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

Uterus didelphys with obstructed hemivagina and ipsilateral renal anomaly (OHVIRA syndrome): A case report

Uterus didelphys with obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome is a rare congenital urogenital anomaly. We report a case of a 14-year-old female who presented with acute lower abdominal pain and tender pelvic mass. The initial diagnosis of twisted left ovarian cyst was confirmed by abdominal ultrasonography (US), which showed an associated absent left kidney. The findings at laparoscopy were that of uterus didelphys with obstructed left hemivagina. Parents were concerned about hymnal integrity and refused hemivaginal septal resection

Webbed penis: A new classification

<b>Aim:</b> To introduce a new classification for the congenital anomaly of webbed penis and suggest an operative technique that can be planned according to the severity of webbing. <b>Materials and Methods:</b> A prospective study was conducted in two pediatric surgical units in Egypt and UAE on babies who were referred for circumcision. A preplanned written protocol was designed before commencing the study. <b>Results:</b> A total of 5,881 babies aged from 1 day to 6 months were seen in two pediatric surgical units. The webbed penis is broadly classified into primary and secondary types. The primary is further subdivided into simple and compound. <b>Conclusion</b> : We believe that the new classification will serve as a baseline for the anatomical variants and help to streamline the operative procedure accordingly

[17] Correlation of renal scarring to urinary tract infections and vesico-ureteric reflux in children

Objective: To study the association between the grade of reflux and urinary tract infections (UTIs) and renal scarring at the first clinical presentation of patients who underwent anti-reflux surgery. Methods: Between 2010 and 2017, 150 patients (194 renal units) who underwent anti-reflux surgery, had dimercaptosuccinic acid (DMSA) renal scans preoperatively (retrospective study). The patients were classified into non-scar and scar groups according to the DMSA scan results. Moreover, cases were classified into afebrile UTI, febrile UTI, and antenatal hydronephrosis (ANH) according to the mode of presentation. We correlated the mode of presentation and the grade of reflux to the presence/absence of renal scars in both groups. Grading of reflux was (I–V) according to the International Reflux Study Committee 1987. Results: The mean follow-up was 45 months. The mode of presentation was afebrile, febrile UTIs and ANH in (50, 14) (20, 46) and (10, 10) in the non-scar and scar groups, respectively. Of the 20 patients who presented with ANH, 10 (50%) had scars. The mode of clinical presentation was correlated to the presence of renal scarring and its degree. The scar group had significantly higher grades of vesico-ureteric reflux than the non-scar group; grades I–II [40 patients, 50 units vs eight patients, 10 units], grade III [24 patients, 28 units vs 30 patients, 40 units] and grade IV–V [16 patients, 22 units vs 32 patients, 44 units] for the non-scar vs scar groups, respectively (P = 0.005). Conclusion: Renal scarring is linked to higher grades of reflux and UTIs. We advocate proper investigations of infants who have UTIs with or without fever for early detection of reflux

Correlation of Renal Scarring to Urinary Tract Infections and Vesicoureteral Reflux in Children

Objective. To study the association of the grade of vesicoureteral reflux (VUR) and urinary tract infections (UTI) with renal scarring at the first clinical presentation of patients who underwent antireflux surgery. Materials and methods. Between 2015 and 2020, 150 patients (194 units) who underwent antireflux surgery had dimercaptosuccinic acid (DMSA) renal scans preoperatively. Patients were classified into the nonscar and scar groups according to DMSA scan results. Moreover, cases were classified into afebrile UTI, febrile UTI, and antenatal hydronephrosis (ANH) according to the mode of presentation. We correlated the mode of presentation and the grade of VUR to the presence/absence of renal scars in both groups. Results. The mean follow-up was 45 months preoperatively. The mode of presentation was afebrile, febrile UTIs, and antenatal hydronephrosis in (50, 14), (20, 46), and (10, 10) patients in the nonscar and scar groups, respectively. Of the 20 patients who presented ANH, 10 (50%) had scars. Clinical presentation was correlated to the presence of renal scarring and its degree. The scar group had significantly higher grades of VUR than the nonscar group (grades I–II (50 units versus 10 units), grade III (28 units versus 40 units), and grade IV–V (22 units versus 44 units) for the nonscar versus scar groups, respectively (pvalue <0.001). Conclusion. Renal scarring is associated with higher grades of reflux and urinary tract infections. We advocate further research investigating infants who had UTIs with or without fever for early detection of reflux

A systematic review of hepatitis C virus epidemiology in Asia, Australia and Egypt

The hepatitis C pandemic has been systematically studied and characterized in North America and Europe, but this important public health problem has not received equivalent attention in other regions