Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

A HYPOKALEMIA CASE RES?STANT TO TREATMENT ASSOCIATED WITH LEFLUNOMIDE

Leflunomide is a disease-modifying antirheumatic drug which is used in the treatment of rheumatoid arthritis. It prevents inflammation by inhibition of dihydroorotate dehydrogenase, the enzyme responsible for de novo pyrimidine synthesis. The most common side effect of leflunomide is diarrhea. Rash, nausea, vomiting, abdominal pain, liver toxicity, hypocalcaemia, hypokalemia, vasculitis are some of the other side effects can be caused by this drug. Here, we present a case of treatment resistant hypokalemia in a patient taking leflunomide for approximately 8 weeks for treatment of rheumatoid arthritis

A treatment resistant hypokalemia case associated with leflunomide

Introduction: Leflunomide is a disease-modifying antirheumatic drug which is used in the treatment of rheumatoid arthritis. The most common side effect of leflunomide is diarrhea, however, hypokalemia may also develop during treatment with this drug. Here, we present a case with treatment resistant hypokalemia in a patient who has been on leflunomide treatment for approximately 8 weeks for treatment of rheumatoid arthritis. Case report: Fifty six years old woman was admitted to internal medicine outpatient clinic with complaints of weakness, constipation, loss of appetite, abnormal weight loss (approximately 10 kilograms) and arthralgias for 3 weeks. Laboratory analyse revealed hypokalemia on admission (serum potassium: 2.3 mmol/L). Potassium chloride was infused in isotonic solutions with close monitoring; a potassium value of 4.5 mmol/L was achieved on the fifth day of treatment. Her complaints such as nausea, constipation, lack of appetite were decreased with normalization of serum potassium. Conclusion: We suggest close electrolyte monitoring is important if leflunomide treatment was planning especially in patients whose treatment regimens include multiple medications.</jats:p