Dysautonomia and small fiber neuropathy in post-COVID condition and Chronic Fatigue Syndrome.

BACKGROUND: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and post-COVID condition can present similarities such as fatigue, brain fog, autonomic and neuropathic symptoms. METHODS: The study included 87 patients with post-COVID condition, 50 patients with ME/CFS, and 50 healthy controls (HC). The hemodynamic autonomic function was evaluated using the deep breathing technique, Valsalva maneuver, and Tilt test. The presence of autonomic and sensory small fiber neuropathy (SFN) was assessed with the Sudoscan and with heat and cold evoked potentials, respectively. Finally, a complete neuropsychological evaluation was performed. The objective of this study was to analyze and compare the autonomic and neuropathic symptoms in post-COVID condition with ME/CFS, and HC, as well as, analyze the relationship of these symptoms with cognition and fatigue. RESULTS: Statistically significant differences were found between groups in heart rate using the Kruskal-Wallis test (H), with ME/CFS group presenting the highest (H = 18.3; p ≤ .001). The Postural Orthostatic Tachycardia Syndrome (POTS), and pathological values in palms on the Sudoscan were found in 31% and 34% of ME/CFS, and 13.8% and 19.5% of post-COVID patients, respectively. Concerning evoked potentials, statistically significant differences were found in response latency to heat stimuli between groups (H = 23.6; p ≤ .01). Latency was highest in ME/CFS, and lowest in HC. Regarding cognition, lower parasympathetic activation was associated with worse cognitive performance. CONCLUSIONS: Both syndromes were characterized by inappropriate tachycardia at rest, with a high percentage of patients with POTS. The prolonged latencies for heat stimuli suggested damage to unmyelinated fibers. The higher proportion of patients with pathological results for upper extremities on the Sudoscan suggested a non-length-dependent SFN.

Aumento del síndrome de burnout en los adjuntos de Medicina Interna durante la pandemia de COVID-19 / Burnout syndrome increase during COVID-19 pandemic in attending Internal Medicine physicians

Introducción El burnout es un síndrome psicosocial causado por situaciones estresantes en el ámbito laboral. Afecta al 30-60% de los profesionales médicos. El objetivo de este estudio es realizar un análisis comparativo de su frecuencia antes y después del brote de la COVID-19 en los médicos adjuntos de Medicina Interna españoles. Métodos Se enviaron encuestas por correo electrónico y redes sociales integradas con el Maslach Burnout Inventory a los miembros de la Sociedad Española de Medicina Interna en 2019 y 2020. Resultados Se ha observado un aumento no significativo de burnout (38,0% vs. 34,4%). Sin embargo, sí se constata un aumento en la baja realización personal (66,4% vs. 33,6%; p=0,002), dimensión asociada a la prevención de la morbilidad psiquiátrica, además de otras dos: la fatiga emocional y la despersonalización, que pueden afectar negativamente a la atención del paciente. Conclusiones Es esencial abordar este síndrome individual e institucionalmente (AU)

Introduction Burnout is a psychosocial syndrome caused by stressful situations in the workplace. It affects 30% to 60% of medical professionals. The aim of this study is to carry out a comparative analysis of its frequency before and after the COVID-19 outbreak in Spanish internal medicine attending physicians. Methods Surveys that included the Maslach Burnout Inventory were sent via email and associated social networks to physicians who were members of the Spanish Society of Internal Medicine in 2019 and 2020. Results A non-significant increase in burnout was observed (38.0% vs. 34.4%). However, an increase in low personal fulfilment was observed (66.4% vs. 33.6%; p=0.002), a dimension associated with the prevention of psychiatric morbidity, in addition to two others: emotional fatigue and depersonalization, which can negatively affect patient care. Conclusions It is essential to address this syndrome individually and institutionally (AU)

Burnout syndrome increase during COVID-19 pandemic in attending Internal Medicine physicians.

