Burnout in Academic Medicine: A Peripandemic Assessment.

The impact of burnout on academic medicine has affected its 3 major missions-education, patient care, and research-in ways both similar to and dissimilar from the community practice of medicine. The authors have assessed major themes in the literature regarding burnout in health care professionals in academic medicine in the peripandemic periods-pre-, intra-, and postpandemic-to gain information on the impact of the pandemic on these perspectives. Additionally, burnout in military physicians, particularly in the military medicine academic community, was assessed to provide comparative perspectives on the factors of military training, personal resiliency, and unit cohesiveness on the development of, or resistance to, professional burnout. Overall, there are data to indicate an aggravation of burnout during the pandemic, but currently no long-term data to indicate a persistence of its effects over time on health care professionals beyond baseline prevalence identified prepandemic. Based on the assessments, recommendations are provided for future research, including clarification and standardization of the concepts of burnout, developing longitudinal studies on health care practitioner burnout status with preventive and/or mitigating interventions, and the special protection of certain professionals, including female physicians, physicians in training, and early-career faculty, including nonclinical researchers.

Neuropeptides SP and CGRP Diminish the Moraxella catarrhalis Outer Membrane Vesicle- (OMV-) Triggered Inflammatory Response of Human A549 Epithelial Cells and Neutrophils.

Neuropeptides such as substance P (SP) and calcitonin gene-related peptide (CGRP) play both pro- and anti-inflammatory activities and are produced during infection and inflammation. Moraxella catarrhalis is one of the leading infectious agents responsible for inflammatory exacerbation in chronic obstructive pulmonary disease (COPD). Since the airway inflammation in COPD is connected with activation of both epithelial cells and accumulated neutrophils, in this study we determined the in vitro effects of neuropeptides on the inflammatory potential of these cells in response to M. catarrhalis outer membrane vesicle (OMV) stimulant. The various OMV-mediated proinflammatory effects were demonstrated. Next, using hBD-2-pGL4[luc2] plasmid with luciferase reporter gene, SP and CGRP were shown to inhibit the IL-1ß-dependent expression of potent neutrophil chemoattractant, hBD-2 defensin, in transfected A549 epithelial cells (type II alveolar cells) upon OMV stimulation. Both neuropeptides exerted antiapoptotic activity through rescuing a significant fraction of A549 cells from OMV-induced cell death and apoptosis. Finally, CGRP caused an impairment of specific but not azurophilic granule exocytosis from neutrophils as shown by evaluation of gelatinase-associated lipocalin (NGAL) or CD66b expression and elastase release, respectively. Concluding, these findings suggest that SP and CGRP mediate the dampening of proinflammatory action triggered by M. catarrhalis OMVs towards cells engaged in lung inflammation in vitro.

[Lincomycin applied to the alveolus on TCP carrier and its effect on wound healing after surgical extraction of a third molar]. / Wplyw aplikowania do zebodolu linkomycyny na nosniku TCP na proces gojenia rany po chirurgicznym usunieciu zeba madrosci.

INTRODUCTION: The dental surgeon is often confronted by complications particularly after extraction ofunerupted lower third molars. The most common complication is alveolar periostitis. The healing process after extraction is accompanied by physiologic atrophy of the alveolus involving on the average 30% of bone tissue. Beta-tricalcium phosphate (TCP) is a synthetic material used in medicine to fill up bone defects caused by pathologic processes. The properties of TCP are appropriate for the material to be used as a carrier for drugs, in particular antibiotics. This study was undertaken to determine whether lincomycin applied to the alveolus on TCP carrier can be used to accelerate wound healing and reduce inflammation after surgical extraction of a third molar. MATERIALS AND METHODS: We enrolled 80 patients (males and females between the age of 18 and 50 years) who underwent extraction of a third molar at the Department of Dental Surgery, Pomeranian Medical University in Szczecin. Surgical difficulty in the patients according to the Pederson scale corresponded to grade 2 or 3 (medium or high difficulty). The study group consisted of 40 patients who received lincomycin on TCP. Beta-tricalcium phosphate (300-700 microm pores) obtained from the Department of Technology of Ceramics and Refractories, AGH University of Science and Technology in Cracow, was soaked with 500 mg of lincomycin in solution and applied to the dental alveolus after tooth extraction. The alveolus was tightly sutured. The control group comprised 40 patients not treated with lincomycin. The patients reappeared for examination on the first, third, and seventh day after surgery. Attention during follow-up was directed to alveolar periostitis, pain, and trismus. Pain intensity was assessed with the 10-degree Visual Analog Scale (VAS). RESULTS: We analyzed the subjective pain intensity reported during follow-up by the patients. In the study group, 20 patients reported no pain 24 hours after extraction. On the third day after surgery, alveolar periostitis was present in 15% of patients in the study group and 75% of patients in the control group. On the last day of follow-up, periostitis was present in only 2.5% of patients in the study group as opposed to 45% of patients in the control group. The differences were statistically significant (chi-square 36.05, p < 0.0001). CONCLUSIONS: (1) Lincomycin on TCP can be used to prevent alveolar periostitis. (2) Lincomycin on TCP reduces complications in the form of pain and trismus. (3) Beta-tricalcium phosphate prevents atrophy of the alveolar process.