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

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Comparative study for evaluation of the horizontal white-to-white corneal diameter using the optic low-coherent reflectometer and the Scheimpflug topography in normal Egyptian population

Purpose: Comparison of the horizontal white-to-white corneal diameter measured by Lenstar LS 900® (Haag‑Streit AG, Koeniz, Switzerland) and TOMEY TMS-5® (topographic modeling system, version 5) to assess the agreement between them. Setting: El-Agouza police hospital, Egypt. Materials and methods: Comparative prospective cross-sectional clinical study in which measurements of the horizontal WTW corneal diameter were obtained by LENSTAR LS900 and TOMEY TMS-5. Results: The study included 219 eyes of 115 randomly chosen normal Egyptian subjects of both sex (68 males and 47 females). The WTW diameters measured by LENSTAR LS900 and TOMEY TMS-5 ranged from 10.88 to 13.15 mm and 10.69 to 12.94 mm respectively. Lenstar LS 900 gives slightly higher values for WTW diameter than TOMEY TMS-5. Pearson coefficient of correlation (r) revealed a strong statistically significant level of correlation between WTW values measured by both devices (r = 0.87 with p&lt;0.01). Paired samples t-test showed a small mean inter-device difference with high statistical significance (0.29 mm and p&lt;0.01). The Bland-Altman limits of agreement for WTW values measured by them showed a LoA extending from -0.1 to 0.68 mm. Cf the patient.&nbsp

Differential Effects of Ivabradine and Metoprolol on Cardiovascular Remodeling and Myocardial Infarction Induced by Isoprenaline in Chronic N-nitro-L-arginine Methyl Ester (L-NAME) Treated Rats

Background: Elevated heart rate is associated with cardiovascular morbidity and mortality in the general population and in patients with cardiovascular disease Aim: This study was designed to investigate the effects of the two bradycardiac agents ivabradine and metoprolol on cardiovascular changes and the infarction size induced by isoprenaline in chronic N-nitro-L-arginine methyl ester (L-NAME) treated rats. Methods: Four groups of male Wistar rats were studied: the 1st group served as a normal control, the 2nd received L-NAME (100 mg/kg), the 3rd group was treated with the same dose of L-NAME plus ivabradine (10 mg/kg) and the 4th group was treated with the same dose of L-NAME plus metoprolol (150 mg/kg). All treatments were administered daily by gastric gavage. After 6 weeks of L-NAME and drug treatment myocardial infarction was induced by isoprenaline injection (11 mg/100g/day for 2 consecutive days). The following parameters were assessed; systolic blood pressure, electrocardiographic changes, cardiac enzymes, and histopathological examination of heart tissues, aorta & coronary vessels. Moreover, vascular reactivity of the isolated aortic rings to phenylephrine and acetylcholine was tested. Results: Ivabradine and metoprolol administration to L-NAME/isoprenaline treated rats significantly reduced heart rate, microvascular remodeling, infarct size, serum lactate dehydrogenase, serum creatine kinase and attenuated the mortality resulting from isoprenaline-induced infarction. Pretreatment with ivabradine had non-significant effect on L-NAME-induced hypertension and cardiac hypertrophy, in contrast to metoprolol pretreatment. Selective heart rate reduction with ivabradine improved endothelial dysfunction, and reduced atherosclerotic plaque formation in L-NAME treated rats. On the contrary, metoprolol showed insignificant improvement of endothelial dysfunction as evidenced by assessment of mean EC50 and Emax of phenylephrine-induced contraction and by considering the mean percent of acetylcholine-induced relaxation in comparison to the L-NAME/isoprenaline treated group. Conclusion, these results suggest that ivabradine has a significant protective effect against isoprenaline-induced myocardial infarction with improvement of endothelial dysfunction in chronic L-NAME-treated rats

Hepatoprotective Effects Exerted by Propolis against Doxorubicin-induced Rat Liver Toxicity: A Biochemical and Histopathological Study

Abstract Doxorubicin (DOX) is a currently used broad spectrum anticancer agent used to treat many cancer types. DOX belongs to anthracycline group of cytotoxic drugs. Unfortunately, DOX induces many side effects e.g. cardiotoxicity, hepatotoxicity and nephrotoxicity. In this experimental study, we assessed the protective potential of honey bee propolis against DOX-induced side effects. Thirty Sprague Dawley male rats (weighing about 200-220 g) were included in our study and divided into three equal experimental groups: group I (untreated control), group II (DOX-treated rats) that received 25 mg/kg DOX by intraperitoneal (i.p) injection for three consecutive days and group III where animals received both DOX and propolis oral propolis (250 mg/kg for 30 consecutive days). By the end of experimental time, all animals were sacrificed on the 30th day where blood samples and tissue sections were collected for detection of the biochemical and histopathological changes. Our data revealed that propolis evidently resulted in hepatoprotective effects against DOX-induced toxicity in rats liver. It can be concluded that propolis provides partial protection against DOX-induced hepatotoxicity

Frequency of Estrogen Receptor-1 (ESR-1) Gene Polymorphism (PvuII and XbaI) in Patients with Coronary Artery Disease &quot;Frequency of Estrogen Receptor-1 (ESR-1) Gene Polymorphism (PvuII and XbaI) in Patients with Coronary Artery Disease

Abstract Sex hormones might be viewed as biomarkers for cardiovascular health status, as well as protective agents against heart diseases. Coronary artery disease (CAD) is the most common disease in humans and has a complex etiology. In this study, we aimed to investigate the association of CAD with ESR1 PvuII and XbaI gene mutation frequencies and to see if it&apos;s important as a genetic risk factor and the susceptibility for CAD in Tanta region, Egypt. By polymerase chain reaction with restriction fragment length polymorphism (PCR-RFLP), we determined the frequency of the ESR1 gene polymorphisms in 110 healthy and 100 CAD sample. Results revealed that there were no significant differences between CAD patients and the control group as regard the frequency AA, AG and GG of XbaI genotype. PvuII genotype frequencies were TT, TC and CC with no significant value. Regarding allele frequencies of PvuII and XbaI polymorphism, they were not statistically important. There was no significant difference among all studied subjects regarding sex, age, menopausal status, cardiac complications and lipid profile, but there was highly significant differences regarding the body mass index. In conclusion, estrogen receptor alpha gene polymorphism Pvu II and XbaI site are not associated with the coronary artery disease