INTRODUCTION: Burnout is a psychosocial syndrome caused by stressful situations in the workplace. It affects 30%-60% of medical professionals. The aim of this study is to carry out a comparative analysis of its frequency before and after the COVID-19 outbreak in Spanish internal medicine attending physicians. METHODS: Surveys that included the Maslach Burnout Inventory were sent via email and associated social networks to physicians who were members of the Spanish Society of Internal Medicine in 2019 and 2020. RESULTS: A non-significant increase in burnout was observed (38.0% vs. 34.4%). However, an increase in low personal fulfilment was observed (66.4% vs. 33.6%; p = 0.002), a dimension associated with the prevention of psychiatric morbidity, in addition to two others: emotional fatigue and depersonalization, which can negatively affect patient care. CONCLUSIONS: It is essential to address this syndrome individually and institutionally.

[Burnout syndrome increase during COVID-19 pandemic in attending Internal Medicine physicians]. / Aumento del síndrome de burnout en los adjuntos de Medicina Interna durante la pandemia de COVID-19.

Introduction: Burnout is a psychosocial syndrome caused by stressful situations in the workplace. It affects 30% to 60% of medical professionals. The aim of this study is to carry out a comparative analysis of its frequency before and after the COVID-19 outbreak in Spanish internal medicine attending physicians. Methods: Surveys that included the Maslach Burnout Inventory were sent via email and associated social networks to physicians who were members of the Spanish Society of Internal Medicine in 2019 and 2020. Results: A non-significant increase in burnout was observed (38.0% vs. 34.4%). However, an increase in low personal fulfilment was observed (66.4% vs. 33.6%; p = 0.002), a dimension associated with the prevention of psychiatric morbidity, in addition to two others: emotional fatigue and depersonalization, which can negatively affect patient care. Conclusions: It is essential to address this syndrome individually and institutionally.

Síndrome de burnout en especialistas de medicina interna y factores asociados a su desarrollo / Burnout syndrome in internal medicine specialists and factors associated with its onset

ANTECEDENTES Y OBJETIVOS: El burnout es un síndrome psicosocial que se produce en respuesta a situaciones estresantes durante el desarrollo laboral; afecta a un 30-60% del personal sanitario. El objetivo de este estudio es valorar su frecuencia en los internistas de España y qué factores podrían relacionarse con su aparición. MATERIAL Y MÉTODOS: Se realizó una encuesta sobre las condiciones laborales seguida del Maslach Burnout Inventory y se difundió mediante el registro de correos electrónicos y las redes sociales de la Sociedad Española de Medicina Interna. Se realizó un estudio descriptivo y un análisis univariante y multivariante para valorar qué variables se asociaron con la presencia de síndrome de burnout. RESULTADOS: Contestaron la encuesta 934 internistas, 58,8% mujeres, con una mediana de edad de 40,0 años. Un 55,0% presentaba un grado de cansancio emocional alto, un 61,7% un grado de despersonalización alto y un 58,6% un grado de realización personal bajo. El 33,4% presentaba burnout. El síndrome de burnout se relacionó de forma independiente con la edad (OR 0,96; IC 95% 0,94-0,98), el mal ambiente de trabajo (OR 1,94; IC 95% 1,31-2,82), no ganar suficiente dinero (OR 1,79; IC 95% 1,20-2,67), haber recibido amenazas (OR 1,703; 1,204-2,410) y tener la sensación de no progresar profesionalmente (OR 2,83; IC 95% 1,92-4,17). CONCLUSIONES: El síndrome de burnout afecta al 33,4% de los internistas de España. Su desarrollo se relaciona de forma independiente con la edad, el mal ambiente de trabajo, no tener la sensación de poder progresar profesionalmente, no creer suficiente la retribución económica recibida y haber sufrido amenazas por parte de pacientes o compañeros

