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

Using postgenome-wide association study analysis; Vars2-Pic3ca-AKT is novel putative interactive pathway associated with conotruncal heart defects

Background: Genome-wide association studies (GWASs) have identified 43-associated variants with conotruncal heart defects (CTD) at P ≤ 5E-7, P ≤ 5E-6, and P ≤ 5E-5 till January 2018. Despite the GWASs still provide a growing number of associated genetic variants, the identification of their pathogenic mechanisms remains a major challenge in human genetics requiring data mining efforts and predictive models for accurate interpretation of noncoding variants especially. Hence, I applied a post-GWAS analysis approach to identify the possible mechanism of action of noncoding variants associated with CTD according to the latest update of the GWAS catalog. Method: I aimed in this study to conduct a post-GWAS analysis of the most associated noncoding variants with CTD to elucidate its probable pathogenic mechanisms. Through three GWAS traits belong to CTDs, it was used in a variety of integrated and computational algorithms to collect the available information about the selected noncoding variants and its associated partners. Results: It was found differential histone modification, motif binding, and gene expression among the CTD-associated single nucleotide polymorphisms. Through intensive analysis, it was also found that both the linked rs2517582 and rs17189763 haplotype might lead to alteration in the Pic3ca-AKT signal pathway due to a change of CTCF-binding affinity and upregulation of VARS2 gene. Conclusion: It was concluded that the indirect effect of the upregulation VARS2 gene might associates with CTD. Consequently, phosphoinositide 3-kinases/AKT (pic3ca/AKT) pathway has a pivotal role in the signal system of heart morphogenesis

A Novel Loss-of-Sclerostin Function Mutation in a First Egyptian Family with Sclerosteosis

Sclerosteosis is a rare autosomal recessive condition characterized by increased bone density. Mutations in SOST gene coding for sclerostin are linked to sclerosteosis. Two Egyptian brothers with sclerosteosis and their apparently normal consanguineous parents were included in this study. Clinical evaluation and genomic sequencing of the SOST gene were performed followed by in silico analysis of the resulting variation. A novel homozygous frameshift mutation in the SOST gene, characterized as one nucleotide cytosine insertion that led to premature stop codon and loss of functional sclerostin, was identified in the two affected brothers. Their parents were heterozygous for the same mutation. To our knowledge this is the first Egyptian study of sclerosteosis and SOST gene causing mutation

Association between MTHFR C677T variant and risk for congenital heart defects in Egyptian children: a case–control study including meta-analysis based on 147 cases and 143 controls

Abstract Background Stratification analysis studies showed that ethnicity has a significant association regarding MTHFR C677T variant and congenital heart diseases (CHDs) risk, and many published studies have controversial conclusions toward this association. Methods In this study, the association between the MTHFR C677T variant and the risk for CHDs was evaluated in 91 children with CHD and 95 healthy controls, as new cases, by using restriction fragment length polymorphism (RFLP) technique. Besides that, 2 case–control studies in the Egyptian population published before 2021 were included in this meta-analysis. The association was assessed by the odds ratio (OR) with a 95% confidence interval (CI) based on 294 alleles in CHD cases and 286 alleles in controls. Results The overall meta-analysis showed a significant association between MTHFR C677T variant and CHDs risk in Egyptian children with heterogeneity (Heterogeneity = 0.001) in all the genetic models with the highly significant association in T versus C allele (pooled OR 1.89, 95% CI 1.31–2.74; p value < 0.0004). The consistency of the genotypes was detected by Hardy–Weinberg equilibrium (HWE). Conclusions Our results support the MTHFR -677T allele as a susceptibility factor for CHDs in the Egyptian pediatric patients

New drug-like small molecule antagonizes phosphatidylinositol (3,4,5)-trisphosphate (PIP3) in patients with conotruncal heart defects

