The impact of the COVID-19 pandemic on the well-being, work conditions, and education of early career psychiatrists in the WHO Eastern Mediterranean Region: study protocol

Background

The COVID-19 pandemic placed great strain on healthcare professionals, leading to a substantial impact and a redistribution of the workforce. Despite the active involvement of the Eastern Mediterranean Region Office (EMRO) and the World Health Organization in managing mental health crises, there is a knowledge gap concerning the working conditions and training opportunities available for early career psychiatrists (ECPs) during the pandemic period.

Objectives

This study aims to investigate the impact of the COVID-19 pandemic on ECPs and how it affected their well-being, employment, and educational opportunities.

Methods

A mixed methods study has been conducted in Iran, Egypt, and Tunisia, three EMRO member countries. It includes a cross-sectional survey with self-reported questions, and a qualitative study with individual in-depth interviews.

Discussion

The findings of this study will raise awareness to the working conditions of ECPs within the EMRO region and its member societies, both during the COVID-19 pandemic and beyond. The results will serve as a basis for encouraging supervisors and policymakers to mitigate the pandemic's impact on psychiatric training, strengthen healthcare systems' preparedness, and equip early career psychiatrists with the necessary skills to deal with the mental health consequences of the COVID-19 pandemic.

Management of tibial nonunion and osteoarthritis using a 3D-printed titanium cone: A case report

The use of customized 3D-printed structures has been gaining popularity in non-union management, as it allows for bypassing the defect while promoting osseointegration. Additionally, porous titanium implants minimize stress shielding due to their stiffness and elastic modulus being closer to that of bone. The interconnected channels increase the surface area and provide space for cell adhesion and proliferation. This study presents the case of a 62-year-old female patient with concomitant knee osteoarthritis recalcitrant aseptic atrophic nonunion in the tibial proximal metaphysis. Due to the small distance between the nonunion site and the joint line, nonunion treatment had to be included in the treatment plan, as it would result in a lack of mechanical stability of the tibial component, and techniques such as plating were not an option. A customized 3D-printed porous titanium cone was used to bypass the fracture site and support the stem used with the CCK prosthesis, allowing for simultaneous nonunion and osteoarthritis management.

Ipsilateral Concurrent Knee Arthroplasty and Tibial Osteotomy with 3D-Printed Patient-Specific Instrumentation: A Case Report

CASE

A 70-year-old woman presented with knee pain and instability and was diagnosed with advanced knee osteoarthritis and bifocal tibial deformities. The complexity of the case challenged our team to perform a significant sagittal correction (>60°) and restore her ability to walk independently. We performed ipsilateral total knee arthroplasty and anterior closed wedge tibial osteotomy using virtual planning and 3D-printed patient-specific instrumentation.

CONCLUSION

Using 2 separate 3D-printed patient-specific cutting guides for this patient with a complex deformity and managing the whole planning process in close collaboration between the surgeons and engineers resulted in a satisfactory postoperative outcome, optimal implant positioning and leg alignment, and minimal soft-tissue damage.

Fresnel diffraction from a step in the general case

Recently, Fresnel diffraction from phase steps with parallel plates has been studied in detail, and the subject has led to many interesting metrological applications. In this report we formulate Fresnel diffraction from a physical step with arbitrarily oriented plates in reflection mode. We simulate the diffraction patterns for different orientations of the plates and develop the required procedure for determining the involved angles by analysis of the diffraction pattern. In the experimental part of the report we arrange a setup to form diffraction patterns in different orientations of the step plates and test the derived formulations. Also, we briefly review the application potentials of the subject.

Chronic diseases among older people in Amirkola, northern Islamic Republic of Iran

This descriptive cross-sectional study was undertaken to describe the prevalence of noncommunicable diseases and their risk factors in elderly people in Amirkola, Islamic Republic of Iran. A total of 1019 people aged 60+ years were assessed using a standard questionnaire and a review of medical records. The most common chronic diseases were cardiovascular disease (29.5%), digestive disorders (28.5%), hypertension (23.6%) and diabetes mellitus (23.5%), while 44.4% of subjects were overweight or obese. Overall, 83.0% of the sample reported at least 1 chronic disease and 64% had 2 or more diseases. In age-adjusted logistic regression analysis, hypertension (OR 3.94, 95% CI: 2.87-5.40) and diabetes mellitus (OR 1.83, 95% CI: 1.32-2.55) were associated with cardiovascular disease, but sex, smoking, overweight and lack of walking were not. The study provides valuable data for planning appropriate health services for elderly people in this area of the Islamic Republic of Iran.

Simplified retropubic prostatectomy technique: faster and not more hemorrhagic

AIM

To report the technical feasibility of performing modified open prostatectomy.

METHODS

From July 2004 to May 2007, 103 patients suffering from benign prostatic hyperplasia were operated with this technique. We only used two wide transverse stay sutures at the anterior prostate surface and performed capsulotomy with electrocautery. We did not use the incision of endopelvic fascia, control of lateral pedicles or the transection of puboprostatic ligament. We analyzed the preoperative, operative and post operative data of these patients, prospectively.

RESULTS

The mean prostatic weight was 86g (range: 65-195). The mean operative time was 43 minutes (range: 36-52). The mean catheterization time was 5 days (range: 4-8). The mean hospital stay was 4 days (rang: 3-7). The mean decrease in the heamoglobin level from before to one day after the surgery was 1.3 g/dL. The estimated mean bleeding during the surgery was 423cc (range: 200-800cc). Post-operatively, 9 patients (8.7%) had mild urge incontinence.

CONCLUSION

Our modified retropubic prostatectomy is a simple and efficient technique that can significantly reduce the operation time. In comparison to other techniques; we had no more significant bleedings and further decreases in hemoglobin level during the procedure.

Totally tubeless percutaneous nephrolithotomy

PURPOSE

We evaluated the requirement for routine placement of a ureteral stent and a nephrostomy tube following percutaneous nephrolithotomy (PCNL).

PATIENTS AND METHODS

A total of 43 patients underwent totally tubeless PCNL and was compared with a control group of 43 age-, sex-, weight-, and procedure-matched patients who had previously undergone PCNL with placement of a ureteral stent and a nephrostomy tube. Exclusion criteria for the tubeless approach were more than two percutaneous accesses, significant perforation of the collecting system, a large residual stone burden, significant postoperative bleeding, ureteral obstruction, and renal anomaly. The incidence of complications, length of hospitalization, analgesia requirements, and interval to return to normal activities were compared in the two groups.

RESULTS

All 43 percutaneous procedures were performed without significant complications. None of the patients demonstrated urinoma in postoperative renal ultrasound scans. The average length of hospital stay was 1.6 days, with two-thirds of the patients staying <1 day for the study group, and 5.2 days for the controls (P < 0.001). The average analgesia requirement was 9.8 mg and 28.4 mg of morphine, respectively (P < 0.001). Patients returned to normal activities with 12.7 days v 24.6 days for the controls (P < 0.001).

CONCLUSION

Totally tubeless PCNL is a safe and effective procedure. The hospitalization and analgesia requirements are less and the return to normal activities faster with this technique.