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  • Pattern of Gall Bladder Diseasse View Research Paper on 2017.pdf Jan N/A
  • The breast is the tissue overlying the chest (pectoral) muscles. Women's breasts are made of specialized tissue that produces milk (glandular tissue) as well as fatty tissue. The amount of fat determines the size of the breast. The milk-producing part of the breast is organized into 15 to 20 sections, called lobes. Within each lobe are smaller structures, called lobules, where milk is produced. The milk travels through of tiny tubes called ducts. The ducts connect to the larger ducts, which exit the skin in the nipple. The dark area of skin surrounding the nipple is called the areola. Connective tissue and ligaments provide support to the breast and give it its shape. Nerves provide sensation to the breast. The breast also contains blood vessels, lymph vessels, and lymph nodes.  Up to 7 in 10 women develop breast pain (mastalgia) at some stage in their lives. Breast pain is usually classed as • Cyclic breast pain - where the pain is related to periods. • Non-cyclic breast pain - the pain is not related to periods. • Pain coming from the breast itself - for example, infection or breast-feeding • Pain which does not come from the breast itself. Usually the pain comes from the muscles of the chest wall. Many other causes can result in a pain which is felt in the breast. If you are not sure which type of breast pain you have, it may be pain for 2-3 months. Record the days when you have breast pain and highlight the days when the pain is severe. Cyclic breast pain, pain is very common. It can first occur at any age after periods start but most commonly first develops between the ages of 30 and 50 years. It does not occur in women past the menopause when the periods have stopped.        In many women the symptoms are mild. Indeed, it can be considered normal to have some breast discomfort for a few days before a period. However, in some women the pain can be severe . The 3-5 days prior to a period are usually the worst. In a few women, the pain gradually increase up to two weeks before a period. The pain usually eases soon after a period starts. The severity usually varies from month to month. Typically, the pain affects both breasts. It is usually worst in the upper and outer part of the breast and may travel to the inner part of the upper arm. Your breasts may also feel more swollen and lumpy than usual. This lumpiness is generalised so does not lead to a single definite lump forming. This swelling and lumpiness then improve soon after your period starts. Quality of life for some women can be significantly affected. Physical activity such as jogging can make the pain worse. Such things as hugging children. The pain may interfere with sleep.  It is thought that women with cyclical breast pain have breast tissue which is more sensitive than  Surgeon, Bir Hospital, NAMS Breast Problem in Women x]8\; /ht :dfl/sf–@)&% 51 usual to the normal hormonal changes that occur each month. It is not due to any hormone disease or to any problem in the breast itself. It is not related to any other breast conditions. Although it is not serious.        No treatment may need if the symptoms are mild. Many women are reassured to know cyclical breast pain is not a symptom of cancer or serious breast disease. If the pain is more severe or worse than usual, treatment options include the following: • Support your breasts. Wear a well-supporting bra when you have pain. It may be worthwhile having a bra fitted for you, as many women actually wear the wrong size of bra. Some women find that wearing a supporting bra 24 hours a day for the week before a period is helpful. It is best to avoid underwired bras. Wear a sports bra when you exercise. A soft bra at night may help you sleep more comfortably. • Painkillers and anti-inflammatory painkillers • Rub-on (topical) non-steroidal antiinflammatory drugs (NSAIDs) in topical • Evening primrose oil. This used to be a very popular treatment.  