BACKGROUND AND OBJECTIVES: Burnout is a psychosocial syndrome caused by stressful working conditions and affects 30-60% of medical personnel. The aim of this study was to assess the burnout rate of Spanish internists and the factors related to its onset. MATERIAL AND METHODS: We conducted a survey of work conditions followed by the Maslach Burnout Inventory, which was disseminated through the email registry and social networks of the Spanish Society of Internal Medicine. We performed a descriptive study and a univariate and multivariate analysis assessing the variables associated with burnout syndrome. RESULTS: A total of 934 internists (58.8% women and a median age of 40.0 years) answered the survey. Some 55.0% of the internists indicated high emotional fatigue, 61.7% indicated a high sense of depersonalisation, and 58.6% indicated low personal fulfilment. Some 33.4% of the interns experienced burnout. Burnout syndrome was independently related to age (OR 0.96; 95% CI 0.94-0.98), poor work environment (OR 1.94; 95% CI 1.31-2.82), insufficient wages (OR 1.79; 95% CI 1.20-2.67), receiving threats (OR 1.703; 95% CI 1.204-2.410) and the feeling of a lack of professional progress (OR 2.83; 95% CI 1.92-4.17). CONCLUSIONS: Burnout syndrome affects 33.4% of internists in Spain, and its onset is independently related with age, poor work environment, a lack of professional progress, insufficient financial remuneration and experiencing threats by patients or colleagues

Burnout syndrome in internal medicine specialists and factors associated with its onset. / Síndrome de burnout en especialistas de medicina interna y factores asociados a su desarrollo.

BACKGROUND AND OBJECTIVES: Burnout is a psychosocial syndrome caused by stressful working conditions and affects 30-60% of medical personnel. The aim of this study was to assess the burnout rate of Spanish internists and the factors related to its onset. MATERIAL AND METHODS: We conducted a survey of work conditions followed by the Maslach Burnout Inventory, which was disseminated through the email registry and social networks of the Spanish Society of Internal Medicine. We performed a descriptive study and a univariate and multivariate analysis assessing the variables associated with burnout syndrome. RESULTS: A total of 934 internists (58.8% women and a median age of 40.0 years) answered the survey. Some 55.0% of the internists indicated high emotional fatigue, 61.7% indicated a high sense of depersonalisation, and 58.6% indicated low personal fulfilment. Some 33.4% of the interns experienced burnout. Burnout syndrome was independently related to age (OR 0.96; 95% CI 0.94-0.98), poor work environment (OR 1.94; 95% CI 1.31-2.82), insufficient wages (OR 1.79; 95% CI 1.20-2.67), receiving threats (OR 1.703; 95% CI 1.204-2.410) and the feeling of a lack of professional progress (OR 2.83; 95% CI 1.92-4.17). CONCLUSIONS: Burnout syndrome affects 33.4% of internists in Spain, and its onset is independently related with age, poor work environment, a lack of professional progress, insufficient financial remuneration and experiencing threats by patients or colleagues.

Residentes de medicina interna de quinto año en España: encuesta sobre educación, evaluación de competencias y perspectivas de empleo / Fifth-year internal medicine residents in Spain: a survey on education, assessment of competencies and job perspectives

Introducción: la formación de especialistas está basada en la adquisición gradual de conocimientos, habilidades y responsabilidades. El objetivo del estudio es conocer la opinión de los residentes sobre su formación. Material y métodos: estudio descriptivo transversal basado en una encuesta online realizada a los residentes de quinto año durante los meses de febrero y marzo de 2017. Resultados: respondieron la encuesta 194 residentes (62,8% del total); el 62,9% fueron mujeres y el 50% eran menores de 30años, con representación de hospitales de todos los niveles y de las 17 comunidades autónomas. Más del 80% volverían a elegir la especialidad y creen que la duración de la residencia es adecuada; sin embargo, el 76,3% eliminarían alguna de las rotaciones. La mayoría de los residentes desconocen los objetivos de cada rotación y un 37,1% no se han sentido adecuadamente supervisados. Un 82,5% cambiarían el sistema de evaluación y un 68,0% estarían a favor de realizar una prueba de excelencia. La mayoría de residentes han publicado al menos un artículo o realizado una comunicación en un congreso; sin embargo, solo el 27,8% están realizando una tesis doctoral. A pesar de que un 74,7% consideran que van a encontrar empleo, solo un 28,4% tienen una oferta a un mes de finalizar la residencia. Conclusiones: los residentes están satisfechos con la formación recibida, aunque sigue existiendo un déficit en la supervisión y un descontento tanto con la forma de evaluar sus conocimientos como con la precariedad laboral durante los primeros años de especialistas

