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

Application of Bacteriophages for Biocontrol of Extensively Drug Resistant Salmonella Serovars Isolated from Poultry Farms

Salmonella is one of the most common foodborne pathogens causing diseases in humans and animals. Increased resistance to antibiotics necessitates the need for an alternative control strategy. This study aimed to screen, isolate and evaluate the bacteriophage characteristics for biocontrol of pathogenic Salmonella serovars. Twelve Salmonella isolates, including different Salmonella enterica serovars, were obtained from different sources of poultry farms. All isolates were screened for antibiotic sensitivity and showed multiple antibiotic resistance. Two lytic bacteriophages, vB_SalSph_WW1, and vB_SalM_WW2, were isolated from the sewage and characterized against Salmonella enterica serovar Enteritidis. Morphological analysis by transmission electron microscopy revealed that the vB_SalSph_WW1 phage belonged to the family Siphoviridae while the vB_SalM_WW2 phage belonged to the family Myoviridae. Both phages showed a broad host range within the Salmonella genus. Phages vB_SalSph_WW1 and vB_SalM_WW2 had a lytic effect on 3 (25%) and 4 (33.3%) of the 12 Salmonella isolates, respectively. The lytic cycle of each phage was determined by a one-step growth curve and both phages had the same short latent period (15 min). WW1 phage gave a burst size of 90 PFU/infected cell, while the vB_SalM_WW2 phage gave a higher burst size of 150 PFU/infected cell. The stability test revealed that vB_SalSph_WW1 and vB_SalM_WW2 phages were stable at pH 4–9 and pH 4–10, respectively. Both Phages exhibited high degrees of thermal tolerance with active titer as high as 42◦C. However, they lost their stability and the titers declined when heated at 50◦C for 30 min. This study revealed that vB_SalSph_WW1 and vB_SalM_WW2 phages have the potency to be used as an alternative strategy to control the infection of Salmonella in poultry farms and to prevent transmission of Salmonella infection to humans and spread of the pathogen into environment

Selection, Molecular Identification and Testing of Potentially Probiotic Bacteria Recovered from Popular Artisanal Egyptian Cheeses

The present study was aimed to select potential probiotic and functional strains among lactic acid bacteria (LAB) isolated from some artisanal Egyptian dairy products. For this, 75 samples comprising karish (fresh skimmed), mish (aged salted skimmed) and Domiati (brined ripened) cheese varieties were surveyed in this study. Approximately, 300 lactic acid bacterial (LAB) strains were isolated and initially screened for their antibacterial activity against the two common food-borne pathogens; Staphylococcus aureus and Escherichia coli O157:H7. Using cell free extract of isolated LAB strains, various antimicrobial inhibition patterns have been noted against the tested pathogens. Upon further proteolytic and neutralization treatments, only 16 strains were proved to have potent antimicrobial attribute. Based on 16S rRNA gene sequencing identification of those 16 strains, 8 different species were identified (Lactobacillus plantarum, Lb. fermentum, Pediococcus acidilacticii and Enterococcus faecium). Additionally, those 16 strains were tested for different probiotic, functional and safety criteria (acid and bile resistance, salt tolerance, milk acidification ability, heamolytic activity and antibiotic sensitivity).  The present study showed that artisanal Egyptian artisanal chesses were proven to be sources of safe potentially probiotic LAB with interesting physiological properties, thus it could be further incorporated in manufacture of various dairy products as starter and non-starter cultures

Soluble ACE2 and angiotensin II levels are modulated in hypertensive COVID-19 patients treated with different antihypertension drugs.

This study examines the effect of antihypertensive drugs on ACE2 and Angiotensin II levels in hypertensive COVID-19 patients. Hypertension is a common comorbidity among severe COVID-19 patients. ACE2 expression can be modulated by antihypertensive drugs such as ACEis and ARBs, which may affect COVID-19's prognosis. BB and CCB reduce mortality, according to some evidence. Their effect on circulating levels of ACE2 and angiotensin II, as well as the severity of COVID-19, is less well studied. The clinical data were collected from 200 patients in four different antihypertensive medication classes (ACEi, ARB, BB, and CCB). Angiotensin II and ACE2 levels were determined using standard ELISA kits. ACE2, angiotensin II, and other clinical indices were evaluated by linear regression models. Patients on ACEi ( = 57), ARB ( = 68), BB ( = 15), or CCB ( = 30) in this study had mild ( = 76), moderate ( = 76), or severe ( = 52) COVID-19. ACE2 levels were higher in COVID-19 patients with severe disease ( = 0.04) than mild ( = 0.07) and moderate ( = 0.007). The length of hospital stay is correlated with ACE2 levels ( = 0.3,  = 0.003). Angiotensin II levels decreased with severity ( = 0.04). Higher ACE2 levels are associated with higher CRP and D-dimer levels. Elevated Angiotensin II was associated with low levels of CRP, D-dimer, and troponin. ACE2 levels increase with disease severity in patients taking an ARB ( = 0.01), patients taking ACEi, the degree of disease severity was associated with a decrease in angiotensin II. BB patients had the lowest disease severity. We found different levels of soluble ACE2, and angiotensin II are observed among COVID-19 patients taking different antihypertensive medications and exhibiting varying levels of disease severity. COVID-19 severity increases with elevated ACE2 levels and lower angiotensin II levels indicating that BB treatment reduces severity regardless of levels of ACE2 and angiotensin II.Open Access funding is provided by the Qatar National Library. This report was made possible by an RRC award [RRC-2-076] from the Qatar National Research Fund (a member of The Qatar Foundation). The statements made herein are solely the responsibility of the authors. We would like to acknowledge Qatar BioBank for helping with the logistics of the collected samples, Prof. Nahla Afifi, Dr. Marwa A. El Deeb, and Ms. Sidra Abdulshakoor. The publication of this paper is covered by Qatar National Library