STRESS AND BURNOUT SYNDROME AMONG MOROCCAN MEDICAL STUDENTS: A CROSS-SECTIONAL STUDY

Background:Christina Maslach and colleagues define burnout as a psychological syndrome in response to chronic interpersonal stressors on the job which is further characterized by its three dimensions of exhaustion, depersonalization, and a decreased sense of accomplishment. Burnout and stress are symptomatically similar, with burnout attributed specifically to occupational or academic stressors. Both can cause seriousconsequences on studenthealth, professionalism, and patient care. There are few studies evaluating the level of stress and burnoutsyndrome among medical students in Morocco.The aim of this study was to assess the prevalence and levels of burnout syndrome to identify associated factors as well as the level of stress among a group of medical students in Morocco. Method: Our study was descriptive andcross-sectional. It focused on 5th grade level medical students and was carried out during the month of November 2014. Data was collected through a self-administered questionnaire based on volunteering. Results:The study was conducted in a total of 178 fifth-year medical students. The response rate was 97.2% (n = 173). The mean age was 22.2 years (SD = 0.87 years) with a female predominance (74%). The average daily working hours were 8.33 hours (SD= 2.74) and the average daily hours of sleep was 7 hours (SD= 1.1). The majority of students (96.5%) were single.The prevalence of burnout, based on Maslach Burnout Inventory, was 49% (n = 87) of students.The prevalence of high emotional exhaustion was 44%, high depersonalization was 33.3% and high burnout score for personal accomplishment accounted for 64 %.We found a positive correlation between the number of working hours and the burnout score (r = 0.341, p <0.001) as well as the stress score (r=0.3, p=0.009). We also found a negative correlation between the number of hours of sleep and the Burnout score (r = -0.215, p = 0.019).Clearly, this study provides an idea for necessity to plan specific interventions to reduce student stress and avoid burnout.

SAPHO Syndrome and Pustulotic Arthro-Osteitis (PAO)

ABSTRACTS Synovitis, Acne, Pustulosis, Hyperostosis and Osteitis (SAPHO) syndrome is a rare inflammatory osteo-articular disorder, which encompassed many diseases, including pustulotic arthro-osteitis (PAO). Bone and joint manifestations, including osteitis, synovitis and hyperostosis, are the hallmark of the SAPHO syndrome and affect a variety of regions of the body. Recent GRAPPA survey indicated that more than 80 percent of cases of SAPHO syndrome in Japan were thought to be PAO, originally proposed by Sonozaki et al. in 1981, whereas severe acne was the most commonly reported skin ailment amongst participants with SAPHO syndrome in Israel. SAPHO syndrome is a rare disease and adequate data regarding its prevalence remains unavailable, whereas prevalence of PPP was reported to be 0.12 % in Japan and 10-30% of patients with PPP had PAO. SAPHO syndrome and PAO are predominantly found in patients in the third through fifth decades of life, and a female predominance are seen in both groups. The diagnosis of SAPHO syndrome/PAO is typically made by a rheumatologist or dermatologist. Identification of a variety of the clinical, radiological, and laboratory features outlined, as well as diagnostic criteria, are used to make the diagnosis. Goals for treating patients with SAPHO syndrome/PAO seek to maximize health-related quality of life by improving skin and articular symptoms, preventing structural changes and destruction, and normalizing physical function and social participation. Finally, we review the non-pharmacological (ie: smoking cessation and controlling focal infections) and pharmacological managements including NSAIDs, bisphosphonates, cs DMARDs, bDMARDs, and other treatments for SAPHO syndrome/PAO.

Prevalence of Helicobacter Pylori Serologically in Patients Who Presented With Dyspeptic Symptoms to Orotta Medical Surgical National Referral Hospital

Background: Optimum management of dyspepsia in primary care is a debatable subject. Testing and treatment for Helicobacter pylori has become widely accepted as the approach of choice for patients with chronic dyspepsia but no alarming features. We evaluated prevalence of H. pylori among outpatients with dyspepsia and serologic investigations for it in tertiary hospital Orotta Medical Surgical National Referral Hospital (OMSNRH) retrospectively.Methods: A retrospectively collected data of H. pylori status among dyspeptic patients from Out Patient Department (OPD) and laboratory of OMSNRH, who had undergone serologic test for the infection, of the year 2012 was reviewed for the period from February 2013 to May 2013.Results: The prevalence of dyspepsia visited OMSNRH was 6.08%, with female predominance, from a total visit of 30,035. Of all 1844 dyspeptic patients from the OPD, 20.93% were positive, 48.05% were negative and 31.02% were untested for H. pylori. From a total of 4136 of the laboratory results, the prevalence of H. pylori was 31%. In adults (>14 years), it was 34% and pediatric (<15 years), prevalence was 12.5%. Male sex preference was observed among the adults in this study (37.7% vs. 31.7%, P=0.034). Conclusion: The prevalence of dyspepsia was 6.08% and the prevalence of H. pylori serologically in this study was 34% in adults and 12.5% in pediatric age group.

