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

Vaspin in type 2 diabetes in relation to atherosclerosis

Background Vaspin is a novel adipocytokine with insulin-sensitizing effects. However, it is not known whether a correlation exists between human vaspin serum levels and markers of insulin sensitivity and glucose or lipid metabolism. Aim of the work To determine whether there is an association between serum vaspin levels (a novel adipocytokine with insulin-sensitizing effects), type 2 diabetes mellitus (T2D) and atherosclerosis. Patients and methods The study included 40 patients with T2D divided into 20 without hypertension (group 1), 20 with hypertension (group 2) and 15 age-matched and sex-matched healthy control participants (group 3). The serum vaspin level was determined by enzyme-linked immunosorbent assay. Its level was compared between both diabetic patients and controls, and between diabetic patients without hypertension and those with hypertension. All participants were subjected to an imaging procedure in the form of carotid Doppler to measure the intima - media thickness as an early marker of atherosclerosis. Results The serum vaspin level was significantly higher in diabetic patients compared with control participants. There was significant increase in the left carotid intima-media thickness in diabetic patients with hypertension and without hypertension compared with control participants. There was a significant positive correlation between the serum vaspin level and the BMI in diabetic patients with hypertension, a significant negative correlation between the serum vaspin level and the duration of diabetes and a significant negative correlation between the serum vaspin level and HDL in diabetic patients without hypertension. Conclusion There was a significantly high level of serum vaspin in T2D patients. Serum vaspin was shown to be significantly lower in T2D patients with a longer duration of illness. An increased carotid intima-media thickness in diabetic patients was not related to the vaspin level, denoting an underlying combining factor for atherosclerosis in diabetic patients other than vaspin

Paraoxonase-1 activity in type 2 diabetes mellitus with and without nephropathy

Background Paraoxonase-1 (PON-1) is an enzyme synthesized in the liver that has antioxidant functions as it binds to the HDL particles and prevents the oxidation of LDL, which possibly plays a role in the prevention of atherosclerosis and coronary artery disease. Objectives To determine PON-1 activity in type 2 diabetic patients with and without diabetic nephropathy and its correlation with the lipid profile, disease duration, and glycemic status. Patients and methods This study was carried out on 30 patients with type 2 diabetes mellitus who attended the diabetes and endocrine clinic at Kasr Al Ainy Hospital, Cairo University, including 20 patients with evidence of diabetic nephropathy and 10 patients without diabetic nephropathy as well as 15 healthy age-matched control participants. Fasting blood sugar, 2 h postprandial blood sugar, total cholesterol, HDL, LDL, triglycerides, and serum creatinine were measured. PON-1 activity was detected using a colorimetric method. Results PON-1 activity was reduced significantly in diabetic patients with and without nephropathy, with mean 226.1 ΁ 135.4 and 221.7 ΁ 119.6 nmol/ml/min, respectively, versus 758.5 ΁ 353.9 nmol/ml/min in the control group (P < 0.001). PON-1 activity was not significantly different between diabetic patients with and without nephropathy. PON-1 activity was correlated negatively with HDL (r = −0.496, P = 0.026) in diabetic patients with nephropathy. PON-1 activity was not correlated significantly with disease duration and glycemic status. Conclusion PON-1 activity was significantly reduced in type 2 diabetes, but did not differ between diabetics with or without nephropathy

Nanogold Particles Suppresses 5-Flurouracil-Induced Renal Injury: An Insight into the Modulation of Nrf-2 and Its Downstream Targets, HO-1 and γ-GCS

The development of the field of nanotechnology has revolutionized various aspects in the fields of modern sciences. Nano-medicine is one of the primary fields for the application of nanotechnology techniques. The current study sheds light on the reno-protective impacts of gold nano-particles; nanogold (AuNPs) against 5-flurouracil (5-FU)-induced renal toxicity. Indeed, the use of 5-FU has been associated with kidney injury which greatly curbs its therapeutic application. In the current study, 5-FU injection was associated with a significant escalation in the indices of renal injury, i.e., creatinine and urea. Alongside this, histopathological and ultra-histopathological changes confirmed the onset of renal injury. Both gene and/or protein expression of nuclear factor erythroid 2–related factor 2 (Nrf-2) and downstream antioxidant enzymes revealed consistent paralleled anomalies. AuNPs administration induced a significant renal protection on functional, biochemical, and structural levels. Renal expression of the major sensor of the cellular oxidative status Nrf-2 escalated with a paralleled reduction in the renal expression of the other contributor to this axis, known as Kelch-like ECH-associated protein 1 (Keap-1). On the level of the effector downstream targets, heme oxygenase 1 (HO-1) and gamma-glutamylcysteine synthetase (γ-GCS) AuNPs significantly restored their gene and protein expression. Additionally, combination of AuNPs with 5-FU showed better cytotoxic effect on MCF-7 cells compared to monotreatments. Thus, it can be inferred that AuNPs conferred reno-protective impact against 5-FU with an evident modulatory impact on Nrf-2/Keap-1 and its downstream effectors, HO-1 and γ-GCS, suggesting its potential use in 5-FU regimens to improve its therapeutic outcomes and minimize its underlying nephrotoxicity

Development of New Restorer Lines Carrying Some Restoring Fertility Genes with Flowering, Yield and Grains Quality Characteristics in Rice (<em>Oryza sativa</em> L.)

This study was carried out using 22 promising restorer lines of rice and their parental lines to study genetic variability and genetic advance for yield and yield-associated grain quality traits and floral traits. These genotypes are evaluated in a replicated trial using Randomized Complete Block Design (RCBD) with three replications at the Experimental Farm of Sakha Agricultural Research Station, Sakha, Kafr El-Sheikh, Egypt, during the seasons from 2012 to 2020. Analysis of variance revealed that highly significant variations were observed among the genotypes for all the studied characters. Both GCV% and PCV% were high for the number of spikelets per panicle, the number of filled grains per panicle, and panicle weight. The genetic advance in the percentage of mean was high for days to plant height, panicle length, number of spikelets per panicle, number of filled grains per panicle, panicle weight, grain yield per plant, anther length, anther breadth, duration of floret opening, and head rice percentage. Mean performance of the rice genotypes indicated that the genotypes NRL 59, NRL 55, NRL 62, NRL 63, NRL 66, and NRL 54-2 were promising for grain yield and associated desirable traits. Thus, some of these promising lines can be promoted as a new rice variety and could be used as a source for developing new hybrid combinations in hybrid rice breeding programs. The percentage of advantage over better parent and Giza 178 as the commercial variety was significant and there were highly significant desirable values among the genotypes for all the studied traits in the two years, indicating that the selection is effective in the genetic improvements for these traits

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially