Prevalence of stress, burnout syndrome, anxiety and depression among physicians of a teaching hospital during the COVID-19 pandemic. / Prevalencia de estrés, síndrome de desgaste profesional, ansiedad y depresión en médicos de un hospital universitario durante la pandemia de COVID-19.

INTRODUCTION: Health care workers experience a tremendous strain while performing their activities, very frequently leading to stress, burnout syndrome, and psychopathological impact. The COVID-19 pandemic may cause physicians to suffer these effects even to a greater extent. Our objective was to describe the frequency of stress, burnout syndrome, anxiety, and depression during the pandemic, and analyze the associations with different independent outcome measures. METHODS: Observational, cross-sectional study conducted 2 months after the lockdown was established in Argentina. Clinical specialists, surgeons, emergency physicians, and those with no direct contact with patients were surveyed using a sociodemographic questionnaire and 3 self-administered inventories: Health Professions Stress Inventory, Maslach Burnout Inventory, and Hospital Anxiety and Depression Scale. RESULTS: The prevalence of stress was 93.7 % (95 % confidence interval [CI]: 90.33-96.2), burnout syndrome 73.5 % (95 % CI: 68.2-78.4), anxiety 44 % (95 % CI: 38.4-49.8), and depression 21.9 % (95 % CI: 17.3-26.9). No association was observed between the frequency and medical specialty. The frequency of burnout syndrome, anxiety, and depression was significantly higher among residents and physicians working in the emergency department. CONCLUSIONS: Residents and emergency physicians working 24-hour shifts showed significantly higher percentages of burnout syndrome, anxiety, and depression compared to staff and head physicians. These findings may be associated with a higher workload and less experience. It is compulsory to take preventive and therapeutic measures to protect those in the pandemic front line.

Introducción. Los trabajadores de la salud se encuentran sometidos a una gran tensión en el desarrollo de sus actividades, lo que genera alta frecuencia de estrés, desgaste laboral e impacto psicopatológico. La pandemia de COVID-19 podría provocar un incremento de estas entidades en los médicos. El objetivo fue describir la frecuencia de estrés, síndrome de desgaste profesional (burnout), ansiedad y depresión durante la pandemia, y analizar las asociaciones con distintas variables independientes. Métodos. Estudio observacional, transversal, realizado dos meses después del inicio de la cuarentena en Argentina. Se encuestó a médicos de especialidades clínicas, quirúrgicas, solo de emergencias, y a aquellos sin contacto directo con pacientes, mediante un cuestionario sociodemográfico y tres inventarios autoadministrados: Health Professions Stress Inventory, Maslach Burnout Inventory y la Escala de ansiedad y depresión hospitalaria. Resultados. La prevalencia de estrés fue del 93,7 % (IC95 %: 90,33-96,2), burnout 73,5 % (IC95 %: 68,2-78,4), ansiedad 44 % (IC95 %: 38,4- 49,8) y depresión 21,9 % (IC95 %: 17,3-26,9). No se observó asociación entre la frecuencia y el tipo de especialidad realizada. La frecuencia de burnout, ansiedad y depresión fue significativamente mayor en los médicos residentes y en aquellos que trabajan en emergencias. Conclusiones. Los médicos residentes y quienes trabajan en emergencias en turnos de 24 horas mostraron porcentajes significativamente más altos de burnout, ansiedad y depresión, en comparación con médicos de planta y con aquellos en posiciones de liderazgo. Estos hallazgos pueden estar asociados con una mayor carga de trabajo y una menor experiencia. Es mandatorio tomar medidas preventivas y terapéuticas para preservar a quienes hacen frente a esta pandemia. Palabras clave: COVID-19.

Prevalencia de estrés, síndrome de desgaste profesional, ansiedad y depresión en médicos de un hospital universitario durante la pandemia de COVID-19 / Prevalence of stress, burnout syndrome, anxiety and depression among physicians of a teaching hospital during the COVID-19 pandemic

