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

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Thyroid Hemiagenesis Associated with Retrosternal Nodular Goiter: a Case Report

Thyroid hemiagenesis can be associated with various thyroid pathologies such as papillary thyroid cancer or nodular goiter. However, we did not encounter any publication in the literature in which hemiagenesis could be observed together with retrosternal goiter. In this report, a thyroid hemiagenesis associated with a benign nodular goiter extending retrosternally is reported. A 59-year-old male patient presented to the surgery clinic because of swelling in the neck. A mass was observed in the right thyroid lobe extending to the retrosternal region. On ultrasonography, a nodule in the right thyroid lobe measuring 63 mm was determined, which was extended retrosternally. However, the left lobe of the thyroid could not be visualized. Scintigraphy and Computerized Tomography confirmed hemiagenesis. Total thyroidectomy was performed without sternotomy. In conclusion, thyroid hemiagenesis can be associated with a retrosternally located nodular goiter

The effect of chemical insecticides on the scavenging performance of Steinernema carpocapsae: Direct effects and exposure to insects killed by chemical insecticides

Entomopathogenic nematodes are used widely in biological insect control. Entomopathogenic nematodes can infect live insects as well as dead insects (i.e., they can act as scavengers). It is important to determine compatibility of entomopathogenic nematodes with other pest management tactics such as chemical insecticides. We hypothesized that chemical insecticides have negative impact on scavenging nematodes. According to our hypothesis, we first investigated the effects of direct exposure of Steinernema carpocapsae infectivity juveniles (IJs) to three chemical insecticides, cypermethrin, spinosad or diflubenzuron in terms of nematode survival and virulence. Subsequently, using the same chemicals, we tested the effects of insecticide-killed insects on scavenger nematode penetration efficiency, time of emergence and the number of nematode progeny. Prior to our study, the impact of pesticides on scavenger nematode fitness had not been studied. Fall webworm, Hyphantria cunea, and greater wax moth, Galleria mellonella, larvae were used as host insects. The survival rate of IJs after direct exposure was 83% for cypermethrin and 93-97% for the other insecticides and control. There were no significant differences in the survival and virulence of the nematodes after 24 h exposure to insecticides. The number of nematodes that invaded the insecticide-killed host was significantly higher in cypermethrin and spinosad treated groups and live H. cunea than in the diflubenzoron treated group and freeze-killed control. However, no significant differences were observed in time of emergence. Significantly more progeny IJs emerged from Spinosadkilled insects than the freeze-killed control. In conclusion, we discovered that the fitness of scavenging IJs is not diminished by insecticides in insect cadavers. In fact, in some cases the exposure to chemical insecticides may enhance virulence.WOS:0006947162000102-s2.0-85108913403PubMed: 3418608

Antagonists and defense mechanisms of entomopathogenic nematodes and their mutualistic bacteria

Entomopathogenic nematodes (EPNs) in the families Steinernematidae and Heterorhabditidae are effective biocontrol agents against a number of important soil insect pests and are safe to vertebrates, plants and other non-target organisms with no negative effects on the environment. They are associated with mutualistic bacteria in the genus Xenorhabdus for Steinernematidae and Photorhabdus for Heterorhabditidae and are often referred to as the nematode/bacterium complex. The natural habitat of EPNs is the soil where the third-stage infective juveniles (IJs), the only free-living stage, can infect an array of insect hosts. However, the survival of the IJs is affected by various abiotic (i.e., temperature, moisture, soil texture, soil salinity, UV light, oxygen, and pH) and biotic (i.e., natural enemies, omnivores, scavengers, competitors, and plants) factors in the soil. In this review, we summarize the impact of the biotic factors, especially natural enemies, omnivores, scavengers, and competitors against EPNs and conclude that the major predators of the IJs appear to be nematophagous fungi, mites, and collembolans. Omnivores and scavengers, particularly, mites, collembolans, ants and birds, feeding on EPNkilled insects appear to be the major mortality factors on the developing nematodes especially of insects that are 2 days or less post infection. In addition, we discuss the defense mechanisms of EPN IJs against nematophagous fungi, and the protection of the nematode-killed insects by production of the scavenger deterrent factor produced by the mutualistic bacteria against omnivores and scavengers. By understanding the interactions between EPNs and their antagonists we can improve and increase the successful use of EPNs in biological control programs.Aydin Adnan Menderes University Research Fund, Turkey [FEF-14006]; Scientific and Technical Research Council of Turkey (TUBITAK)Turkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [116Z074]; RUSA -Phase 2.0 grant [Policy (TN Multi-Gen), Dept. of Edn. Govt. of India] [F.24-51/2014-U]; University Science Instrumentation Centre (USIC), Alagappa University, Karaikudi, Tamil Nadu, IndiaThe study was supported by Aydin Adnan Menderes University Research Fund, Turkey (Project number: FEF-14006); Scientific and Technical Research Council of Turkey (TUBITAK-Project Number: 116Z074); RUSA -Phase 2.0 grant [Letter No. F.24-51/2014-U, Policy (TN Multi-Gen), Dept. of Edn. Govt. of India, Dt. 09.10.2018] and University Science Instrumentation Centre (USIC), Alagappa University, Karaikudi, Tamil Nadu, India.WOS:0005973333000032-s2.0-8509211622

