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

Glenohumeral tuberculous arthritis complicated with beta haemolytic streptococcus: An extraordinary rare association: A case report

Introduction: Septic arthritis of the glenohumeral joint is a rare entity and its diagnosis is difficult with a superadded infection in the presence of underlying tuberculosis. We report the first case of group B beta haemolytic streptococcal glenohumeral arthritis with underlying tuberculosis.Case Presentation: A 40 year old lady previously diagnosed to have poliomyelitis, rheumatoid arthritis, hepatitis C, and diabetes mellitus for the last 10 years, presented to the emergency room with diabetic ketoacidosis. Two weeks prior to presentation she developed fever along with pain and swelling in left shoulder with uncontrolled blood sugars. Local examination of the shoulder revealed global swelling with significant restricted range of motion. MRI showed a large multiloculated collection around the left shoulder joint extending into the axilla, and proximal arm. Urgent arthrotomy performed and about 120ml thick pus was drained. The Patient was started on clindamicin and antituberculous chemotherapy and her symptoms dramatically improved.Discussion: Bone and joint involvement accounts for approximately 2% of all reported cases of tuberculosis (TB), and it accounts for approximately 10% of the extra pulmonary cases of TB. Tuberculosis of the shoulder joint constitutes 1-10.5% of skeletal tuberculosis. Classical symptoms of fever, night sweats, and weight loss may be absent, and a concurrent pulmonary focus may not be evident in most cases.Conclusions: Despite acute presentation of septic arthritis, in areas endemic for tuberculosis and particularly in an immunocompromised Patient, workup for tuberculosis should be part of the routine evaluation

The Fish Fauna of the Zarineh River (Urmia Lake Basin) Downstream Sector – Conservation and Management

This study aimed to investigate the fish fauna in the downstream sector of the Zarineh River, Urmia Lake basin. Seven stations were sampled along the Zarineh River before and after Shahin-Dezh City to help gain a better understanding of human activities on its fish fauna. The results revealed 11 fish species, which belong to three families, including Cyprinidae, Nemacheilidae and Gobiidae. Nine of them were Cyprinidae. Out of 11 species, five species, Carassius gibelio, Rhodeus amarus, Pseudorasbora parva, Hemiculter leucisculus and Rhinogobius lindbergii were exotic that were unintentionally introduced to the Zarineh River along with Asian carps. The threats to fish fauna are categorized into two categories: natural and anthropogenic. According to the observations, anthropogenic activities such as overfishing, pollutions, sand and gravel extraction, dam construction and introduction of exotic fish species were among the main threats for the ichthyofauna of the Zarineh River

Seroprevalence of subclinical HEV infection in asymptomatic, apparently healthy, pregnant women in Dakahlya Governorate, Egypt

Background and Aim: Hepatitis E virus (HEV) is a major public health problem in the developing countries. HEV infection in pregnant women is more common and fatal in the third trimester. The present study was designed to determine the seroprevalence of subclinical HEV infection in asymptomatic pregnant women. Materials and Methods: A total of 116 asymptomatic pregnant women divided into 2 groups: Group 1 included 56 pregnant women with HCV positive serology and group 2 included 60 pregnant women with negative HCV serology were included in this study. Prevalence of anti-HEV antibodies and anti-HCV were determined by an enzyme linked immunosorbent assay (ELISA) kit. Results: The overall prevalence of anti-HEV IgG was highly significant among pregnant women with chronic HCV infection 40/56 (71.42%) than pregnant women free from chronic HCV infection 28/60 (46.7%) (P = 0.006). Chronic HCV infection in pregnant women appeared to be a risk factor associated with HEV IgG seropositivity (OR = 2.86, CI = 1.24-6.6). The seropositivity of anti-HEV IgG was significantly high in rural areas than urban areas (62.5% vs. 37.5%) in group 1 and (78.58% vs. 21.42%) in group 2 (P = 0.15) and OR = 2.2, CI = 0.65-7.7). A decrease in albumin level (P = 0.047) and an increase in bilirubin (P = 0.025), ALT (P = 0.032), and AST (P = 0.044) in pregnant women with positive HCV and IgG anti-HEV than the second group with negative HCV serology. Conclusions: The seroprevalence of anti-HEV IgG in pregnant women is high in Egypt especially in rural areas. With chronic HCV coinfection, a marked increase in anti-HEV IgG seropositivity and significant worsening of the biochemical liver indices were noted. Increased public awareness about the sound hygienic measures for a less prevalence of HEV is strongly advised. The need for HEV vaccination for those at risk, especially pregnant ladies, should be considered

