Akbar Jaleel Zubairi

Factors associated with burnout among residents in a developing country

Introduction Recent literature has focused on burnout as a specific job related distress syndrome among physicians and residents having adverse effects on patient care. Local data on burnout is lacking. Materials & methods An online self-administered questionnaire was sent via email to all residents (325) at our institute with and a response rate of 110 (34%) was achieved. Out of these 82 residents consented and completely filled the questionnaires and were included in the analysis. The questionnaire comprised of demographic variables, the Maslach burnout inventory and occupational risk factors. Results High levels of burnout on at least one subscale were reported by 61(74.4%) residents, in 2 components by 34(41.5%) whereas an alarming 10(12.2%) residents scored high on all three subscales. Among the individual subscales emotional exhaustion was most frequent in 49(59.8%). Among the departments Radiology reported the highest levels (100%) of burnout and low levels were reported by Pediatrics (45%). There was no difference between burnout levels among junior and senior residents. Dissatisfaction with workload, length of work hours, relationship with co-workers and lack of autonomy were significantly associated with high level of burnout. Conclusion High levels of burnout are prevalent among trainee doctors in our part of the world which are comparable with international literature. Efforts to improve the work environment of residents may significantly reduce levels of burnout.

Long Term Follow-Up of a Successful Lower Limb Replantation in a 3-Year-Old Child

Replantation of the lower extremity has controversial indications but nevertheless it may be considered in carefully selected patients who present early and are expected to show good functional recoveries. Here we present a successful replantation in a 3-year-old boy who has made excellent recovery with no functional deficit evident at 12 years of follow-up. He sustained a traumatic amputation at the level of distal tibia when he fell of a “Qing Qi” (motorcycle rickshaw). Replantation was attempted at 8 hours cold ischemia time with the tibia shortened 4 cm and all tendons, vessels, and nerves repaired. Patient required a second procedure during the same hospital stay for skin coverage. Patient made good recovery with ambulation without support at 6 months, less than 3 cm limb length discrepancy, plantar and dorsiflexion power 4/5, and recovery of sensation over the foot. Now at 12 years of follow-up patient has a normal gait and has integrated into society with no functional deficit. Considering the functional outcome of our case, replantation should be attempted whenever possible and feasible especially in children.

Proximal Femur Locking Plate for Sub-Trochanteric Femur Fractures: Factors Associated with Failure

Introduction: Proximal femur locking compression plates (PF-LCP) have gained popularity since their inception due to superior biomechanical stability and durability but clinical experience has shown conflicting results including implant failure. Objective: To study the incidence of implant failure in patients with sub-trochanteric fractures managed with proximal femoral locking compression plate and identify potential risk factors associated with the failure. Materials & Methods: Fifty patients with sub-trochanteric fractures, operated upon with titanium PF-LCP were included in the study from January 2012 to December 2014. These plates were of two designs including one five 5.0 mm proximal locking screws (implant A) and other with three 6.5 mm proximal locking screws (implant B). Fractures were classified according to AO/OTA and Seinsheimer classification. Patients had regular follow-up visits for at least a year, allowing for clinical and radiological assessment of union and implant-related complications. Results: A total of 13 out of 50 (26%) plates failed of which 7 were implant fractures, 3 screw breakage and 3 screw cut outs. 70% of the failures occurred in elderly females. Overall implant failure was significantly more common in patients >50 years (p 0.04). Comparing the two different designs of implants used, implant A was more likely to fail at a plate screw density of 0.8 or more (p 0.02), whereas implant B was associated with significant failure when less than 4 proximal screws were used (p 0.03). Conclusion: This study revealed a high failure rate (26%) of this implant. Attention to the neck shaft angle difference, number of proximal screws and plate screw density may help reduce failure rates, particularly in elderly osteoporotic females.