Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Early markers of renal damage in obstructive sleep apnea syndrome (OSAS) patients with or without diabetes mellitus

Background: Although obstructive sleep apnea syndrome (OSAS) has been associated with chronic kidney disease CKD, there are little data about early screening of renal affection in OSAS patients. Aim of the work: To evaluate renal function in OSAS patients with or without diabetes mellitus (DM) using blood indices [mean platelet volume (MPV) and red cell distribution width (RDW)] and serum neutrophil gelatinase associated lipocalin (NGAL) as early markers of kidney injury. Patients and methods: This case control analytic study was designed to enroll 20 OSAS patients with DM, 20 OSAS patients without DM, and 20 non OSAS diabetic patients as control group. All patients underwent full over-night attended diagnostic polysomnography. Those with AHI ≥5 were considered to have OSAS. Laboratory parameters including complete blood count with MPV and RDW, serum glucose, urea, creatinine, Hemoglobin A1c, urine albumin creatinine ratio UACR and serum NGAL were done to all enrolled participants. Results: Urine albumin creatinine ratio UACR ≥ 3 mg/mmol was found in 11 (55%) of OSAS diabetic group, 6 (30%) of non diabetic OSAS group and in 11 (55%) of D.M group. Both diabetic and non diabetic OSAS patients had significantly higher RDW and NGAL compared to non OSAS diabetic. The diabetic OSAS group had also significantly higher serum urea and creatinine compared to DM group. In OSAS patients, RDW had significant positive correlation with UACR. Meanwhile both RDW and NGAL were determined to have significant positive correlation with desaturation index during sleep, but not correlated to AHI. Conclusion: Renal impairment is common in OSAS patients but more frequent if associated with diabetes mellitus. RDW% can be used as simple screening test for early detection of renal injury in OSAS patients with or without diabetes mellitus

Correlation of anti-cardiolipin antibodies with right ventricular systolic strain in systemic lupus erythematosus patients

Introduction: The association between anticardiolipin antibodies (aCL) and cardiac disease in the presence of systemic lupus erythematosus (SLE) has been reported in various clinical trials. However, the correlation between these auto-antibodies and right ventricular (RV) function has been inadequately investigated. Objective: The present study investigated the possible correlation of the plasma anticardiolipin antibodies, as a marker of autoimmune phenomenon, with RV functions, assessed by right ventricular speckle tracking, in patients with systemic lupus erythematosus independent of significant pulmonary hypertension, systolic dysfunction or valvular disease. Methods: Forty-six SLE patients and 20 healthy controls were enrolled in our study and submitted thorough history, complete clinical examination then clinical scoring according to SLEDAI-2K score and then laboratory investigations particularly plasma anticardiolipin Ig_G or Ig_M antibodies. Then echocardiography was done to assess cardiac dimensions, left ventricular systolic functions, right ventricular functions and lastly speckle tracking for assessment of the right ventricular systolic strain. Results: Most of the study patients were young adult females with long-standing SLE (mean = 26 ± 3.1). All study patients had a high clinical SLE score (>6). All patients were normotensives and non-diabetics. No significant correlation was found between anticardiolipin titre and left ventricular dimensions or systolic functions. Significant negative correlation was found between RV strain and plasma level of both anticardiolipin Ig_M and Ig_G. Conclusion: The present study identified that with the use of 2D speckle tracking in patients with SLE, right ventricular systolic function was significantly diminished with rising plasma titre of autoimmune (Ig_G or Ig_M) antibodies independent of cardiovascular risk factors

DNA fingerprinting and drug resistance patterns of active pulmonary Mycobacterium tuberculosis in Mansoura hospitals, Egypt

Increased application of DNA fingerprinting has advanced the understanding of the dynamics of TB epidemiology. Typing of MTB is important for case tracing, and identifying community outbreaks. Objective: We aim to detect pattern of drug resistance and molecular genotypes of MTB at Mansoura hospitals using PCR-RFLP. Methodology: 123 sputum samples obtained from ZN smear positive cases were cultivated on Lowenstein Jensen (LJ) medium, out of them 67 specimens (54.5%) were positive culture. Genotypic analysis was done by the RFLP method after DNA extraction and PCR amplification. The susceptibilities to isoniazid (INH), rifampicin (RIF), streptomycin (STR) and ethambutol (EMB) were determined by the indirect nitrate reductase assay. Results: The identified restriction patterns yielded 3 bands with different sizes and revealed 3 genotypes only. Restriction patterns are equal to 245/125/100 bp, and 245/125/80 bp fragments for Bst EII digests and 155/140/60 bp (MTC), 155/110/70 bp (intracellulare) and 160/140/70 bp (malmoense) fragments for Hae III digest. Genotyping of MTB detected that MTC was the commonest genotype among studied cases 49/67 (73.1%), followed by Mycobacterium intracellulare 14/67 (20.9%), while Mycobacterium malmoense had the least incidence 4/67. There was significant increased risk of resistance to STM, RIF, ETH and INH with M. intracellulare (p = 0.021, p < 0.001, p = 0.001, p < 0.001) while MTC showed lower resistance to STM, RIF, ETH and INH and all M. malmoense isolates showed no resistance. Conclusion: PCR-RFLP was found to be a simple and reproducible method for genotyping of MTB strains and for early detection of Mycobacterium tuberculosis infection