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

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

Influence of antepartum administration of immunopotentiators on reproductive efficacy of buffalo and viability of their newborn

The authors determine the efficacy of prepartum immunopotentiators administered during late gestation on postpartum fertility, IgG levels and calf viability. Fifty buffalo were divided into five groups (10 animals in each group). Group I was the control group. Each animal in Group II received 30 ml intramuscularly of viteselen (1.7 mg sodium selenium and 150 mg vitamin E/ml). Each animal in Group III received a subcutaneous injection of bacillus Calmette-Guérin (BCG) at 0.5 ml. In Group IV, each animal received 12.5 ml of levamisole hydrochloride intramuscularly, while those in Group V received 10 ml of ultra-corn subcutaneously. The immunopotentiators were administered according to each group 60 days prior to the anticipated date of parturition. Postpartum fertility was assessed by close observation and rectal examination after parturition. Colostrum from the dams and sera from the newborn were collected to estimate the level of immunoglobulin (IgG). Body weight, growth rate and viability of the calves were recorded after parturition. Prepartum treatment with viteselen reduced the period of foetal membrane expulsion by 2 h compared to the other groups. Concomitantly, the uterine involution period was significantly shorter in animals treated with viteselen and ultra-corn than in the other groups. Injection of viteselen, BCG or ultra-corn significantly reduced the calving to the first oestrus interval and length of postpartum service period (by 57, 54, 48 days and 67, 57, 44 days, respectively) than the levamisole group. The IgG level was significantly higher in both the colostrum of the dam and in newborn serum after administration of immunopotentiating agents. Furthermore, the viteselen injection resulted in a significantly higher level of IgG in both dam colostrum (at parturition) and calf serum in comparison to the other groups. The calves from viteselen and ultra-corn treated dams showed a higher growth rate and better health condition than the controls. Prepartum administration of immunopotentiators appears to be beneficial, promising and offer improvements to postpartum reproductive performance and calf viability in Egyptian buffalo. Finally, additional work involving a larger number of animals is suggested

Synthesis of indanones by sequential Heck-reduction-cyclization-alkylation (HRCA) reactions

A simple and efficient synthesis of indanones, bearing a quaternary carbon centre, has been developed. The method features, in a one-pot process, the use of a multi-task palladium catalyst for the sequential Heck-reduction reactions, followed by a base-mediated cyclization-allcylation sequence. This methodology, called Heck-reduction-cyclization-allcylation (HRCA), is carried out under mild and simple experimental conditions with the use of inexpensive reagents. The mild conditions have been made possible by the use of diazonium salts that allow Heck couplings at moderate temperature (40 degrees C) under ligand-free conditions. (C) 2011 Elsevier Ltd. All rights reserved