Burnout in gastrenterologists: a national-level analysis.

INTRODUCTION: The term burn-out or burnout, means 'burn to exhaustion', this term was first used by Herbert Freundenberg. According to Freundenberg, burnout is a 'state of physical and mental exhaustion conditioned by the individual's professional activity'. That is manifested through a set of signs and symptoms associated with physical and emotional breakdown that result from total energy exhaustion and the lack of resources or forces to 'help' others. OBJECTIVES: Assess the occurrence of burnout in Portuguese gastroenterologists and understand how certain sociodemographic and professional variables might be associated with burnout manifestations. MATERIAL AND METHODS: Observational descriptive, prospective and multicenter study, with analyzed data related to a sample of 52 national gastroenterologists, during the time between 5 February 2019 and 13 April 2019. An estimate of the burnout levels was carried out by the Copenhagen Burnout Inventory (CBI) questionnaire validated for the Portuguese population - CBI-PT. Possible interconnection between sociodemographic and socio-professional variables were analyzed. RESULTS: More than half of the gastroenterologists surveyed did not experience burnout in all subscales of the CBI. On a personal level, there were 13 gastroenterologists with moderate burnout and 11 with high burnout. Regarding the work extent, 18 gastroenterologists with moderate burnout and 7 with high burnout were identified. When considering patient level, it was possible to determine 21 gastroenterologists with moderate burnout and 3 with high burnout. There were no cases of severe burnout. Physicians who developed burnout were significantly younger (p < .001), had less service time (p = .007) and less leisure time (p = .024). Doctors in internship had a higher prevalence of burnout, which might be significantly related to a higher level of professional stress (p = .016). The performance of certain examinations (varicose ligation and endoscopic capsule), working during the weekend and the involvement in medico-legal issues had revealed an association with a higher prevalence of burnout. DISCUSSION AND CONCLUSION: A higher prevalence of burnout was identified in young gastroenterologists, doctors in the internship, those performing high amounts of techniques (upper gastrointestinal endoscopy and colonoscopy), as well as doctors working during the weekend or involvement in legal-medical issues. Therefore, it is possible to conclude that if these young doctors do not acquire tools that will allow them to deal with this problem, it is expected that this pathology will reach critical levels within gastroenterologists, and consequently have a negative impact on healthcare.

Haemolytic disease of the fetus and newborn: do not miss a positive maternal antierythrocyte antibody screen.

Jaundice is one of the most common situations during the neonatal period. Alloimmune haemolytic disease of the fetus and newborn (AHDFN) is a major cause of pathological jaundice during the neonatal period. Since the establishment of anti-D prophylaxis, other antigens have gained greater clinical importance. The maternal antierythrocyte antibody screen is of great importance in monitoring pregnancy and in predicting the risk of AHDFN. A positive result should alert to the possibility of AHDFN and promote close surveillance of fetal anaemia, as well as neonatal anaemia and hyperbilirubinaemia. We describe a case of AHDFN due to incompatibility of the Rhesus c (Rhc) subgroup, diagnosed in pregnancy, but without effective transmission of information in the perinatal period, so a positive maternal antierythrocyte antibody screen was missed. This case highlights the importance of non-RhD antigens in this disease, but also the importance of a successful handoff of information in the delivery room.

Cervical adenitis caused by Staphylococcus aureus in a newborn.

Cervical acute lymphadenitis is rarely described in neonates. We present the case of a 12-day-old preterm, fed by nasogastric tube, who presented a tender erythematous submandibular swelling. Laboratory data showed neutrophilia and an elevation of C reactive protein and procalcitonin. Ultrasound findings suggested cellulitis and adenitis with abscess. The culture of the drainage material identified methicillin-sensitive Staphylococcus aureus With the administration of the right antibiotic treatment, a good clinical outcome was observed.

Improving hydraulic permeability, mechanical properties, and chemical functionality of cellulose acetate-based membranes by co-polymerization with tetraethyl orthosilicate and 3-(aminopropyl)triethoxysilane.

Composite cellulose acetate (CA) membranes are widely used but their multiphase nature results in additive losses, poor mechanical strength, low chemical resistance and thermal stability, limiting their separation/purification yields. To overcome this, we fabricated monophasic hybrid membranes using a modified phase inversion technique, where tetraethylorthosilicate and 3-(aminopropyl)triethoxysilane were added to the CA casting solution. The resulting co-polymerization between CA, silanols and amine-functionalized silica groups, through sol-gel chemistry, was proved by ATR-FTIR (1118 cm-1, ν(SiOC)). The presence of propyl-amine groups increases the hydraulic permeability (3×), the rupture elongation (×1.5), and decreases the Young modulus (×1/2), due to the disruption of the CA-silica 3D network. For high propyl-amine contents this behaviour is reversed due to intensive cross-linking between CA-silica chains (decrease in 903 cm-1, ν(CH3COOC-)). The addition of silica- and amine-based structures to the CA framework increases the system degrees of freedom, opening the door to the design of new CA membranes.