Impact of the COVID-19 pandemic on orthopedic surgeon in Pakistan

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

Digital breast tomosynthesis versus additional diagnostic mammographic views for the evaluation of asymmetric mammographic densities

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 \u3c 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

Concordance between clinical and pathological response assessment after neo-adjuvant chemotherapy in patients with invasive lobular carcinoma

Background: Neo-adjuvant chemotherapy (NAC) is frequently administered in breast carcinoma patients. The clinical response to NAC guides further treatment. The pathological response is not only an independent prognostic factor, but it also guides further treatment and prognosis.Objectives: The aim of our study was to find the degree of concordance between clinical and pathological response assessments after NAC in Invasive lobular Carcinoma (ILC) cases by using World Health Organization (WHO) criteria and different pathological systems, respectively. We also tried to identify any useful parameter of clinical assessment that could better correlate with pathologic assessment and provide a better estimation of residual tumor.Methods: This retrospective study was conducted on 26 ILC tumors diagnosed in 24 patients who were treated with NAC followed by surgical resection between January 2009 and December 2020. Medical records and microscopy glass slides were reviewed for clinical and pathological response assessments, respectively.Results: The pre-treatment tumor area ranged from 1.8-255 cm2 and the mean±SD was 52.2±66.8 cm2. After NAC, complete clinical response was observed in four (15.3%) cases. The clinically assessed mean tumor area significantly reduced from 52.2±66.8 cm2 to 17.2±22.6 cm2 (p-value2) didn’t differ significantly from the clinically assessed mean tumor area (17.2±22.6 cm2) (p-value=0.114). Pathologically, the majority of the cases showed partial response, and a complete pathological response was achieved in only two (7.7%) cases. The concordance rates between clinical assessment by the WHO method and pathological assessment of the breast using the Sataloff method, Miller-Payne (MP) system, Residual Cancer Burden system, and Chevallier method were 26.7%, 15.8%, 9%, and 3.5%, respectively, with insignificant p-values. Percentage reduction in clinical size and percentage reduction in tumor cellularity differed significantly (p-value=0.038).Conclusion: Clinical response assessment provides a less accurate estimation of residual disease, as it shows poor concordance with pathological assessment using different assessment systems/methods

Stability analysis of implicit fractional differential equations with anti-periodic integral boundary value problem

In this manuscript, we study the existence, uniqueness and various kinds of Ulam stability including Ulam-Hyers stability, generalized Ulam-Hyers stability, Ulam-Hyers-Rassias stability, and generalized Ulam-Hyers-Rassias stability of the solution to an implicit nonlinear fractional differential equations corresponding to an implicit integral boundary condition. We develop conditions for the existence and uniqueness by using the classical fixed point theorems such as Banach contraction principle and Schaefer's fixed point theorem. For stability, we utilize classical functional analysis. The main results are well illustrated with an example

Existence and stability of impulsive coupled system of fractional integrodifferential equations

In this manuscript, we deal with a class and coupled system of implicit fractional differential equations, having some initial and impulsive conditions. Existence and uniqueness results are obtained by means of Banach’s contraction mapping principle and Krasnoselskii’s fixed point theorem. Hyers–Ulam stability is investigated by using classical technique of nonlinear functional analysis. Finally, we provide illustrative examples to support our obtained results

In tandem effects of activated carbon and quorum quenching on fouling control and simultaneous removal of pharmaceutical compounds in membrane bioreactors

This study aimed to integrate the quorum quenching (QQ) strategy with powdered activated carbon (PAC) adsorption for fouling control and simultaneous removal of trace amounts of selected pharmaceutically active compounds (PhACs) in laboratory membrane bioreactors (MBRs). With the addition of QQ strains immobilized in PAC-alginate beads, a 4.6-folds delay in fouling was achieved. The QQ strains not only altered the sludge properties, but also influenced the microbial communities in the MBRs, thus leading to distinct quorum sensing signal molecule (acyl-homoserine lactones, AHLs) profiles. Despite the difference in AHL profiles, the total AHL concentrations were greatly reduced in bulk sludge, and completely quenched in biocake with QQ supplementation. PAC addition enabled high removals of all PhACs, and also resulted in a prominent increase in sludge floc size, which further enhanced sludge filterability. These QQ-entrapped PAC-alginate beads provide a novel MBR setting with less biofouling and high removal efficiency of PhACs.Accepted versio

Insights into quorum quenching mechanisms to control membrane biofouling under changing organic loading rates

A quorum quenching (QQ) consortium comprised of both acyl homoserine lactones (AHLs)- and autoinducer-2 (AI-2)-degrading bacteria, either immobilized in polymer-coated alginate beads or in liquid suspension, was examined for fouling control in lab-scale MBRs under both steady and changing organic loading rates (OLRs). Under steady conditions the QQ consortium retarded biofouling by a factor of 3. However, a continuous increase in OLR vastly reduced the effectiveness of QQ bacteria; the biofouling was retarded only by factors of 1.4–1.8. A significant increase in extracellular polymeric substance (EPS), especially loosely-bound EPS in mixed liquor together with an increase in polysaccharide content up to 4 times in EPS resulted from the increase in OLR, was attributed to the impaired QQ efficacy. In control MBRs, cake layer resistance was the major factor (>60%) contributing to the increased trans-membrane pressure, as compared with pore blockage resistance and intrinsic membrane resistance. In contrast, the pore blockage resistance became dominant in QQ MBRs (>40%).Accepted versio