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

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

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

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

Human Lung Cancer (A549) Cell Line Cytotoxicity and Anti-Leishmania major Activity of Carissa macrocarpa Leaves: A Study Supported by UPLC-ESI-MS/MS Metabolites Profiling and Molecular Docking

Lung cancer and cutaneous leishmaniasis are critical diseases with a relatively higher incidence in developing countries. In this research, the activity of Carissa macrocarpa leaf hydromethanolic extract and its solvent-fractions (n-hexane, EtOAc, n-butanol, and MeOH) against the lung adenocarcinoma cell line (A549) and Leishmania major was investigated. The MeOH fraction exhibited higher cytotoxic activity (IC50 1.57 &plusmn; 0.04 &mu;g/mL) than the standard drug, etoposide (IC50 50.8 &plusmn; 3.16 &mu;g/mL). The anti-L. major results revealed strong growth inhibitory effects of the EtOAc fraction against L. major promastigotes (IC50 27.52 &plusmn; 0.7 &mu;g/mL) and axenic amastigotes (29.33 &plusmn; 4.86% growth inhibition at 100 &mu;g/mL), while the butanol fraction exerted moderate activity against promastigotes (IC50 73.17 &plusmn; 1.62), as compared with miltefosine against promastigotes (IC50 6.39 &plusmn; 0.29 &mu;g/mL) and sodium stibogluconate against axenic amastigotes (IC50 22.45 &plusmn; 2.22 &mu;g/mL). A total of 102 compounds were tentatively identified using UPLC-ESI-MS/MS analysis of the total extract and its fractions. The MeOH fraction was found to contain several flavonoids and flavan-3-ol derivatives with known cytotoxic properties, whereas the EtOAc fractions contained triterpene, hydroxycinnamoyl, sterol, and flavanol derivatives with known antileishmanial activity. Molecular docking of various polyphenolics of the MeOH fraction with HDAC6 and PDK3 enzymes demonstrates high binding affinity of the epicatechin 3-O-&beta;-D-glucopyranoside and catechin-7-O-&beta;-D-glucopyranoside toward HDAC6, and procyanidin C2, procyanidin B5 toward PDK3. These results are promising and encourage the pursuit of preclinical research using C. macrocarpa&rsquo;s MeOH fraction as anti-lung cancer and the EtOAc fraction as an anti-L. major drug candidates

The Sorption of Erythrosine E127 Dye onto Commercial Kaolin Thermokinetic Studies

In this study, a highly efficient and economical method was used to remove E127 dye using commercial kaolin (CK) as the adsorbent. The optimal pH for adsorption was found to be 4.7, and the maximum surface concentration of the dye was 53.8 mg.g-1 when 125 mg of adsorbent was used. The Freundlich isotherm was used to describe the adsorption process, which suggested that the active sites in the adsorption process were randomly selected. The adsorption capacity (qmax), enthalpy (?H), and entropy (?S) were calculated to be 74.6 mg.g-1, -12.3 KJ.mol-1, and 75.0 J.mol-1, respectively. Both thermodynamic and kinetic analyses indicated that the adsorption process was spontaneous, involved physical adsorption, and followed the pseudo-second-order (PSO) model. The method was effective in extracting the E127 dye up to four times

Ocular Complications after COVID-19 Vaccination: A Systematic Review

Background and Objectives: The COVID-19 pandemic affects various populations worldwide. The discovery of vaccinations was necessary for the prevention and elimination of the disease. Despite the high importance of these vaccinations, they may cause some complications, such as ocular complications. This study aims to draw attention to the possible complications of the vaccination and highlight its importance. Materials and Methods: Systematic review of the literature from January 2021 to January 2023. A total of 20 published articles were included and reported cases of ocular complications in patients who received COVID-19 vaccines. Results: A total of 243 patients with verified ocular complications following the COVID-19 vaccination were included, ranging in age from 18 to 84 years. The most common ocular complications reported in the current study were ocular inflammatory complications, which represented 47.3%, followed by optic neuritis (24.3%). Retinal artery occlusion, retinal vein occlusion, acute macular neuroretinopathy, and paracentral acute middle maculopathy represented 10.7%. Herpetic ocular infections and herpetic eye disease (14%). Nearly half (42%) of the patients with ocular problems received the Pfizer-BioNTech vaccination. Conclusions: Despite the high importance of the COVID-19 vaccination, it was found that it is associated with the occurrence of some ocular complications. Future projects should come with more extensive prospective studies to further elucidate the underlying mechanisms and risk factors associated with ocular complications following COVID-19 vaccination, thereby enhancing our understanding and guiding appropriate management strategies

