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

Nurses' Knowledge and Responsibility toward Nutritional Assessment for Patients in Intensive Care Units

Introduction: Nutritional assessment is a prerequisite for nutritional delivery. Patients in intensive care suffer from under-nutrition and nutritional failure due to poor assessment. Nursing ability to early detect nutritional failure is the key for minimizing imparities in practice and attaining nutritional goals. Aim of this article is to examine the ability of Jordanian ICU nurses to assess the nutritional status of critically ill patients, considering biophysical and biochemical measures. Methods: This cross sectional study recruited nurses from different health sectors in Jordan. ICU nurses from the governmental sector (two hospitals) and private sectors (two hospitals) were surveyed using a self-administered questionnaire. Nurses' knowledge and responsibility towards nutritional assessment were examined. Results: A total of 220 nurses from both sectors have completed the questionnaire. Nurses were consistent in regard to knowledge, responsibility, and documentation of nutritional assessment. Nurses in the governmental hospitals inappropriately perceived the application of aspiration reduction measures. However, they scored higher in applying physical examination and anthropometric assessment.  Although both nurses claimed higher use of biochemical measurements, biophysical measurements were less frequently used. Older nurses with longer clinical experience exhibited better adherence to biophysical measurement than younger nurses. Conclusion: Nursing nutritional assessment is still suboptimal to attain nutritional goals. Assessment of body weight, history of nutrition intake, severity of illness, and function of gastrointestinal tract should be considered over measuring albumin and pre-albumin levels.  A well-defined evidence-based protocol as well as a multidisciplinary nutritional team for nutritional assessment is the best to minimize episodes of under-nutrition

Nurses' Knowledge and Responsibility toward Nutritional Assessment for Patients in Intensive Care Units

Introduction: Nutritional assessment is a prerequisite for nutritional delivery. Patients in intensive care suffer from under-nutrition and nutritional failure due to poor assessment. Nursing ability to early detect nutritional failure is the key for minimizing imparities in practice and attaining nutritional goals. Aim of this article is to examine the ability of Jordanian ICU nurses to assess the nutritional status of critically ill patients, considering biophysical and biochemical measures. Methods: This cross sectional study recruited nurses from different health sectors in Jordan. ICU nurses from the governmental sector (two hospitals) and private sectors (two hospitals) were surveyed using a self-administered questionnaire. Nurses' knowledge and responsibility towards nutritional assessment were examined. Results: A total of 220 nurses from both sectors have completed the questionnaire. Nurses were consistent in regard to knowledge, responsibility, and documentation of nutritional assessment. Nurses in the governmental hospitals inappropriately perceived the application of aspiration reduction measures. However, they scored higher in applying physical examination and anthropometric assessment.  Although both nurses claimed higher use of biochemical measurements, biophysical measurements were less frequently used. Older nurses with longer clinical experience exhibited better adherence to biophysical measurement than younger nurses. Conclusion: Nursing nutritional assessment is still suboptimal to attain nutritional goals. Assessment of body weight, history of nutrition intake, severity of illness, and function of gastrointestinal tract should be considered over measuring albumin and pre-albumin levels.  A well-defined evidence-based protocol as well as a multidisciplinary nutritional team for nutritional assessment is the best to minimize episodes of under-nutrition

Cofiring of Oil and Gaseous Fuels Through an Innovative Coaxial, Double Swirl Burner

This paper presents a newly designed coaxial burner capable of simultaneous combustion of oil and gas fuels. The burner addresses the need for renewable energy production from syngas and biofuels derived from solid waste. The focus is on evaluating the burner's effectiveness in co-firing light diesel fuel and LPG, including flame appearance and exhaust emissions. The study establishes a reference for future comparisons when burning syngas and blended biofuels. The burner configuration allows for various influential variables, such as oil/gas ratio, and inner/outer air ratio. The evaluation concentrates on visible flame appearance, exhaust emissions, and heat transfer to the cooling water jacket. The experiments are conducted at a fixed 55 kW input load. Results indicate that different inner/outer air ratios have minimal impact on CO_2 and O_2 levels but affect CO and NOX levels, both in single fuel burning and co-firing scenarios. Increasing inner air reduces CO levels, particularly in oil fuel burning, while decreasing inner air reduces CO levels in co-firing

Remedial Action of Yoghurt Enriched with Watermelon Seed Milk on Renal Injured Hyperuricemic Rats