Breast pain can be present all the time or come and goes. This type of breast pain is not related to periods and is most common in women aged over 40. The pain may be in just one breast and may be localised to one area in a breast.There are various causes - for example: • Pain coming from the breast tissue itself without any lumps, tumours or any abnormality being found. • Pain coming or radiating from the chest wall under the breast rather than the breast itself. Muscular or bony pain. • Pregnancy causes breasts to swell and tender, particularly in the first few weeks. Breastfeeding may also cause breast pain. • Infection (mastitis) is a cause breast pain in a small number of cases. Breast tumors, cancer and lumps are a very uncommon cause of breast pain. Fluid-filled lumps (cysts) are painful. Women with breast pain often worry that the pain is caused by breast cancer. However, the first symptom of breast cancer is usually a painless lump. Pain is not usually an early symptom. However, you should visit your doctor if you have any concerns about breast pain or any other breast symptoms. In particular, see a doctor promptly if you have breast pain and any of the following: • A lump in your breast or under your arms. • Discharge from a lump or nipple. • A family history of breast cancer. • Swelling and redness in your breast. • Any symptoms of pregnancy, such as a missed period. dfgj ;d'bfosf] ;]jfdf ;dlk{t x]8\; g]kfnsf] /ht dxf]T;j tyf x]8\; /ht :dfl/sf–@)&% ljdf]rg sfo{qmdsf] kfjg cj;/df x]8\; g]kfnsf] pQ/f]Q/ k|ultsf] z'esfdgf JoQm ub{5' . sfg'gL ;Nnfxsf/ tyf cfhLjg ;b:o x]8\; g]kfn xflb{s z'esfdgf s [ i0fk|;fb e§/fO{ 52 x]8\; /ht :dfl/sf–@)&% View Research Paper on headsnepal.org Jan 2017
  • Bir Hospital, NAMS *Corresponding Author Rakesh Sthapit Bir Hospital, NAMS Niraj Banepale Bir Hospital, NAMS ShreeKrishna Shrestha Bir Hospital, NAMS Bishnu Prashad Shrestha Bir Hospital, NAMS Surgery IF : 4.547 | IC Value 80.26 Volume : 3 | Issue : 11 | November 2014 • ISSN No 2277 - 8179 VOLUME-6, ISSUE-12, DECEMBER-2017 • ISSN No 2277 - 8160 KEYWORDS : Carcinoma gallbladder, Chronic cholecystitis, Gall bladder pathologies, Nepal Introduction : Gall bladder pathologies are one of the most common surgical conditions surgeons often come across. And cholecystectomy is most commonly performed surgery worldwide, majority for chronic cholecystitis. Objective : Objective of our study was to analyze the different pathological ndings of post cholecystectomy gall bladder specimens submitted to the pathology department of a tertiary care hospital in Kathmandu. Methodology : This is a retrospective study that was carried out in a tertiary care hospital in Kathmandu. The records on histopathology reports of gallbladder specimens were obtained from the pathology department for patients operated from April 2014 to April 2017 Analysis was done in IBM SPSS statistics version 20. Result: Out of the total 1330 histopathological reports of gall bladder specimens, 1063 gall bladder specimens were of female patients and remaining 267 specimens belonged to males. More than 50% of patients were from age group 21 - 40 (female, N=682 and male, N=101). Chronic cholecystitis was the most common nding of the histopathological reports of gall bladder specimens, 1319 (99.2%). Prevalence of carcinoma gall bladder was 0.4%. Conclusion: Histopathological report is essential for the identication of various gall bladder pathologies. Chronic cholecystitis is the most common pathology encountered in cholecystectomy specimen. ABSTRACT 578 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS Age Category (Years) Male Female Total N ( %) N (%) N (%) ≤ 20 7(0.5) 35 (2.6) 42 (3.1) 21-40 101 (7.6) 581(43.7) 682 (51.3) 41-60 129 (9.7) 346(26.0) 475 (35.7) > 60 30 (2.3) 101 (7.6) 131 (9.9) Total 267 (20.1) 1063 (79.9) 1330 Table 2: Disease distribution of Gallbladder *Based on multiple entries (one patient might have multiple gall bladder pathologies) Table 3: Variation of gallbladder disease with age. *Based on multiple entries (one patient might have multiple gall bladder pathologies) Similarly, among the gall bladder polyp cases, the prevalence of cholesterol type poylps were more common (N=9, 52.9%). (Table 4) Among ve cases of carcinoma of gall bladder, the histological differentiation was available for 3 cases, out of which 2 were poorly differentiated and one was well differentiated. Among the miscellaneous ndings, there were eight (47.1%) cases of pyloric metaplasia followed by 5 cases of choledochal cyst. (Table 5) Table 4: Different Types of Polyp Table 5: Miscellaneous ndings