Study design: A cross-sectional study among health care providers working at one hospital. Objective: To investigate the prevalence, the consequences and the risk factors associated with low back pain (LBP) among hospital staff. Materials and Methods:The study sample consisted of 931 health care providers who answered a pre-established questionnaire including 30 items in two languages. Results:The cumulative life-prevalence of LBP was 72.5% and the yearly prevalence was 56.9%. Chronic LBP prevalence was noted 5.1% of the cases. Treatment was sought in 34.1% of LBP sufferers and 7.3% required sick leave or absence from work due to LBP. Risk factors associated with LBP were professional categories, bad body posture, lifting objects or patients and the increased levels of lifting, levels of job satisfaction and stressful job demands. Conclusion: There was a high prevalence of LBP among hospital staff, resulting in significant medical and socio-professional consequences. Many risk factors were identified that would necessitate multidisciplinary involvement to reduce the LBP incidence and related costs. Key Words: Low Back Pain (LBP); Hospital Members of Staff; Prevalence; Consequences; Risk Factors INTRODUCTIONLow back pain (LBP) is a very frequently occurring phenomenon. Among adults in the general population, 70-85% were believed to experience at least one episode of low back pain at some time during their lives 1 . The direct and indirect costs of LBP in terms of quality of life, productivity, and employee absenteeism are enormous, making this common condition the single largest contributor to musculoskeletal disability world wide 2 . LBP is associated with multiple risk factors, including gender, age, lifestyle, psychosocial profile, physical demands of the workplace, social support, and pain perception 3 . Hospital workers seem to have higher rates of LBP compared to the general population due to physical and emotional factors involved in their occupation, such as stress 4,6 . These rates are not well established in Malaysia. Hence, this purpose of this study was to estimate the prevalence of LBP among hospital workers in a hospital, query as to its consequences and to identify the risk factors associated with the LBP in this population. MATERIALS AND METHODSSelf-administered questionnaires were used in this survey. For the purposes of this study, health professionals were defined as the 8 largest groups of direct care providers in this hospital: doctors, staff nurses, community nurses, assistant medical officers, attendants, radiographers, physiotherapists and occupational therapists. Staff members in these categories were invited to complete a standardized questionnaire composed of 30 items. The investigation took place over a period of 2 months (from Jan to February 2010). For the survey, LBP was defined as a mechanical pain of the lower part of the back. LBP associated with thigh or buttock pain radiating down the lower limb was also acceptable. Chronic LBP was defined by pain lasting for more than ...

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Up to 50% of recurrences of ductal carcinoma in situ of the breast are associated with invasive carcinoma but no pathological or molecular features have yet been found to predict for the development of invasive disease. For a tumour to invade, it requires the formation of new blood vessels. Previous studies have described a vascular rim around ducts involved by ductal carcinoma in situ, raising the possibility that the characteristics of periductal vascularisation may be important in determining transformation from in situ to invasive disease. Periductal vascular density and phenotype were determined using morphometry and a panel of anti-endothelial antibodies (von Willebrand factor, CD31, CD141 and CD34) and related to the presence of invasive carcinoma and other histological features. Compared to normal lobules, pure ductal carcinoma in situ exhibited a greater density of CD34 + and CD31 + vessels but a decrease in those that were immunopositive for vWF, indicating a difference in phenotype and in density. Ductal carcinoma in situ associated with invasive carcinoma showed a profile of vascular immunostaining similar to that of pure ductal carcinoma in situ but there were significantly greater numbers of CD34 + and CD141 + vessels and fewer staining for vWF. There was a significant negative correlation between vascular density and both the cross-sectional areas of the ducts involved and the extent of the necrosis of the tumour they contained. A correlation between vascular density and nuclear grade was also noted, being highest in the intermediate grade. The greater density of CD34 + and CD141 + vessels around ductal carcinoma in situ associated with invasive carcinoma could reflect a greater predisposition to invade but a direct effect of co-existent invasive carcinoma cannot entirely be ruled out in the present study. The relationship between vascular density, grade, duct size and nuclear grade suggests that periductal angiogenesis increases with tumour growth rate but is unable to keep pace with the most rapidly growing lesions.

Purpose:Lower extremity amputation prevention (LEAP) is an ongoing program in our institution aimed at salvaging limbs in patients with critical limb ischemia (CLI). Patients in the LEAP program with reconstructible anatomy on initial Doppler imaging received either bypass surgery or percutaneous transluminal balloon angioplasty (PTA). We present the 3 year limb salvage rate and angiographic disease patterns in 42 consecutive diabetic patients with CLI who received PTA in 2005.Methods and Material:26 women and 16 men with diabetes between the ages of 45 and 91 years old (mean age, 70.8 years) received PTA in 2005. Presenting symptoms were rest pain (n = 22), pre-existing gangrene (n = 17), non-healing ulcer (n = 16) and cellulitis (n = 2). The aim of the PTA was to achieve straight-line flow from the abdominal aorta down to the patent dorsalis pedis or plantar arch, with limb salvage as the ultimate outcome. Failure of treatment was defined as any amputation above the level of a Syme’s amputation or the need for further surgical bypass. Technical success was achieved in 90% (38 out of 42 patients).Results:Limb salvage rates were 93% at 1 month, 87% at 3 months, 82% at 6 months, 78% at 1 year, 69% at 2 years and 66% at 3 years. Mortality was 17% (n = 7) at 3 years. Of the 13 patients with failed therapy, 3 underwent bypass, 9 had amputations and 1 had bypass followed by amputation. Four of the cases required further intervention due to worsening gangrene and infection, while the remaining was due to persistent rest pain. The rest of the 32 patients had no lower limb related issues at the end of 3 years, with improvement of the presenting symptoms. Patterns of treated segments were aortoiliac occlusions (n = 3), pure infrapopliteal disease (n = 3), femoropopliteal with at least 1 good infrapopliteal run-off vessel (n = 14) and combined femoropopliteal and infrapopliteal disease (n = 25).Conclusion:Involvement of infrapopliteal vessels that needs to be treated is common in Asian diabetics. While early limb salvage rates up to 1 year are similar, the 3 year limb salvage rates in Asian diabetics are lower than the western population.