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

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

A 14 years old woman with a giant mucinous adenocarcinoma of the ovary

The diagnosis of ovarian tumor in pediatrics is often difficult and delayed due to unspecific call signs and polymorphic imaging presentations. These tumors are rare, estimated in children at around 2.6 / 100,000 girls per year, functional lesions being excluded. Ten to 20% of them are malignant [1-2] and represent 3% of cancers in girls under the age of 15 [3]. The World Health Organization classifies these tumors into three main groups based on whether they are derived from the surface epithelium, germline cells or ovarian stroma or sex cords. Primary or secondary locations are possible in leukemias and lymphomas [4-5]. Giant ovarian cystadenocarcinomas are rarely described. The huge ovarian masses are mostly benign, but the malignancy should be ruled out by pathology exams. Giant cysts require resection by laparotomy because of compression symptoms or the risk of malignancy, but also to prevent perforation and spillage of cystic fluid into the peritoneal cavity [6]. Here we report an observation made in a 14-year-old girl who was diagnosed with a large ovarian tumor and who was found to be a malignant tumor on pathology with papillary-type mucinous cystadenocarcinoma.</jats:p

Peritonitis by Spontaneous rupture of ovarian dermoid cyst: a case report

Background: Ovarian dermoid cyst is a benign congenital tumor. It is often incidentally diagnosed and can be revealed in very rare cases by spontaneous rupture. We report the case of a ruptured ovarian dermal cyst complicated by generalized peritonitis. Case report: This was a 20-year-old female patient, who consulted for abdominal pain associated with fever and vomiting. Physical examination found generalized abdominal contracture. Plain abdominal radiography found pneumoperitoneum. Biology showed leukocytosis at 18000 / mm3. Median laparotomy revealed a collection 2000 cc of pus with a ruptured right ovarian mass. An adnexectomy with lavage of abdominal cavity were performed. Anatomopathological examination concluded to an ovarian dermoid cyst with no sign of malignancy. The postoperative course was uneventful. Conclusion: Rupture of a dermoid cyst of the ovary is a rare acute complication. Examination of the operative specimen is mandatory to eliminate malignancy. Keywords: Ovary; Dermoid cyst; Rupture; Acute complication; Peritonitis; Ovary</jats:p