in gall bladder histopathology reports Discussion In the present study, gall bladder diseases were found to be common among females compared to males with male to female ratio of 1:4. Similarly, histopathological reports conrmed that majority of the patients who underwent cholecystectomy (99.2%) 3 4 were having chronic cholecystitis. Zoysa et al , Tantia et al and 5 Sharma et al also found male to female ratio of approximately 1:3 in their gall bladder pathology studies. Similarly, chronic cholecystitis 6 was the commonest nding in the studies by Dix et al (95.5%), Pillai 7 5 et al (94.4%), and Sharma et al (86.2%). Whereas, in the studies 8 9 10 done by Sharma JD et al , Tyagi et al and Chauhan et al the occurrence of chronic cholecystitis was around 50%. Carcinoma gall bladder is most common cause of death from billiary 11 malignancy . In current study, occurrence of gall bladder carcinoma was 0.4%. Most of them (3 out of 5) were well differentiated and remaining (2) were poorly differentiated, which is same as the 6 nding of the study by Dix et al (0.4%). This nding is comparable to 5 the study by Sharma et al which found 0.86% case of malignancy in 8 10 9 their study. Sharma J D , Chauhan et al and Tyagi et al found 2.7%, 2% and 6.8% malignancies of gall bladder respectively in their studies. Gall bladder carcinoma is most commonly seen in advancing age. It is seen in the patient of more than 40 years old patient in the present study, which is supported by the nding by the study done by 8 Sharma JD which stated the peak age be 41-60(78%), similarly 12 Bazoua et al showed that malignancy developed in the patients of 10 age more than 50 years, and study by Chauhan et al showed its occurrence mainly in between the age of 40 to 50 years. Acute cholecystitis is rarely encountered condition. Only 0.075% of acute cholecystitis was found in the present study. Other studies 5 also support our ndings. Sharma et al showed 0.94% of acute acalculous cholecystitis and 1.6% acute calculous cholecystitis in 6 9 8 10 their study. Dix et al , Tyagi et al , Sharma J D and Chauhan et al also found only 2.9%, 4.1%, 4.6% and 9% acute cholecystitis respectively in their studies. Histopathology helps to differentiate various pathologies of gall bladder and determine the further management of the patients and its outcome. Major limitation of this study is that it was conducted in only one hospital in Kathmandu, hence the ndings of this study might not represent the national scenario of the problem. However, being the central referral hospital, patients from all over Nepal come for the treatment and hence it may portray the gall bladder pathologies of the Nepalese population as a whole. Nevertheless, we recommend further multicentre study on the same issue for more appropriate nding. Conclusion Histopathological report is essential for the identication of various gall bladder pathologies. Chronic cholecystitis is the most common pathology encountered in cholecystectomy specimen. Acknowledge We would like to thank Pathology Lab of Bir Hospital for providing us the data for the study. We are also thankful to hospital director for granting the approval for this study. We acknowledge the medical students from Kathmandu Medical College who helped us in carrying out this research. Reference 1. Rosai J: Ackerman's Surgical Pathology. New York, NY, Mosby, 1996 2. Jessurun J, Albores-Saavedra J: Gallbladder and extrahepatic biliary ducts, in Damjanov I, Linder J (eds): Anderson's Pathology. New York, NY, Mosby, 1996, pp 1859-1890 3. M I M De Zoysa, S K L A De Silva, A Illeperuma; Is Routine Histological Examination of Gallbladder Specimen;Ceylon Medical Journal March 2010; Vol. 55(1): 13-15. 4. Om Tantia, Mayank Jain, Shashi Khanna, Bimalendu Sen; Incidental Carcinoma Gallbladder During Laparoscopic Cholecystectomy For Symptomatic Gallstone Disease; Surg Endosc. 2009; 23: 2041-2046. 5. Sharma I, Choudhury D. Histopathological patterns of gall bladder diseases with special reference to incidental cases: a hospital based study. Int J Res Med Sci. 2015 Dec;3(12):3553-3557 6. F P Dix, I A Bruce, A Krypcyzk, S Ravi; A Selective Approach To Histopathology Of The Gallbladder Is Justiable; Surg J R Coll Surg Edin Irel. 2003, 1(4): 233-235 7. Pillai V, Sreekantan R, Chisthi M M. Gall bladder stones and the associated histopathology– a tertiary care centre study. International Journal of Research in Medical Sciences. 