Burnout syndrome and depression in students of a Colombian medical school, 2018.

INTRODUCTION AND OBJECTIVES: Burnout syndrome (BS) has been evaluated in few populations of medical students, and its relationship with depression is even less studied. The objective was to determine the frequency of BS in medical students of the Universidad Pedagógica y Tecnológica de Colombia (UPTC), in Tunja, Colombia, as well as its association with depression and other social, economic, demographic, and academic factors. METHODS: An observational, analytical, cross-sectional study was carried out on 182 UPTC medical students during 2018. The Maslach Burnout Inventory-Student Survey (MBI-SS) was applied, with which 3 components were obtained to determine positive SB. This was crossed in the Stata 15 program for depression and other social, economic, demographic, and academic covariates with the Generalised Linear Model (GLM). RESULTS: Of 182 respondents, 51.4% were women. The median age was 21 years (20-23 years). 14% had BS, of which 48% had depression. In the multiple regression, BS was significantly associated with a higher frequency of depression (RPa = 5.54; IC95%, 2.36-13.02; P < 0.001) and the feeling of insufficient money (RPa = 4.37; IC95%, 1.95-9.83; P < 0.001), in contrast to a negative association with smoking (RPa = 0.13; IC95%, 0.06-0.30; P < 0.001) and being a woman (RPa = 0.32; IC95%, 0.12-0.82; P = 0.018). The age of onset of marijuana use was not significant. CONCLUSIONS: BS shows a high association with increased depression and a feeling that the money is not enough at the end of the month, but it showed a negative association with tobacco consumption and being a woman. Such students should be detected to provide them with adequate academic support.

The Influence of a Flexible Model on the Marginal Adaptation of Inlay Composite Restorations: A MicroCT Analysis.

The aim of this study was to evaluate the influence of flexible models on the marginal adaptation of indirect resin composite restorations. Thirty-six cavity preparations were made for class II restorations in permanent molar teeth. Three groups (n=12) were defined following three impressions/model material combinations: G(STONE), polyvinylsiloxane, and type IV stone model, as a control group; G(IMPRESSIONPVS), alginate and flexible polyvinylsiloxane; G(MODELPVS), alginate and flexible polyvinylsiloxane for models. All restorations were positioned on their respective teeth and evaluated by micro-computed tomography. Absolute marginal discrepancies were measured digitally (ImageJ). The results were compared using one-way ANOVA (p⟨ 0.05). The mean ± SD absolute marginal discrepancy of indirect resin composite restorations made from flexible and rigid stone models was as follows: G(STONE), 206 (±79.95) µm; G(IMPRESSIONPVS), 221.50 (±61.73) µm; G(MODELPVS), 203.25 (±65.93) µm. Absolute marginal discrepancies were not significantly influenced by the flexible and rigid stone models (p=0.78). The flexible or rigid stone model did not influence the marginal adaptation of the indirect resin composite restorations.

Multidisciplinary management of giant cervicothoracic cutaneous squamous cell carcinoma.

INTRODUCTION: Cutaneus squamous cell carcinoma (SCC) is the second most common type of nonmelanoma skin cancer. SCC is a malignant neoplasm of the skin characterized by aberrant proliferation of keratinocytes. PRESENTATION CASE: We report multidisciplinary surgical management of a 36-year-old male who presented with a huge cutaneous protruding tumor of the cervicothoracic wall. Clinically, he presented with a growing mass on the anterior cervicothoracic wall 3 years ago. Microscopic examination revealed SCC. He underwent complete excision of the lesion. The patient neglected attending our oncological department for receiving chemotherapy. Today, one year after surgery, he is alive without evidence of disease recurrence. DISCUSSION: SCC treatment depends on location of the lesion, involvement of neighboring structures, functional level of the patient, and the patient's acceptance of the proposed management strategy. CONCLUSION: We conclude that SCC can grow to a huge size if left untreated. Surgery by a multidisciplinary surgical team is the primary mode of treatment, followed by chemotherapy if necessary.

A new combined operative technique using crossed inguinal lymphatic rescue for pediatric patients with mixed lymphatic and venous malformations.