Juglone from Walnut Produces Cardioprotective Effects against Isoproterenol-Induced Myocardial Injury in SD Rats

Therapeutic and/or preventive interventions using phytochemical constituents for ischemic heart disease have gained considerable attention worldwide, mainly due to their antioxidant activity. This study investigated the cardioprotective effect and possible mechanism of juglone, a major constituent of the walnut tree, using an isoproterenol (ISO)-induced myocardial infarction (MI) model in rats. Rats were pretreated for five (5) days with juglone (1, 3 mg/kg, i.p) and atenolol (1 mg/kg, i.p) in separate experiments before inducing myocardial injury by administration of ISO (80 mg/kg, s.c) at an interval of 24 h for 2 consecutive days (4th and 5th day). The cardioprotective effect of juglone was confirmed through a lead II electrocardiograph (ECG), cardiac biomarkers (cTnI, CPK, CK-MB, LDH, ALT and AST) and histopathological study. The results of our present study suggest that prior administration of juglone (1 and 3 mg/kg) proved to be effective as a cardioprotective therapeutic agent in reducing the extent of myocardial damage (induced by ISO) by fortifying the myocardial cell membrane, preventing elevated T-waves, deep Q-waves in the ECG, heart to body weight ratio, infarction and also by normalizing cardiac marker enzymes (cTnI, CPK, CK-MB, LDH, ALT and AST) and histopathological changes, such as inflammation, edema and necrosis. In conclusion, this study has identified phytochemical constituents, in particular juglone, as a potential cardioprotective agent

Fluoroquinolones as Tyrosinase Inhibitors; Enzyme Kinetics and Molecular Docking Studies to Explore Their Mechanism of Action

The binding of fluoroquinolones, the most commonly prescribed antibiotics, with melanin is well explored. However, their binding patterns and exact mechanism of interaction with tyrosinase, a key enzyme in melanogenesis, are not explored yet. Thus, in the present study, seven fluoroquinolone drugs were selected to characterize their interactions with the tyrosinase enzyme: ciprofloxacin, enoxacin sesquihydrate, ofloxacin, levofloxacin, sparfloxacin, moxifloxacin and gemifloxacin. The results confirmed that all the drugs execute excellent enzyme activity, with an inhibition range from IC50 = 28 ± 4 to 50 ± 1.9 μM, outperforming the standard hydroquinone (IC50 = 170 μM). Later, kinetic studies revealed that all the drugs showed irreversible, but mixed-type, tyrosinase inhibition, with a preferentially competitive mode of action. Further, 2D and 3D docked complexes and binding analyses confirmed their significant interactions in the active region of the target enzyme, sufficient for the downstream signaling responsible for the observed tyrosinase inhibition. Thus, this is the first report demonstrating their mechanism of tyrosinase inhibition, critical for melanin-dependent responses, including toxicity

Statistical Study of Nonthermal Plasma-Assisted ZnO Coating of Cotton Fabric through Ultrasonic-Assisted Green Synthesis for Improved Self-Cleaning and Antimicrobial Properties

Nonthermal plasma processing is a dry, environment-friendly and chemical-free method of improving the wettability, adhesion, self-cleaning and dying quality of fabrics without affecting their bulk properties. This study presents a green synthesis and coating method for the immobilization of nanoparticles of ZnO on the nonthermal plasma functionalized cotton fabric. The self-cleaning activity of ZnO-coated cotton was then optimized statistically. The ultraviolet protection and antimicrobial activity of the optimized and a control sample were also elaborated in this study. Psidium guajava Linn (guava) plant extract and zinc chloride were used in the ultrasonic biosynthesis of ZnO nanoparticles and concurrent immobilization over plasma functionalized cotton. Sodium hydroxide was used as a reaction accelerator. Statistical complete composite design (CCD) based on the amount of ZnCl2, NaOH and plasma exposure time was used to optimize the role of input parameters on the self-cleaning ability of the coated cotton. Methylene blue in water was used as a sample pollutant in the self-cleaning study. The ZnO-coated cotton showed notably high self-cleaning activity of 94% and a UV protection factor of 69.87. The antimicrobial activity against E. Coli and S. Aureus bacteria was also appreciably high compared to the control