2017 Apr;5(4):1368-1372) 8. Sharma J D, Kalita I, Das T, Goswami P, Krishnatreya M. A retrospective study of postV IF : 4.547 | IC Value 80.26 olume : 3 | Issue : 11 | November 2014 • ISSN No 2277 - 8179 VOLUME-6, ISSUE-12, DECEMBER-2017 • ISSN No 2277 - 8160 GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS X 579 Histopatholog ical Diagnosis Male Female Total N % (among total of specic diseases) N % (among total of specic diseases) N % (among total patients) Acute Cholecystitis 0 0.0 1 100.0 1 0.08 Chronic Cholecystitis 263 19.9 1056 80.1 1319 99.2 Polyp gallbladder 6 35.3 11 64.7 17 1.3 Carcinoma gallbladder 2 40.0 3 60.0 5 0.4 Miscellaneous 8 47.1 9 52.9 17 1.3 Histopathological Diagnosis Age Category(Years) ≤ 20 21-40 41-60 > 60 Total N (%) N (%) N (%) N (%) N (%) Acute Cholecystitis 0 (0.0) 1 (100.0) 0 (0.0) 0 (0.0) 1 (100.0) Chronic Cholecystitis 42 (3.2) 678 (51.4) 472 (35.8) 127 (9.6) 1319 (100.0) Polyp Gallbladder 0 (0.0) 11 (64.7) 6 (35.3) 0 (0.0) 17 (100.0) Carcinoma Gallbladder 0 (0.0) 1 (20.0) 2 (40.0) 2 (40.0) 5 (100.0) Miscellaneous 2 (11.7) 6 (35.3) 6 (35.3) 3 (17.7) 17 (100.0) Types of Polyp N (%) Cholesterol polyp 9 (52.9) Hyperplastic polyp 1 (5.9) Tubular adenoma polyp 5 (29.4) Not Specied polyp 2 (11.8) Total 17 (100.0) Diseased status under Miscellaneous N (%) Choledochal Cyst 5 (29.4) Fistulous Tract 1 (5.9) Pyloric Metaplasia 8 (47.1) Porcelain Gallbladder 3 (17.7) Total 17 (100.0) operative gall bladder pathology with special reference to incidental carcinoma of the gall bladder. International Journal of Research in Medical Sciences. 2014 Aug;2(3):1050-1053.DOI: 10.5455/2320-6012.ijrms20140871 9. Tyagi SP, Tyagi N, Maheshwari V, Ashraf SM, Sahoo P. Morphological changes in diseased gall bladder: a study of 415 cholecystectomies at Aligarh. J Indian Med Assoc. 1992;90(7):178-81 10. Damor N T, Chauhan H M,Jadav H R.Histological study of human gallbladder. International Journal of Biomedical And Advance Research. (2013) 04 (09). Journal DOI:10.7439/ijbar 11. Greenberger NJ, Paumgartner G. Chapter 311. Diseases of the Gallbladder and Bile Ducts. In Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J (Eds), 'Harrison's Principles of Internal Medicine, 18e.Retrieved November 08, 2014 12. George Bazoua, Numan humza, Taha lazim; Do we need histology for a nor Jan 2017
  • Available Online at http://www.nepjol.info/index.php/ijosh International Journal of Occupational Safety and Health, Vol 5 No 2 (2015) 6 – 10 Introduction Occupation of surgeons is considered as one of the highies risk profession as they are often exposed to various occupational hazards, such as potential contact with infectious agents as serious as human immunodeficiency virus (HIV), hepatitis B, hepatitis C, due to needle stick or direct exposure with body secretions like blood, pus, respiratory secretions. They are also at higher risk for frequently being exposed to radiation.[1]Work related ergonomic hazards and associated musculoskeletal disorders are often overlooked despite being very common among surgeons. Likely explanations for high prevalence of work related musculoskeletal disorders (WRMSD) include repetitive movement, static posture for long time, prolonged exposure to ergonomic risk factors. The term Musculoskeletal disorders (MSD) denotes health problem of locomotor apparatus, i.e. of muscles, tendons, skeleton, cartilage, ligaments and nerves. Musculoskeletal disorders includes all forms of ill-health ranging from light, transient disorder to irreversible & disabling injuries[2].There are various factors responsible for developing WRMSD and associated pain[3].Static posture, repetitive movement, suboptimal lighting condition, poor positioning, genetic predisposition, mental stress, physical conditioning, aging and obesity are some of the risk factors which can result in WRMSD including pain[4]. A large number of research have studied global burden of diseases and injuries related to occupation. Annual incidence of MSDs was estimated to comprise almost 1/3rd of all occupational diseases in the world in 1994, which makes MSDs as the most common occupational disease affecting workers throughout the world [5]. Original Article Work related