Psychological Health of Surgeons in a Time of COVID-19: A Global Survey

OBJECTIVE: To assess the degree of psychological impact among surgical providers during the COVID-19 pandemic. SUMMARY BACKGROUND DATA: The COVID-19 pandemic has extensively impacted global healthcare systems. We hypothesized that the degree of psychological impact would be higher for surgical providers deployed for COVID-19 work, certain surgical specialties, and for those who knew of someone diagnosed with, or who died, of COVID-19. METHODS: We conducted a global web-based survey to investigate the psychological impact of COVID-19. The primary outcomes were the Depression Anxiety Stress Scale-21 (DASS-21) and Impact of Event Scale-Revised (IES-R) scores. RESULTS: 4283 participants from 101 countries responded. 32.8%, 30.8%, 25.9% and 24.0% screened positive for depression, anxiety, stress and Post-Traumatic Stress Disorder (PTSD) respectively. Respondents who knew someone who died of COVID-19 were more likely to screen positive for depression, anxiety, stress and PTSD (OR 1.3, 1,6, 1.4, 1.7 respectively, all p < 0.05). Respondents who knew of someone diagnosed with COVID-19 were more likely to screen positive for depression, stress and PTSD (OR 1.2, 1.2 and 1.3 respectively, all p < 0.05). Surgical specialities that operated in the Head and Neck region had higher psychological distress among its surgeons. Deployment for COVID-19-related work was not associated with increased psychological distress. CONCLUSIONS: The COVID-19 pandemic may have a mental health legacy outlasting its course. The long-term impact of this ongoing traumatic event underscores the importance of longitudinal mental health care for healthcare personnel, with particular attention to those who know of someone diagnosed with, or who died of COVID-19

Exogenous testosterone and estrogen affect bladder tissue contractility and histomorphology differently in rat ovariectomy model

Introduction. Changes in sex hormone levels may play a role in the etiology of lower urinary tract dysfunction of aging women where the possible role of testosterone is overlooked. Aim. To determine the effect of testosterone with/without estrogen replacement on histological and functional deterioration in ovariectomized rat bladder tissue. Methods. A total of 54 female Sprague Dawley rats were divided into 6 groups. Except sham operated (control group), all others underwent bilateral ovariectomy. No further treatment was given to the ovariectomy-only group (OVX group). At the third week of ovariectomy treatments were started; vehicle agent (VA group), estradiol (E2 group), testosterone undecanoate (T group), and estradiol + testosterone undecanoate combination (E2 + T group) in physiological doses. Nine weeks after ovariectomy, bladder strips were harvested for isometric tension and histopathological studies. Main Outcome Measures. To assess the effect of testosterone/estradiol on ovariectomized rat bladder tissue function and histomorphology. Results. OVX and VA groups showed statistically significant histological changes such as urothelial damage, inflammatory cell infiltration, increase in collagen fibers and muscular atrophy compared with the control group. Both E2 and T reversed these changes but best histomorphological restoration was observed in E2 + T group. In isometric tension studies, ovariectomy tended to increase contractile responses which were normalized after E2 treatment. In contrary to E2, T significantly increased contractile responses that were normalized with combination treatment. During relaxation studies statistically significant higher relaxation responses were observed in ovariectomized rats. Although both exogenous testosterone and estradiol tended to reverse this effect, a statistically significant difference was found only after testosterone treatment. Conclusion. Either estradiol or testosterone replacement alone or in combination prevents significant alterations in bladder tissue histology following ovariectomy whereas both affect the bladder tissue contractility. Thus, combination treatment appears to be the best method to restore both contractility and histomorphology of bladder tissue after ovariectomy. Tanidir Y, Ercan F, and Tarcan T. Exogenous testosterone and estrogen affect bladder tissue contractility and histomorphology differently in rat ovariectomy model. J Sex Med 2011;8:1626-1637

Comparison of the efficacy of single or double intravesical epirubicin instillation in the early postoperative period to prevent recurrences in non-muscle-invasive urothelial carcinoma of the bladder: Prospective, randomized multicenter study

PubMed ID: 20332605Objectives: To investigate the efficacy of single or double epirubicin instillation during the early postoperative period (EPP) in intermediate-risk non-muscle-invasive urothelial cancer. Methods: Patients with primary and solitary or multiple (3 or less) Ta (grade 2-3) or T1 (grade 1-2) tumors were enrolled. Patients were randomized to receive either a single dose of 100 mg epirubicin instillation within 6 h or a second 100 mg epirubicin instillation during the 12th-18th hours after a complete TUR-BT. At the end of the 60-month follow-up period, the available data were statistically analyzed. The end-points of the study were determined as disease-free survival, progression and recurrence rates, time to recurrence, and time to progression. Results: A total of 299 patients from 24 institutions were randomized between January 2002 and June 2004. There were 143 patients from 18 institutions who met the eligibility criteria. The follow-up and disease-free survival periods were 16.9 months and 16 months, respectively. There was no statistical difference in the demographic properties and the end-points between the groups. Conclusions: A single dose of intravesical 100 mg epirubicin chemotherapy during the early postoperative period for primary intermediate-risk non-muscle-invasive urothelial cancer achieved 16 months of mean disease-free survival. A second intravesical epirubicin instillation did not provide any significant benefit. Copyright © 2010 S. Karger AG, Basel