A Study on the Clinicopathological Profile of the Cases of Colorectal Carcinoma

Aim: To assess the clinicopathological details of patients with colorectal cancer in a tertiary care centre in India and compare it other studies reported in the literature. Study Design: This is a retrospective study conducted on all the patients who were admitted in the period of 2017 to 2020. Place and Duration of Study: Department of Pathology, Saveetha Medical College, Thandalam, Chennai. The data was processed and the manuscript was prepared between June 2020 and January 2021. Methodology: Patient details were collected from the histopathology records and the parameters studied were age, gender, tumour site, histological type, differentiation and tumour stage of the colorectal carcinoma. The sampling was done using the complete enumerate sampling method. The patients diagnosed histopathologically as colorectal carcinoma were included in our study. Results: A total of 51 patients had been admitted in the years 2017, 2018, and 2019 in our institute. There was a female predominance among the patients. The mean age of the patients was lesser than the mean age of colorectal cancer cases in other studies which have been reported in the country. The most common tumour site was rectum in both the sexes and the most common histologic type was adenocarcinoma. The most common histological differentiation was moderate differentiation. Conclusion: The increased incidence in younger patients as compared to previous studies may be attributable to the lifestyle and dietary changes.

A Systematic Review of Subacute Thyroiditis Related to COVID-19

Background: The novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which belongs to the family Coronaviridae, is the cause of COVID-19 infection. Its outbreak was declared a pandemic on March 11, 2020. COVID-19 does not involve the respiratory system solely, but other systems were also noted to be affected, including the endocrine, cardiovascular, and gastrointestinal systems. Several case reports and series have been published regarding SAT related to COVID-19 infection, yet management and clinical outcomes of the disease have not been discussed in detail. Methods: This is a systematic review of cases that have been reported to have subacute thyroiditis induced by COVID-19 infection. A systematic search was conducted throughout multiple databases, including PubMed, Google Scholar, and MeSH network. Results: The total number of reported subacute thyroiditis cases attributed to COVID-19 is 24. There was a female predominance (18 females and 6 males) with a female to male ratio of 3:1. Ages ranged from 18 to 69 years (mean = 38.67). Twenty-four symptoms related to thyroiditis were reported, the most common of which being neck pain (95.83%, n=23), palpitations (79.17%, n=19), and fever (66.67%, n=16). The outcome was complete resolution in 70% of cases. Conclusion: The endocrine complications of COVID-19 and their management have been disregarded by most as they are rare. Our knowledge of COVID-19 and its complications is growing rapidly. More favourable outcomes were linked with the use of corticosteroid therapy. Until larger studies can be conducted, the management of SAT caused by COVID-19 remains to be based on each individual case. However, the treatment regimen should include corticosteroid therapy.

Differences in clinical and imaging presentation of maxillary sinus fungus ball with and without intralesional hyperdensity

Maxillary sinus fungal balls (MSFBs) mostly occur in older individuals and demonstrate female predominance. Early diagnosis is important to avoid treatment delays. Intralesional hyperdensity (IH) indicates the presence of heavy metal deposition within fungal hyphae and has been the most specific characteristic of MSFB on computed tomography (CT). For those without IH on CT, the diagnosis of MSFB remains challenging. This study aimed to characterize clinical presentation of MSFB with and without IH and to study factors contributing to MSFB with no IH formation. We retrospectively identified 588 patients with MSFB. The clinical characteristics and CT findings were reviewed. Patients with unilateral MSFB had a mean age of 57.4 years and demonstrated female predominance (64.63%). The female-to-male ratio was highest at 51–60 years (2.02) and rose to 2.60 in MSFB with IH only. Compared to those with IH, MSFB without IH was significantly more common in males (OR = 2.49), in those with diabetes mellitus (DM) (OR = 1.87), adjacent maxillary odontogenic pathology (OR = 1.75). Complete opacification on CT was less common in MSFB without IH (OR = 0.60). Patients with MSFB without IH were more likely to have DM, no female predominance, adjacent maxillary odontogenic pathology, and partial opacification of the sinus, compared to those with IH. These may be helpful in better understanding of the formation of MSFBs without IH, early identification of them and prevention of post-operative recurrence.