musculoskeletal disorders among surgeons working in a tertiary care hospital in Kathmandu, Nepal Abstract: Background: Musculoskeletal disorders are common work-related health problems affecting professionals in many sectors. Surgeons are among the most vulnerable as they have to work for long hours in unfavorable posture. Objective: Aim of this study was to determine both prevalence of work related musculoskeletal disorders and types of ailments among surgeons of different sub-specialties in a tertiary care hospital in Kathmandu. Methods: In This cross sectional study was conducted in Bir Hospital, a tertiary care hospital in Kathmandu. A total of 50 surgeons of different sub-specialties were surveyed. Self-reported questionnaires included i) socio-demographic information, ii) Dutch Musculoskeletal Questionnaire on ergonomic hazards and iii) Nordic musculoskeletal disorders questionnaire on pain and discomfort. Data were analyzed using SPSS version 20. Result: Respondents were 40 male and 10 female surgeons with mean age of 38.9 years. Forty-four respondents (88%) reported that their job usually require them to stand for long hours, and41 (82%) also reported that they would work in the same posture for long period of time. In addition, 43 (86%) also reported that they would have to bend their trunk slightly during their job. Thirty-five respondents (70%) reported having at least one musculoskeletal disorder. Twenty-three (65.7%) surgeons had to miss their job at least once during last 12 month of which nineteen (54.3%) missed them in last 7 days. Conclusion: This survey showed that various musculoskeletal ailments were common among surgeons of all sub-specialties in our hospital which is likely one of the common and a serious occupational hazards in this population. Key Words: Work related musculoskeletal disorder, surgeons, Nepal Vaidya A1 , Sainju N K2 , Joshi S K2 1National Academy for Medical Science, Bir Hospital 2 Kathmandu Medical College Corresponding Author: Dr. Anira Vaidya Email: [email protected] © 2015 IJOSH All rights reserved. Original Article / IJOSH/ ISSN 2091-0878 7 Among health care providers, surgeons are always at higher risk of developing work related musculoskeletal disorders. There is paucity of study on WRMSD among surgeon in various sub-specialties. The present study aims to determine prevalence of MSDs in surgeon in terms of perception of pain experienced due to the rigors of their respective professional works. Methods This is a cross sectional study conducted via a survey among surgeons working in a tertiary health care centre in Kathmandu. Self-reporting general questionnaire, Dutch Musculoskeletal Questionnaire [6] and Standard Nordic MSD questionnaire [7], were used for this study. These questionnaires are valid and reliable that include various parameters related to MSD. The survey was conducted among 50 surgeons from various sub-specialties and dental surgeons working in the same hospital. All the surgeons who were working in the hospital actively and full-time basis who volunteered to participate were included in the study. Informed consent was obtained from all the respondents. Data were analyzed by using SPSS version 20. Results The study respondents consisted of 40 male and 10 female surgeons whose mean age was 38.9 years with a range of 29 to 66 years old. They consisted of 22 general surgeons, 7 ENT surgeons, 3 neurosurgeons, 7 orthopedic surgeons, 3 plastic surgeons and 8 dental surgeons. Twenty five (50%) of them had job experience of less than 6 years. Forty one of them reported regularly consuming alcohol and 13 were smokers. Data on workplace ergonomic hazards based on Dutch Musculoskeletal questionnaires that have direct effect on MSDs are presented in Table 1.Forty-four respondents (88%) reported that their job usually require them to stand for long hours, and 41 (82%) also reported that they would work in the same posture for long period of time. In addition, 43 (86%) also reported that they would have to bend their trunk slightly during their job and 41 (82%) had to make repetitive movement with arm, hand or finger during their work. Table 1: Workplace ergonomic hazards based on Dutch Musculoskeletal questionnaires S.N Workplace ergonomic hazards Yes No 1. In the work often have to: -stand for a long periods 44 