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

Therapeutic effect of adipose-derived mesenchymal stem cells (AD-MSCs) compared to pirfenidone on corticosteroid resistance in a mouse model of acute exacerbation of idiopathic pulmonary fibrosis

Introduction. Acute exacerbation-idiopathic pulmonary fibrosis (AE-IPF) is a life-threatening condition. In the treatment of AE-IPF, corticosteroid medication is commonly utilized. However, there is insufficient evidence to justify its usage. Pirfenidone (PFD) has recently been discovered to be effective in the treatment of AE-IPF patients. However, regenerative therapy, such as stem cell therapy or tissue engineering, is necessary due to ineffective and limited therapies. Combining MSC transplantation with pharmacological therapy may also give additional benefits; nevertheless, its use must be proven experimentally. As a result, the goal of this study was to assess the therapeutic effects of adipose-derived mesenchymal stem cells (AD-MSCs) on corticosteroid resistance in an animal model of AE-IPF caused by bleomycin compared to PFD. Materials and methods. Seventy C57BL/6J male mice were randomly divided into seven groups, control, BLM, methylprednisolone (MP), PFD, AD-MSCs, PFD +MP, and AD-MSCs +MP. Results. In terms of survival, collagen deposition, the acute lung injury score (ALI), and the Ashcroft score, AD-MSCs exceeded PFD. AD-MSCs + MP provided protection and preserved the lung's architecture in BLM-induced AE. In addition, AD-MSCs successfully decreased chemokine (CC motif) ligand-2 (CCL2) positive cells and lower pro-fibrotic and proinflammatory cytokines. Conclusions. AD-MSCs enhanced histological structure, Ashcroft and ALI scores, lung collagen deposition, survival, and cytokines in an animal model of AE-IPF. As a result, we believe that AD-MSCs may be more therapeutically helpful for AE-IPF than presently available therapies, either alone or in conjunction with MP

Clinical and microbiological characteristics of healthcare-associated infections in a tertiary care pediatric hospital

Background and aim: Healthcare-associated infections (HAIs) are an important cause of prolonged hospital stay. This study was conducted to assess the incidence, causative organisms and risk factors of HAIs in pediatric patients. Subjects and methods: Our study was a prospective evaluation of Healthcare-associated infections (HAI) in patients admitted to Mansoura University Children’s Hospital, Mansoura, Egypt over a period of one year. Results: Five-hundred twenty-nine patients were included in the study. The overall rate of HAI was 5.2/100 admissions. Infection rates were highest in Pediatric ICU (25.9/100 admissions). The most frequent sites of HAI in our study were BSI (154 cultures; 33.3%), UTI (152 cultures; 32.9%), and VAP (90 cultures;19.5%). Gram negative bacteria were the most common bacteria isolated from positive cultures (47.6% of total 462 positive cultures) and were found to be multidrug resistant bacteria. A high prevalence of Methicillin-resistant Staphylococcus aureus (MRSA) was found. Candida species were the commonest pathogens causing urinary tract infection (UTI). Mechanical ventilation, invasive device utilization, neonatal age, neutropenia, ICU residence and hospital stay for > 7 days were the risk factors significantly associated with HAI in our hospital. We found also, multiple antibiotic therapy usage, beta lactam usage, and ICU residence to be significant risk factors for infection by multidrug resistant pathogens. Conclusion: HAI is a significant problem. We recommend further nationwide multicenter studies to identify the commonest infectious pathogens, antibiotic resistance pattern, and to identify risk factors and pattern of antibiotic usage to overcome multidrug resistance

Design of Innovative Parametric/Dynamic Façade Integrated in the Library Extension Building on UAEU Campus

The building industry is in constant change and the United Arab Emirates (UAE) is a leader in innovative solutions for green buildings. The standards used in achieving sustainable buildings, such as LEED, Estidama, have contributed to building structures that reduce energy consumption. More than 40% of the total energy is consumed by residential and commercial buildings as electricity. The strategies applied in a building in order to have low energy consumption vary depending on the region and climate. In the UAE, a country with a hot arid climate, these strategies have relevant importance. The aim of this study is to design an innovative parametric/dynamic façade in a new building, to be built on the United Arab Emirates University Campus, AL Ain, Abu Dhabi, UAE. The new structure is an additional library building (with additional functions to the current building). The design shall be based on the region’s architectural heritage. The modelling and simulation tools used are Rhino and plug-ins like Grasshopper. Furthermore, an optimization process of the parametric/dynamic façade is conducted. Based on the energy simulation results, the application of the innovative parametric/dynamic façade brings a reduction of 25% in the energy consumption of the building. In addition, the daylight improvement by the application of this façade is 44%. This research brings innovation in terms of the advanced tools used in calculating several parameters for the advanced façade and the process from concept to modeling and simulation. These findings are promising for regional industry due to the advanced tools and methods used. Moreover, it shall help the local authorities such as Abu Dhabi Municipality achieve the sustainability goals 2030

Design of Innovative Parametric/Dynamic Façade Integrated in the Library Extension Building on UAEU Campus

