COVID-19 pandemic and its impact on medical interns' mental health of public and private hospitals in Guadalajara

INTRODUCTION

Burnout syndrome is a global burden characterized by exhaustion, work detachment, and a sense of ineffectiveness. It affects millions of individuals worldwide, with a particularly high prevalence among medical students. Factors such as demanding education, exposure to suffering, and the COVID-19 pandemic have contributed to elevated stress levels. Addressing this issue is crucial due to its impact on well-being and health-care quality.

MATERIALS AND METHODS

This cross-sectional survey study assessed fear of COVID-19 and burnout levels among medical student interns in hospitals in Guadalajara, Jalisco. The study used validated scales and collected data from September 2021 to September 2022. A snowball sampling method was employed and a minimum sample size of 198 participants was calculated.

RESULTS

This study included 311 medical students (62.1% female and 37.9% male with a mean age of 23.51 ± 2.21 years). The majority were in their second semester of internship (60.5%) and from public hospitals (89.1%). Most students believed that the COVID-19 pandemic affected the quality of their internship (82.6%). Female students had higher personal burnout scores, while male students had higher work-related burnout scores. The mean score for fear of COVID-19 was 13.71 ± 6.28, with higher scores among women (p = 0.004) and those from public hospitals (p = 0.009). A positive weak correlation was found between COVID-19 scores and burnout subscales.

CONCLUSION

Our study emphasizes the significant impact of various factors on burnout levels among medical students and health-care professionals during the COVID-19 pandemic. Prolonged exposure to COVID-19 patients, reduced staffing, and increased workload contributed to burnout, affecting well-being and quality of care. Targeted interventions and resilience-building strategies are needed to mitigate burnout and promote well-being in health-care settings.

Risk Factors and Prevalence Associated With Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy: A Tertiary Care Hospital Experience in Western Mexico

Introduction Laparoscopic cholecystectomy (LC) is a common procedure used for the treatment of different pathologies caused by gallstones in the gallbladder, and one of the most common indications is acute cholecystitis. The definitive treatment for acute cholecystitis is surgery, and LC is the gold standard. Nevertheless, transoperative complications (like intraoperative bleeding, anatomical abnormalities of the gallbladder, etc.) of LC and some other preoperative factors (like dilatation of bile duct, increased gallbladder wall thickness, etc.) can cause or be a risk factor for conversion to open cholecystectomy (OC). The objective of this study was to determine the risk factors and prevalence associated with the conversion from LC to OC in patients with gallbladder pathology and the indication for LC. Materials and methods This was a prospective cohort study. We included patients of both sexes over 18 years of age with gallbladder disease. To determine the risk factors associated with conversion, we performed a bivariate analysis and then a multivariate analysis. Results The rate of conversion to OC was 4.54%. The preoperative factors associated with conversion, in the bivariate analysis, were common bile duct dilatation (p=0.008), emergency surgery (p=0.014), and smoking (p=0.001); the associated intraoperative variables were: laparoscopic surgery duration (p <0.0001), Calot triangle edema (p=0.033), incapacity to hold the gallbladder with atraumatic laparoscopic tweezers (p=0.036), and choledocholithiasis (p=0.042). Laparoscopic Surgery duration was the only factor with a significant association in the multivariate analysis (p=0.0036); we performed a receiver operating characteristic (ROC) curve analysis and found a cut-off point of 120 minutes for the duration of laparoscopic surgery with a sensitivity and a specificity of 67 and 88%, respectively. Conclusion The prevalence of conversion from LC to OC is similar to that reported in the international literature. The risk factors associated with conversion to OC, in this study, should be confirmed in future clinical studies, in this same population, with a larger sample size.

Hyaluronic Acid Reduces Fibrosis in a Rabbit Model of Urethral Anastomosis

INTRODUCTION

Urethral stricture caused by fibrosis is a common medical condition, but top-line therapy for this pathology has a high recurrence rate. This study aimed to determine the efficacy of hyaluronic acid (HA) treatment in preventing the development of fibrosis in a rabbit model of urethral anastomosis.

