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

Relationship between cortisol increment and basal cortisol: Implications for the low-dose short adrenocorticotropic hormone stimulation test

BACKGROUND: We analyzed the low-dose (1 microg) rapid adrenocorticotropic hormone test (LDST) in 17 patients with a normal hypothalamic-pituitary-adrenal axis to determine reference intervals for the LDST on the basis of poststimulation cortisol increments. METHODS: We analyzed test results for 17 patients (14 females and 3 males; age range, 18-46 years) who had received a 2-mL aliquot of low-dose (1 microg) adrenocorticotropic hormone prepared from one 250-microg vial of Synacthen diluted in 500 mL of sterile normal saline solution. Sampling took place at 0, 20, 30, and 60 min post stimulation. The cortisol increment was plotted against basal cortisol. RESULTS: We observed a marked interdependence of the basal cortisol concentration with the increase in cortisol concentration. The relationship was inverse and linear with the best fit observed at 30 min post stimulation. The lower 95% prediction limit for basal cortisol at the zero increment was 400 nmol/L with a mean concentration of 600 nmol/L. CONCLUSIONS: We propose that a peak cortisol concentration 600 nmol/L confirm normal adrenal function. Repeat analyses with larger sample sizes are warranted to confirm these observations

Long-Term Population Trends and Diversity Shifts among Shorebirds: A Predictor of Biodiversity Loss along the Arabian Gulf Coasts

Bahrain is a cluster of islands in the mid-section of the Arabian Gulf that serves as an important wintering and stop-over ground for many migratory shorebirds in the Central Asian Flyway (CAF). However, natural and anthropogenic factors have had a significant impact on these ecosystems over the last few decades. Long-term, systematic studies based on standardized survey observations are needed to understand the population dynamics and diversity changes of shorebirds in these critical sites. We systematically surveyed the shorebird population and community in Bahrain between 2010 January to 2021 December. This is the first comprehensive study from the entire Kingdom of Bahrain, and covered 13 sites over 12 years to establish the results. A total of 39 species were encountered during the study period from all 13 sites in Bahrain, of which 27 species were common and regular migrants to all the study sites; these were selected to analyze the population trend. Five species represented 77% or more of the total wintering shorebird population. All the shorebird species assessed exhibited significant declining trends over the years, and majority of them had over 1% relative abundance. Shorebirds in Bahrain were severely threatened at these sites, indicating that their population trend in the area could be crucially affected. Further conservation efforts are needed, aided by an understanding of the mechanisms driving the decline and diversity changes of shorebirds in the most stressed coastal regions of Bahrain. Further studies organized throughout the country’s coasts may aid in establishing improved conservation measures to protect the shorebirds of the CAF in Bahrain

Kinobead Profiling Reveals Reprogramming of BCR Signaling in Response to Therapy within Primary CLL Cells

PURPOSE: B-cell receptor (BCR) signaling is critical for the pathogenesis of chronic lymphocytic leukemia (CLL), promoting both malignant cell survival and disease progression. Although vital, understanding of the wider signaling network associated with malignant BCR stimulation is poor. This is relevant with respect to potential changes in response to therapy, particularly involving kinase inhibitors. In the current study, we describe a novel high-resolution approach to investigate BCR signaling in primary CLL cells and track the influence of therapy on signaling response. EXPERIMENTAL DESIGN: A kinobead/mass spectrometry–based protocol was used to study BCR signaling in primary CLL cells. Longitudinal analysis of samples donated by clinical trial patients was used to investigate the impact of chemoimmunotherapy and ibrutinib on signaling following surface IgM engagement. Complementary Nanostring and immunoblotting analysis was used to verify our findings. RESULTS: Our protocol isolated a unique, patient-specific signature of over 30 kinases from BCR-stimulated CLL cells. This signature was associated with 13 distinct Kyoto Encyclopedia of Genes and Genomes pathways and showed significant change in cells from treatment-naïve patients compared with those from patients who had previously undergone therapy. This change was validated by longitudinal analysis of clinical trials samples where BCR-induced kinome responses in CLL cells altered between baseline and disease progression in patients failing chemoimmunotherapy and between baseline and treatment in patients taking ibrutinib. CONCLUSIONS: These data comprise the first comprehensive proteomic investigation of the BCR signaling response within CLL cells and reveal unique evidence that these cells undergo adaptive reprogramming of this signaling in response to therapy

A Regional Review of Marine and Coastal Impacts of Climate Change on the ROPME Sea Area

The Regional Organization for the Protection of the Marine Environment (ROPME) Sea Area (RSA) in the northern Indian Ocean, which comprises the Gulf, the Gulf of Oman and the northern Arabian Sea, already experiences naturally extreme environmental conditions and incorporates one of the world’s warmest seas. There is growing evidence that climate change is already affecting the environmental conditions of the RSA, in areas including sea temperature, salinity, dissolved oxygen, pH, and sea level, which are set to continue changing over time. The cumulative impacts of these changes on coastal and marine ecosystems and dependent societies are less well documented, but are likely to be significant, especially in the context of other human stressors. This review represents the first regional synthesis of observed and predicted climate change impacts on marine and coastal ecosystems across the ROPME Sea Area and their implications for dependent societies. Climate-driven ecological changes include loss of coral reefs due to bleaching and the decline of fish populations, while socio-economic impacts include physical impacts from sea-level rise and cyclones, risk to commercial wild capture fisheries, disruption to desalination systems and loss of tourism. The compilation of this review is aimed to support the development of targeted adaptation actions and to direct future research within the RSA.Science, Faculty ofNon UBCOceans and Fisheries, Institute for theReviewedFacultyResearcherOthe

Optimal use and interpretation of the aldosterone renin ratio to detect aldosterone excess in hypertension

With the introduction of the aldosterone/renin ratio as a screening test, the detection rate of primary aldosteronism has increased considerably. Nevertheless, no consensus has so far been reached regarding the cutoff points, operating characteristics or indeed even the reference values for reporting the aldosterone/renin ratio using plasma active renin (ng/l or mU/l) measured by immunoradiometric assay. We review the characteristics of this ratio in normal individuals, essential hypertension and primary hyperaldosteronism in an attempt to reach an agreement regarding its optimum use and interpretation - both using the renin activity or concentration. It seems that the optimal cutoff for patients with primary aldosteronism is above 30 ng/dl per mug/l/h or 800 pmol/l per mug/l/h or 130 pmol/ng or 80 pmol/mU. We explore enhancing measures such as captopril loading or use with a plasma aldosterone cutoff as well as pitfalls with the test such as confounding medications or the need for confirmatory testing. For the latter, demonstration of autonomous aldosterone production via salt loading is widely used, but may not be most advantageous and may even be contraindicated in patients with severe hypertension. The renin stimulation test may be an alternative being safe, well tolerated, and cost effective