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

FLASH DISSOLVING SUBLINGUAL ALMOTRIPTAN MALATE LYOTABS FOR MANAGEMENT OF MIGRAINE

Objective: Development of sublingual fast dissolving lyophilized almotriptan tablets, to enhance its pre-gastric absorption and so alleviating the gastrointestinal dysmotility that is commonly associated with migraineurs.Methods: Primary almotriptan lyophilized tablets (Alm-lyotab), were prepared using polyvinyl alcohol (PVA), polyvinyl pyrrolidone (PVP), gelatin, or sodium alginate, as a bulk forming agent and mannitol as a disintegrant, cryoprotectant and taste improver. Physical properties, wetting time, in vitro dissolution and disintegration behaviour, were investigated. A combination of PVP, gelatin and chitosan in different ratios with mannitol were developed and characterised for further improvement. Optimised formula was examined by scanning electron microscope (SEM), differential scanning calorimetry (DSC) and Fourier-transform infrared spectroscopy (FTIR).Results: Both PVP and gelatin primary formulations showed elegant appearance with fast in vitro disintegration time of 5.67 and 5.64 sec, short wetting time of 4.06 and 4.05 sec, respectively, and high in vitro release rate of about 80% after 1 min, thus they were selected for further improvement. Optimised formula from polymer blend formulations (F8) which consisted of PVP: gelatin: chitosan in a ratio of its constituting solutions of 1:5:0.5, exhibited an elegant appearance, drug content of 98.75 %, in vivo disintegration time of 1.85 sec and complete drug release within 1 min. SEM micrographs revealed spongy, highly porous structure. DSC results indicated the presence of the drug in its crystalline form. FTIR studies revealed no interaction between the drug and excipients.Conclusion: Sublingual instantly dissolving Almo-lyotab was successfully developed and may constitute an advance in the management of acute migraine attacks

Nanocarrier Drug Delivery Systems: Characterization, Limitations, Future Perspectives and Implementation of Artificial Intelligence

There has been an increasing demand for the development of nanocarriers targeting multiple diseases with a broad range of properties. Due to their tiny size, giant surface area and feasible targetability, nanocarriers have optimized efficacy, decreased side effects and improved stability over conventional drug dosage forms. There are diverse types of nanocarriers that have been synthesized for drug delivery, including dendrimers, liposomes, solid lipid nanoparticles, polymersomes, polymer–drug conjugates, polymeric nanoparticles, peptide nanoparticles, micelles, nanoemulsions, nanospheres, nanocapsules, nanoshells, carbon nanotubes and gold nanoparticles, etc. Several characterization techniques have been proposed and used over the past few decades to control and predict the behavior of nanocarriers both in vitro and in vivo. In this review, we describe some fundamental in vitro, ex vivo, in situ and in vivo characterization methods for most nanocarriers, emphasizing their advantages and limitations, as well as the safety, regulatory and manufacturing aspects that hinder the transfer of nanocarriers from the laboratory to the clinic. Moreover, integration of artificial intelligence with nanotechnology, as well as the advantages and problems of artificial intelligence in the development and optimization of nanocarriers, are also discussed, along with future perspectives

Phytotoxic and Antimicrobial Activities of Teucrium polium and Thymus decussatus Essential Oils Extracted Using Hydrodistillation and Microwave-Assisted Techniques

Essential oils (EOs) have been described as promising eco-friendly secondary products of aromatic plants with several biological activities. The present study aimed to characterize the chemical composition and explore phytotoxic and antimicrobial activities of Teucrium polium and Thymus decussatus EOs extracted using hydrodistillation (HD) and microwave-assisted extraction (MAE) methods. Twenty-seven and twenty-eight compounds were identified from HD and MAE extracted EOs of T. polium, respectively. The oxygenated sesquiterpenes (57.68%) were characterized as the main components of the hydrodistilled EO with a prominence of 6-epi-shyobunol (33.00%), while sesquiterpene hydrocarbons (54.48%) were the main components of the MAE method, with a prominence of delta-cadinene (25.13%). Eighteen and nineteen compounds, were characterized in T. decussatus EOs extracted using HD and MAE methods, respectively, and oxygenated monoterpenes represented the main components of both EOs with carvacrol (94.40% and 75.91%, respectively) as the main compound. The EOs extracted using the MAE method were slightly more phytotoxic than those extracted using the HD method. The T. decussatus EO extracted using the MAE method showed a higher inhibitory effect than T. polium by 16-, 32-, and 24-fold, regarding seed germination, shoot, and root growth of lettuce, respectively. Moreover, EOs extracted by HD method showed a similar pattern with 16-, 28-, and 14-fold effects. Both T. decussatus EOs exhibited potent inhibitory effect against all tested bacteria with an inhibition zone of 34–39 mm and the lowest minimum inhibitory concentration (MIC) of 0.49, 0.98, and 1.95 μg/mL against Aspergillus niger, Escherichia coli, and Staphylococcus aureus, respectively. However, the EOs of T. polium showed weak antibacterial activity and no antifungal effect. Further studies are needed for the characterization of bioactive major compounds, either singular or synergistic, at field scale and to determine their modes of action and safety