6-Hydroxyimino-5α-cholestane

The title compound, C27H47NO, is a steroid derivative composed of a saturated carbon fused-ring framework with an alkyl side chain. Ring bond lengths have normal values with an average of 1.533 (2) Å, while the cholestane side chain shows an average bond length of 1.533 (2) Å. The three cyclohexane rings adopt chair conformations or close to chair conformations while the cyclopentane ring is twisted. The cholesterol side-chain is fully extended with a gauche–trans conformation of the terminal methyl groups. There are eight chiral centres in the molecule; the absolute configuration of these sites was determined from the structure presented. There are two molecules in the asymmetric unit; in one, the alkyl chain is disordered over two sets of sites [occupancy ratios of 0.50:0.50 and 0.67:0.33]

6-Hydroxyimino-5α-cholestane

The title compound, C27H47NO, is a steroid derivative composed of a saturated carbon fused-ring framework with an alkyl side chain. Ring bond lengths have normal values with an average of 1.533 (2) Å, while the cholestane side chain shows an average bond length of 1.533 (2) Å. The three cyclohexane rings adopt chair conformations or close to chair conformations while the cyclopentane ring is twisted. The cholesterol side-chain is fully extended with a gauche–trans conformation of the terminal methyl groups. There are eight chiral centres in the molecule; the absolute configuration of these sites was determined from the structure presented. There are two molecules in the asymmetric unit; in one, the alkyl chain is disordered over two sets of sites [occupancy ratios of 0.50:0.50 and 0.67:0.33]

Sporadic Fibrodysplasia Ossificans Progressiva in an Egyptian Infant with c.617G > A Mutation in ACVR1 Gene: A Case Report and Review of Literature

Fibrodysplasia ossificans progressiva (FOP) is an autosomal dominant severe musculoskeletal disease characterized by extensive new bone formation within soft connective tissues and unique skeletal malformations of the big toes which represent a birth hallmark for the disease. Most of the isolated classic cases of FOP showed heterozygous mutation in the ACVR1 gene on chromosome 2q23 that encodes a bone morphogenetic protein BMP (ALK2). The most common mutation is (c.617G > A) leading to the amino acid substitution of arginine by histidine (p.Arg206His). We currently report on an Egyptian infant with a sporadic classic FOP in whom c.617G > A mutation had been documented. The patient presented with the unique congenital malformation of big toe and radiological evidence of heterotopic ossification in the back muscles. The triggering trauma was related to the infant's head, however; neither neck region nor sites of routine intramuscular vaccination given during the first year showed any ossifications. Characterization of the big toe malformation is detailed to serve as an early diagnostic marker for this rare disabling disease

Parental care protects traumatized Sri Lankan children from internalizing behavior problems

Sriskandarajah V, Neuner F, Catani C. Parental care protects traumatized Sri Lankan children from internalizing behavior problems. BMC Psychiatry. 2015;15(1): 203.Background: Research in war-torn regions has mainly focused on the impact of traumatic experiences on individual mental health and has found high prevalence rates of psychiatric disorders in affected adults and children. However, little is known about the possible protective factors occurring in children's environments in the aftermath of mass trauma. Therefore, we conducted a cross-sectional study with families in Northern Sri Lanka, a region that had been shattered by a long-lasting civil war and devastated by the Asian tsunami in 2004. Methods: Schoolchildren aged 7 to 11 (N = 359) were interviewed on the basis of standardized measures to assess children's exposure to traumatic events, mental health symptoms, and parenting behavior as perceived by children. All interviews were carried out by local senior counselors. Results: Linear regression analyses identified exposure to mass trauma and family violence as significant risk factors of child mental health whereas parental care emerged as a significant factor associated with fewer behavior problems. In addition, parental care significantly moderated the relationship between mass trauma and internalizing behavior problems. Conclusions: Family characteristics seem to be strongly associated with children's mental health even in regions severely affected by mass trauma. This finding is particularly relevant for the development of targeted psychosocial interventions for children and families living in war torn areas