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

Diagnosis and Management of a Unilateral Posterior Open Bite Using a Temporary Anchorage Device (TAD): Case Report and Review of the Literature

This report describes the diagnosis and successful treatment of a unilateral posterior open bite (POB) in a 15-year-old Caucasian boy. Simple mechanics were used to rule out ankylosis of left posterior teeth as the etiological factor of the POB. Thereafter, the same mechanics were continued to expand the unilateral constricted maxilla, to create a space, and to close POB. Sectional biomechanics were applied to avoid undesirable tooth movements. Then, continuous arch wires were employed to coordinate arches and to achieve treatment objectives

Seasonal variation in the incidence of in-hospital cardiac arrest

Background: Seasonal variation in cardiovascular outcomes, including out-of-hospital cardiac arrest, has been described. Objectives: This study aimed to investigate seasonal differences in the incidence of in-hospital cardiac arrest (IHCA) and associated mortality. Methods: Using National Inpatient Sample data from 2005 to 2019, we determined the incidence of IHCA in 4 seasons. The primary objective was to evaluate overall seasonal trends in the incidence of IHCA and trends stratified by sex, age, and region. The secondary aim was to determine common causes of admission that led to IHCA, differences in those with shockable vs nonshockable IHCA, independent predictors of IHCA, and seasonal variation in IHCA-related in-hospital mortality and length of stay. Results: A consistent winter peak was observed in the incidence of IHCA in both male and female patients over the years in all age groups except young ( Conclusions: Improving insights into factors that influence the higher IHCA event rate during winter may help with proper resource allocation, development of strategies for early recognition of patients vulnerable to IHCA, and closer monitoring and optimization of care to prevent IHCA and improve outcomes

Trends of antihypertensive use among patients with cancer and hypertension in the United States 2002–2019

Background: Hypertension (HTN) is the most frequently reported comorbidity in patients with malignancy. This study was conducted to assess the trend of different antihypertensive (AHT) medications used in cancer patients. Methods: We used the Medical Expenditure Panel Survey (MEPS) database from 2002 to 2019 to identify adult (age >18 years) cancer patients with HTN using appropriate International Classification of Disease (ICD)-9 and ICD-10 codes. Benign and uncertain neoplasms were excluded. P-trend values were calculated using weighted logistic regression with “year” as the predictor variable. Results: We identified ∼46 million adult hypertensive cancer patients with an increasing trend from 2002 to 2019 (3.3 m–6.7 m). Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) use in hypertensive cancer patients increased steadily, while diuretics and combined drugs decreased. Calcium channel blocker (CCB) use increased since 2014–15. In cancer patients with heart failure (HF), beta-blocker (BB) use increased; however, diuretic use peaked in 2014–15 and declined. The use of ACEi/ARB in cancer patients with Diabetes (DM) has increased, whereas BB, CCB, and diuretic use remained stable. Hypertensive cancer patients with Atherosclerotic Cardiovascular Disease (ASCVD) had increased ACEI/ARB use. Combination AHT use has decreased broadly. Conclusion: The ACEI/ARB and CCB use trends increased over the past two decades, whereas diuretics have declined. In cancer patients with DM or ASCVD, the use of ACEI/ARB is trending up. BB use showed an increasing trend in patients with HF. Combined AHT and diuretics use decreased. Total expenditure and out-of-pocket expenditure have a decreasing trend for all AHT medications

Chronic Stress Burden, Visceral Adipose Tissue, and Adiposity-Related Inflammation: The Multi-Ethnic Study of Atherosclerosis

ObjectiveWe investigated the role of chronic stress burden on adiposity and adiposity-related inflammation with two hypotheses: a) greater chronic stress is associated with higher central adiposity and selective accumulation of visceral adipose tissue (VAT) compared with subcutaneous adipose tissue (SAT), and b) associations between VAT and inflammatory biomarkers are exacerbated when chronic stress is high.MethodsData come from 1809 participants included in a Multi-Ethnic Study of Atherosclerosis ancillary study of body composition and adiposity-related inflammation. Chronic psychosocial stress was measured with a five-item version of the Chronic Stress Burden Scale. First, we tested associations between chronic stress (three-level categorical variable) and VAT, SAT, and VAT/SAT ratio. Second, we tested whether associations between VAT and inflammatory biomarkers varied by level of chronic stress.ResultsParticipants were approximately 65 years, 50% female, and 40.5% White, 25.6% Hispanic, 21.2% African American, and 12.8% Chinese American. About half of the sample reported little to no stress, and a quarter and a fifth of the sample reported medium and high levels of stress. Higher levels of chronic stress were associated with greater VAT and SAT, but not VAT/SAT ratio. Greater levels of VAT were associated with increased levels of adiposity-related inflammation in a graded pattern. These associations did not vary by stress level.ConclusionsGreater chronic stress burden is associated with both central and subcutaneous adiposity. We found no evidence that the associations between VAT and inflammatory biomarkers are exacerbated by chronic stress. Findings contribute to ongoing literature untangling pathways in which psychosocial stress contributes to adiposity-related inflammation

Enhancing The Adsorption Capacity of Commercial Kaolin for Efficient Removal of Lead Ions from Aqueous Solutions

