[Burnout syndrome and associated factors among physicians in two University Hospitals in Antananarivo]. / Burnout syndrome et ses facteurs chez les médecins de deux centres Hospitalo-Universitaires d'Antananarivo.

Medical profession is stressful and can cause professional exhaustion syndrome or Burnout syndrome (BOS). This study aims to determine Burnout syndrome levels (low, medium, high) by its dimensions and by causing factors related to physicians' professional activity. We conducted a cross-sectional study based on self-administered questionnaire to practicing physicians in Soavinandriana Hospital Center and Joseph Ravoahangy Andrianavalona University Hospital in 2012. Correlation and linear regression analyses were made (SigmaStat® 3.5). Out of 138 hospital physicians, questionnaire response rate was 47.1%. Forty eight medical records were selected. The study population was male-dominated (sex ratio: 1.8) with a median age of 37 [25-59] years. Physicians-in-training and assistant physicians accounted for 56.3% of the study population. According to the seniority of the physicians, 16.7% had worked for less than 1 year. Burnout syndrome was found in 51.2% of physicians, of whom 4.2% had high syndrome levels. Occupational status was significantly correlated with Burnout syndrome and with its level (p=0.0142 and p=0.0362), including emotional exhaustion (p=0.0414). BOS wasn't related with physician seniority and sector of activity. BOS in hospital environment is mainly related to occupational status. Early diagnosis is essential to prevent its deleterious effects.

[Intraoperative management of esophageal atresia: small steps that cannot be ignored in Madagascar]. / Prise en charge péri-opératoire de l'atrésie de l'œsophage: petits pas non négligeables à Madagascar.

The management of esophageal atresia is still limited due to the precariousness of technical equipments in Madagascar. Our case study aims to highlight possible therapeutic options and to describe the progresses to be made so as to optimize treatment of this congenital pathology. We collected the medical records of all patients hospitalized for esophageal atresia in the Department of Surgical Reanimation at the University Hospital-JRA Antananarivo. The first patients admitted who survived for a period of 42 months (between January 2011 and June 2014) were included in the study. Among the 17 patients admitted with esophageal atresia, three full-term newborns with type III esophageal atresia, successively admitted in Surgical Reanimation, were the first patients in Madagascar to survive after surgery. Only one patient had associated malformations. These three babies were extubated early in the operating room; they underwent oxygen therapy until normal spontaneous breathing. New-born babies underwent post-operatory physical therapy allowing to improve their respiratory status. Overall mortality rate from this pathology was 76.5% in 42 months. Despite these initial success, progresses still remain to be done in the treatment of this congenital anomaly, from diagnosis up to postoperative period. The improvement of technical equipments, especially ventilation and nutritional support equipments would allow more meaningful results, like in the countries where progresses has been made in the field of reanimation.