MATERIALS AND METHODS

This experimental study involved 20 rabbits. HA (0.5 mL, 25 μg/mL) was applied in the experimental group (n = 10) during an experimental urethral anastomosis, and sterile saline (0.9%) solution was applied in the control group (n = 10). Animals underwent reoperation 12 weeks later for urethral resection. Fibrosis, inflammation, and urethral diameter were measured by two blinded pathologists at the site of the anastomosis.

RESULTS

The amount of inflammatory infiltrate was similar in both groups. The thicknesses of the collagen fiber band were 275.9 ± 62.3 and 373.4 ± 44.3 μm in the study and control groups (p = 0.001), respectively, and the urethral lumen diameters at the anastomosis site at follow-up were 2575 ± 167 and 2382 ± 214 μm, respectively (p = 0.04).

CONCLUSION

HA treatment reduced fibrosis at the anastomosis site during this experiment; we suggest further research to corroborate its efficacy in the treatment of urethral stricture.

Minimally Invasive Therapy Using Intralesional OnabotulinumtoxinA in Peyronie's Disease

PURPOSE

To determine the effectiveness of intralesional administration of onabotulinumtoxinA in patients with Peyronie’s disease (PD).

MATERIALS AND METHODS

A prospective therapeutic cohort study was undertaken in patients aged ≥ 18 years with stable PD. Intervention included one-time intralesional application of 100 U of onabotulinumtoxinA. We included 22 patients who attended the urology clinic from October 1, 2011 to June 30, 2012. Primary outcome measure was degree of curvature. Secondary outcome measures were thickness of the fibrous plaque, improvement in erectile function and pain. Erectile function was evaluated using the International Index of Erectile Function (IIEF-5) questionnaire. The Visual Analog Scale (VAS) was used to measure pain during an erection. Statistical analyses were performed by Pearson’s chi-squared test for categorical variables and student’s t-test for quantitative variables. Any P value < .05 was considered statistically significant.

RESULTS

The size of the fibrous plaque was reduced from 0.34 ± 0.20 to 0.27 ± 0.13 cm after treatment (P = .014). The curvature initially averaged 32.95 ± 9.21°, and improved to 25 ± 9.38° (P = .025). According to the Kelami classification, the curvature was < 30° in 14 cases (63.6%) and was 30°-60° in eight cases (36.4%). At 16 weeks, the curvature was < 30° in 19 cases (86.4%) and 30°-60° in three cases (13.6%). The IIEF-5 score was 16.18 ± 4.46 before treatment and 18.22 ± 4.55 after treatment (P = .002). Pain was reduced from 3.36 ± 3.48 before treatment to 1.14 ± 1.58 after treatment (P = .001).

CONCLUSION

The administration of onabotulinumtoxinA may improve the clinical manifestations of PD resulting from fibrosis, thus improving sexual function in patients.

Oral allopurinol to prevent hyperamylasemia and acute pancreatitis after endoscopic retrograde cholangiopancreatography

AIM: To assess the efficacy of allopurinol to prevent hyperamylasemia and pancreatitis after endoscopic retrograde cholangiopancreatography (PEP).

METHODS: One hundred and seventy patients were enrolled and randomized to two groups: a study group (n = 85) who received 300 mg of oral allopurinol at 15 h and 3 h before endoscopic retrograde cholangiopancreatography (ERCP) and a control group (n = 85) receiving an oral placebo at the same times. Main Outcome Measurements included serum amylase levels and the number severity of the episodes of pancreatitis. Serum amylase levels were classified as normal (< 150 IU/L) or hyperamylasemia (> 151 IU/L). Episodes of PEP were classified following Ranson’s criteria and CT severity index.

