Burnout is a state of physical or mental collapse caused by overwork or stress. Burnout during residency training has gained significant attention secondary to concerns regarding job performance and patient care. The new COVID-19 pandemic has raised public health problems around the world and required a reorganization of health services. In this context, burnout syndrome and physical exhaustion have become even more pronounced. Resident doctors, and especially those in certain specialties, seem even more exposed due to the higher workload, prolonged exposure and first contact with patients. This article is a short review of the literature and a presentation of some considerations regarding the activity of the medical residents in a non-Covid emergency hospital in Romania, based on the responses obtained via a questionnaire. Burnout prevalence is not equal in different specialties. We studied its impact and imagine the potential steps that can be taken in order to reduce the increasing rate of burnout syndrome in the pandemics.

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RezumatDiverticulita apendiculară este o cauză rară a durerii din fosa iliacă dreaptă. Chiar dacă este simptomatică sau descoperită întâmplător în timpul apendicectomiei sau irigografiei, trebuie înţeleasă evoluţia clinică pentru a avea o atitudine terapeutică corectă. În acest articol vom prezenta cazul unei bolnave în vârstă de 50 de ani cu diverticulită apendiculară descoperită întâmplător în timpul apendicectomiei.Cuvinte cheie: diveticulită, apendicită, chirurgie de urgenţă, diverticuli AbstractAppendiceal diverticulitis is a very rare cause for pain in the right iliac fossa. Whether it is simptomatic or discovered randomly during an appendectomy or barium enema, understanding its clinical evolution is important for having a good management. In this report we present the case of a 50 year old female who underwent an open appendectomy during which we discovered appendiceal diverticulitis.

Over the past six decades, abdominal compartment syndrome (ACS) remained a very controversial subject, both in surgical and non-surgical specialties. Doctors failed to understand why critically ill patients died in the ICU with distended abdomens without fi nding any cause or why postoperative patients with wound defects such as dehiscence died after suturing the wound again "very tightly". After the concept of intra-abdominal pressure (IAP) was established and methods for measuring it and diagnosing intra-abdominal hypertension (IAH) were available for clinicians to use it, it became clearer that ACS was a very serious and life threating pathology and the need for a correct treatment is essential. In this article we will try to make a literature review of the past decade and see when and how to diagnose correctly a patient with ACS and also how the diagnostic and treatments methods changed over the years. RezumatÎn ultimele șase decenii, sindromul compartimentului abdominal a rămas un subiect foarte controversat, atât în specialităţile chirurgicale, cât și în cele non-chirurgicale. Medicii nu înţelegeau de ce pacienţii în stare critică decedau în ATI cu abdomenul destins, fără a găsi nicio cauză sau de ce pacienţii cu evisceraţii postoperatorii, decedau după resuturarea "foarte strânsă" a plăgii. După ce a fost stabilit conceptul de presiune intraabdominală și au fost disponibile metode pentru măsurarea și diagnosticarea hipertensiunii intra-abdominale pentru clinicieni, a devenit mai clar că sindromul de compartiment reprezintă o patologie foarte gravă, care ameninţă viaţa și că necesitatea unui tratament corect este esenţială. În acest articol vom încerca să facem o revizuire a literaturii ultimului deceniu și să vedem când și cum diagnosticăm corect un pacient cu sindrom de compartiment și, de asemenea, modul în care metodele de diagnosticare și tratament s-au schimbat de-a lungul anilor. Cuvinte cheie: sindrom de compartiment, presiune intra-abdominală crescută REVIEW Bogdan Socea et al.

Background and Objectives: Current recommendations and treatment regimens in breast cancer are a reflection of its heterogeneity on multiple levels including histological subtypes, grading, molecular profiling, and numerous prognostic indices. Although based on extensive research, current guidelines are not explicit in the case of surgical specimens showing various degrees of mismatch between different parts of the same tumor and even more so between multicentric lesions. Synchronous breast cancer is the ideal prototype for studying inter- and intra-tumoral heterogeneity, therefore we envisaged that a study on patients with multicentric and multifocal lesions could contribute to the reshaping of the staging, prognosis, and treatment of breast malignancies. Material and Methods: A prospective observational study was conducted between January 2013 and May 2017 on 235 patients diagnosed with breast cancer (BC) and surgically treated at Emergency University Hospital, Bucharest. Thirty-seven patients had multiple breast tumors and were eligible for assessment of the heterogeneity of their lesions. Results: 6 were multicentric and 31 multifocal. The number of foci varied from 2 to 11. We encountered numerous mismatches between the index and the secondary tumors, as follows: 3 cases (8.1%) with histopathological mismatch, 13 (35.1%) with different grades of differentiation, 11 (29.8%) with ER (Estrogen Receptors) status mismatch, 12 (32.4%) with PR (Progesterone Receptors) status mismatch, 8 (21.6%) with molecular phenotype mismatch, and 17 (45.9%) cases with variable Ki-67. After careful analysis of index and secondary tumors, apart from the mismatches reported above, we discovered that the secondary tumors were actually dominant in 5 cases (13.5%), and therefore at least those cases had to be reclassified/restaged, as the supplementary data commanded changes in the therapeutic decision. Conclusions: For synchronous breast tumors, the current Tumor-Node-Metastasis (TNM) staging system ignores not only the histopathological and immunohistochemical characteristics of the secondary foci, but also their size. When secondary lesions are more aggressive or their cumulative mass is significantly bigger than that of the index tumor, the treatment plan should be adapted accordingly. We believe that information obtained from examining secondary foci in synchronous breast cancer and assessment of the cumulative tumoral mass should be reflected in the final staging and definitive treatment. The clinical benefit of staging the patients based on the most aggressive tumor and the cumulative tumoral burden rather than according to the biggest single tumor, will avoid under-treatment in cases with multifocal/multicentric BC displaying intertumoral mismatch.

Weight gain during pregnancy can be a real risk factor for long-term obesity which has implications in all areas of medicine. This study is designed to assess pregnancy-related weight gain and postpartum weight loss, to identify a possible correlation between weight gain during pregnancy and the risk of obesity in the late postpartum period. The batch comprised 306 women, hospitalized in the Obstetrics and Gynecology Section of the “Nicolae Malaxa” Clinical Hospital between June - November 2017. During this study, we assessed the weight status using the Weight, Body Mass Index, Height, and Abdominal Circumference. These parameters were clinically assessed in three periods pre-pregnancy, early postpartum period, late postpartum period. We also collected data on the evolution of the pregnancy using the anamnesis and the personal pregnancy monitoring sheet. Pregnancy and postpartum period represent a key moment in women’s lives in which the risk of obesity is real. Understanding women experiences with weight changes during pregnancy and postpartum period can improve the management of losing weight following pregnancy, avoid long-term weight gain and so reduce the risk for obesity. Also, the correct management of obesity should include the assessment of somatic disorders that may cause major dysfunction, requiring complex rehabilitation programs.

Appendicite aigue après coloscopie-série des cas et revue de la littérature La coloscopie est une procédure de diagnostic courante pour le côlon. La perforation du côlon est une complication iatrogène bien connue de la coloscopie diagnostique. Toutefois, les atteintes appendiculaires avec inflammation ou perforation sont extrêmement rares et seuls quelques cas d'appendicite aiguë après coloscopie ont été rapportés jusqu'à présent. Nous décrivons une série de quatre cas opérés dans notre clinique d'appendicite aiguë, qui se sont développés à un jeune âge, peu après la coloscopie d'une autre pathologie (syndrome de l'intestin irritable, maladie diverticulaire du côlon, douleur a la fosse iliaque gauche et au flanc gauche).