PHC physicians have unsatisfactory knowledge and practice on hypertension. There is a need of more continuing medical education. Local and international manuals, workshops, and seminars on how to make use of these guidelines would improve doctors' performance.

Physicians should suspect the entrapment of the FHL tendon in cases of flexion deformity of the hallux associated with talar fracture. Proper examination of the forefoot when a patient presents with a hindfoot injury will help to avoid missing such deformities.

INTRODUCTIONXanthoma (or xanthofibroma) is a benign proliferative lesion, mostly seen in soft tissue. Xanthoma of bone is very rare benign primary bone tumor, more frequently seen in men and in patients over 20 years of age. Histologically, it is characterized by mononuclear macrophage-like cells, abundant foam cells, and multinucleated giant cells. It is sometimes discovered coincidentally and the most frequent symptom is pain.PRESENTATION OF CASEWe present a 50-year-old healthy male patient with primary xanthoma of the calcaneus, who was treated by curettage and bone cement. He presented with a pathological fracture in a calcaneus bone lesion. Giant cell tumor was suspected on X-ray and MRI. Curettage and bone cementing was done through the posterolateral approach. Lipid profile was normal and histological examination revealed findings consistent with primary xanthoma of calcaneus bone.DISCUSSIONTo avoid an erroneous diagnosis, all material should be examined microscopically, the radiological features of the lesion should be studied properly and lipid profile should be investigated to differentiate between primary and secondary xanthoma. Primary xanthoma may be treated with curettage and bone graft while secondary xanthoma is treated nonsurgically and the skeletal manifestations will disappear with systemic treatment of hyperlipidemia.CONCLUSIONWe present this case to raise the suspicion of this lesion that is rarely described in the literatures. This is the first case of primary xanthoma of calcaneus bone that has been reported in Qatar.

Study Design Cross-sectional survey. Objectives This study aimed to investigate work-related neck pain among AO spine surgeons in different regions by estimating its prevalence, predictors, consequences, and management methods. Methods A cross-sectional survey of 411 spine surgeon members of AO spine was conducted during March–May 2021, using the Modified Nordic Questionnaire and the Neck Disability Index. Data on neck pain experience during the last 12 months and its consequences and risk factors were collected. Logistic regression analysis was done to identify significant predictors of neck pain. Significance was set at P < .05. Results The 1-year neck pain was experienced by 66.7% of surgeons. According to the Neck Disability Index, more than one-half (52.8%) experienced disability due to neck pain of mild (45.5%), moderate (6.5%), and severe (.8%) grades. Neck pain was responsible for stopping work in 17.5% of surgeons, with a median of 3.5 (IQR, 2-7.8) days off work. One-half of the participants (56.3%) were treated by medical care, 31.5% by physiotherapy, and 16.5% requested rest days and sick leave. Physical stress (P < .001) and non-exercising (P = .04) were the significant predictors of neck pain. Conclusion The 12-month prevalence of neck pain was high among spine surgeons, with an impact on activities of daily living, mainly of a mild degree, reported by one-half of surgeons. Physical stress was the only significant predictor, while sports practice was a protective factor ag neck pain. Medication was the primary management adopted—an increased focus on pain prevention through improved workplace ergonomics and sports activity programs is recommended.

IntroductionOdontoid fractures are common. They represent 20% of all cervical trauma. There is a trend towards surgical stabilization. Fracture fixation with 1 or 2 anterior screws is standard operative treatment in younger population.Presentation of caseA case of type 2 odontoid fracture. The fracture was fixed initially with a halo vest temporarily. The patient was later treated operatively with anterior odontoid screw fixation. Reduction of the fracture was achieved using a bivector traction over a halo ring. The patient achieved an anatomical reduction and a rigid fixation.DiscussionType 2 odontoid fracture is very controversial to treat. Several methods of fracture reduction have been described in the literature including Gardner-Wells Tongs and Mayfield head clamp. To our knowledge, fracture reduction with biverctor traction over a halo frame hasn’t been described before in the literature.ConclusionBivector traction over a halo ring can be used for intraoperative reduction of odontoid fracture.

Aim: The aims of this study were: 1) to estimate the prevalence and pattern of complications after Achilles tendon (AT) repair, and 2) to determine the significant predictors of post-operative infection. Methods: A retrospective cohort study of all patients who were operated at Hamad General Hospital (HGH) between June 2010 and June 2012 for AT rupture (n = 102), was conducted. Data was collected on 1) patient' characteristics such as age, sex; 2) disease characteristics such as mechanism of rupture, type of rupture (partial or complete), whether an anterior or posterior slab was applied, number of suture materials, number of antibiotics, surgical time, time to surgery and length of hospital stay (LOS), number of follow up visits, and 3) complications. Descriptive and analytical statistical analyses were applied. Receiver operating characteristic curve was applied to identify the validity of different LOS values, with a significance level at p ≤ 0.05. Results: Of the 102 patients with Achilles rupture, almost males (96.1%), with a mean age 31.07 ± 9.71 years, 52% with complete rupture, the majority were open ruptures (81.4%) and bathroom-related (70.6%). Anterior slab was applied to 58.2% and 2 types of suture materials to 71.6% of cases. Fifteen cases (14.7%, 95% CI: 7.8% -21.6%) presented with one or more complications (9.8% post-operative infections, 5.9% stiffness and 2% re-rupture). Post-operative infections were significantly associated with: old age (z = 2.11, p = 0.035), longer LOS (z = 2.01, p = 0.04), and presence of diabetes (Fisher exact test: p = 0.003). After adjustment for age, LOS (p = 0.04) and diabetes (p = 0.017) remained as significant predictors of post-operative infections. LOS of 2.5 days was the optimum cut-off point above which post-operative infection is more likely to occur, with sensitivity of 80% and specificity of 54%. Conclusion: Achilles repair post operative infection ranks first as a complication of AT surgical repair, and its incidence is relatively higher in HGH than the counterpart figures in the literature. The presences of diabetes and LOS are independent predictors of this infection. Further prospective studies are recommended to control for all possible confounders of outcome of AT rupture repair.