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

Seroprevalence of brucellosis and typing of Brucella melitensis biovar 2 in lactating cows in Kuwait

Objective: This study was conducted to determine the seroprevalence and typing of brucellosis in lactating cows in some dairy farms in Kuwait. Materials and methods: A total of 4671 serum samples were collected from 4671 apparently healthy lactating cows comprising of 486 from Al-Wafra, 348 from Al-Kabed and 3837 from Al-Salebia areas. The sera were tested by Buffered Acidified Plate Antigen Test (BAPAT), Rose Bengal Plate Test (RBPT) and Complement Fixation Test (CFT) for the presence of brucellosis. Besides, Milk Ring Test (MRT) was done with 60 milk samples collected from 60 lactating cows comprising 18 from Al-Wafra, 5 from Al-Kabed and 37 from Al-Salebia areas. The stomach content of aborted feti were tested for typing of Brucella organism by using specific antisera. Results: The results showed that the overall seroprevalence of bovine brucellosis was 339 (7.25%) by BAPAT, 332 (7.1%) by RBPT, and 329 (7.04%) by CFT. The results revealed that, 42 (8.6%), 5 (1.4%) and 292 (7.6%) sera were positive for brucellosis by BAPAT in the cows of Al-Wafra, Al-Kabed and Al-Salebia areas, respectively. Whereas, their respective number and seroreactive cases by RBPT were 39 (8.02%), 5 (1.4%) and 288 (7.4%). Similarly, as confirmatory test by CFT, the number and seroreactive cases in these areas were 39 (8.02%), 5 (1.4%) and 285 (7.46%). MRT revealed that the average positive case was 61.67% (59.46% in Al-Wafra; 60% in Al-Kabed and 66.6% in Al-Salebia). Two Brucella isolates could be recovered from the stomach content of the two aborted feti and typed as Brucella melitensis biovar 2. Conclusion: Brucellosis is prevalent among lactating cows in Kuwait. This indicates the potential role of these dairy animals in disseminating and spread of such zoonosis to human. Considering public health significance, appropriate preventive measures are suggestive for combating brucellosis in Kuwait. [J Adv Vet Anim Res 2016; 3(3.000): 229-235

Supernumerary ovary presenting as a paraduodenal duplication cyst

Supernumerary ovary is a rare gynecological anomaly and is generally excised due to its potential malignant transformation. We report a case of a patient who was referred for excision of a probable duodenal duplication cyst that was subsequently identified as a paraduodenal supernumerary ovary. Pediatric surgery was consulted on an adolescent patient due to a presumed congenital anomaly of the intestinal tract based on imaging studies

Iatrogenic diaphragmatic hernia in infants: Potentially catastrophic when overlooked

Acquired diaphragmatic hernias are a rare occurrence. They can result from blunt, penetrating or inadvertent iatrogenic injury. When overlooked they can potentially be catastrophic. We report a case of iatrogenic diaphragmatic hernia in a six-month old infant presenting with acute respiratory distress as a result of strangulated bowel herniating into the left hemithorax caused from a traumatic chest tube insertion in the neonatal period

Long-gap esophageal atresia: gastric transposition or esophageal lengthening with delayed primary anastomosis? A systematic review

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Sheep Brucellosis in Kuwait: A Large-Scale Serosurvey, Identification of Brucella Species and Zoonotic Significance

Brucellosis is a common zoonotic disease of major concern in humans of Kuwait, and B. melitensis causes most human cases. The disease is endemic in small ruminants, cattle, and camels for decades, causing substantial economic losses in livestock production. However, a nationwide large-scale investigation of brucellosis in the small ruminant population has not been done in the past two decades. A serosurvey of sheep brucellosis in the five districts of Kuwait with most animal production farms was done between 2016 and 2019. In total, 67,054 serum samples from 233 sheep herds were collected and tested. Additionally, milk and tissue samples were collected from 46 seropositive cases for bacteriology. Thirty persons from seven seropositive farms were tested by serology. The incidence of seropositive cases was 7% in districts devoid of vaccination, while it was 4.7% in farms with history of vaccination. The serosurvey revealed that 89% of non-vaccinated herds (n = 181) were seropositive by Rose Bengal test (RBT), buffered acidified plate antigen test (BAPAT), and complement fixation test (CFT). Prevalence of 100% was reported for non-vaccinated sheep herds from Al-Wafrah and Al-Jahra districts, followed by those from Al-Salmi (88.24%), Al-Abdali (86.7%) and Kabd (75.6%). Implementation of vaccination with B. melitensis Rev.1 vaccine and test-and-slaughters in 20 herds reduced the seroprevalence to 33.3% and 25% in herds from Al-Jahra and AL-Wafrah, respectively. B. melitensis was isolated from 20 samples (43.5%). More than half of the examined animal owners (56.6%) tested positive for Brucella using RBT, BAPAT and CFT. The high numbers of infected herds and high prevalence in herdsmen are alarming. Thus, control measures have to be ensured immediately. The epidemiological situation in Kuwait is similar to those of the neighboring countries and the combined action of these states is needed. The understanding of the economic and public health impact of brucellosis in Kuwait needs to grow

Pancreatic duct cells as a source of VEGF in mice

Protostars and young stars are strongly spatially ‘clustered’ or ‘correlated’ within their natal giant molecular clouds. We demonstrate that such clustering leads to the conclusion that the incident bolometric radiative flux upon a random young star/disc is enhanced (relative to volume-averaged fluxes) by a factor that increases with the total stellar mass of the complex. Because the Galactic cloud mass function is top-heavy, the typical star in our Galaxy experienced a much stronger radiative environment than those forming in well-observed nearby (but relatively small) clouds, exceeding fluxes in the Orion Nebular Cluster by factors of ≳30. Heating of the circumstellar disc around a median young star is dominated by this external radiation beyond ∼50 au. And if discs are not well shielded by ambient dust, external ultraviolet irradiation can dominate over the host star down to sub-au scales. Another consequence of stellar clustering is an extremely broad Galaxy-wide distribution of incident flux (spanning >10 decades), with half the Galactic star formation in a substantial ‘tail’ towards even more intense background radiation. We also show that the strength of external irradiation is amplified superlinearly in high-density environments such as the Galactic Centre, starbursts, or high-redshift galaxies