ABSTRACT
Background and Aim: The coronavirus disease-2019 (COVID-19) pandemic has placed significant stress on gastroenterologists worldwide. However, its toll on the mental health of gastroenterologists within Southeast Asia was unknown. A mixed methods, multi-national study was conducted to elucidate the prevalence of burnout and its stressors within the region. Methods: A survey was disseminated electronically to 1761 gastroenterologists via the gastroenterology and endoscopy societies of Brunei, the Philippines, Indonesia, Malaysia, Singapore, and Thailand from September 1 to December 7, 2020. This included the 22-item Maslach Burnout Inventory to detect burnout. Ethical approval was granted. Quantitative and qualitative data were collected. Logistic regression identified associations between variables and burnout. Qualitative data were analyzed by content analysis method. Results: The response rate was 38.8%;66.6% reported significant stress. The regional prevalence of burnout was 17.1% although inter-country variation existed (Fig. 1A). Depression, being a trainee, public sector work, and the lack of awareness or access to mental health support services increased burnout risk significantly (Fig. 1B). The 50.1% of gastroenterologists were unaware of or did not have access to support services. The onset of depression intra-pandemic was 2.1%;the pre-pandemic prevalence was 2.2%. Stressors commonly involved service requirements (53.2%), difficult relationships with patients and relatives (23.0%), and difficult relationships with colleagues (20.5%). Specific to the pandemic, the three most common stressors were fear of getting infected (39.7%), reduced income (28.0%), and stringent infection control measures adding to workload (18.5%). Conclusion: Burnout is common in gastroenterologists in Southeast Asia;however;better safeguards for mental health are urgently needed.
ABSTRACT
Coronavirus disease 19 (COVID-19) which is caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), has been a problem worldwide, particularly due to the high rate of transmission and wide range of clinical manifestations. Acute respiratory distress syndrome (ARDS) and multiorgan failure are the most common events observed in severe cases and can be fatal. Cytokine storm syndrome emerges as one of the possibilities for the development of ARDS and multiorgan failure in severe cases of COVID-19. This case report describes a case of a 53-year-old male patient who has been diagnosed with COVID-19. Further evaluation in this patient showed that there was a marked increase in IL-6 level in blood accompanied with hyperferritinemia, which was in accordance with the characteristic of cytokine storm syndrome. Patient was treated with tocilizumab, a monoclonal antibody and is an antagonist to IL-6 receptor. The binding between tocilizumab and IL-6 receptors effectively inhibit and manage cytokine storm syndrome. Although this case report reported the efficacy of tocilizumab in managing cytokine storm syndrome, tocilizumab has several adverse effects requiring close monitoring. Further clinical randomized control trial is required to evaluate the efficacy and safety of tocilizumab administration in participants with various clinical characteristics and greater number of subjects.
ABSTRACT
Introduction: With ongoing development of technology, and especially amid the current COVID-19 pandemic, there is rapidly increasing need for remote communications, including in the field of medical education. This study aimed to evaluate our telemedicine activities between Japan and Indonesia.