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

A REVIEW ON ANTITUMOR ACTIONS OF POLYSACCHARIDE ISOLATED FROM MEDICINAL MUSHROOMS

ABSTRACT Mushrooms have long been attracting a great deal of interest in many area

Overlap of obstructive sleep apnea and bronchial asthma: Effect on asthma control

Obstructive sleep apnea (OSA) and asthma are highly prevalent respiratory disorders that share several risk factors and are frequently comorbid. Multiple mechanisms have been postulated to explain this frequent coexistence, which is recently referred to as the “alternative overlap syndrome”. Moreover, OSA is generally linked to worse asthma outcomes. Objectives: First, to assess the prevalence of OSA in a group of asthmatics. Second, to evaluate the potential risk factors underlying the development of OSA in these patients. Third, to determine the effect of this overlap on asthma control. Methods: Polysomnography was done for 30 asthmatics and 12 controls. Demographics, spirometry, comorbidities and clinical data were collected. Asthma control was assessed according to the latest GINA guidelines. Results: OSA defined by an AHI of ⩾5 events/h was present in 18 (60%) asthmatics and 2 (17%) controls. Regression analysis revealed that high body mass index (BMI), coexistent gastroesophageal reflux disease (GERD) and asthma severity (FEV1%) are significant independent predictors for the development of OSA in asthmatics (p = 0.03, 0.034, and <0.001 respectively). Moreover, the presence of OSA in asthmatic patients was significantly associated with worse asthma control (p < 0.001). Conclusion: A high index of suspicion is warranted for the overlap of OSA and asthma, particularly in the presence of obesity, GERD, and in patients with severe asthma. Individualized therapy addressing these moderating factors is warranted for optimal health outcomes. Recognition and treatment of OSA in asthmatics is an important element in improving asthma control

Potent antibacterial activity of Terminalia chebula-based herbal soap formulation against propionibacterium acnes and its cytotoxic evaluation on human skin fibroblast cells

Background: Recently, many approaches have been conducted in natural skin healthcare, with herbal remedies gaining prominence due to their perceived efficacy and fewer side effects. Herbal soaps, in particular, are noted for their antimicrobial, anti-inflammatory, and antioxidant properties, making them appealing for acne-causing bacteria such as Propionibacterium acnes, Terminalia chebula, a medicinal plant with a rich history of traditional medicinal properties, including antibacterial effects. However, limited information exists on its activity against acne-causing bacteria and its cytotoxicity on human skin cells. Methods: Our study demonstrated the anti-propionibacterium activity using a novel Terminalia chebula herbal soap formulation (TC-HSF), and to determine its cytotoxicity on Human skin fibroblast cells, Terminalia chebula aqueous extract was used to make herbal soap,  the antibacterial activity was performed against wild isolated propionibacterium acne strain using well-diffusion method, MIC and time-kill Kinetics, several concentrations were evaluated for cytotoxicity on Human skin fibroblast cell lines. Results Our findings indicate a potent activity of TC-HSF against P.acne at 0.18mg\ml with lower CFU\ml in tested intervals and high cell viability 98%, IC50 Value was 50mg\ml. Conclusion: Our study highlights the promising antibacterial efficacy of TC-HSF against Propionibacterium acnes and its cytotoxic effects on human skin fibroblast cells. The research adds valuable insights into the potential of TC-HSF for acne management and underscores the importance of dosage considerations in the formulation of herbal soap products

Pattern of vitamin D in patients with chronic obstructive pulmonary diseases and in patients with bronchial asthma

