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

Obesity and Cancer: A Current Overview of Epidemiology, Pathogenesis, Outcomes, and Management

Background: Obesity or excess body fat is a major global health challenge that has not only been associated with diabetes mellitus and cardiovascular disease but is also a major risk factor for the development of and mortality related to a subgroup of cancer. This review focuses on epidemiology, the relationship between obesity and the risk associated with the development and recurrence of cancer and the management of obesity. Methods: A literature search using PubMed and Google Scholar was performed and the keywords ‘obesity’ and cancer’ were used. The search was limited to research papers published in English prior to September 2022 and focused on studies that investigated epidemiology, the pathogenesis of cancer, cancer incidence and the risk of recurrence, and the management of obesity. Results: About 4–8% of all cancers are attributed to obesity. Obesity is a risk factor for several major cancers, including post-menopausal breast, colorectal, endometrial, kidney, esophageal, pancreatic, liver, and gallbladder cancer. Excess body fat results in an approximately 17% increased risk of cancer-specific mortality. The relationship between obesity and the risk associated with the development of cancer and its recurrence is not fully understood and involves altered fatty acid metabolism, extracellular matrix remodeling, the secretion of adipokines and anabolic and sex hormones, immune dysregulation, and chronic inflammation. Obesity may also increase treatment-related adverse effects and influence treatment decisions regarding specific types of cancer therapy. Structured exercise in combination with dietary support and behavior therapy are effective interventions. Treatment with glucagon-like peptide-1 analogues and bariatric surgery result in more rapid weight loss and can be considered in selected cancer survivors. Conclusions: Obesity increases cancer risk and mortality. Weight-reducing strategies in obesity-associated cancers are important interventions as a key component of cancer care. Future studies are warranted to further elucidate the complex relationship between obesity and cancer with the identification of targets for effective interventions

Zika Virus: An Emerging Worldwide Threat

ZIKA virus (ZIKV) poses a severe threat to the world. Recent outbreaks of ZIKV after 2007 along with its quick transmission have made this virus a matter of international concern. The virus shows symptoms that are similar to those caused in the wake of dengue virus (DENV) and other flaviviruses, which makes it difficult to discern the viral infection. Diagnosis is further complicated as the virus cross-reacts with antibodies of other viruses. Currently, molecular diagnosis of the virus is being performed by RT-PCR and IgM-captured enzyme-linked immunosorbent assay (MAC-ELISA). The real brunt of the virus is, however, borne by children and adults alike. Case studies of the ZIKV outbreaks in the French Polynesia and other places have suggested that there is a close link between the ZIKV and Gullian-Barre syndrome (GBS). The GBS has closely followed in areas facing ZIKV outbreaks. Although solid evidence is yet to emerge, clinical data integration has revealed a large number of ZIKV patients having GBS. Moreover, the amniotic fluids, blood cord, and miscarriage tissues of mothers have been detected with ZIKV, which indicates that the virus either gets transferred from mother to fetus or seeks direct entry in the fetus, causing microcephaly and other brain anomalies in the newborn babies. Studies on mice have confirmed the link between the ZIKV infection during pregnancy and microcephaly in babies. Reports have highlighted the sexual transmission of the ZIKV, as it has been detected in the semen and saliva of affected persons. The intensity with which the ZIKA is spreading can collapse the health sector of several countries, which are poor. A comprehensive strategy is a need of an hour to combat this virus so as to prevent its transmission and avert the looming threat. At the same time, more research on the cure of the ZIKV is imperative

Integration of Different Individual Heating Scenarios and Energy Storages into Hybrid Energy System Model of China for 2030

Traditional energy supply infrastructures are on the brink of facing a major transformation due to energy security concerns, environment pollution, renewable energy intermittency and fossil fuel scarcity. A hybrid energy system constitutes the integration of different energy carriers like electricity, heat and fuel which play a vital role in addressing the above challenges. Various technological options like combined heat and power, heat pumps, electrolysers and energy storages ease out multiple carrier integration in an energy hub to increase system flexibility and efficiency. This work models the hybrid energy system of China for the year 2030 by using EnergyPLAN. Atmosphere decarbonization is achieved by replacing conventional coal and natural gas boilers with alternative individual heating sources like hydrogen operated micro combined heat and power natural gas micro combined heat and power and heat pumps. Moreover, rockbed storage as well as single and double penstock pumped hydro storages are added in the proposed system in order to cope with the stochastic nature of intermittent renewable energy such as wind and solar photovoltaic. The technical simulation strategy is employed to analyze the optimal combination of energy producing components by determining annual costs, fuel consumption and CO2 emissions. The results substantiate that a heat pump and double penstock pumped hydro storage addition to the individual heating and electricity network not only proves to be an economically viable option but also reduces fuel consumption and emissions

CRISPR/Cas9-Mediated Genome Editing of Soluble Starch Synthesis Enzyme in Rice for Low Glycemic Index

In the present study, the selected rice (Oryza sativa cv. indica) was genetically modified to increase the amylose content in the seeds. The ‘CRISPR-Cas9’ genome-editing tool was used to knock out three isoforms of soluble starch synthase (SSS) viz. SSSII-1, SSSII-2 and SSSII-3. A genetic transformation vector designed with appropriate gRNAs, Cas9, and antibiotic resistance was used to create SSS knockout mutants to enrich the content of amylose. Putative rice mutants were developed with high amylose content in the seeds of up to 63% as compared to 23% in the wild types (control). Rice with a low Glycemic Index (GI) value and high amylose content rice is preferred to avoid a sudden rise in glucose in the bloodstream. The frequencies of bi-allelic or homozygous transgenic lines of SSSII-1, SSSII-2, and SSSII-3 in the first generation were tested via the Mendelian fashion of segregated bi-allelic lines in the T1 generation of the putative rice mutants. The T1 generation segregation showed a frame-shift mutation. A molecular characterization of the putative mutants successfully demonstrated the development of a Cas9-free rice mutant with a higher amount of amylose in the rice

Ultratrace Determination of Cr(VI) and Pb(II) by Microsample Injection System Flame Atomic Spectroscopy in Drinking Water and Treated and Untreated Industrial Effluents

Simple and robust analytical procedures were developed for hexavalent chromium (Cr(VI)) and lead (Pb(II)) by dispersive liquidliquid microextraction (DLLME) using microsample injection system coupled with flame atomic absorption spectrophotometry (MIS-FAAS). For the current study, ammonium pyrrolidine dithiocarbamate (APDC), carbon tetrachloride, and ethanol were used as chelating agent, extraction solvent, and disperser solvent, respectively. The effective variables of developed method have been optimized and studied in detail. The limit of detection of Cr(VI) and Pb(II) were 0.037 and 0.054 g/L, respectively. The enrichment factors in both cases were 400 with 40 mL of initial volumes. The relative standard deviations (RSDs, = 6) were <4%. The applicability and the accuracy of DLLME were estimated by the analysis of Cr(VI) and Pb(II) in industrial effluent wastewater by standard addition method (recoveries >96%). The proposed method was successfully applied to the determination of Cr(VI) and Pb(II) at ultratrace levels in natural drinking water and industrial effluents wastewater of Denizli. Moreover, the proposed method was compared with the literature reported method