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

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

Interruption of the inferior vena cava with azygos/hemiazygos continuation accompanied by distinct renal vein anomalies: MRA and CT assessment

We report a case of interruption of the inferior vena cava with azygos/hemiazygos continuation and additional variations of the renal veins, an uncommon developmental anomaly. Magnetic resonance angiography and computed tomography, in association with clinical awareness, can be used to diagnose this entity

Pretreatment with stellate ganglion blockade before ischemia reduces infarct size in rat hearts

Objectives: To investigate the role of stellate ganglion blockade (SGB) in cardio-protection against ischemia reperfusion injury. Methods: This prospective randomized, experimental study was carried out between August and October 2008 in the Department of Anesthesia, Abant Izzet Baysal University, Bolu, Turkey. Twenty-one rats were randomly divided into 3 groups; group 1 - SGB group (rats with percutaneous ganglion blockade), group 2 - preconditioned (P) group (rats that were subjected to ischemia and then reperfusion periods for 5 minutes), and group 3 - control group (rats that were injected with normal saline). Results: During the ligation period, the length of arrhythmia was significantly shorter in group 2 compared with group 3 (p0.05). But the arrhythmia score was significantly lower both in group 1 and group 3, compared with group 2 (p<0.02). Both in the ischemic and reperfusion periods, the incidence of arrhythmia was lowest in group 1. The infarct size was measured significantly less in groups 1 and 2 compared with group 3 (p<0.001). Conclusion: Pretreatment with the left SGB leads to lower arrhythmia scores and reduced infarct size in the Langendorff-perfused rat hearts compared with group 3, but not with group 2

Effects of sildenafil on ocular perfusion demonstrated by color Doppler ultrasonography

The aim of this study was to investigate the effects of sildenafil on ocular hemodynamics by color Doppler ultrasonography (CDU). In all, 38 patients with erectile dysfunction diagnosed by International Index of Erectile Function (IIEF) and Sexual Health Inventory of Men ( SHIM) scores were included into the study. After taking 100 mg of oral sildenafil citrate, all patients underwent CDU examination of central retinal artery at 60 and 75 min and CDU examination of cavernosal artery at 20, 60 and 75 min. All of the side effects during and after the test were also recorded. The mean cavernous artery peak systolic flow velocity increased significantly after sildenafil. However, no significant change was determined in central retinal artery flow parameters including peak systolic flow velocity, end-diastolic flow velocity, resistive index, pulsatility index, volume and diameter. Five patients experienced ocular side effects. No significant change was observed in retinal artery CDU measurements of patients having ocular side effects. Sildenafil has no effect on ocular hemodynamics on the basis of CDU. Ocular side effects may be the result of other changes in retinal photoreceptors rather than the ocular circulation

Increased oxidative stress in patients with familial Mediterranean fever during attack period

OBJECTIVES: We aimed to investigate the status of oxidant and antioxidants during attack period (AP) and attack free periods (AFP) in Familial Mediterranean fever (FMF) patients. METHODS: Measured the levels of malondialdehyde (MDA), protein carbonyl (PC), glutathione (GSH) and antioxidant vitamins (A,C and E) as well as the activities of catalase (CAT) and glutathione peroxidase (GSH-Px) in serum and whole blood of FMF patients in FMF-AP and FMF-AFP. RESULTS: Levels of MDA and PC were found significantly higher (p <0.05) both in serum and whole blood of FMF-AP group compared with other groups. The CAT and GSH-Px activities in FMF-AP group were found markedly lower (p <0.05) comparing to HC group. However, there were no statistically significant differences between the groups in terms of antioxidant vitamin levels. CONCLUSIONS: Our study demonstrated increased oxidative stress in patients with FMF during AP. Investigations are needed to establish the effect of antioxidant supplementation on FMF attack frequency and severity. We also suggest that these increased MDA and PC levels and decreased antioxidants may be used as supportive markers to differentiate AP from AFP. These conclusions need to be validated in further multicenter studies with high number of FMF patients

Magnesium: does it reduce ischemia/reperfusion injury in an adnexal torsion rat model?

