ABSTRACT
Water-borne infections like typhoid fever are common in the developing world. The emergence of extensively drug-resistant Salmonella typhi (XDR S. typhi) is of great concern for both local and global public health. Fever, diarrhea, and abdominal pain are the commonest manifestations of typhoid fever. Abdominal pain may be due to ileal and colonic inflammation/ulceration and mesenteric lymphadenitis. Sometimes, abdominal pain in typhoid is due to ileal perforation leading to peritonitis, and acute appendicitis which needs urgent surgical intervention. Delayed surgical intervention can result in morbidity and sometimes even death. We report a case of XDR S. typhi infection in a 17-year-old female who presented with fever and abdominal pain. During the course of the hospital stay, while she was on appropriate antibiotics, her abdominal pain worsened due to acute appendicitis. She underwent an appendectomy and had an uneventful recovery. This is the first case, to our knowledge, of acute appendicitis caused by XDR S. typhi. Although appropriate antibiotics are the mainstay of treatment for typhoid fever, physicians should be mindful that surgical consultation may be necessary in certain cases.
ABSTRACT
OBJECTIVE: To evaluate the direct and interactive role of personal and work-related factors in psychological burnout among doctors. METHODS: The cross-sectional study was conducted in September, 2018, at three hospitals of the twin cities of Rawalpindi/Islamabad, Pakistan, and comprised doctors aged 24-49 years. Data was collected using a demographic questionnaire and the self-reporting Copenhagen Burnout Inventory. Data was analysed using SPSS 23. RESULTS: Of the 161 doctors, 66(41%) were males and 96(59%) were female. The overall mean age of the sample was 26.44 4.80 years (range: 24-49 years). There was significant direct effect of work setting and indirect effect of gender and work setting on psychological burnout (p<0.05). Doctors experienced more burnout in emergency room settings compared to wards and outpatient departments (p<0.05). Further, young and low-salaried doctors were more prone to psychological burnout, and continuous working hours added to the adversity of burnout (p<0.05).. CONCLUSIONS: Personal and workplace related factors were found to play a significant role in psychological burnout which may possibly affect the overall efficiency of doctors.
Subject(s)
Burnout, Professional , Physicians , Adult , Burnout, Professional/epidemiology , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Pakistan , Surveys and Questionnaires , Young AdultABSTRACT
BACKGROUND AND OBJECTIVE: Mental health problems not only affect the common person but also medical health practitioners (MHPs) dealing with health care issues of patients. The current study aimed to explore the triadic (three dimensional) comorbidity of mental health problems and its association with three forms of psychological burnout (person, client and work related). METHODS: This correlational study was conducted at three hospitals of Islamabad/ Rawalpindi (Holy Family Hospital=57, District Headquarter Hospital=60, and Benazir Bhutto Hospital=40) from June 2018 to September 2018. The sample comprised of 157 medical health practitioners (medical doctors) serving in general ward (n=64), emergency (n=60) and OPD (n=33) sections. The participants were administered self-report measures of DASS-21 and Copenhagen Burnout Inventory. RESULTS: Triadic comorbidity of depression, anxiety and stress ranged from 9% to 26% for excessive severe and normal levels respectively. Comorbidity of work related and personal related burnout at severe level was found 8%. Further, depression, anxiety and stress symptoms were strongly associated with psychological burnout at .0001 significance level. CONCLUSION: MHPs demonstrated excessive severe comorbidity of depression, anxiety and stress simultaneously. Along with this triadic comorbidity, the presence of severe psychological burnout is alarming and affecting overall efficiency and mental health of doctors which need to be identified, screened out and managed timely and managed properly.
