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

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Association between lifestyle and health variables with nutritional status of the elderly in the northern region of Ghana.

With fertility and mortality steadily declining, a remarkable shift in the world’s population age structure toward older ages is expected in the coming decades . The elderly population is at particular risk of malnutrition. The presence of malnutrition could be the result of, and also lead to, social, medical and other health problems . Currently, Ghana has the highest proportion of persons aged 60 years and above in sub- Saharan Africa and little attention has been given to this segment of the population. A cross -sectional study of 400 (177 males and 223 females) individuals who are 65 years and above was carried out in urban areas in the Northern Region of Ghana to evaluate the nutrition and health situation of the elderly . Socio -demographic and economic data, dietary patterns, state of health, level of physical activity and lifestyle variables were collected using a questionnaire. Anthropometric data (weight and height) were measured using standard procedures. More than half of the participants (56.2%) were married and living with their spouses. These were mostly the males. Most of the participants (93.5% ) had no formal education while over half of them (57.2%) relied on family members and friends for their financial needs . Slightly over half (53.2%) of the subjects had fair health status with females experiencing more disease conditions than males. Almost all the respondents were independent in performing all daily activities. Using Body Mass Index ( BMI ) in kg/m 2 as an indicator for nutritional status, 18.0% of the participants were underweight, 60.5% had normal weight and 21.5% were overweight. Alcohol consumption and sight problems were found to have significant negative association with BMI (p=0 .007 and p=0.005, respectively). Malnutrition is, therefore, an important public health burden among the elderly in the region and therefore deserves attention . The formulation and implementation of a national policy on the elderly and nutrition education targeting the whole populace is urgently needed in Ghana to ensure healthy aging.</jats:p

Granulomatory Mastitis: A histological benign lesion with a malignant Radioclinical profile: About 3 Cases

Granulomatous mastitis is characterized by an inflammatory lesion of the breast lobules without caseous necrosis and without microorganisms. It has a probable immunological origin by analogy to thyroiditis or granulomatous orchitis. Frequently the lesion presents itself in a clinical and mammographic form raising suspicion of a malignancy. We report 3 observations of granulomatous mastitis confirmed histologically whose clinical and radiological presentations clearly pointed towards malignancy. This lesion constituted in our three cases an example of radio-clinical and histological discrepancy.</jats:p