Ebru Celik Kavak,1 Funda Gulcu Bulmus,2 Ozgur Bulmus,3 Salih Burcin Kavak,1 Nevin Kocaman4 1Department of Obstetrics and Gynecology, 2Vocational School of Health Services, 3Department of Physiology, 4Department of Histology and Embryology, School of Medicine, Firat University, Elazig, Turkey Aim: The aim of the present study was to assess the protective effects of magnesium sulfate (MgSO4) on ischemia/reperfusion (I/R) induced ovarian damage in a rat ovarian torsion model.Methods: Forty-two female Sprague Dawley rats were included in the study. They were divided into six groups as Group 1, sham; Group 2, bilateral ovarian torsion; Group 3, bilateral ovarian torsion&ndash;detorsion; Group 4, MgSO4&ndash;sham; Group 5, MgSO4&ndash;bilateral ovarian torsion; Group 6, bilateral ovarian torsion&ndash;MgSO4&ndash;detorsion. Both torsion and detorsion periods lasted 3 hours. In Groups 4, 5 and 6, MgSO4 (600 mg/kg) was administered by intraperitoneal route 30 minutes before sham operation, torsion and detorsion, respectively. At the end of the study period, both ovaries were removed. One of the ovaries was used for histopathological analyses and the other for biochemical analyses.Results: In the torsion&ndash;detorsion group, all the histopathological scores were higher compared to the sham and torsion only group (p&lt;0.05). Administration of MgSO4 only caused significant decrease in the inflammatory cell scores of the torsion&ndash;detorsion group (p&lt;0.05). MgSO4, whether given before torsion or before detorsion, suppressed malondialdehyde levels when compared to the untreated groups (p&lt;0.01 and p&lt;0.001, respectively). Glutathione peroxidase activities were significantly higher in the MgSO4 applied torsion and detorsion groups than Groups 2 and 3 (p&lt;0.05, for both). Administration of MgSO4 also caused an increase in glutathione levels in the torsion and detorsion groups compared to the torsion only and detorsion only groups (p&lt;0.05, for both). Also, total oxidant status levels decreased in the MgSO4 applied torsion and detorsion groups compared to the untreated corresponding ones (p&lt;0.01 and p&lt;0.001, respectively). MgSO4 significantly decreased the Oxidative Stress Index levels in the torsion&ndash;detorsion group compared to Group 2 (p&lt;0.001).Conclusion: Histopathological and biochemical analysis revealed that prophylactic treatment with MgSO4 reduces the changes observed in I/R injury in a rat model. Keywords: ovarian torsion, ischemia/reperfusion injury, magnesium sulfat

Increased oxidative stress in patients with familial Mediterranean fever during attack period

Objectives: We aimed to investigate the status of oxidant and antioxidants during attack period (AP) and attack free periods (AFP) in Familial Mediterranean fever (FMF) patients. Methods: Measured the levels of malondialdehyde (MDA), protein carbonyl (PC), glutathione (GSH) and antioxidant vitamins (A,C and E) as well as the activities of catalase (CAT) and glutathione peroxidase (GSH-Px) in serum and whole blood of FMF patients in FMF-AP and FMF-AFP. Results: Levels of MDA and PC were found significantly higher (p <0.05) both in serum and whole blood of FMF-AP group compared with other groups. The CAT and GSH-Px activities in FMF-AP group were found markedly lower (p <0.05) comparing to HC group. However, there were no statistically significant differences between the groups in terms of antioxidant vitamin levels. Conclusions: Our study demonstrated increased oxidative stress in patients with FMF during AP. Investigations are needed to establish the effect of antioxidant supplementation on FMF attack frequency and severity. We also suggest that these increased MDA and PC levels and decreased antioxidants may be used as supportive markers to differentiate AP from AFP. These conclusions need to be validated in further multicenter studies with high number of FMF patients