الملخص: أهداف البحث: عيوب القلب الوعائية وراثية بشكل كبير وحوالي ثلث عيوب القلب الخلقية ناتجة عن عيوب القلب الوعائية. باستخدام التحليل اللاحق لعيوب القلب المخروطية -بيانات دراسة الترابط الجينومي الكامل ذات الصلة، تم افتراض مسار جديد مفترض لنقل الإشارات، يسمى ''فارس2-بك3كا-أ ك ت''، المرتبط بعيوب القلب الوعائية. كنا نهدف بشكل أساسي إلى التحقق من مسار ''فارس2-بك3كا-أ ك ت” بشكل تجريبي باستخدام المقياسين ''فارس2” و ''بيب3” في كل من مرضى عيوب القلب والعينة الضابطة، وإنشاء مثبط ''بيب3''، كواحد من مسببات عيوب القلب الضارة ذات الصلة، باستخدام استراتيجية تصميم الأدوية القائمة على ''أ ك ت''. طرق البحث: تم إجراء التنميط الجيني ''ار اس 2517582” والتعبير النسبي لـ ''فارس2” في 207 أفراد باستخدام تفاعل البلمرة المتسلسل الكمي، إلى جانب ذلك تم أيضا قياس ''بيب3” المحررة فى البلازما لدى 190 فردا باستخدام تقنية المقايسة الامتصاصية المناعية للإنزيم المرتبط. استخدمنا نموذج ميزات ''أ ك ت''-حامل الخاصة الدوائية لاكتشاف خصم ''بيب3” باستخدام أدوات حسابية متعددة وأدوات تقدير شبيهة بالعقاقير. النتائج: تم تأكيد إمراض عيوب القلب الوعائية بسبب فرط التحفيز المفرط لـ ''فارس2-بك3كا-أ ك ت” عن طريق ''فارس2” المرتفع و ''بيب3” في مرضى عيوب القلب الوعائية. حددنا جزيئا صغيرا جديدا، يسمى ''بيسب322''، قادرا على أن يقاوم ارتباط ''بيب3''، وتم منحه الأولوية من خلال الفحص الافتراضي لـ 21 جزيئا صغيرا افتراضيا. أظهر ''بيسب322” الحد الأدنى من التغير النسبى لاختلاف موقع جزيئاته ''رمسد''، وتقارب ربط عال، وثابت تفكك أقل من مجمع بيب3-أ ك ت” بمقدار 1.99 كيلو كالوري/مول مما يؤدي إلى تحول التوازن التفضيلى نحو تكوين معقد ''بيسب322-أ ك ت''. عرضت ''بيسب322” الخصائص الدوائية المقبولة وخصائص تشابه الأدوية وفقا لقاعدة ليبنيسكي و قاعدة امتصاص وتوزيع وتمثيل الغذاء وإفرازه المكونة من خمسة مصنفات. هذا هو أول جزيء محتمل كشبيه علاجى الدواء لمرضى عيوب القلب الوعائية الذين يعانون من ارتفاع ''بيب3''. الاستنتاجات: ''بيب3” هي مؤشرات حيوية تشخيصية مفيدة لمرضى عيوب القلب. يعد نموذج ميزات ''أ ك ت''-حامل الخاصة الدوائية نهجا ممكنا لاكتشاف المزيد من مضادات تأثير''بيب3''. يوصى بإجراء المزيد من اختبارات التطوير لجزئ ''بيسب322''. Abstract: Objectives: Conotruncal heart defects (CTDs) are highly heritable, and approximately one-third of all congenital heart defects are due to CTDs. Through post-analysis of GWAS data relevant to CTDs, a new putative signal transduction pathway, called Vars2-Pic3ca-Akt, associated with CTD has been hypothesized. Here, we aimed to validate the Vars2-Pic3ca-Akt pathway experimentally by measuring Vars2 and PIP3 in patients with CTDs and controls, and to construct a PIP3 inhibitor, as one of harmful-relevant CTD pathogenesis, through an Akt-based drug design strategy. Methods: rs2517582 genotype and relative Vars2 expression in 207 individuals were determined by DNA sequencing and qPCR respectively, and free plasma PIP3 in 190 individuals was quantified through ELISA. An Akt-pharmacophore feature model was used to discover PIP3 antagonists with multiple computational and drug-like estimation tools. Results: CTD pathogenesis due to Vars2-Pic3ca-Akt overstimulation was confirmed by elevated Vars2 and PIP3 in patients with CTDs. We identified a new small molecule, 322PESB, that antagonizes PIP3 binding. This molecule was prioritized via virtual screening of 21 hypothetical small molecules and it showed minimal RMSD change, high binding affinity andlower dissociation constant than PIP3-Akt complex by 1.99 Kcal/Mol, thus resulting in an equilibrium shift toward 322PESB-Akt complex formation. Moreover, 322PESB exhibited acceptable pharmacokinetics and drug likeness features according to ADME and Lipinski's rule of five classifiers. This compound is the first potential drug-like molecule reported for patients with CTDs with elevated PIP3. Conclusion: PIP3 is a useful diagnostic biomarker for patients with CTDs. The Akt-pharmacophore feature model is a feasible approach for discovery of PIP3 signalling antagonists. Further 322PESB development and testing are recommended

DALIA- a comprehensive resource of Disease Alleles in Arab population.

The Arab population encompasses over 420 million people characterized by genetic admixture and a consequent rich genetic diversity. A number of genetic diseases have been reported for the first time from the population. Additionally a high prevalence of some genetic diseases including autosomal recessive disorders such as hemoglobinopathies and familial mediterranean fever have been found in the population and across the region. There is a paucity of databases cataloguing genetic variants of clinical relevance from the population. The availability of such a catalog could have implications in precise diagnosis, genetic epidemiology and prevention of disease. To fill in the gap, we have compiled DALIA, a comprehensive compendium of genetic variants reported in literature and implicated in genetic diseases reported from the Arab population. The database aims to act as an effective resource for population-scale and sub-population specific variant analyses, enabling a ready reference aiding clinical interpretation of genetic variants, genetic epidemiology, as well as facilitating rapid screening and a quick reference for evaluating evidence on genetic diseases