Objective: To determine the prevalence of vitamin D deficiency in patients with COPD and bronchial asthma, and the relation of vitamin D serum levels to pulmonary spirometric measures as well as other important clinical parameters that could affect quality of life in these patients. Subjects and methods: The study included 80 subjects: 30 patients with COPD and 30 patients with bronchial asthma and 20 healthy volunteers. Patients and control groups were subjected to vitamin D assay by ELISA as well as spirometric assessment. Assessment of patients with COPD was done according to GOLD guidelines 2013: using (mMRCs), CAT score, spirometric assessment of FEV1, and exacerbation assessment. They were also subjected to Combined COPD assessment and BODE index calculation. For all patients with bronchial asthma, GINA classification 2014 of bronchial asthma severity and asthma control assessment were done. Results: Statistically significant lower values of vitamin D were found in patients with COPD (11.94 ± 7.66 ng/ml) compared to patients with bronchial asthma (22.03 ± 8.19 ng/ml) with p < 0.001, while mean ± SD values of 25-hydroxy vitamin D of both groups of patients (COPD and bronchial asthma) were statistically significant lower than control group (35.21 ± 6.04 ng/ml) with (p2, p3 < 0.001) respectively. Seventeen patients that is to say (56.7%) of patients with COPD and 11 patients that is to say (36.7%) patients with bronchial asthma demonstrated a mild to moderate degree of vitamin D deficiency, whereas 13 that is to say (43.3%) patients of COPD and 4 that is to say (13.3%) patients with bronchial asthma showed severe deficiency and all control subjects (n = 20) had a normal concentration of 25-hydroxy vitamin D. Statistically significant positive correlation was found between serum level of 25-hydroxy vitamin D and FEV1% of predicted in patients with COPD with (p = 0.002), whereas no statistically significant correlation was found between serum level of 25-hydroxy vitamin D and FEV1% of predicted in patients with bronchial asthma with (p = 0.120). Statistically significant negative correlations existed between serum level of 25-hydroxy vitamin D and exacerbation risk of patients with COPD and bronchial asthma with (rs = −0.481 and p = 0.007), and (rs = −0.496 and p = 0.005), respectively. Statistically significant negative correlations were found between serum level of 25-hydroxy vitamin D and exacerbation risk of patients with COPD and bronchial asthma with (rs = −0.481 and p = 0.007), and (rs = −0.496 and p = 0.005), respectively. Regarding relation between vitamin D level and grading severity of COPD, we found a significant correlation between serum 25-hydroxy vitamin D level and severity of COPD as assessed by GOLD spirometric classification, with decreased serum level of vitamin D as gold severity increased (19.12 ± 4.37, 9.97 ± 7.64, 8.21 ± 5.72 ng/ml) in gold I, II, III respectively with p = 0.012. Also it was found that CAT score increased and got worse as serum level of vitamin D decreased (16.65 ± 6.98, 8.68 ± 2.27, 9.01 ± 5.67 ng/ml) in categories II, III, IV respectively with rs = −0.468 and p = 0.034, and according to Combined COPD assessment, vitamin D levels were (19.78 ± 4.66, 17.38 ± 4.59, 6.75 ± 4.77, 7.56 ± 5.83 ng/ml) in groups A, B, C and D respectively with rs = −0.448 and p = 0.001. A statistically significant negative correlation was found between serum 25-hydroxy vitamin D level and BODE index score of COPD assessment with rs = −0.421, p = 0.020. According to the correlation of bronchial asthma severity and control to serum level of 25-hydroxy vitamin D, we found a statistically significant negative correlation between mean ± SD of serum level of 25-hydroxy vitamin D and different levels of asthma control with (rs = −0.636, p < 0.001) as well as a statistically significant negative correlation between quantification of 25-hydroxy vitamin D and levels of asthma severity with (rs = −0.875, p < 0.001). Conclusion: Vitamin D deficiency was highly prevalent in COPD and bronchial asthma (100% and 50%) respectively. Low levels of vitamin D were associated with low FEV1%, frequent exacerbations in patients with COPD and bronchial asthma, and increased COPD severity as assessed by GOLD guidelines. Important statistically significant negative associations between vitamin D level and both asthma control and asthma severity according to GINA classification were also found. Thus it is advised to include vitamin D levels in the routine assessment of patients with bronchial asthma and COPD, as well as studying the importance and clinical impact of oral supplementation of vitamin D in patients with COPD and bronchial asthma should be an important goal of future research

Avocado Seeds Relieve Oxidative Stress-Dependent Nephrotoxicity but Enhance Immunosuppression Induced by Cyclosporine in Rats

Cyclosporine A’s (CsA) immunosuppressive effect makes it an ideal drug for organ transplantation. However, CsA’s uses are restricted due to its side effects. We investigated the effects of avocado seed (AvS) powder on CsA-induced nephrotoxicity and immunosuppression in rats. The injection of CsA (5 mg/kg, subcutaneously, for 10 days) increased serum levels of creatinine, uric acid, and urea, and the renal levels of the malondialdehyde. It decreased creatinine clearance and the renal activity of antioxidant enzymes (superoxide dismutase, catalase, and glutathione peroxidase) and Na+/K+ ATPase. The administration of CsA also significantly downregulated the renal expression of interferon-gamma, tumor necrosis factor-alpha, interleukin 1 beta, monocyte chemotactic protein 1, intercellular adhesion molecule-1, and vascular cell adhesion molecule 1 genes, and increased renal DNA damage. Histopathological examination confirmed the biochemical and molecular alterations that accompanied CsA nephrotoxicity. All CsA-induced deleterious effects, except immunosuppression, were ameliorated by feeding rats on a basal diet supplemented with 5% AvS powder for 4 weeks. Importantly, AvS also maximized CsA’s immunosuppressive effect. These findings suggest a potential ameliorative effect of AvS on CsA-induced nephrotoxicity, and AvS enhances CsA’s immunosuppressive effect. Therefore, AvS might be used in combination with CsA in transplantation treatment to relieve the CsA-induced nephrotoxicity

NT-proBNP as Early Marker of Subclinical Late Cardiotoxicity after Doxorubicin Therapy and Mediastinal Irradiation in Childhood Cancer Survivors

