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

Prevalence of hyperhomocysteinemia in β-TM patients according to their <i>MTHFR</i> genotypes.

<p>Prevalence of hyperhomocysteinemia in β-TM patients according to their <i>MTHFR</i> genotypes.</p

Demographic characteristics, hematological, and biochemical parameters of β-TM patients and controls.

<p>Demographic characteristics, hematological, and biochemical parameters of β-TM patients and controls.</p

Impact of Genetic Polymorphism of <i>methylenetetrahydrofolate reductase C677T </i>on Development of Hyperhomocysteinemia and Related Oxidative Changes in Egyptian β-Thalassemia Major Patients

<div><p>Background</p><p>β-thalasemia major (β-TM) patients often suffer from various vascular complications together with increased oxidative stress. Hyperhomocysteinemia (Hhcy) has been defined as a risk factor for these complications. Genetic polymorphism of methylenetetrahydrofolate reductase <i>(MTHFR) C677T</i> has been shown to cause Hhcy particularly in individuals with low B-vitamins. However, the status of homocysteine (hcy) in β-TM has not yet been adequately defined.</p><p>Aim</p><p>To evaluate the genetic polymorphism of <i>MTHFR C677T</i> among β-TM patients and its prospective contribution to Hhcy and related oxidative changes.</p><p>Subjects and Methods</p><p>Genotyping for <i>MTHFR C677T</i> was done by PCR-RFLP technique. Plasma hcy, vitamin B12, folate, malondialdehyde (MDA), total antioxidant capacity (TAC), oxidized low density lipoprotein (oxLDL), total nitric oxide (NOx) and lipid profile were determined in 66 β-TM patients and 66 control subjects of matched age and sex.</p><p>Results</p><p>The prevalence of <i>MTHFR 677TT</i> genotype was significant among β-TM patients (12%) compared to (3%) controls (OR = 4.9, 95%CI:1.2–24.2,P = 0.03). A strong association between Hhcy and <i>MTHFR TT</i> genotype was observed (OR = 7.7, 95%CI:2.8–20.9) where all β-TM patients with <i>TT</i> genotype were hyperhomocystienemic (≥ 15 μmol/l) and having sub-optimal folate level than those with <i>CT</i> or <i>CC</i> genotypes. Hyperhomocystienemic patients have suffered from increased oxidative stress characterized by significant increase in plasma MDA and oxLDL, and a significant reduction of plasma TAC and total NOx. Lipid profile of those patients was severely affected indicated by reduction in HDL and HDL/LDL and elevation in atherogenic index as compared with <i>CC</i> genotype. Other measured parameters were not significantly different among β-TM patients with different <i>MTHFR</i> genotypes.</p><p>Conclusion</p><p>This study suggests that Egyptian β-TM patients with <i>MTHFR 677TT</i> genotype could be at increasing risk of developing Hhcy particularly with folate deficiency. This state of Hhcy may account potentially for most oxidative changes and atherogenic vascular complications frequently reported in β-TM patients.</p></div

Detection of <i>MTHFR C677T</i> gene polymorphism.

<p>M: DNA molecular weight marker. Lane 5: PCR product before Hinf I RFLP at 198bp. Lanes 4&2: Wild type <i>CC</i>. Lane1: Heterozygous (<i>CT</i>). Lane 3: Homozygous (<i>TT</i>). RFLP Restriction Fragment Length Polymorphism</p

Genotype and allele frequency distribution of <i>MTHFR C677T</i> in β-TM patients and controls.

<p>Genotype and allele frequency distribution of <i>MTHFR C677T</i> in β-TM patients and controls.</p

Biochemical parameters of β-TM patients and controls.

<p>Biochemical parameters of β-TM patients and controls.</p

The Prevalence and Molecular Biology of Staphylococcus aureus Isolated from Healthy and Diseased Equine Eyes in Egypt

This work aimed to characterize S. aureus isolates from the eyes of healthy and clinically affected equines in the Kafrelsheikh Governorate, Egypt. A total of 110 animals were examined for the presence of S. aureus, which was isolated from 33 animals with ophthalmic lesions and 77 healthy animals. We also investigated the antimicrobial resistance profile, oxacillin resistance mechanism, and the major virulence factors implicated in many studies of the ocular pathology of pathogenic S. aureus. The association between S. aureus eye infections and potential risk factors was also investigated. The frequency of S. aureus isolates from clinically affected equine eyes was significantly higher than in clinically healthy equids. A significant association was found between the frequency of S. aureus isolation from clinically affected equine eyes and risk factors including age and season but not with sex or breed factors. Antimicrobial resistance to common antibiotics used to treat equine eyes was also tested. Overall, the isolates showed the highest sensitivity to sulfamethoxazole (100%) and the highest resistance to cephalosporin (90.67%) and oxacillin (90.48%). PCR was used to demonstrate that mecA was present in 100% of oxacillin- and &beta;-lactam-resistant S. aureus strains. The virulence factor genes Spa (x region), nuc, and hlg were identified in 62.5%, 100%, and 56%, of isolates, respectively, from clinically affected equines eyes. The severity of the eye lesions increased in the presence of &gamma;-toxin-positive S. aureus. The phylogenetic tree of the Spa (x region) gene indicated a relationship with human reference strains isolated from Egypt as well as isolates from equines in Iran and Japan. This study provides insight into the prevalence, potential risk factors, clinical pictures, zoonotic potential, antimicrobial resistance, and &beta;-lactam resistance mechanism of S. aureus strains that cause eye infection in equines from Egypt