Background: specialist training is based on the gradual acquisition of expertise, skills and responsibilities. The aim of this study is to determine the opinion of residents regarding their training. Material and methods: this was a cross-sectional descriptive study based on an online survey of 5th-year residents during February and March 2017. Results: a total of 194 residents (62.8% of the total) responded to the survey, 62.9% of whom were women and 50% of whom were younger than 30years, representing hospitals from all levels and from the 17 autonomous communities. More than 80% of the residents choose the specialty once again and believed that the duration of the residence was appropriate; however, 76.3% would eliminate some of their rotations. Most of the residents did not know the objectives of each rotation, and 37.1% felt they were not adequately supervised. Some 82.5% would change the evaluation system, and 68.0% would favour performing an excellence test. Most of the residents had published at least one article or performed one presentation at a congress; however, only 27.8% had completed a doctoral thesis. Although 74.7% of the internists believed they would find employment, only 28.4% had an offer 1month after completing their residence. Conclusions: the residents are satisfied with their training, although there is still a deficit in supervision and dissatisfaction with the method of assessing their knowledge and the precarious job market during the first year for specialists

Conociendo a los tutores de Medicina Interna: nuevas necesidades para la formación / Getting to know internal medicine mentors: new training requirements

Introducción y objetivos: los tutores son los responsables de planificar el aprendizaje de los residentes. El objetivo de este trabajo es conocer la situación de los tutores de Medicina Interna en España y detectar áreas de mejora que puedan facilitar su trabajo. Material y métodos: encuestas online a tutores de Medicina Interna de mayo a julio de 2017 con análisis posterior de los datos. Resultados: respondieron 110 tutores, de 13 comunidades autónomas y hospitales de todos los niveles con docencia en Medicina Interna. Sesenta y tres fueron hombres (57,3%), la media de edad fue de 48 años y tenían una experiencia como tutores de 8,5 años. En el 88,2% de los casos se respeta la ratio de cinco residentes por tutor; un 46% piensa que debería disminuirse esta ratio para optimizar su labor. Un tercio había sido elegido por el responsable del servicio y el 30% nunca ha realizado cursos sobre formación. La entrevista tutor-residentes es utilizada por la mayoría de los tutores (96,4%) como herramienta de comunicación. En relación a las rotaciones, la cuarta parte no son planificadas por los tutores y, solo la mitad, contacta con los centros donde los residentes realizan las rotaciones externas. El 61% cree que no se realiza bien la evaluación de residentes, con muy escasa utilización de las nuevas herramientas de evaluación. Conclusiones: disminuir la ratio tutor/residente y la formación en técnicas de evaluación y desarrollo del aprendizaje podría mejorar la calidad de la tutorización