6 -walk for long periods 11 39 -work in the same postures for long periods 41 9 2. In your work often have to lift: -in an uncomfortable position 31 19 -with the load for away from your body 16 34 -with twisted trunk 29 21 -with the loads above the shoulder level 20 30 -with a load which is difficult to grip or hold 20 30 3. In your work often have to: -bent slightly with your trunk 43 7 -bent heavily with your trunk 8 42 -twist slightly with your trunk 36 14 -twist heavily with your trunk 17 33 -bent and twist simultaneously with your trunk 30 20 4. In your work often have to work: -in a slightly bent posture for long periods 38 12 -in a heavily bent posture for long periods 12 38 - in a slightly twisted posture for long periods 31 19 - in a heavily twisted posture for long periods 11 39 - in a bent and twisted for long periods 15 35 5. In your work often have to: 36 14 - bent your wrist or hold your wrist bent for long periods - twist your wrist or hold your wrist twisted for long periods 22 28 6. In your work often have to make: -same movements with your arms, hands or fingers many times per minutes 22 28 - same movements bending, twisting with your trunk many times per minutes 24 26 - same movements bending, twisting with your head many times per minutes 33 17 7. In your work often have to: -hold your hands at or under shoulder level 33 17 -hold your hands above shoulder level 16 34 - work in uncomfortable posture 26 24 8. Normal breaks sufficient? 35 15 9. Able to take holiday on wish 30 20 10. Your work is physically very strenuous 27 23 11. Your work cause you to perspire or to be out of breath 17 33 12. You are mentally exhausted by your work 26 24 13. You feel tired when you wake up at the start of a new working day 20 30 14. You feel frustrated by your jobs 14 36 15. You mostly enjoy your work 41 9 16. You are much hindered in your work by -noise 28 22 -lack of fresh air 27 23 -dry air 22 28 -changes or extreme of temperature 31 19 -bad smells 35 15 International Journal of Occupational Safety and Health, Vol 5 No 2 (2015) 6 – 10 A. Vaidya et.al. 2015 Tables 2, 3 and 4 are based on Nordic questionnaire on MSDs. Table 2 shows number of respondents who experienced pain in different body parts in last 12 months. It reveals that thirty-five (70%) surgeons had at least one MSD. Twenty-one (60%) of them complained of pain in lower back, 45% neck pain, and 34% elbow pain and so on. Tables 3 and 4 show the information on respondents who missed their normal work because of pain in last 12 months and 7 days respectively. Twenty-three (65.7%) of them missed their normal work at any time during last 12 month and nineteen (54.3%) during last 7 days. Table 2. Pain in different body parts in last 12 months Table 3: Respondents prevented from doing normal work because of pain in last 12 month Table 4: Respondents prevented from doing normal work because of pain in last week Table 5 shows higher odds ratios for various MSDs due to exposure to various work related ergonomic hazards. Except for pain in elbow joint due to holding hands above the shoulder level OR (95% CI)6.780 (1.140, 40.325), other MSDs were not statistically significant. Wrist (45%), Shoulder (20%). Table 5: Odds Ratio (OR) of MSDs due to exposure to work related ergonomic hazards * Statistically significant OR Discussion and conclusion This study has examined work-related musculoskeletal disorders among fifty surgeons from different sub-specialties working in a tertiary care hospital in Kathmandu, Nepal. The respondents were 40 male and 10 female surgeons with mean age of 38.9 years. Twenty-five surgeons had been working for less than 6 years as surgeons. We found that thirty-five surgeons had at least one MSD, of which 60% surgeons complained of pain in lower back, 45% reported neck pain, and 34% reported elbow pain. Similarly, we found that twenty-three (65.7%) of them missed their normal work at any time during last 12 month and nineteen (54.3%) missed them during last 7 days. We performed binary logistic regression to see the odds ratio for various MSDs and work related ergonomic hazards. It showed increased odds ratios for various MSDs due to exposure to various work related ergonomic hazards. But it was statistically significant only for elbow joint pain due to holding hands above the shoulder