Introducción. Los trabajadores de la salud se encuentran sometidos a una gran tensión en el desarrollo de sus actividades, lo que genera alta frecuencia de estrés, desgaste laboral e impacto psicopatológico. La pandemia de COVID-19 podría provocar un incremento de estas entidades en los médicos. El objetivo fue describir la frecuencia de estrés, síndrome de desgaste profesional (burnout), ansiedad y depresión durante la pandemia, y analizar las asociaciones con distintas variables independientes. Métodos. Estudio observacional, transversal, realizado dos meses después del inicio de la cuarentena en Argentina. Se encuestó a médicos de especialidades clínicas, quirúrgicas, solo de emergencias, y a aquellos sin contacto directo con pacientes, mediante un cuestionario sociodemográfico y tres inventarios autoadministrados: Health Professions Stress Inventory, Maslach Burnout Inventory y la Escala de ansiedad y depresión hospitalaria. Resultados. La prevalencia de estrés fue del 93,7 % (IC95 %: 90,33-96,2), burnout 73,5 % (IC95 %: 68,2-78,4), ansiedad 44 % (IC95 %: 38,4-49,8) y depresión 21,9 % (IC95 %: 17,3-26,9). No se observó asociación entre la frecuencia y el tipo de especialidad realizada. La frecuencia de burnout, ansiedad y depresión fue significativamente mayor en los médicos residentes y en aquellos que trabajan en emergencias. Conclusiones. Los médicos residentes y quienes trabajan en emergencias en turnos de 24 horas mostraron porcentajes significativamente más altos de burnout, ansiedad y depresión, en comparación con médicos de planta y con aquellos en posiciones de liderazgo. Estos hallazgos pueden estar asociados con una mayor carga de trabajo y una menor experiencia. Es mandatorio tomar medidas preventivas y terapéuticas para preservar a quienes hacen frente a esta pandemia.

Introduction. Health care workers experience a tremendous strain while performing their activities, very frequently leading to stress, burnout syndrome, and psychopathological impact. The COVID-19 pandemic may cause physicians to suffer these effects even to a greater extent. Our objective was to describe the frequency of stress, burnout syndrome, anxiety, and depression during the pandemic, and analyze the associations with different independent outcome measures. Methods. Observational, cross-sectional study conducted 2 months after the lockdown was established in Argentina. Clinical specialists, surgeons, emergency physicians, and those with no direct contact with patients were surveyed using a sociodemographic questionnaire and 3 self-administered inventories: Health Professions Stress Inventory, Maslach Burnout Inventory, and Hospital Anxiety and Depression Scale. Results. The prevalence of stress was 93.7 % (95 % confidence interval [CI]: 90.33-96.2), burnout syndrome 73.5 % (95 % CI: 68.2-78.4), anxiety 44 % (95 % CI: 38.4-49.8), and depression 21.9 % (95 % CI: 17.3-26.9). No association was observed between the frequency and medical specialty. The frequency of burnout syndrome, anxiety, and depression was significantly higher among residents and physicians working in the emergency department. Conclusions. Residents and emergency physicians working 24-hour shifts showed significantly higher percentages of burnout syndrome, anxiety, and depression compared to staff and head physicians. These findings may be associated with a higher workload and less experience. It is compulsory to take preventive and therapeutic measures to protect those in the pandemic front line.

Cannabis medicinal: riesgos relacionados con la indicación previa a su aprobación / Medical cannabis: Risks related to its indication prior to approval

En los últimos años, se ha observado un incremento significativo en el interés por la prescripción del cannabis medicinal. En el siguiente artículo, se informa acerca de la escasa base científica que avala la prescripción de estos compuestos en un listado amplio y diverso de patologías médicas. Se considera fundamental que cualquier sustancia que vaya a ser utilizada en humanos siga un protocolo de aprobación estricto y científico, que pueda desligarse de modas o de resultados individuales. Es necesario que, antes de la prescripción de una droga en personas, deba tenerse un panorama claro de cuáles son los usos del compuesto en cuestión, pero, sobre todo, de su seguridad, que es prácticamente desconocida en el cannabis medicinal.

In recent years, the interest in medical cannabis prescription has increased significantly. This article provides information about the little scientific basis supporting the prescription of these products for a wide and diverse range of medical conditions. It is critical for any substance to be used in human beings to follow a strict scientific approval protocol, detached from any trend or individual outcome. Before prescribing any drug to human beings, it is necessary to have a clear picture of its uses, especially its safety, which is practically unknown in the case of medical cannabis.

Medical cannabis: Risks related to its indication prior to approval. / Cannabis medicinal: riesgos relacionados con la indicación previa a su aprobación.

In recent years, the interest in medical cannabis prescription has increased significantly. This article provides information about the little scientific basis supporting the prescription of these products for a wide and diverse range of medical conditions. It is critical for any substance to be used in human beings to follow a strict scientific approval protocol, detached from any trend or individual outcome. Before prescribing any drug to human beings, it is necessary to have a clear picture of its uses, especially its safety, which is practically unknown in the case of medical cannabis.

