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

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Toll-like receptor 4 and cytotoxic T cells CD8+ are prognostic markers in type 1 Diabetes Mellitus

Objective: To determine the correlation between toll-like receptor 4 and cytotoxic T cells in patients with type-1 diabetes mellitus. Method: The cross-sectional, case control study was conducted at Al-Manatharah Hospital in the Al-Najaf province of Iraq from June 2021 to December 2021, and comprised patients of either gender aged 20-69 years having type-1 diabetes mellitus in group A, and healthy subjects in control group B. From all the subjects, 4ml blood was collected by vein puncture. Fasting blood glucose and lipid profile were estimated using a precipitant kit. Also measured were toll-like receptor 4 and cytotoxic T cell levels using an enzyme-linked immunosorbent assay kit. Data was also noted on age, gender and body mass index. Data was analysed using SPSS version 23 Results: Of the 100 subjects, 60(60%) were cases; 30(50%) males and as many females with mean age 59.21±18.092 years. The remaining 40(40%) were controls; 20(50%) males and as many females with mean age 42.076±11.019 years. BMI values were not significantly different between the groups (p>0.05), and all lipid profile values were significantly higher in group A compared to group B (p<0.05) except high-density lipoprotein which was higher in group B compared to group A (p<0.05). Group A patients had significantly higher levels of toll-like receptor 4 and cytotoxic T cell than group B subjects (p<0.05). Conclusion: A significant relationship was found between type-1 diabetes and higher levels of toll-like receptor 4 and cytotoxic T cells. Keywords: Diabetes mellitus, Toll-like receptor 4, Cytotoxic T cells, CD8

Effectiveness of muscle energy technique on pain intensity and disability in chronic low back patients: a systematic review

Abstract Background Low back pain (LBP) is a highly prevalent musculoskeletal condition and causes activity limitations resulting in reduced productivity and high medical expenditure. Muscle energy technique (MET) is a therapeutic technique that has the potential to be successful in LBP, although the evidence for this notion is still inconclusive. The effectiveness of the muscular energy technique on pain intensity and disability for individuals with chronic low back pain was evaluated in published studies through this systematic review of the literature. Methods Studying the English language and humans, as well as scanning article reference lists from PubMed, Scopus, ScienceDirect, the Cochrane Library, Ovid, ClinicalTrials.gov, and Embase, was searched until October 30, 2022. Randomised controlled studies reporting on the effectiveness of muscle energy technique on pain intensity and disability for chronic low back patients were included. Information related to demographics, number and duration of treatment, MET protocol, assessment tools used for pain and disability, and key findings was extracted. The Physiotherapy Evidence Database (PEDro) classification scale was used to assess the methodological quality of studies, and two authors assessed the risk of bias and extracted the data independently. Results Seventeen research studies (including 817 participants) were retrieved and included for qualitative analysis. The studies published between 2011 and 2022 were retrieved, and the sample size ranged from 10 to one hundred twenty-five participants. The age of the subjects ranged between 18 and 60 years, and interventions were done between 2 days and 12 weeks. Of the included 17 studies, five were from Egypt, four were from India, two each from Iran and Nigeria, and one each from Brazil, Poland, Thailand, and Pakistan. Compared to other interventions or the control groups, MET was found to significantly, although modestly, decrease the severity of pain and reduce functional disability in patients with chronic LBP. Most of the included studies had moderate to high study quality. Conclusion In patients with chronic low back pain (CLBP), it was observed that MET alone as well as in conjunction with other interventions was found to be beneficial in reducing pain intensity, improving lumbar spine range of motion, and decreasing the degree of functional disability

Uterine choriocarcinoma diagnosed 11 years after menopause: A case report

Background: Gestational trophoblastic neoplasms (GTNs) encompass a wide spectrum of diseases, of which choriocarcinoma is one of the most common. Choriocarcinoma occurs mainly in relation to pregnancy and rarely after the menopause. It has the potential to metastasize to organs other than the uterus. Case Report: We describe a 62-year-old woman who presented with postmenopausal bleeding 11 years after the menopause. Pelvic ultrasound and abdominal/pelvic computerized tomography showed an intrauterine mass. Choriocarcinoma was diagnosed by Pipelle endometrial biopsy with positive staining for beta-human chorionic gonadotropin (hCG) and KI 67 along with an elevated serum beta-hCG level. The tumor was managed with multiple cycles of multidrug chemotherapy and follow-up based on serum beta-hCG levels according to the guidelines of the International Federation of Gynecology and Obstetrics (FIGO). Conclusion: This case report highlights that choriocarcinoma, a tumor normally associated with pregnancy, can present after the menopause. Keywords: Postmenopausal Bleeding, Gestational Trophoblastic Neoplasms, Uterine Choriocarcinoma, Menopause, Chemotherap

Detection of ON1 and novel genotypes of human respiratory syncytial virus and emergence of palivizumab resistance in Lebanon.

Respiratory syncytial virus (RSV) is a common cause of respiratory tract infections in children and immunocompromised individuals. A multi-center surveillance of the epidemiologic and molecular characteristics of RSV circulating in Lebanon was performed. The attachment (G) and fusion (F) glycoproteins were analyzed and compared to those reported regionally and globally. 16% (83/519) of the nasopharyngeal swabs collected during the 2016/17 season tested positive for RSV; 50% (27/54) were RSV-A and 50% (27/54) were RSV-B. Phylogenetic analysis of the G glycoprotein revealed predominance of the RSVA ON1 genotype, in addition to two novel Lebanese genotype variants, hereby named LBA1 and LBA2, which descended from the ON1 and NA2 RSV-A genotypes, respectively. RSV-B strains belonged to BA9 genotype except for one BA10. Deduced amino acid sequences depicted several unique substitutions, alteration of glycosylation patterns and the emergence of palivizumab resistance among the Lebanese viruses. The emergence of ON1 and other novel genotypes that are resistant to palivizumab highlights the importance of monitoring RSV globally