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

Inflammatory biomarkers in chronic obstructive pulmonary disease

AbstractBackgroundChronic obstructive pulmonary disease (COPD) is a multicomponent disease. There is a need for biological markers for better evaluation of patients with COPD.ObjectiveTo test the hypothesis that elevated levels of inflammatory biomarkers fibrinogen, C-reactive protein (CRP) and leukocyte count (WBC) in individuals with stable COPD are associated with an increased risk of exacerbation.Patients and methodsNinety-eight COPD patients diagnosed and classified as COPD and 30 age and gender matched healthy subjects with normal pulmonary function were observed. Patient follow-up was performed to evaluate the strength of the associations between inflammatory biomarker levels and future outcome.ResultsInflammatory biomarkers increase with exacerbation compared to the remission state, mean WBC, CRP and fibrinogen at 12.212×109/L, 39.462mg/L and 5.09g/L in exacerbation respectively compared to 7.877×109/L, 4.142mg/L and 2.299g/L in remission with P values <0.001, <0.001 and <0.004, respectively.Statistically significant correlation was noticed between the levels of fibrinogen and the % predicted FEV1 (r=0.209, P=0.038) however CRP and WBC did not correlate with % predicted FEV1 (r=−0.031, P=0.765) for CRP, and that for WBC (r=0.125, P=0.221).ConclusionElevated levels of CRP, fibrinogen and leukocyte count in individuals with COPD were associated with increased exacerbation risk. Fibrinogen in particular has emerged as a potentially useful biomarker and requires further investigation

Possible diagnostic role of microRNA-122 in chronic HCV infection and hepatocellular carcinoma

Background:  Infection with hepatitis C virus frequently progresses to cirrhosis and liver cell cancer. Objectives: The objective of this study was testing the usefulness of miR-122 as a marker for diagnosis of cirrhosis in chronic infection with hepatitis C virus (CHC) and as a diagnostic tool for early detection of hepatocellular cancer. Methods: This study included 118 patients; the first group included eighty-eight patients with chronic hepatitis C (CHC) and HCV related cirrhosis, the second group included thirty patients with HCC on to of chronic HCV infection, and the third one included twenty controls. Quantification of the viral RNA by real-time-PCR. MicroRNA-122 expression level was measured by RT-PCR. Results: The mean serum levels of miR‑122 were much higher in CHC, compensated cirrhosis and decompensated cirrhosis patients’ than in controls, while they were less in HCC patients than control group (p = 0.0001). Serum miR-122 revealed gradual decrease in levels with progression of fibrosis stage, with more significant decrease in late fibrosis stages including F3 and F4 (p =0.01). Conclusion: The mean levels of serum miR-122 decreased in patients of HCC thus can differentiate HCC from CHC and liver cirrhosis. MicroRNA -122 had high efficiency compared to other noninvasive indices in prediction of HCV, and progression towards HCC

Isolation, Identification, and In Vitro Antifungal Susceptibility Testing of Dermatophytes from Clinical Samples at Sohag University Hospital in Egypt

Aim: The objective of this study was to isolate, identify, and explore the in-vitro antifungal susceptibility pattern of dermatophytes isolated from clinically suspected cases of dermatophytosis (tinea infections) attending the Dermatology Outpatient Clinic. Methods: This study was conducted at Sohag University Hospital from December 2014 to December 2015. Clinical samples (e.g., skin scrapings and hair stumps) were collected under aseptic precautions. The identification of dermatophytes was performed through microscopic examination using 10% potassium hydroxide (KOH) with 40% dimethyl sulphoxide (DMSO) mounts and culture on Sabouraud dextrose agar (SDA) and on Dermasel agar base media, both supplemented with chloramphenicol and cycloheximide. All dermatophytes isolates were subjected to antifungal susceptibility testing using the agar-based disk diffusion (ABDD) method against Clotrimazole, Miconazole, Fluconazole, and Griseofulvin. Data were analyzed via SPSS 16, using Chi square and a screening test (cross-tabulation method). Results: A total of 110 patients of dermatophytosis were studied. The patients were clinically diagnosed and mycologically confirmed as having tinea capitis (49), tinea corporis (30), tinea pedis (16), tinea cruris (9), or tinea barbae (6). The dermatophytes isolates belonged to 4 species: Microsporum canis 58 (52.7%), Microsporum gypseum 23 (20.9%), Trichophyton mentagrophytes 18 (16.4%), and Microsporum audouinii 11 (10%). The most effective antifungal drugs tested were Clotrimazole, followed by Miconazole (95.5% and 84.5% of isolates were susceptible, respectively). Conclusion: Every patient with a tinea infection should be properly studied for a mycological examination and should be treated accordingly. Dermasel agar is more useful as an identification medium in the isolation of dermatophytes. The ABDD method appears to be a simple, cost-effective, and promising method for the evaluation of antifungal susceptibility of dermatophytes

The potential role of cell surface complement regulators and circulating CD4+ CD25+ T-cells in the development of autoimmune myasthenia gravis

Introduction: CD4+CD25+ regulatory T-lymphocytes (T-regs) and regulators of complement activity (RCA) involving CD55 and CD59 play an important role in the prevention of autoimmune diseases. However, their role in the pathogenesis of human autoimmune myasthenia gravis (MG) remains unclear. This study aimed to determine the frequency of peripheral blood T-regs and CD4+ T-helper (T-helper) cells and the red blood cells (RBCs) level of expression of CD55 and CD59 in MG patients. Methods: Fourteen patients with MG in neurology outpatient clinics of Sohag University Hospital and Sohag General Hospital from March 2014 to December 2014, and 10 age-matched healthy controls participated in this case-control study. We did flowcytometric assessments of the percentage of peripheral T-regs and T-helper cells and the level of expression of CD55 and CD59 on RBCs in the peripheral blood of patients and controls. Results: There was a statistically significant decrease in the percentage of peripheral blood T-regs and T-regs/T- helper cell ratio in the MG patients group. Moreover, the level of expression of CD55, CD59, and dual expression of CD55/CD59 on RBCs were statistically significantly lower in MG patients than those of healthy controls. However, regression analysis indicated that there was no significant correlation between all the measured parameters and disease duration or staging. Conclusion: Functional defects in the T-regs and RCA may play a role in the pathogenesis of autoimmune MG and their functional modulation may represent an alternative therapeutic strategy for MG treatment