level [OR (95% CI) 6.780 (1.140, 40.325)]. Doctors have various occupational hazards. MSDs are important occupational health problems, especially for medical and dental surgeons due to static posture, repetitive movements, forceful exertions and precise hand and wrist movement during surgery [8,9]. This study shows that MSD is very common among surgeons, of which lower back pain is the most common ailment. Previous study has also found that low back pain is a common health problem throughout the world which is a major cause of disability among professionals in different occupations[10]. A study involving 400 operating room assistants in the Netherlands reported that the prevalence of back pain was as high as 46%[11].A study conducted among 285 surgeons found Parts of body where pain occurred Yes No Neck 16 34 Shoulders 11 39 Elbows 12 38 Wrists/hands 10 40 Upper back 9 41 Lower back 21 29 Hips/thighs 7 43 Knees 10 40 Ankles/feet 10 40 Parts of body where pain occurred Yes No Neck 5 45 Shoulders 6 44 Elbows 3 47 Wrists/hands 6 44 Upper back 3 47 Lower back 9 41 Hips/thighs 2 48 Knees 5 45 Ankles/feet 5 45 Parts of body where pain occurred Yes No Neck 3 47 Shoulders 3 47 Elbows 1 49 Wrists/hands 6 44 Upper back 5 45 Lower back 6 44 Hips/thighs 3 47 Knees 3 47 Ankles/feet 6 44 Musculoskeletal Disorders Work related ergonomic hazards Odds Ratio (OR) with 95% Confidence Interval (95% CI) Low back pain Standing for long period at work 1.852 (.280, 12.245) Low back pain Lift things in an uncomfortable position 2.050 (.590, 7.118) Low back pain Bent slightly with trunk at work 2.695 (.374, 19.431) Low back pain Bent heavily with trunk 4.923 (.744, 32.584) Low back pain Bent and twist simultaneously with trunk 2.397(.537, 10.698) Pain in elbow Hold the hands above the shoulder level 6.780 (1.140, 40.325)* Pain in wrist/ hand Hold the hands at or under shoulder level 1.097 (.161, 7.491) Pain in wrist/ hand Hold the hands above the shoulder level 1.184 (.143, 9.827) International Journal of Occupational Safety and Health, Vol 5 No 2 (2015) 6 – 10 A. Vaidya et.al. 2015 that over 80% reported experiencing discomfort in the neck, shoulders and back areas [12]. A study conducted among the surgeons doing endourology and laparoscopic surgery revealed that more than 85% experienced musculoskeletal complaints in the past 12 months[13]. Ergonomics is the science of fitting work environment and job demands to the capability of the workers by designing tools, equipment, work stations and tasks to fit the job to the worker not the worker to the job [16]. The objective of ergonomics is to reduce stress and eliminate injuries and disorders associated with overuse of muscles, bad postures and repeated tasks. Risk factors include awkward postures, repetition, material handling, vibration, duration of exposure etc. Workers who spend many hours at a workstation may develop ergonomic-related problems resulting in musculoskeletal disorders (MSDs)[17]. Findings from this study have established association between different workplace ergonomic hazards and musculoskeletal disorders among the surgeons working in a tertiary care hospital in Kathmandu, Nepal. One can suspect that scenario could also be similar in other hospitals in Nepal. Therefore, work needs to be done to reduced ergonomic hazards in hospitals in order to prevent musculoskeletal disorders. This may be achieved by engineering controls and appropriate organizational arrangements. Our emphasis should be in reduction of the mechanical load on locomotor system during surgery, which is also an important measure for the prevention of musculoskeletal disorders [1]. We should think about holistic approach in management of musculoskeletal disorders. There are different techniques that can increase endurance to pain, reduce stress and anxiety levels. Regular physical activity could be very helpful in this regard. Role of practicing Yoga in improving physical and psychological elements, thereby minimizing musculoskeletal pain in doctors has been previously discussed [18]. This is the first research studying WRMSD among surgeons in Nepal, although the same has been studied among dentists previously [14, 15]. This study was designed as a pilot study in a tertiary care hospital in Kathmandu, Nepal to assess prevalence of work related ergonomic