Introduction and objectives: mentors are responsible for planning the residents' learning. The aim of this study was to determine the situation of internal medicine mentors in Spain and detect areas of improvement that can facilitate their work. Material and methods: online surveys were sent to internal medicine mentors from May to July 2017, the results of which were subsequently analysed. Results: a total of 110 mentors from 13 autonomous communities and from hospitals of all levels with courses in internal medicine responded to the survey. Of these mentors, 63 were men (57.3%), and the mean age was 48 years. The mean experience as mentors was 8.5 years. Some 88.2% of the cases had a ratio of 5 residents to 1 mentor; 46% of the mentors believed this ratio should be decreased to optimize their work. A third of the mentors were chosen by the heads of the department, and 30% had not previously taken courses on training. The mentor-resident interview was used by most mentors (96.4%) as a communication tool. A quarter of the rotations were not planned by the mentors, and only half had contact with the centres where the residents performed the external rotations. Sixty-one percent of the mentors were of the opinion that resident assessments were not conducted properly, with very little use of the new assessment tools. Conclusions: reducing the mentor-resident ratio and adding training in assessment techniques and learning development could improve the quality of the mentoring

Evolution of retinal changes measured by optical coherence tomography in the assessment of hydroxychloroquine ocular safety in patients with systemic lupus erythematosus.

OBJECTIVE: The objective of this report is to analyse retinal changes over a five-year period, assessed by spectral domain-optical coherence tomography (SD-OCT), in patients from the Lupus-Cruces cohort treated with hydroxychloroquine (HCQ). METHODS: SD-OCT screening was performed annually between 2012 and 2017. Average macular thickness (AMT), ganglion cell layer thickness (GCLT) and qualitative data of retinal pigment epithelium (RPE) and external retina (ExtR) were collected prospectively. We compared data from 2012 (first) and 2017 (second) SD-OCT. RESULTS: We studied 110 patients and 195 eyes. No cases of HCQ toxicity were detected. At the time of the second SD-OCT, 99% patients had taken a daily dose of HCQ ≤5 mg/kg/day. The median time on HCQ was 133 months. The mean AMT and GCLT were significantly lower in both eyes at the second SD-OCT; however, all the differences were clinically insignificant at less than 1%. Qualitative analysis of RPE and ExtR showed no significant changes. Similar results were found among patients with risk factors for retinopathy. The comparison of patients with and without risk factors showed no differences. CONCLUSIONS: This study shows clinically irrelevant retinal changes in an SLE cohort on HCQ treatment over a five-year follow-up. Our findings support the safety of long-term HCQ at doses ≤5 mg/kg/day.

Fifth-year internal medicine residents in Spain: A survey on education, assessment of competencies and job perspectives. / Residentes de medicina interna de quinto año en España: encuesta sobre educación, evaluación de competencias y perspectivas de empleo.

BACKGROUND: Specialist training is based on the gradual acquisition of expertise, skills and responsibilities. The aim of this study is to determine the opinion of residents regarding their training. MATERIAL AND METHODS: This was a cross-sectional descriptive study based on an online survey of 5th-year residents during February and March 2017. RESULTS: A total of 194 residents (62.8% of the total) responded to the survey, 62.9% of whom were women and 50% of whom were younger than 30years, representing hospitals from all levels and from the 17 autonomous communities. More than 80% of the residents choose the specialty once again and believed that the duration of the residence was appropriate; however, 76.3% would eliminate some of their rotations. Most of the residents did not know the objectives of each rotation, and 37.1% felt they were not adequately supervised. Some 82.5% would change the evaluation system, and 68.0% would favour performing an excellence test. Most of the residents had published at least one article or performed one presentation at a congress; however, only 27.8% had completed a doctoral thesis. Although 74.7% of the internists believed they would find employment, only 28.4% had an offer 1month after completing their residence. CONCLUSIONS: The residents are satisfied with their training, although there is still a deficit in supervision and dissatisfaction with the method of assessing their knowledge and the precarious job market during the first year for specialists.

Getting to know internal medicine mentors: new training requirements. / Conociendo a los tutores de Medicina Interna: nuevas necesidades para la formación.