En los últimos años, se ha observado un incremento significativo en el interés por la prescripción del cannabis medicinal. En el siguiente artículo, se informa acerca de la escasa base científica que avala la prescripción de estos compuestos en un listado amplio y diverso de patologías médicas. Se considera fundamental que cualquier sustancia que vaya a ser utilizada en humanos siga un protocolo de aprobación estricto y científico, que pueda desligarse de modas o de resultados individuales. Es necesario que, antes de la prescripción de una droga en personas, deba tenerse un panorama claro de cuáles son los usos del compuesto en cuestión, pero, sobre todo, de su seguridad, que es prácticamente desconocida en el cannabis medicinal.

[The impairment of A-delta fibers in median nerve compression at the wrist, using the cutaneous silent period]. / Alteración de las fibras finas A-delta por entrampamiento del nervio mediano en la muñeca utilizando el período silente cutáneo.

Carpal tunnel síndrome (CTS) is an entrapment neuropathy of the median nerve at the wrist, that leads to pain, paresthesia and painful dysesthesia. The electrophysiological diagnosis is based upon nerve conduction studies which evaluate thick nerve fibers. Our hypothesis is that there is an additional dysfunction of small fibers in CTS, which correlates with the degree of severity of the neuropathy. A retrospective study of 69 hands that belonged to 47 patients of both sexes (mean age 53.8, years, range 22-87) was performed, and, as a control group, 21 hands which corresponded to the asymptomatic side of those patients were evaluated. Motor and sensory conduction studies, as well as F-waves were performed to classify the neuropathy according to the degree of severity. Cutaneous silent period (CSP) was elicited in all hands. Mean onset latencies and durations of CSP were evaluated. Mean onset latencies were significantly prolonged in neuropathic hands (84.3 ± 16.3 msec) compared to asymptomatic hands (74.8 ± 11.6 msec) (p < 0.05). Mean latencies of the CSP were even prolonged (p < 0.05) in hands affected by a more severe neuropathy. In the 3 hands with most severe neuropathy, a CSP could not be elicited. In CTS an impairment of A-delta fibers was recorded through the CSP. The more severe the neuropathy is, the more impairment of A-delta fibers can be found. CSP may be assessed as a complement of motor and sensory nerve conduction studies in this neuropathy.

Alteración de las fibras finas A-delta por entrampamiento del nervio mediano en la muñeca utilizando el período silente cutáneo / The impairment of A-delta fibers in median nerve compression at the wrist, using the cutaneous silent period

El síndrome del túnel carpiano (STC) es una neuropatía por entrampamiento a nivel de la muñeca que cursa con dolor, parestesias y disestesias dolorosas. El diagnóstico electrofisiológico se basa en el estudio de la neuroconducción de las fibras gruesas. Nuestra hipótesis consiste en la existencia del compromiso de las fibras nerviosas finas y que este compromiso se correlaciona con el grado de gravedad. Se evaluaron retrospectivamente 69 manos correspondientes a 47 pacientes, varones y mujeres (edad media 53.8, rango 22-87 años) y como grupo contro, 21 manos correspondientes a los lados asintomáticos de estos casos. Se realizaron estudios de neuroconducción motora, sensitiva y ondas F para clasificar a las manos según el grado de gravedad. Se realizó el período silente cutáneo (PSC) en todas las manos. Se evaluaron latencias medias y duraciones medias del PSC. Las latencias medias se hallaron significativamente prolongadas en las manos con neuropatía (84.3 ± 16.3 mseg) con respecto a las manos sin neuropatía (74.8 ± 11.6 mseg), p < 0.05. Las latencias medias se hallaron más prolongadas en las manos con neuropatía de mayor gravedad (p < 0.05). En los 3 pacientes con neuropatía grado más grave no se halló el PSC. Se demostró el compromiso de las fibras finas A-delta en los pacientes con STC, con mayor compromiso a mayor severidad. El PSC puede usarse como complemento de los estudios de neuroconducción motora y sensitiva.