Truncular venous malformations and acquired functional or anatomical venous occlusions (or sub-occlusions) can be the cause of secondary lymphedema and even the cause of primary lymphedema when they are associated with lymphatic malformations (lymphangiodysplasia - LAD I, lymphadenodysplasia - LAD II, or a combination of both) in pediatric patients. This understanding recognizes the shared and successive embryogenesis of both systems. These conditions can exhibit hypertension in the venous pedicles intended for lymph-venous anastomosis, and this finding would be a formal contraindication to the procedure. However, this hypertension is a rarely considered condition and is not commonly identified. As a technique to solve this problem, we have combined Nielubowicz, Olszewski, Campisi, and Palma's proposals and created a lymph-venous anastomosis from the side with lymphedema and venous hypertension (lymphatic donor and venous recipient) with an internal suprapubic saphenous venous bridge (from the normal side to the lymphedematous side with venous hypertension) to enable a crossed inguinal lymphatic/venous rescue. We believe this newly synthesized approach will allow better clinical care of pediatric patients with complex and combined lymphatic-venous malformations and is worthy of further investigation.

Transvaginal ultrasound-guided cumulus oocyte complexes aspiration and in vitro embryo production in suckled beef and lactating dairy cattle on pasture-based management conditions.

This study was conducted to determine the use of repeated transvaginal ultrasound-guided cumulus oocyte complex (COC) aspiration on COC recovery rate, in vitro embryo production (IVP) and subsequent pregnancy rates in Holstein Friesian (HF) and Aberdeen Angus (AA) cows (Experiment 1), and in pregnant and non-pregnant Holstein Friesian cows (Experiment 2). Cycling, non-pregnant HF (n=17) and AA (n=32) cows with 40-70 days postpartum, between 3 and 5 years of age were used in the Experiment 1. All cows were submitted to repeated transvaginal ultrasound-guided COC aspiration twice a week for 5-7 weeks. Cumulus ooctye complexes (COC) were in vitro matured, fertilized and cultured for 8 days. An overall of 100 and 350 embryos from HF and AA cows respectively were cryopreserved using a conventional slow freezing (Experiment 1). A total of 81 and 285 frozen-thawed embryos from HF and AA cows respectively were transferred to recipient cows. Pregnancy diagnosis was performed at 60 and 150 days of gestation using transrectal ultrasonography. In Experiment 2, cycling non-pregnant (n=9) and pregnant (n=8) HF cows were submitted to repeated ultrasound-guided COC aspiration and COC were in vitro matured, fertilized and cultured as in Experiment 1, except that embryos were cryopreserved but not thawed and transferred as described for Experiment 1. The results of this study indicate that COC recovery rate and blastocyts production are affected by the breed of the donor cow. The quality of blastocyts produced from both breed did not differ in terms of pregnancy and calving rates (Experiment 1). The physiologic state of pregnancy did not affect COC recovery rate and blastocysts production per donor/session (Experiment 2). The use of ultrasound-guided COC aspiration and IVP could be a powerful technique to improve the genetic of beef and dairy cattle managed under pasture-based conditions management in the southern Chile.

Influence of continuous infusion of citrate on responses of immunoreactive parathyroid hormone, calcium and magnesium components, and other electrolytes in normal adults during plateletapheresis.

To study the relationships between changes in concentrations of different forms of calcium and the responses of immunoreactive PTH in humans during citrate-induced hypocalcemia, we studied 12 healthy donors undergoing continuous flow plateletapheresis. Concentrations of intact, amino-terminal, and midregion PTH; ionized, ultrafiltrable, and total calcium; total and ultrafiltrable magnesium; protein; albumin; pH; phosphate; and citrate were measured in sera collected during the first 95 min of apheresis. Although ionized calcium decreased steadily in every donor, both intact and amino-terminal PTH rose quickly in most donors to a peak level 5-15 min after starting the infusion of citrate and then declined during the remainder of apheresis. Midregion PTH also rose quickly by 5-remainder of apheresis. Midregion PTH also rose quickly by 5-15 min, but levelled off at 30-90 min. Total calcium inversely correlated with both intact PTH (r = -0.76) and amino-terminal PTH (r = -0.81) better than did ionized calcium (r = -0.47 and -0.46, respectively). The rapid rise and then gradual fall of PTH may be due to glandular depletion of stored PTH, increased peripheral metabolism of PTH, or PTH initiation of other hormonal actions that compensate for hypocalcemia. Protein-bound calcium measured, and this change probably reflected dissociation of calcium from its albumin-binding sites to minimize the changes in ionized calcium concentrations.

Erythema multiforme following the infusion of hydroxyethyl starch.

Approximately 18 hours after attempted leukocytapheresis, erythema multiforme developed in a normal 28-year-old woman. About 50 milliliters of 6 percent hydroxyethyl starch (HES) had been infused before the procedure was stopped because of difficulty with access to the veins of her other arm. Although she had donated platelets several times, this was her first leukocytapheresis and first exposure to HES. Preapheresis steroids had not been given.