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

Fine Needle aspiration of superficial Lymph node enlargement seen in Lagos, Nigeria: our experience over a six-year period

Background: Lymphadenopathy is one of the common palpable superficial tumours in the body. The diagnosis of these masses can be challenging to physicians. Fine needle aspiration cytology (FNAC) is a cost effective investigation for the diagnosis especially in resource limited settings like ours.Objectives: The aim of this study is to present the use of FNAC of lymph nodes, highlighting the benefits of this investigation.Methods: This is a six year retrospective study of all lymph nodes FNAC performed in two laboratories in Ikeja, Lagos between January 2008 and December 2013. All cytological slides were retrieved and re-evaluated. Clinical details including age, gender, site of aspirations were retrieved from the request forms.Results: A total of 128 cases were seen during the study period with an age range of 1 to 84 years and male to female ratio of 1:1.1. Cervical lymph node (90/128) was the commonest aspirated site. Tuberculous lymphadenitis accounted for 32.3% of cases. Diagnosis of malignancy accounted for 25% of cases comprising metastatic carcinoma (71.9%) and lymphoma (28.1%). All cases of lymphoma diagnosed were from cervical lymph node which also accounted for 60.9% metastatic carcinoma diagnosis.Conclusion: Chronic granulomatous lymphadenitis is a very common cause of lymphadenopathy in our environment. Metastatic carcinoma is the most common cause of malignant lymphadenopathy. FNAC is a veritable tool for the diagnosis of lymphadenopathy and it can be performed on all age groups. Introduction of special technique such as immunohistochemistry and flow cytometry is advocated for definitive diagnosis of lymphomas.Keywords: Lymphadenopathy, FNAC, tuberculous lymphadenitis, metastatic carcinoma, lymphoma

First successfully separated set of thoraco-omphalopagus twins in Ilorin, Nigeria: A case report

The birth of babies sharing body part(s) and surviving independently is indeed a scientific marvel. Conjoined twinning is a rare phenomenon with various presentations, having an estimated incidence of 1 per 200,000 live births. The successes recorded by experts in developed countries in the separation of conjoined twins in recent times, especially among those with complex unions are indeed fascinating. The management of conjoined twins presents a great challenge to medical and surgical teams in tropical African countries such as ours where we are faced with challenges of limited resources and facilities, even amidst the presence of well-trained experts. The incidence of conjoined twins is difficult to report in our practice because of failures that accompanied previous cases that were managed and not reported. This is the first successful separation after two previous failed attempts at our center. We report a case of successful surgical separation of thoraco-omphalopagus conjoined twins who were undiagnosed prenatally and delivered by emergency cesarean section following prolonged labor by a primiparous woman. Babies were joined from the lower chest and the upper abdomen and they shared a single umbilicus and omphalocele sac. No internal viscus was shared apart from the torso wall. They were cared for from 12 h of live until 127 days of live when they were successfully separated by a team of medical and surgical experts. This is a report of a successful separation of conjoined twins at the University of Ilorin Teaching Hospital in North Central Nigeria. Careful interdisciplinary conduct of expert activities will ensure the survival of rare congenital malformations such as conjoined twinning even in underdeveloped climes