Carpal tunnel síndrome (CTS) is an entrapment neuropathy of the median nerve at the wrist, that leads to pain, paresthesia and painful dysesthesia. The electrophysiological diagnosis is based upon nerve conduction studies which evaluate thick nerve fibers. Our hypothesis is that there is an additional dysfunction of small fibers in CTS, which correlates with the degree of severity of the neuropathy. A retrospective study of 69 hands that belonged to 47 patients of both sexes (mean age 53.8, years, range 22-87) was performed, and, as a control group, 21 hands which corresponded to the asymptomatic side of those patients were evaluated. Motor and sensory conduction studies, as well as F-waves were performed to classify the neuropathy according to the degree of severity. Cutaneous silent period (CSP) was elicited in all hands. Mean onset latencies and durations of CSP were evaluated. Mean onset latencies were significantly prolonged in neuropathic hands (84.3 ± 16.3 msec) compared to asymptomatic hands (74.8 ± 11.6 msec) (p < 0.05). Mean latencies of the CSP were even prolonged (p < 0.05) in hands affected by a more severe neuropathy. In the 3 hands with most severe neuropathy, a CSP could not be elicited. In CTS an impairment of A-delta fibers was recorded through the CSP. The more severe the neuropathy is, the more impairment of A-delta fibers can be found. CSP may be assessed as a complement of motor and sensory nerve conduction studies in this neuropathy.

[Vitamin D deficit in hospitalized patients]. / Déficit de vitamina D en pacientes hospitalizados.

We prospectively studied 60 consecutive patients in order to evaluate the prevalence of vitamin D deficiency. All of them were inpatients, and were evaluated from October 2013 through May 2014. Levels of 25 OH vitamin D were classified as sufficient (> 30 ng/ml), mild to moderate deficiency (15 to 30 ng/ml) and severe deficiency (< 15 ng/ml). The mean age was 72.1 ± 19.5 years; 43 were females and 17 males. Five percent of the patients had normal values of vitamin D, 31.6% had mild to moderate deficit and 63.3% had severe deficit of the vitamin. Severe deficit was associated with hypoalbuminemia, compared with mild to moderate deficit and with sufficient values (2.98 g/dl vs. 3.52 g/dl and vs. 4.39 g/dl, respectively, p: 0.012) and low levels of serum calcium (8.35 mg/dl vs. 8.61 mg/dl and 9.8 mg/dl, respectively, p: 0.003). Although there was a trend of low vitamin D levels with increasing age, female sex, immobilization, higher levels of glucose and glycated haemoglobin, more duration of hospitalization, we didn't find any statistically significance difference between groups. Vitamin D deficiency is common in hospitalized patients. It correlates with low levels of serum albumin and calcium. Improving diagnosis and recognition of this condition may enable us to improve the management of this deficit.

Déficit de vitamina D en pacientes hospitalizados

El objetivo de este estudio fue investigar la frecuencia del déficit de vitamina D en una población adulta de pacientes internados en una sala de clínica médica. Se evaluaron 60 pacientes internados entre los meses de octubre de 2013 y mayo de 2014. El nivel de 25 OH vitamina D, determinado por electroquimioluminiscencia, se clasificó como suficiente (> 30 ng/ml) (GS), déficit leve a moderado (15 a 30 ng/ml) (DL) y déficit grave (< 15 ng/ml) (DG). La edad media fue de 72.1 ± 19.5 años; 43 eran mujeres y 17 varones. Presentaron valores normales de vitamina D el 5%, DL el 31.6% y DG el 63.3%. El DG se asoció con hipoalbuminemia, comparado contra DL y GS (2.98 g/dl vs. 3.52 g/dl y 4.39 g/dl, respectivamente, p: 0.012) y con menor calcemia (8.35 mg/dl con DG vs. 8.61 mg/dl con DL y 9.8 mg/dl con GS, p: 0.003). El grupo con DG se asoció con mayor edad promedio, sexo femenino, mayores niveles de glucemia y de hemoglobina glicosilada, mayor postración e internaciones más prolongadas, aunque la diferencia no fue estadísticamente significativa. El déficit de vitamina D es muy frecuente en pacientes hospitalizados, en especial con hipoalbuminemia y con bajos valores de calcio. Reconocer el diagnóstico de esta condición permitirá mejorar el manejo de este déficit.