The building industry is in constant change and the United Arab Emirates (UAE) is a leader in innovative solutions for green buildings. The standards used in achieving sustainable buildings, such as LEED, Estidama, have contributed to building structures that reduce energy consumption. More than 40% of the total energy is consumed by residential and commercial buildings as electricity. The strategies applied in a building in order to have low energy consumption vary depending on the region and climate. In the UAE, a country with a hot arid climate, these strategies have relevant importance. The aim of this study is to design an innovative parametric/dynamic façade in a new building, to be built on the United Arab Emirates University Campus, AL Ain, Abu Dhabi, UAE. The new structure is an additional library building (with additional functions to the current building). The design shall be based on the region’s architectural heritage. The modelling and simulation tools used are Rhino and plug-ins like Grasshopper. Furthermore, an optimization process of the parametric/dynamic façade is conducted. Based on the energy simulation results, the application of the innovative parametric/dynamic façade brings a reduction of 25% in the energy consumption of the building. In addition, the daylight improvement by the application of this façade is 44%. This research brings innovation in terms of the advanced tools used in calculating several parameters for the advanced façade and the process from concept to modeling and simulation. These findings are promising for regional industry due to the advanced tools and methods used. Moreover, it shall help the local authorities such as Abu Dhabi Municipality achieve the sustainability goals 2030

Potential of Natural Phenolic Compounds as Antimicrobial Agents against Multidrug-Resistant <i>Staphylococcus aureus</i> in Chicken Meat

Staphylococcus aureus is one of the most widespread foodborne bacteria that cause high morbidity, mortality, and economic loss, primarily if foodborne diseases are caused by pathogenic and multidrug-resistant (MDR) strains. This study aimed to determine the prevalence of S. aureus in chicken meat in Egyptian markets. Thus, this study might be the first to assess the efficiency of different natural phenolic compounds as novel antibacterial agents against MDR S. aureus pathogens isolated from raw chicken meat in the Egyptian market. The incidence and quantification of pathogenic S. aureus were detected in retail raw chicken meat parts (breast, thigh, fillet, and giblets). In total, 73 out of 80 (91.3%) of the chicken meat parts were contaminated, with S. aureus as the only species isolated. Of the 192 identified S. aureus isolates, 143 were coagulase-positive S. aureus and 117 isolates were MDR (81.8%, 117/143). Twenty-two antibiotic resistance profile patterns were detected. One strain was randomly selected from each pattern to further analyze virulence and resistance genes. Extracted DNA was assessed for the presence of antibiotic-resistance genes, i.e., vancomycin-resistance (vanA), aminoglycosides-resistance (aacA–aphD), apramycin-resistance (apmA), and methicillin-resistance (mecA), penicillin-resistance (blaZ), and virulence genes staphylococcal enterotoxins (sea and seb), Panton–Valentine leucocidin (pvl), clumping factor A (clfA), and toxic shock syndrome toxin (tst). Clustering analyses revealed that six S. aureus strains harbored the most virulence and resistance genes. The activity of hydroquinone was significantly higher than thymol, carvacrol, eugenol, and protocatechuic acid. Therefore, phenolic compounds, particularly hydroquinone, could potentially alternate with conventional antibiotics against the pathogenic MDR S. aureus inhabiting raw chicken meat. Hence, this study indicates that urgent interventions are necessary to improve hygiene for safer meat in Egyptian markets. Moreover, hydroquinone could be a natural phenolic compound for inhibiting foodborne pathogens

Empagliflozin in Patients with Chronic Kidney Disease

Background The effects of empagliflozin in patients with chronic kidney disease who are at risk for disease progression are not well understood. The EMPA-KIDNEY trial was designed to assess the effects of treatment with empagliflozin in a broad range of such patients. Methods We enrolled patients with chronic kidney disease who had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m(2) of body-surface area, or who had an eGFR of at least 45 but less than 90 ml per minute per 1.73 m(2) with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Patients were randomly assigned to receive empagliflozin (10 mg once daily) or matching placebo. The primary outcome was a composite of progression of kidney disease (defined as end-stage kidney disease, a sustained decrease in eGFR to &lt; 10 ml per minute per 1.73 m(2), a sustained decrease in eGFR of &amp; GE;40% from baseline, or death from renal causes) or death from cardiovascular causes. Results A total of 6609 patients underwent randomization. During a median of 2.0 years of follow-up, progression of kidney disease or death from cardiovascular causes occurred in 432 of 3304 patients (13.1%) in the empagliflozin group and in 558 of 3305 patients (16.9%) in the placebo group (hazard ratio, 0.72; 95% confidence interval [CI], 0.64 to 0.82; P &lt; 0.001). Results were consistent among patients with or without diabetes and across subgroups defined according to eGFR ranges. The rate of hospitalization from any cause was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.86; 95% CI, 0.78 to 0.95; P=0.003), but there were no significant between-group differences with respect to the composite outcome of hospitalization for heart failure or death from cardiovascular causes (which occurred in 4.0% in the empagliflozin group and 4.6% in the placebo group) or death from any cause (in 4.5% and 5.1%, respectively). The rates of serious adverse events were similar in the two groups. Conclusions Among a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo