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

Dietary effect of soybean lecithin on the growth performance, digestive enzyme activity, blood biomarkers, and antioxidative status of striped catfish, Pangasianodon hypophthalmus.

Soybean lecithin (SBL) is usually added to aquafeed as a lipid source because aquatic animals cannot synthesize phospholipids. Hence, this study aimed to investigate the role of SBL on the growth, nutrient consumption, digestive enzyme activity, blood parameters, and antioxidant capability of striped catfish. The fish were fed on five experimental diets with five grading levels of SBL (0, 2, 4, 6, and 8%) for 60 days. The final weight, weight gain, specific growth rate, feed intake, and protein efficiency ratio were markedly higher in striped catfish treated with 2-4% SBL than the control level (0% SBL). However, the lowest feed conversion ratio was in the fish-fed groups of 4-6% SBL. The carcass lipid content was significantly higher in fish fed 2-4% SBL compared to the control level (0% SBL). The lipase, amylase, and protease activities were significantly increased in the fish fed 2-6% SBL compared to 0% SBL-fed group. The gradually increased levels of SBL improved the structural appearance and increased the intestinal villi length and branching appearance. The triglycerides and total cholesterol were increased in the fish fed with 4, 6, and 8% compared to the control level, with the highest being in the fish fed with 8%. The lysozyme activity was higher in the fish fed with 2, 4, and 6% of SBL compared to the control level, with higher activity in the fish fed with 2 and 4% than 6%. Superoxide dismutase, glutathione peroxidase, and catalase activities were increased in the fish fed with 2, 4, and 6% SBL. The malondialdehyde level was lower in the fish fed with 4-6% SBL compared to the control level. The regression analysis revealed that the optimum dose of SBL is required at 3.65-4.42% for better productivity and health performances in striped catfish

Multi-phasic CT versus dynamic contrast enhanced MRI in characterization of parotid gland tumors

Objective: Salivary gland tumors are challenging as regards preoperative diagnosis. The aim of our study was to highlight the value of multiphasic CT and contrast enhanced dynamic MRI in characterization of benign and malignant parotid tumors as well as to compare diagnostic accuracy of both modalities. Patients and methods: Study group included 45 patients (54 lesions), 26 males and 19 females, their age ranged from 24 to 78 years. All patients underwent both CT and MRI examinations. Time intensity (or attenuation) curve for each lesion is analyzed and compared with the final post-operative pathology. Results: Type of the curve on dynamic contrast enhanced MRI had high sensitivity, specificity, positive predictive, negative predictive values and accuracy in characterization of benign and malignant parotid tumors (94.4%, 97.2%, 94.4%, 97.2%, and 96.3% respectively). Also, curve analysis on multiphasic CT revealed similar high sensitivity, specificity, positive predictive, negative predictive values and accuracy as compared to DCE-MRI (92.6%, 96.3%, 92.6%, 96.3%, and 95.1% respectively). Conclusion: Both dynamic contrast enhanced MRI and multiphasic CT have comparable high accuracy in characterizing the different histological types of parotid gland tumors

Malocclusion and Temporomandibular Disorders: Verification of the Controversy

Aims: To investigate the dental and skeletal aspects of malocclusion in the anteroposterior and vertical dimensions in a sample of temporomandibular disorders (TMD) patients and to correlate these aspects with the signs and symptoms of TMD. Methods: A total of 150 TMD patients were divided into five groups according to the Diagnostic Criteria for TMD: Group 1 = myalgia (M); Group 2 = disc displacement with reduction (DDWR); Group 3 = disc displacement without reduction (DDWOR); Group 4 = degenerative disorders (D); and Group 5 = subluxation (S). Molar and canine relations, overjet, overbite, occlusal guidance, occlusal interferences, and centric slides were recorded for each patient, and the skeletal craniofacial patterns were analyzed for each patient using cone beam computed tomography. One-way analysis of variance was used to compare the variable means of the different groups. Pearson correlation coefficient was used to assess the correlations of quantitative continuous variables. Significance level was considered at P < .05. Results: No significant difference was found among the groups regarding any aspects of dental occlusion except for mediotrusive interferences, which were significantly higher in Group 3 (DDWOR) (P = .02). Regarding skeletal craniofacial pattern, Group 4 (D) had significantly smaller mean ± standard deviation sella-nasion-B (SNB) point angle (74.31 ± 3.04 degrees) than Group 3 (DDWOR) (78.04 ± 4.88 degrees), and Group 1 (M) showed the greatest SNB angle (79.87 ± 3.73 degrees) (P = .03). Group 3 (DDWOR) showed significantly greater mean mandibular plane/SN angle (39.56 ± 6.19 degrees) than Group 1 (M) (34.73 ± 5.65 degrees) (P = .04). Relations between occlusal variables and TMD parameters were nonsignificant. Conclusion: This study provides robust evidence to diminish the TMD-malocclusion association, especially in myogenic types of TMD. © 2019 by Quintessence Publishing Co Inc

Synergistic effect of Aminoguanidine and L-Carnosine against Thioacetamide-induced Hepatic Encephalopathy in rats: Behavioral, Biochemical and Ultra Structural Evidences

Hepatic encephalopathy (HE) depicts the cluster of neurological alterations that occur during acute or chronic hepatic injury. This study was aimed to evaluate the possible synergistic effect between aminoguanidine (AG; 100 mg/kg; p.o.) and l-carnosine (CAR; 100 mg/kg; p.o.) on HE that was induced by thioacetamide (TAA; 100 mg/kg; i.p) thrice weekly for six weeks. Twenty-four hours after the last treatment; behavioral changes, biochemical parameters, histopathological analysis, immunohistochemical and ultrastructural studies were conducted. Combining AG with CAR improved TAA-induced locomotor impairment and motor incoordination evidenced by; reduced locomotor activity and decline in motor skill performance as well as ameliorated cognitive deficits. Moreover, both drugs restored the levels of serum hepatic enzymes as well as serum and brain levels of ammonia. In addition to, the combination significantly modulated hepatic and brain oxidative stress biomarkers, inflammatory cytokines and cleaved caspase-3 expression. Furthermore, they succeeded to activate nuclear erythroid 2-related factor 2 (Nrf2) expression and ameliorate markers of HE including hepatic necrosis and brain astrocyte swelling. This study depicts that combining AG with CAR exerted new intervention for hepatic and brain damage in HE due to their complementary antioxidant, anti-inflammatory effect and hypoammonemic effects via Nrf2/HO-1 activation and NO inhibition.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author

Blood biochemical indices of striped catfish fed dietary soybean lecithin for 60 days.

Blood biochemical indices of striped catfish fed dietary soybean lecithin for 60 days.</p

Fig 2 -

Histomorphology of the middle intestine of striped catfish in the control fish (A; 0%) and gradually increased levels of soybean lecithin (B, C, D, E; 2, 4, 6, 8% respectively) showing evident enrichment and branching of intestinal villi (blue arrowhead) by increased levels of soybean lecithin in the supplemented diet. Stain H&E. Bar = 100 μm.</p

Blood immunity and antioxidative responses of striped catfish fed dietary soybean lecithin for 60 days.

Blood immunity and antioxidative responses of striped catfish fed dietary soybean lecithin for 60 days.</p

Growth performance of striped catfish fed dietary soybean lecithin for 60 days.

Growth performance of striped catfish fed dietary soybean lecithin for 60 days.</p

Carcass composition of striped catfish fed dietary soybean lecithin for 60 days.

Carcass composition of striped catfish fed dietary soybean lecithin for 60 days.</p