The sorption of lead ions (Pb+2) from aqueous solutions using commercial kaolin (KC) was investigated. The effects of various factors such as dosage, different pH media, different concentration, and temperature on the adsorption process were investigated. The Langmuir model was determined to fit the Pb+2sorption model on KC. Langmuir model parameters qm, KL, and R2, were found to be 31.2, 0.0014, and 0.9908 mg.g-1 respectively. The qmax of the Pb+2 on KC was 31.2 mg.g-1 at pH 5.7, 500 mg of KC, and 25?C. Free energy (?G), enthalpy (?H), and entropy (?S) were calculated to understand the nature of the sorption  process. Negative ?G, negative ?H, and positive ?S were found to indicate the adsorption process is non-spontaneous, exothermic, and random, respectively. A pseudo-second-order (PSO) model was followed for the adsorption process. The percentage extractions (%ER) found ranged from 102.5- 90.8 % for stimulation mineral water and tap water samples. This research provides valuable insights for the development of efficient and sustainable methods for water treatment and environmental remediation

A case report of congenital absence of the pericardium that was diagnosed by cardiac computed tomography angiogram (CCTA)

This case report describes a 40-year-old male who presented to the emergency department (ED) with chest pain. Initial diagnostic workup was concerning for a congenital cardiac anomaly, further imaging revealed complete congenital absence of the pericardium (CAP) which is a rare condition. Multimodality cardiac imaging including cardiac computed tomography angiogram (CCTA) was used to confirm the diagnosis of CAP. We briefly discuss various clinical presentations of CAP along with potential complications and other anomalies that could be associated with pericardial agenesis

Treatment Beliefs and Practices towards Low Back Pain among Teachers in Asir Region, Saudi Arabia—A Cross-Sectional Study

The prevalence of low back pain (LBP) is increasing exponentially, with this public health issue affecting over 70% of the population. However, sedentary careers exacerbate the problem further, with professions such as teaching disproportionately affected. In addition, the general population does not seek interventions from medical professionals for LBP; instead, they opt to manage their pain with over-the-counter medications, such as sedatives. The purpose of this study was to explore practices and beliefs related to back pain treatment among schoolteachers in the Asir region. This cross-sectional study included a sample of 312 teachers from the Asir region, with data collected regarding the prevalence of back pain, management approaches, and beliefs surrounding medical interventions. Chi-square or exact tests defined the association between variables, with significance determined at p < 0.05. Our results revealed that 67.3% of Saudi Arabian teachers experienced LBP within the last two months, with a continuous condition representing 36.7% of cases. This study identified several different treatment modalities the participants use to manage their pain, including sedatives, best rest, kaiy (traditional cautery), and local adhesives, with sedatives being the most employed method. It also highlighted that increased daily working hours and total days worked significantly increased the prevalence of LBP (p < 0.05). Although a considerable number of the included teachers were highly educated, with some teaching experience, they had a poor level of awareness and an incorrect attitude towards pain management. Enhanced efforts should be made to improve teachers’ awareness regarding back pain causes and management methods

Anti-Inflammatory Potentials of β-Ketoester Derivatives of N-Ary Succinimides: In Vitro, In Vivo, and Molecular Docking Studies

Inflammation, being a well-known and complex pathological condition, is always a challenge to the human health. This research work was designed for a rationale-based anti-inflammatory study on β-ketoester derivatives of N-ary succinimides. The compounds (A–D) were synthesized by organocatalytic Michael addition. The compounds were initially screened for in vitro 5-lipoxygenase (5-LOX) and cyclooxygenase (COX-2) assays. For the in vivo activity, carrageenan-induced paw edema and arachidonic acid-induced ear edema tests were used. Furthermore, different in vivo pathways such as prostaglandins E2, histamine, leukotriene, and bradykinin were studied. The results were supported with molecular docking studies. Among the compounds, D (ethyl 1-(1-benzyl-2,5-dioxopyrrolidin-3-yl)-2-oxocyclohexane-1-carboxylate) at a concentration of 1000 μg/ml showed significant inhibitory effects of 83.67% and 78.12% against COX-2 and 5-LOX in comparison to celecoxib and zileuton, respectively. Similarly, compound D also showed excellent in vivo anti-inflammatory potential. Amongst all the compounds, D demonstrated excellent (55.92 ± 2.95%) anti-inflammatory potential at maximum tested dose (100 mg/kg) which accomplished the highest significance at 4 h following the carrageenan insertion and stayed considerable (∗∗∗P<0.001) till the 5th hour of test sample injection. Compound D also exhibited excellent percent inhibition (63.81 ± 2.24%) at the highest dose in arachidonic acid-induced ear inflammation. On the basis of in vivo and in vitro results, compound D was subjected to various inflammation-causing agents such as histamine, prostaglandins E2, bradykinin, and leukotriene via the mouse paw edema test. Compound D revealed moderate effect (28.10 ± 1.64%) against histamine-induced paw edema while nonsignificant result (9.72 ± 3.125%) was marked for the bradykinin pathway. Compound D showed significance against edematogenic consequence of prostaglandin E2 (56.28–72.03%) and leukotriene (55.13 ± 2.25%) induced inflammation. In summary, our findings recommended that compound D possesses double acting anti-inflammatory properties inhibiting both COX and LOX pathways. Binding orientations and energy values computed via docking simulations support the results of the experimental in vitro evaluation