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

Non-missile penetrating spinal injury with an impaled knife

Retention of all or part of the weapon following a non-missile penetrating spinal injury is a rare occurrence. The authors report a case of thoracic spinal cord stab injury in a young man. The patient presented with a knife blade lodged in his back and with Brown-Sequard-plus syndrome. At surgery, the wound with the knife in situ was explored and the knife was removed. Although the wound healed without evidence of cerebrospinal fluid leakage or infection, he developed a complete neurologic deficit post-operatively. This was an unlikely outcome for incomplete spinal cord injury resulting from non-missile penetrating spinal injury, historically known to have a favourable outcome. Pre-operatively, patients with incomplete neurological injury following penetrating spine injury with the retained foreign body should be specifically counselled on the possibility of a worsened neurological outcome after surgical intervention

Non-missile penetrating spinal injury with an impaled knife: An uncommon injury with an unlikely outcome

Retention of all or part of the weapon following a non-missile penetrating spinal injury is a rare occurrence. The authors report a case of thoracic spinal cord stab injury in a young man. The patient presented with a knife blade lodged in his back and with Brown-Sequard-plus syndrome. At surgery, the wound with the knife in situ was explored and the knife was removed. Although the wound healed without evidence of cerebrospinal fluid leakage or infection, he developed a complete neurologic deficit post-operatively. This was an unlikely outcome for incomplete spinal cord injury resulting from non-missile penetrating spinal injury, historically known to have a favourable outcome. Pre-operatively, patients with incomplete neurological injury following penetrating spine injury with the retained foreign body should be specifically counselled on the possibility of a worsened neurological outcome after surgical intervention

On Patterns of Neuropsychiatric Symptoms in Patients With COVID-19: A Systematic Review of Case Reports.

Coronavirus disease 2019 (COVID-19) has various neuropsychiatric manifestations, including psychotic, mood, anxiety disorders, trauma-related disorders, and cognitive disorders, such as delirium. Although the psychosocial effects of the COVID-19 pandemic contribute to an increase in psychiatric comorbidities, the COVID-19 virus is also an independent risk factor. Previous studies have revealed that the virus can invade the neural tissue, which causes an imbalance of neurotransmitters that cause neuropsychiatric symptoms. The aim of this article is to conduct a systematic review to determine the patterns of neuropsychiatric manifestations of COVID-19, discussing the frequency and its impact on pre-existing psychiatric disorders. Thirty-nine case reports were collected and analyzed for a systematic review. They were full-text, peer-reviewed journal publications from November 2020 to February 2021. Fifty-three patients were included in our study. The most frequent symptom was abnormal/bizarre behavior (50.9%), followed by agitation/aggression (49.1%), and the third most common was altered mental status and delirium (47.2%). Only 48% of our patients had a pre-existing psychiatric disorder, including three not formally diagnosed but displayed psychiatric symptoms prior to the COVID-19 infection. Findings suggest a positive correlation of new-onset psychiatric symptoms with the SARS-CoV-2 virus. However, the exact pathophysiology of the virus itself causing neuropsychiatric manifestations needs to be investigated further