RESULTS: Gender distribution was similar between groups. Mean age was 53.5 ± 18.9 years for study group and 52.8 ± 19.8 years for controls. Also, the distribution of benign pathology was similar between groups. Hyperamylasemia was more common in the control group (P = 0.003). Mild PEP developed in two patients from the study group (2.3%) and eight (9.4%) from control group (P = 0.04), seven episodes were observed in high-risk patients of the control group (25%) and one in the allopurinol group (3.3%, P = 0.02). Risk factors for PEP were precut sphincterotomy (P = 0.02), pancreatic duct manipulation (P = 0.002) and multiple procedures (P = 0.000). There were no deaths or side effects.

CONCLUSION: Oral allopurinol before ERCP decreased the incidences of hyperamylasemia and pancreatitis in patients submitted to high-risk procedures.

Esophagopericardial fistula attributed to a barogenic rupture of the esophagus. Report of a case and review of the literature

In this case we describe a fatal condition of esophagopericardial fistula secondary to barogenic rupture of the esophagus. The review of the literature disclosed only one fatal case (reported in 1968) of esophagopericardial fistula attributed to barogenic rupture of the esophagus. Early diagnosis and adequate treatment including pericardiocentesis along with intermittent drainage of the pericardium, full-course antibiotic therapy and a timely, well-planned surgical intervention will substantially improve the prognosis in this type of pathology. Patients similar to our case should be treated with either surgical bipolar esophageal exclusion (conservative disconnection) or esophagectomy combined with large drainage of the pericardial and mediastinal spaces. This case report reinforces the complexity of the diagnosis, and perhaps the need for clinical awareness and the inclusion of this entity in a differential diagnosis.

Complications of central venous catheters

Central vein catheterization is frequently employed for monitoring, administration of drugs and parenteral nutrition in a variety of medical and surgical illnesses. Despite the widespread use of central vein access, both catheter-related infections and mechanical complications remain unacceptably common. In the last few years, data have become available to show that technical innovations and catheter maintenance protocols can reduce both catheter related bloodstream infections as well as mechanical complications. Future developments should be aimed at both educational intervention and biomaterials research. The former incorporates case-based instruction, problem-solving examination, and database analysis; while the latter will probably lead to a new set of catheters that are more resistant to infection and thrombosis.

Retained foreign bodies following intra-abdominal surgery

BACKGROUND/AIMS

A retained foreign body in the abdominal cavity following surgery is a continuing problem. Despite precautions, the incidence is grossly underestimated. The purpose of this study is to report the result of surgical treatment on 24 consecutive cases treated by the authors during a 10-year period.

METHODOLOGY

All consecutive patients with a confirmed diagnosis of foreign body after abdominal surgery were studied. Data collected included the patients' age and sex, the initial diagnosis and primary surgical treatment, period of time between the probable causative operation and the definitive treatment, nature of the foreign body, clinical presentation, predisposing factors, and diagnosis and management; morbidity and mortality are presented as well as guidelines for prevention.

RESULTS

All patients were symptomatic. Eight patients presented as intraabdominal sepsis (4 with intestinal obstruction, 4 with entero- or colo-cutaneous fistula), non-specified abdominal pain in 3, persistent sinus and granuloma in 2, abdominal palpable mass in another 2 cases, and 1 patient with vaginal discharge. The diagnosis was established pre-operatively in 15 cases by means of plain abdominal radiographs, ultrasound or computed tomography (CT) scan. Morbidity was observed in 50% and the rate of surgical reinterventions because of fistulas or residual sepsis in 18%. The mortality was almost 10%.

CONCLUSIONS

The clinical manifestations ranged from mild abdominal pain, palpable mass, persistent drainage and granuloma to intestinal obstruction secondary to adhesions or occlusion of the intestinal lumen because of migration of the foreign body and intraabdominal sepsis. Despite this being a rare situation, when it happens it presents as a very serious problem to patients with high rates of morbidity and mortality. Prevention remains the key to the problem.