Background. Childhood cancer survivors treated with anthracyclines and mediastinal irradiation are at risk for late onset cardiotoxicity. Aims of the Study. To assess the role of N-terminal pro-brain natriuretic peptide (NT-proBNP) and tissue Doppler imaging (TDI) as early predictors of late onset cardiotoxicity in asymptomatic survivors of childhood cancer treated with doxorubicin with or without mediastinal irradiation. Methods. A cross-sectional study on 58 asymptomatic survivors of childhood cancer who received doxorubicin in their treatment protocols and 32 asymptomatic Hodgkin’s lymphoma survivors who received anthracycline and mediastinal irradiation. Levels of NT-proBNP, TDI, and conventional echocardiography were determined. Results. Thirty percent of survivors had abnormal NT-proBNP levels. It was significantly related to age at diagnosis, duration of follow-up, and cumulative dose of doxorubicin. TDI detected myocardial affection in 20% more than conventional echocardiography. Furthermore, abnormalities in TDI and NT-pro-BNP levels were more common in Hodgkin lymphoma survivors receiving both chemotherapy and radiotherapy. Conclusions. TDI could detect early cardiac dysfunction even in those with normal conventional echocardiography. Measurement of NT-proBNP represents an interesting strategy for detecting subclinical cardiotoxicity. We recommend prospective and multicenter studies to validate the role of NT-proBNP as an early marker for late onset doxorubicin-induced cardiotoxicity

Bioefficacy of essential oils emulsion and predatory mite, Euseius scutalis (Athias-Henriot) (Acari: Phytoseiidae) for the management of citrus brown mite, Eutetranychus orientalis (Klein) (Acari: Tetranychidae)

The citrus brown mite, Eutetranychus orientalis (Klein), is a significant pest that is widely distributed in different agricultural systems. It causes significant damage to field crops and fruit trees. The most common method of control is the use of chemical acaricides. However, the extensive use of such chemicals developed resistance in addition to environmental and health hazards. Plant-derived acaricides might therefore be an environmentally friendly alternative to synthetic ones in order to increase agricultural production efficiency and to protect consumer health. Following this prospective, the present study was aimed to evaluate the toxic effects of anise (Pimpinella anisum), rosemary (Rosmarinus officinalis), eucalyptus (Eucalyptus globulus), clove (Eugenia caryophyllus), and garlic (Allium sativum) essential oils (EO) against the eggs and adult’s females of E. orentalis under laboratory conditions. Additionally, Euseius scutalis, a predator mite, was investigated as a bioagent to control E. orientalis under field conditions. GC-MS was used to assess the chemical components of the tested EOs. The results showed that anethole; 9, 12-Octadecadienoic acid (Z, Z); camphor; octatriacontyl pentafluoropropiona; and eugenol, were the major components for anise, rosemary eucalyptus, garlic, and cloves, respectively. Comparably, anise has been shown to be the most effective EO against E. orentalis eggs and adults as it exhibited a high level of efficiency and required the lowest concentration to reach the LC50. Additionally, the three Euseius scutalis release rates significantly reduced the Eutetranychus orientalis population. Ten individuals /seedlings in particular induced the highest reduction (84.95%). Based on our findings, we suggest using Euseius scutalis release and anise essential oil as alternative strategies to control of E. orentalis

Prevalence of Hydatid Cysts in Slaughtered Animals from Elbehera Governorate, Egypt, with a Focus on Histopathology and Molecular Characterization of Camel Cysts

Cystic echinococcosis is a worldwide zoonotic infection that triggers significant economic losses in animals. The study’s goal was to reveal the infection with hydatid cysts in animals slaughtered in Elbehera Governorate, Egypt, as well as perform histopathology and molecular characterization of camel cysts using the cox-1 and G1Y162 genes. Elbehera governorate had a total prevalence of 0.35%. Kom-Hamada abattoir had the highest prevalence of 1.7%. Camels had the highest prevalence of 2.17% among the examined animals. Summer had the highest prevalence, at 0.55%. Females had a higher prevalence than males, except for camels. The older animals were infected at a higher rate than the younger ones, except for the buffalo. Location and season had a significant impact on the prevalence, while sex only impacted the prevalence in cattle and buffaloes. The lung had a higher infection than the liver. The cox-1 and G1Y162 genes PCR reactions provided specific DNA bands, and the sequences were for Echinococcus canadensis. The phylogenetic tree of cox-1 indicated that the Egyptian sequence of Elbehera governorate belongs to genotype 6 (G6) of the Echinococcus complex. The sequence shared an identity percentage of up to 99% with previous Egyptian sequences and other E. canadensis in camels from Iran, Mauritania, Algeria, and Sudan. The phylogenetic tree of the G1Y162 protein sequences confirmed that the Egyptian sequence is E. canadensis. Due to the presence of cysts of zoonotic Echinococcus species in slaughtered animals, stringent health regulations are required to prevent infection in animals and humans. &nbsp