hazards and associated musculoskeletal disorders among surgeons. Therefore, we included only 50 surgeons from different sub-specialties working in that hospital. Hence, we could not establish significance of association between risk factor and outcome. Although odds ratio for pain in elbow joint due to holding hands above shoulder level was statistically significant, 95% confidence interval was wide due to small sample size. This is also a limitation of this study. A multi-centre study involving a large group of surgeons and physicians from different specialties would be desirable to establish exact prevalence of workplace ergonomic hazards and associated MSDs. References 1. Tirthankar Ghosh, Occupational Health and Hazards among Health Care Workers;International Journal of Occupational Safety and Health, Vol 3 No 1 (2013) 1– 4. 2. Luttmann A, Jäger M, Griefahn B, Caffier G, Liebers F, Steinberg U. Preventing musculoskeletal disorders in the workplace. Protecting Workers' Health Series. No 5. Geneva: WHO; 2003. 3. Stewart WF, Ricci JA, Chee E, Morganstein D, Lipton R. Lost productive time and cost due to common pain conditions in the US workforce. JAMA. 2003;290:2443–54. 4. Smith DR, Wei N, Zhang YJ, Wang RS. Musculoskeletal complaints and psychosocial risk factors among physicians in mainland China. Int J IndErgon. 2006;36:599–603. 5. Hugo Piedrahita. Costs of Work-Related Musculoskeletal Disorders (MSDs) in Developing Countries: Colombia Case. International Journal of Occupational Safety and Ergonomics (JOSE) 2006; 12(4):379-386. 6. Hilderbrant, V.H., Bongers, P.M., van Dijk, F.J.H., Kemper, H.C.G. and J.Dul (2001) Dutch Musculoskeletal Questionnaire: description and basic qualities, Ergonomics, 44 (12), 1038-1055. 7. Kuorinka I1, Jonsson B, Kilbom A, Vinterberg H, BieringSørensen F, Andersson G, Jørgensen K. Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Applied Ergonomics 1987, 18.3,233-237. 8. Szeto GP, Ho P, Ting AC, Poon JT, Cheng SW, Tsang RC. Work-related musculoskeletal symptoms in surgeons. J OccupRehabil. 2009;19:175–84. 9. Stomberg MW, Tronstad SE, Hedberg K, Bengtsson J, Jonsson P, Johansen L, et al. Work-related musculoskeletal disorders when performing laparoscopic surgery. SurgLaparoscEndoscPercutan Tech.2010;20:49–53. 10. Choobineh, A., Kasson, and Beek. , (2007). Musculoskeletal problems among workers of an Iranian communication company. Indian Journal of Occupational and Environmental Medicine, 11:32-36. 11. Meijsen P, Knibbe HJJ. Work-related musculoskeletal disorders of perioperative personnel in the Netherlands. AORN. 2007;86 (2):193–208. 12. (Wauben et al., 2006) Wauben LSGL, van Veelen MA, Gossot D, GoossensRHM.Application of ergonomic guidelines during minimally invasive surgery: a questionnaire survey of 284 surgeons. Surg Endosc.2006;20:1268–74 . 13. Irene M. Tjiam et al, Ergonomics in Endourology and Laparoscopy:An Overview of Musculoskeletal Problems in Urology.JOURNAL OF ENDOUROLOGY;Volume 28, Number 5, May 2014; DOI: 10.1089/end.2013.0654. International Journal of Occupational Safety and Health, Vol 5 No 2 (2015) 6 – 10 A. Vaidya et.al. 2015 14. Subham S, Yadav RP. Prevalence of low backache in practicing dentists of Eastern region of Nepal. Journal of Universal College of Medical Sciences 2013; 1(04);29-32. 15. Shrestha BP, Singh GK, Niraula SR. Work Related Complaints among Dentists. J Nepal Med Assoc 2008;47 (170):77-81. 16. Bernard BP, editor. U.S. Department of Health and Human Services, Centers for Disease control and Prevention, National Institute of Occupational Safety and Health. Musculoskeletal disorders and workplace factors: a critical review of epidemiologic evidence for work-related musculoskeletal disorders of the neck, upper extremity, and lower back. July 1997. DHHS (NIOSH) Publication No. 97-141. Available from: http://www.cdc.gov/niosh/docs/ 97-141/. 17. Centers for Disease Control and Prevention. Targeting arthritis: improving quality of Life for more than 46 million Americans, at-a-glance 2008. Atlanta, GA: U.S. Department of Health and Human Services, 2008. 18. Sharma P, Golchha V. Awareness among Indian dentist regarding the role of physical activity in prevention of work related musculoskeletal disorders. Indian J Dent Res. 2011; 22:381–4. Jan 2015
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