The Impact of the COVID-19 Pandemic on Surgeons' and Surgical Residents' Caseload, Surgical Skills, and Mental Health in Kuwait.

INTRODUCTION: The onset of the COVID-19 pandemic resulted in governments implementing new regulations to divert healthcare resources, which in return led to the postponement of elective and semi-elective surgical procedures. Therefore, many surgeons and as well as surgeons in training reported feeling redundant, which eventually resulted in psychological distress. This study aimed to assess the sociodemographic differences in the psychological impact resulting from the COVID-19 pandemic and outline the effect it had on surgical training. METHODS: This is a cross-sectional study conducted in Kuwait. Data were collected by distributing a questionnaire electronically to surgeons and surgeons in training. The survey included questions aimed at assessing both the effect of the pandemic on surgical training and the psychological impact it had on surgeons, assessing the latter using the Depression, Anxiety and Stress Scale-21 screening tool. RESULTS: The response rate for the study was 52%, with the majority being junior male surgeons. A majority of surgeons in training reported postponement of their scheduled academic teaching sessions (78.9%) and pre-assigned surgical rotations (65.8%). In terms of the psychological impact of the pandemic, a majority of the participants reported an element of depression and stress, 61.2% and 55%, respectively, while approximately half, 48.1%, had symptoms associated with anxiety. CONCLUSION: The COVID-19 pandemic had a negative association with the psychological well-being of a significant proportion of surgeons and associated surgical training programs.

Severe ischemic complications in Covid-19-A case series.

INTRODUCTION: Covid-19 has the propensity to result in a wide array of manifestations. Recently, thromboembolic complications of Covid-19 have been denoted in literature. We report 5 cases of Covid-19 positive patients with no significant comorbidities who developed 1st time episodes of either; acute limb ischemia or bowel ischemia. MATERIAL AND METHODS: This is a retrospective observational study analyzing the clinical characteristics and outcomes of five Covid-19 positive patients. Five patients aged 38-60 presented to our institution from 1st April to 1st June and were diagnosed with Covid-19 pneumonia, subsequently developing severe vascular complications. None of our patients included had any history of thromboembolism nor risk factors that could justify the presentations. PRESENTATION OF CASES: Patient 1; presented with bowel ischemia as a first presentation. Patient 2 and 3 developed unsalvageable lower limb ischemia secondary to partial to complete occlusion of infra-renal aorta. Patient 4 presented with acute upper limb ischemia due to complete occlusion of the axillary and brachial artery. Patient 5 developed bilateral lower limb unsalvageable ischemia secondary to aortic bifurcation occlusion. All patients tested Covid-19 positive upon admission, and received standard care. DISCUSSION AND CONCLUSION: The thromboembolic complications seen in our cases were devastating and resulted in significant mortality and morbidity. All vessels affected were medium-large vessels. None of our cases had any significant predisposing medical conditions or history of thromboembolic or ischemic events. A high index of suspicion is necessary when evaluating such patients regardless of thromboembolic history. Appropriate anticoagulation regimens are essential. Our cases add to the currently increasing severe thromboembolic complications of Covid-19.