Early Results of Coronary Artery Bypass Grafting Surgery with or without Coronary Endarterectomy

Background: Managing patients with diffuse coronary artery disease is challenging. The advantages of coronary endarterectomy (CE) combined with coronary artery bypass grafting (CABG) compared to CABG alone are controversial. This study compared short-term outcomes, including ICU and hospital stays, arrhythmias, postoperative myocardial infarction, renal impairment, and hospital mortality, between patients who underwent CABG without and with CE. Methods: This randomized controlled study included 100 patients who underwent CABG with or without CE. Participants were randomly allocated into two equal groups. Group I (n=50) included patients who underwent CABG alone, and Group II (n=50) included patients who underwent CABG combined with CE. Results: The right coronary artery was the most common vessel affected by CE (44%), followed by the left anterior descending artery (42%). Low-output syndrome and pleural effusion were more frequently observed in Group II; however, these differences did not reach statistical significance. There was no difference in postoperative complications or ejection fraction between the groups. The ICU stay was significantly longer in Group II (3.02±0.84 vs. 2.58±0.5 days; p=0.007). Additionally, patients in Group II had significantly longer hospital stays (14.48±1.87 vs. 11.98±1.35, p<0.001). Conclusion: Compared with CABG alone, CABG with CE might not be associated with increased short-term mortality or morbidity. CABG with CE was associated with prolonged hospitalization, necessitating a careful assessment of the benefits versus an extended hospital stay when considering this adjunctive procedure

The Immunophenotyping Changes of Peripheral CD4+ T Lymphocytes and Inflammatory Markers of Class III Obesity Subjects After Laparoscopic Gastric Sleeve Surgery - A Follow-Up Study

Obesity is a chronic disorder characterized by a low-grade inflammatory state and immune cell irregularities. The study aimed to follow up on the changes in the peripheral CD4+ T lymphocytes and the pro-inflammatory cytokines; IL-6, TNF-alpha, MCP-1, and IL-10 at baseline and 12 weeks post-surgical intervention by the laparoscopic gastric sleeve (LGS) in morbidly obese patients (class III obesity subjects). A prospective longitudinal research included 24 class III obesity subjects with a BMI > 40 kg/m. The subjects were enrolled from the Metabolic/Surgical Department at Hamad Medical Corporation (HMC)-Qatar. Fasting blood samples were collected at admission to LGS for weight loss and after 12 weeks of LGS. The immunophenotype of CD4+ T-cell populations; naïve (CD45RAand CD27), central memory T cells (CD45RO and CD27), and effector memory (CD45ROand CD27) and T-regulatory cell (CD4+CD25+ FoxP3+) were identified using flow cytometry. Plasma pro-inflammatory cytokines and adipokines were evaluated. A control group of lean subjects was used to compare changes of T-regulatory and inflammatory biomarkers with postoperative changes in obese patients. The means (SD) of age and BMI of class III obesity subjects was 32.32 (8.36) years and 49.02 (6.28) kg/m respectively. LGS caused a significant reduction in BMI by 32%, p<0.0001. LGS intervention significantly decreased CD4+ T-lymphocytes and effector memory (TEM) cells but increased T-regulatory (Treg), naïve, and central memory (TCM) cells, with all values < 0.05. The increase of Treg cells postoperative is significantly lower compared to lean subjects, p < 0.05. A significant reduction of plasma IL-6, TNF-α, and MCP-1, but IL-10 significantly increased after LGS, with all <0.05. Adiponectin/leptin ratio improved after LGS by 2.9 folds, <0.0001. Weight loss by LGS accomplished a substantial rise of Treg and decreased EM T-lymphocytes with a shift from pro-inflammatory to the anti-inflammatory pattern.QNR

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&nbsp;years; 78.2% included were male with a median age of 37&nbsp;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