We prospectively studied 60 consecutive patients in order to evaluate the prevalence of vitamin D deficiency. All of them were inpatients, and were evaluated from October 2013 through May 2014. Levels of 25 OH vitamin D were classified as sufficient (> 30 ng/ml), mild to moderate deficiency (15 to 30 ng/ml) and severe deficiency (< 15 ng/ml). The mean age was 72.1 ±19.5 years; 43 were females and 17 males. Five percent of the patients had normal values of vitamin D, 31.6% had mild to moderate deficit and 63.3% had severe deficit of the vitamin. Severe deficit was associated with hypoalbuminemia, compared with mild to moderate deficit and with sufficient values (2.98 g/dl vs. 3.52 g/dl and vs. 4.39 g/dl, respectively, p: 0.012) and low levels of serum calcium (8.35 mg/dl vs. 8.61 mg/dl and 9.8 mg/dl, respectively, p: 0.003). Although there was a trend of low vitamin D levels with increasing age, female sex, immobilization, higher levels of glucose and glycated haemoglobin, more duration of hospitalization, we didn’t find any statistically significance difference between groups. Vitamin D deficiency is common in hospitalized patients. It correlates with low levels of serum albumin and calcium. Improving diagnosis and recognition of this condition may enable us to improve the management of this deficit.

Déficit de vitamina D en pacientes hospitalizados

El objetivo de este estudio fue investigar la frecuencia del déficit de vitamina D en una población adulta de pacientes internados en una sala de clínica médica. Se evaluaron 60 pacientes internados entre los meses de octubre de 2013 y mayo de 2014. El nivel de 25 OH vitamina D, determinado por electroquimioluminiscencia, se clasificó como suficiente (> 30 ng/ml) (GS), déficit leve a moderado (15 a 30 ng/ml) (DL) y déficit grave (< 15 ng/ml) (DG). La edad media fue de 72.1 ± 19.5 años; 43 eran mujeres y 17 varones. Presentaron valores normales de vitamina D el 5%, DL el 31.6% y DG el 63.3%. El DG se asoció con hipoalbuminemia, comparado contra DL y GS (2.98 g/dl vs. 3.52 g/dl y 4.39 g/dl, respectivamente, p: 0.012) y con menor calcemia (8.35 mg/dl con DG vs. 8.61 mg/dl con DL y 9.8 mg/dl con GS, p: 0.003). El grupo con DG se asoció con mayor edad promedio, sexo femenino, mayores niveles de glucemia y de hemoglobina glicosilada, mayor postración e internaciones más prolongadas, aunque la diferencia no fue estadísticamente significativa. El déficit de vitamina D es muy frecuente en pacientes hospitalizados, en especial con hipoalbuminemia y con bajos valores de calcio. Reconocer el diagnóstico de esta condición permitirá mejorar el manejo de este déficit.(AU)

We prospectively studied 60 consecutive patients in order to evaluate the prevalence of vitamin D deficiency. All of them were inpatients, and were evaluated from October 2013 through May 2014. Levels of 25 OH vitamin D were classified as sufficient (> 30 ng/ml), mild to moderate deficiency (15 to 30 ng/ml) and severe deficiency (< 15 ng/ml). The mean age was 72.1 ±19.5 years; 43 were females and 17 males. Five percent of the patients had normal values of vitamin D, 31.6% had mild to moderate deficit and 63.3% had severe deficit of the vitamin. Severe deficit was associated with hypoalbuminemia, compared with mild to moderate deficit and with sufficient values (2.98 g/dl vs. 3.52 g/dl and vs. 4.39 g/dl, respectively, p: 0.012) and low levels of serum calcium (8.35 mg/dl vs. 8.61 mg/dl and 9.8 mg/dl, respectively, p: 0.003). Although there was a trend of low vitamin D levels with increasing age, female sex, immobilization, higher levels of glucose and glycated haemoglobin, more duration of hospitalization, we didn’t find any statistically significance difference between groups. Vitamin D deficiency is common in hospitalized patients. It correlates with low levels of serum albumin and calcium. Improving diagnosis and recognition of this condition may enable us to improve the management of this deficit.(AU)

Bilateral diaphragmatic paralysis in an HIV patient: Second reported case and literature review.

Human immunodeficiency virus (HIV) disease is widespread all over the world, and the neurological and respiratory complications have been described previously. Peripheral neuropathy is one of the commonest neurological complications of the HIV infection. In this report we describe a HIV positive male smoker who was admitted to the hospital because of community acquired pneumonia. Bilateral diaphragmatic paralysis was diagnosed for which no other cause was found and was attributed to the HIV infection. Isolated phrenic neuropathy and diaphragmatic paralysis in an HIV positive patient is extremely rare and only a single such association has been described previously.