Environmental tolerance of entomopathogenic nematodes differs among nematodes arising from host cadavers versus aqueous suspension

Environmental factors such as temperature and desiccation impact the survival and efficacy of entomopathogenic nematodes (EPNs). Most studies on environmental tolerance have focused on EPNs applied in aqueous suspension. Another approach for EPN application is via infected host cadavers. Emergence in host cadavers is also more representative of nematodes in natural populations. In prior studies, certain advantages in fitness have been observed with the cadaver application approach relative to aqueous application, yet the impact of environmental stress on these approaches requires investigation. In this study, we compared the effects of various temperatures (heat and cold) and desiccation intervals (48 and 72 hr) on the survival, virulence and reproductive capacity of Heterorhabditis bacteriophora and Steinernema glaseri when applied via cadaver versus aqueous suspension. In the heat tolerance bioassays, following exposure to 30 degrees C, 35 degrees C and 37. 5 degrees C, nematodes (from both species) in the cadaver treatments exhibited higher survival, and reproductive capacity compared with aqueous application. No survival was observed above 37.5 degrees C regardless of species or application approach. In cold tolerance, no differences were observed between the cadaver and aqueous treatments after a sequence of exposures from 10 degrees C to -2 degrees C. In desiccation assays, following exposure to 85% relative humidity for 2 or 3 days, nematodes (from both species) exhibited higher survival and reproduction in the cadaver treatment than in the aqueous treatment, whereas no differences were observed in virulence. This is the first study to find differential stress tolerance among nematodes emerged from infected host cadavers versus those applied in aqueous suspension. Our findings indicate additional advantages when using the cadaver approach for biocontrol applications, and suggest EPNs existing in natural populations may have broader environmental tolerance than those applied via aqueous suspension.Higher Education Commission (HEC) IslamabadHigher Education Commission of Pakistan; Adnan Menderes UniversityAdnan Menderes University [ZRF-15012]Sehrish Gulzar and Muhammad Usman thank the Higher Education Commission (HEC) Islamabad for providing financial support through their International Research Support Initiative Program (IRSIP) research grant program. The authors also thank Stacy Byrd for technical assistance. This study was supported by Adnan Menderes University (project no: ZRF-15012).WOS:0005714734000092-s2.0-85089217696PubMed: 3276323

Surgeons’ practice and preferences for the anal fissure treatment: results from an international survey

The best nonoperative or operative anal fissure (AF) treatment is not yet established, and several options have been proposed. Aim is to report the surgeons' practice for the AF treatment. Thirty-four multiple-choice questions were developed. Seven questions were about to participants' demographics and, 27 questions about their clinical practice. Based on the specialty (general surgeon and colorectal surgeon), obtained data were divided and compared between two groups. Five-hundred surgeons were included (321 general and 179 colorectal surgeons). For both groups, duration of symptoms for at least 6 weeks is the most important factor for AF diagnosis (30.6%). Type of AF (acute vs chronic) is the most important factor which guide the therapeutic plan (44.4%). The first treatment of choice for acute AF is ointment application for both groups (59.6%). For the treatment of chronic AF, this data is confirmed by colorectal surgeons (57%), but not by the general surgeons who prefer the lateral internal sphincterotomy (LIS) (31.8%) (p = 0.0001). Botulin toxin injection is most performed by colorectal surgeons (58.7%) in comparison to general surgeons (20.9%) (p = 0.0001). Anal flap is mostly performed by colorectal surgeons (37.4%) in comparison to general surgeons (28.3%) (p = 0.0001). Fissurectomy alone is statistically significantly most performed by general surgeons in comparison to colorectal surgeons (57.9% and 43.6%, respectively) (p = 0.0020). This analysis provides useful information about the clinical practice for the management of a debated topic such as AF treatment. Shared guidelines and consensus especially focused on operative management are required to standardize the treatment and to improve postoperative results