MELASMA: A HOSPITAL BASED RETROSPECTIVE STUDY ON CLINICOEPIDEMIOLOGICAL PROFILE

Background: Melasma is a common, therapeutically challenging, psychological distressing, pigmentary disorder of sun exposed skin. Aim Of The Study: To study the clinical and epidemiological prole of melasma patients. Materials And Methods: Tertiary care hospital retrospective study using data of melasma patients who attended the dermatology outpatient clinic between February 2012 to May 2021. Study included 296 patients above 18 years. Demographic details were obtained from the pigment clinic proforma. Results: Mean age of 296 patients was 35.4 years, with female predominance (86.1%). Mean age at onset of melasma was 31.9 years. Aggravation with sun exposure was noted in 64.2% cases. Family history was present in 15.2% cases while hypothyroidism in 3.4% cases. Malar involvement was commonest (68.6%). Under Wood's lamp, epidermal type was commonest (57.4%). Cosmetic usage was present in 6.4% cases. Pregnancy precipitation and pregnancy aggravation was noted in 16.5% and 9% females. 7.5% females reported OC pill usage. Conclusion:This study showcases the multifaceted prole of patients aficted with melasma in a tertiary care hospital.

Nationwide epidemiological characteristics of chronic fatigue syndrome in South Korea

Background Chronic fatigue syndrome (CFS) is a long-term disabling illness accompanied by medically unexplained fatigue. This study aimed to explore the epidemiological characteristics of CFS in South Korea. Methods Using the nationwide medical records provided by the Korean Health Insurance Review & Assessment Service (HIRA), we analyzed the entire dataset for CFS patients diagnosed by physicians in South Korea from January 2010 to December 2020. Results The annual mean incidence of CFS was estimated to be 44.71 ± 6.10 cases per 100,000 individuals [95% CI: 40.57, 48.76], and the prevalence rate was 57.70 ± 12.20 cases per 100,000 individuals [95% CI: 49.40, 65.79]. These two rates increased by 1.53- and 1.94-fold from 2010 to 2020, respectively, and showed an increasing trend with aging and an approximately 1.5-fold female predominance. Conclusions This study is the first to report the nationwide epidemiological features of CFS, which reflects the clinical reality of CFS diagnosis and care in South Korea. This study will be a valuable reference for studies of CFS in the future.

Adenoid cystic carcinoma of nasal septum: A review of literature

Adenoid cystic carcinoma(ACC) is a common salivary gland tumour which constitutes about 10% of all salivary gland malignancies and 1% of all head & neck malignancies. It is a slow growing tumour with propensity for perineural invasion., It occurs most commonly in minor salivary glands, most commonly in oral cavity. It is the third most common malignancy of paranasal sinuses with most common site being maxillary sinus followed by nasal cavity, nasopharynx and ethmoid sinus. It is most commonly seen in 4 and 5 decade with female predominance. ACC arising from nasal septum is very rare with only 10 cases published in literature. In this paper we present a case of nasal septal adenoid cystic carcinoma with review of the literature.

Unusually High Prevalence of Stroke and Cerebral Vasculopathy in Hemoglobin SC Disease: A Retrospective Single Institution Study

<b><i>Introduction:</i></b> Unlike homozygous hemoglobin SS (HbSS) disease, stroke is a rare complication in hemoglobin SC (HbSC) disease. However, recent studies have demonstrated a high prevalence of silent stroke in HbSC disease. The factors associated with stroke and cerebral vasculopathy in the HbSC population are unknown. <b><i>Methods:</i></b> We conducted a retrospective study of all patients with sickle cell disease treated at the University of Missouri, Columbia, over an 18-year period (2000–2018). The goal of the study was to characterize the silent, overt stroke, and cerebral vasculopathy in HbSC patients and compare them to patients with HbSS and HbS/β thalassemia1 (thal) in this cohort. We also analyzed the laboratory and clinical factors associated with stroke and cerebral vasculopathy in the HbSC population. <b><i>Results:</i></b> Of the 34 HbSC individuals, we found that the overall prevalence of stroke and cerebral vasculopathy was 17.7%. Only females had evidence of stroke or cerebral vasculopathy in our HbSC cohort (33.3%, <i>p</i> = 0.019). Time-averaged means of maximum velocities were lower in the HbSC group than the HbSS group and did not correlate with stroke outcome. Among HbSC individuals, those with stroke and cerebral vasculopathy had a marginally higher serum creatinine than those without these complications (0.77 mg/dL vs. 0.88 mg/dL, <i>p</i> = 0.08). Stroke outcome was associated with recurrent vaso-occlusive pain crises (Rec VOCs) (75 vs. 25%, <i>p</i> = 0.003) in HbSC patients. The predominant cerebrovascular lesions in HbSC included microhemorrhages and leukoencephalopathy. <b><i>Conclusion:</i></b> There is a distinct subset of individuals with HbSC who developed overt, silent stroke, and cerebral vasculopathy. A female predominance and association with Rec VOCs were identified in our cohort; however, larger clinical trials are needed to identify and confirm specific clinical and laboratory markers associated with stroke and vasculopathy in HbSC disease.