Burnout among resident doctors: An observational study.

Background: Burnout is a syndrome of emotional exhaustion and depersonalization that reduces efficiency at work. No studies have been reported focusing only on residency burnout and risk factors from our country until now. This study aimed to find out the impact and the association of specific demographic and practice characteristics with burnout among resident doctors. Methods: A prospective cross-sectional survey of all resident doctors under training at that point of time in 2019 in the National Academy of Medical Sciences, Nepal in different specialties was done. We evaluated demographic variables, practice characteristics, and assessed burnout through validated Maslach burnout inventory (MBI) tools, and data were analyzed. Results: A total 347 among 410 resident doctors (227 male) responded to the survey. Median age was 30 years (range 25-44). Overall, 147 (42.4%) of responding residents were burned out with high emotional exhaustion in 58 (16.6%), high depersonalization in 55 (15.9%), and low personal achievement in 34 (9.8). In regression analysis, out of independent variables gender, marital status, having children, specialty, hours of work per week and year of residency, specialties (general surgery odds ratio [OR]; 12.595, confidence interval [CI],[ 1.037-152.9], P; 0.047), obstetrics, and gynecology (odds ratio [OR]; 13.977, confidence interval [CI]; [1.324-147.5], P; 0.028), and anesthesiology (odds ratio [OR]; 11.54, confidence interval [CI]; [1.014-131.4], P; 0.049)) and hours of work per week (≥80 h) (odds ratio [OR]; 2.511, confidence interval [CI]; [1.128-5.589], P; 0.024), were significantly associated with high burnout. Conclusions: Burnout is common among trainee resident doctors which is possibly preventable. Thus, the concern should be to prepare strategies to identify and minimize burnout from the individual, institutional, and societal sides. It is essential to preserve and promote the mental health of trainee residents to prevent serious consequences in the personal lives of resident doctors and as well as on patient outcomes.

Excision of rare carotid body tumour without preembolisation: Case report and literature review.

INTRODUCTION: Carotid body tumors also known as parganglioma or chemodactomas are one of the rare tumors of head and neck which present as slow growing masses in the neck region. We present a case of 40 years female with painless slow growing mass over left side of her neck for 6 months. Diagnosis was made on basis of clinical history, examination and radiological findings. Tumor was graded as Shamblin grade II. She was managed with excision of the tumor without preoperative embolisation. Intraoperative and postoperative periods were uneventful. CASE PRESENTATION: A forty years female presented with left sided painless neck swelling∼5 × 4 cm2 over left anterior triangle for 6 months with no history of dysphagia, odynophagia, change in voice, shortness of breath, palpitations, tremors or syncopal attacks. She underwent USG neck and CT angiogram. Based upon the radiological and clinical findings, she was diagnosed asCarotid body tumor. She was managed with excision of the tumor without preembolisation. Her diagnosis was confirmed with histopathology. CONCLUSION: Carotid body tumours are rare entities of head and neck region. They are mostly benign in nature. Though mostly bening, increasing size might result in grave complications. Thus, the recommended treatment for carotid body tumors is early excision with or without pre-embolisation. In our case preembolisation was not performed. Though some studies have suggested the use of preoperative embolisation in large sized tumors, more studies are yet required to justify the choice of preembolisation despite the dreaded complications.

Chronic suppurative otitis media atticoantral- type undergone canal wall down mastoidectomy in a peripheral government hospital of Nepal.

INTRODUCTION: Chronic suppurative otitis media is a severe type of chronic ear infection which is quite common in all geographical situations of Nepal. The mainstay of treatment of this disease is surgery, preferably of canal down method. The objective of the study was to identify the common presentation(s) and the clinical and operative finding(s) in patients with chronic suppurative otitis media attico-antral type and evaluation of efficacy of canal-wall down mastoidectomy in the achievement of dry ear and change in hearing in a setting of a peripheral hospital of Nepal in terms of subjectivity. Per-operative evaluation of mastoid cavities in terms of types of pathologies and post- operative assessment of ears in terms of achieving a dryness and change in hearing ability was carried out in the ENT Department, Bharatpur Hospital, Chitwan, Nepal. Study was done from January 2005 to December 2010. METHODS: Seventy three patients with chronic suppurative otitis media atticoantral-type were evaluated preoperatively in terms of gross pathologies. Postoperatively, patients were subjectively evaluated twice in six months in reference to persistent ear discharge and change in hearing ability. RESULTS: By six months of surgery, 75% of the patients had no discharge. Fifty two patients did not experience any change in hearing ability. Only 16% experienced betterment in hearing while 19% had diminution in hearing. CONCLUSIONS: Canal wall down mastoidectomies are very effective in controlling otorrhoea and complications related to chronic suppurative otitis media attico-antral type.