The consumption of plant-based dairy alternatives has increased rapidly around the world as a result of numerous positive health effects. Little information is available about the potential use of watermelon seed milk in the manufacture of yoghurt. The present study was undertaken to investigate the remedial action of yoghurt enriched with watermelon seed milk in renal injured hyperuricemic rats. A new yoghurt, substituting cow’s milk with different proportions of watermelon seed milk was prepared, followed by evaluation of its acceptability and functionality. Four different types of yoghurt were prepared from cow’s milk containing 3% fat, with different proportions of blended watermelon seed milk (0.0, 25, 50 and 75%). Sensorial traits, i.e., appearance, flavor, body and texture, and overall acceptability demonstrated that the blended treatment (50% cow’s milk and 50% watermelon seed milk.) was the most acceptable. This blend was then tested as an anti-hyperuricemia agent in rats. In this respect, twenty-four male albino rats were assigned into four groups (n = 6). The first group was solely administered a standard diet, and served as the negative control. The other rats (n = 18) received a basal diet including 20 g/kg dietary potassium oxonate in order to induce hyperuricemia. The hyperuricemic rats were then divided into three groups; the first group did not receive any treatment and served as the positive control, while the second and third groups were administered 10% cow’s milk yoghurt and 10% watermelon seed milk yoghurt, respectively. Interestingly, the results showed that the hyperuricemic group receiving a diet supplemented with 10% watermelon seed milk yoghurt was not significantly different from the negative control in the measured biological parameters, and saw a significant improvement in renal function compared to the positive control. The biologically favorable action of watermelon seed milk yoghurt could be attributed to its potential promotion of antioxidant status via enhancement of the activities of superoxide dismutase, catalase, and glutathione transferase. Collectively, this study concluded that watermelon seed milk can be used in yoghurt manufacturing in proportions of up to 50%, and may improve kidney function as an anti-hyperuricemic agent

Trans‐species transmission of Brucellae among ruminants hampering brucellosis control efforts in Egypt

Aims: This study aimed to identify the genotypic fingerprinting of Brucella melitensis biovar 3 isolates from ruminants in Kafr El-Sheikh, Egypt, to compare with other peers globally and to highlight the epidemiology and potential causes of brucellosis control failure.Kafr El-Sheikh University, Grant/Award Number: KFSU-3-13-04Depto. de Sanidad AnimalCentro de Vigilancia Sanitaria Veterinaria (VISAVET)TRUEpu

Comparison of genomic and antigenic properties of Newcastle Disease virus genotypes II, XXI and VII from Egypt do not point to antigenic drift as selection marker

Newcastle disease (ND), caused by avian orthoavulavirus type-1 (NDV), is endemic in poultry in many regions of the world and causes continuing outbreaks in poultry populations. In the Middle East, genotype XXI, used to be present in poultry in Egypt but has been replaced by genotype VII. We investigated whether virus evolution contributed to superseding and focussed on the antigenic sites within the hemagglutinin-neuraminidase (HN) spike protein. Full-length sequences of an NDV genotype VII isolate currently circulating in Egypt was compared to a genotype XXI isolate that was present as co-infection with vaccine-type viruses (II) in a historical virus isolated in 2011. Amino acid differences in the HN glycoprotein for both XXI and VII viruses amounted to 11.7% and 11.9%, respectively, compared to the La Sota vaccine type. However, mutations within the globular head (aa 126-570), bearing relevant antigenic sites, were underrepresented (a divergence of 8.8% and 8.1% compared to 22.4% and 25.6% within the protein domains encompassing cytoplasmic tail, transmembrane part and stalk regions (aa 1-125) for genotypes XXI and VII, respectively). Nevertheless, reaction patterns of HN-specific monoclonal antibodies inhibiting receptor binding revealed differences between vaccine-type viruses and genotype XXI and VII viruses for epitopes located in the head domain. Accordingly, compared to Egyptian vaccine-type isolates and the La Sota vaccine reference strain, single aa substitutions in 6 of 10 described neutralizing epitopes of HN were found. However, the same alterations in neutralization sensitive epitopes were present in old genotype XXI as well as in newly emerged genotype VII isolates. In addition, isolates were indistinguishable by polyclonal chicken sera raised against different genotypes including vaccine viruses. These findings suggest that factors other than antigenic differences within the HN protein account for facilitating the spread of genotype VII versus genotype XXI viruses in Egypt

Temporal Dynamics of Influenza A(H5N1) Subtype before and after the Emergence of H5N8

Highly pathogenic avian influenza (HPAI) viruses continue to circulate worldwide, causing numerous outbreaks among bird species and severe public health concerns. H5N1 and H5N8 are the two most fundamental HPAI subtypes detected in birds in the last two decades. The two viruses may compete with each other while sharing the same host population and, thus, suppress the spread of one of the viruses. In this study, we performed a statistical analysis to investigate the temporal correlation of the HPAI H5N1 and HPAI H5N8 subtypes using globally reported data in 2015-2020. This was joined with an in-depth analysis using data generated via our national surveillance program in Egypt. A total of 6412 outbreaks were reported worldwide during this period, with 39% (2529) as H5N1 and 61% (3883) as H5N8. In Egypt, 65% of positive cases were found in backyards, while only 12% were found in farms and 23% in live bird markets. Overall, our findings depict a trade-off between the number of positive H5N1 and H5N8 samples around early 2017, which is suggestive of the potential replacement between the two subtypes. Further research is still required to elucidate the underpinning mechanisms of this competitive dynamic. This, in turn, will implicate the design of effective strategies for disease control