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

Occurrence of Bacillus cereus in raw milk and some dairy products in Egypt

A total of 160 samples (20 each of raw cow's milk and seven dairy products; pasteurized milk, small and large scales-manufactured ice cream, infant formulas, full-fat milk powder, rice pudding and yoghurt) were investigated for the presence of B. cereus. Biochemical tests followed by PCR were carried out to confirm the suspected B. cereus isolates. Overall 44 samples yielded Bacillus-like growth of which 34 were positive for B. cereus. The highest occurrence % of B. cereus was detected in raw cow's milk (60 %), and rice pudding (55 %). Non-B. cereus isolates were identified based on 16S rRNA GS and 7 isolates of B. licheniformis and 3 isolates of B. subtilis were obtained. No psychrotolerant B. cereus strains were detected in all samples. Evidence evolved from our results confirms the need for authorities and producers to adopt B. cereus as a reference in microbiological hazard control, particularly for dairy products

Prevalence of Pseudomonas aeruginosa in Milk and Some Dairy Products with Reduction Trials by Some Natural Preservatives

Contamination of milk and dairy products with spoilage and pathogenic microorganisms is a common problem worldwide. Therefore, this study was conducted on 200 samples (milk, Kareish cheese, Damietta cheese, and plain yoghurt, 50 of each) collected from Zagazig City, Sharkia, Egypt to be examined bacteriologically to isolate and identify the multi-drug resistant Pseudomonas aeruginosa as well as some reduction trials on cold stored soft cheese using some natural compounds including the essential oil (EO) of Clove (0.01%, 0.1%) and Nigella Sativa (NS 0.5%, 1%), in addition to Nisin (10 ppm 12.5 ppm). The obtained results revealed the pseudomonas aeruginosa prevalence in the examined milk and dairy product samples was 45(22.5%); 24(48%) from raw milk samples, 8(16%) from yoghurt, 9(18%) from soft cheese and 4(8%) from kareish cheese. The isolated Pseudomonas aeruginosa harbored some antibiotic-resistant genes including blaTEM, blaSHV, ermB, and Mcr1 genes, while blaOXA-1 failed to be detected, so it was resistant to different types of antimicrobial agents. The multiple antibiotic resistance index (MAR) of the isolated strains was 0.500. Clove (0.01%, 0.1%) and Nigella Sativa (NS 0.5%, 1%), in addition to Nisin (10 ppm, 12.5 ppm) had an antibacterial effect against Pseudomonas aeruginosa compared with control samples and acted as good preservatives that extended the storage period and shelf life of soft cheese up to thirty days

Occurrence and D-Tryptophan Application for Controlling the Growth of Multidrug-Resistant Non-O157 Shiga Toxin-Producing <i>Escherichia coli</i> in Dairy Products

The objectives of the current study were first to determine the prevalence of non O157:H7E. coli, especially Shiga toxin-producing Escherichia coli (STEC) in retailed milk and dairy products in Egypt. Second, the antimicrobial resistance profiling and virulence genes of the isolated E. coli strains were screened. Third, evaluation of the inhibitory effects of D-tryptophan against E. coli O26:H11 was further performed. The results revealed that 20% (30/150) of the samples were STEC positive, with 64 isolates harboring some virulent genes, such as Stx1, Stx2, eaeA, and hylA. Serological identification revealed four different pathotypes belonging to EPEC, ETEC, EHEC, and EIEC. Antimicrobial susceptibility testing revealed that 100%, 98.44%, 92.19%, 71.87%, 65.63% and 64.06% of the isolates had a resistance against tetracycline, oxacillin, erythromycin, nalidixic acid, sulphamethoxazol, and ampicillin, respectively. D-tryptophan addition (40 mM) to E. coli O26:H11-inoculated soft cheese and ice cream revealed a significant reduction (p < 0.05) in bacterial growth, especially when accompanied with other food stressors. D-Tryptophan is considered as an effective food preservative and as a promising alternative candidate in the dairy industry

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)