INTRODUCTION AND OBJECTIVES: Mentors are responsible for planning the residents' learning. The aim of this study was to determine the situation of internal medicine mentors in Spain and detect areas of improvement that can facilitate their work. MATERIAL AND METHODS: Online surveys were sent to internal medicine mentors from May to July 2017, the results of which were subsequently analysed. RESULTS: A total of 110 mentors from 13 autonomous communities and from hospitals of all levels with courses in internal medicine responded to the survey. Of these mentors, 63 were men (57.3%), and the mean age was 48 years. The mean experience as mentors was 8.5 years. Some 88.2% of the cases had a ratio of 5 residents to 1 mentor; 46% of the mentors believed this ratio should be decreased to optimize their work. A third of the mentors were chosen by the heads of the department, and 30% had not previously taken courses on training. The mentor-resident interview was used by most mentors (96.4%) as a communication tool. A quarter of the rotations were not planned by the mentors, and only half had contact with the centres where the residents performed the external rotations. Sixty-one percent of the mentors were of the opinion that resident assessments were not conducted properly, with very little use of the new assessment tools. CONCLUSIONS: Reducing the mentor-resident ratio and adding training in assessment techniques and learning development could improve the quality of the mentoring.

A favor: Microcarcinoma papilar de tiroides. ¿Es necesario el tratamiento con 131I tras la cirugía? Argumentos a favor / In favor: Papillary thyroid microcarcinoma. Is 131I ablation therapy necessary after surgery? Arguments in favor

El microcarcinoma papilar tiroideo (MPT) es una lesión maligna de diámetro máximo ¾ 10 mm. En nuestra experiencia representa un 18,5% del total de los carcinomas papilares tiroideos y su incidencia ha aumentado en los últimos lustros. Cada uno de los focos de malignidad tiene un origen clonal independiente en un elevado porcentaje de los pacientes. Aunque tiene un pronóstico excelente, con tasas de mortalidad inferiores a un 3% 30 años después del tratamiento quirúrgico, puede dar lugar a morbilidad significativa por metástasis a distancia y/o recidivas regionales. Su descubrimiento puede ser incidental (encontrado de manera inesperada por la intervención de una lesión benigna tiroidea) o no incidental (detectado antes de la intervención, con motivo de una adenopatía palpable, metástasis a distancia o biopsia aspirativa, realizada o no con control ecográfíco). Su tratamiento está en controversia, dada la ausencia de estudios prospectivos de diseño adecuado en los que se haya analizado el tratamiento y el seguimiento posterapéutico más adecuados. Las diferentes líneas directrices no concuerdan en diversos aspectos de los procedimientos terapéuticos. Nosotros, desde hace 35 años, proponemos a la mayoría de nuestros pacientes tiroidectomía total o casi total, seguida de tratamiento ablativo del remanente tiroideo con 131I, basándonos en la eficacia del procedimiento en términos de resultados y para facilitar el seguimiento de una condición en la que no hay marcadores prospectivos inequívocos de recidiva

Papillary thyroid microcarcinoma (PTM) is a malignant lesion with a diameter of 10 mm or less. In our experience, it accounts for 18.5% of all cases of papillary carcinoma and its incidence has been increasing in recent years. In a high percentage of patients, each of the foci in multicentric PTM has an independent clonal origin. Although it has an excellent prognosis, with mortality rates 30 years after surgical treatment below 3%, PTM may give rise to significant morbidity in terms of loco-regional recurrence and/or distant metastases. Clinically, it may present as an incidental lesion, discovered unexpectedly after surgery for benign thyroid disease, or non-incidentally, detected before surgery due to lymph node metastases, distant metastases and/or fine-needle aspiration biopsy of the thyroid, whether guided by ultrasonography or not. Given the absence of prospective, well designed clinical trials, treatment of this entity is controversial. The various guidelines do not agree on therapeutic procedures or follow-up methods. For the past 35 years, we have been performing a relatively uniform therapeutic protocol of total or near total thyroidectomy followed by 131I ablation therapy in most of our patients. So far mortality and morbidity have been acceptable. This approach also facilitates the follow-up of an entity for which no specific markers of future recurrence are available