Educators need to develop an active awareness of burnout and ought to consider incorporating relevant instruction and interventions during the process of training resident physicians.

Burnout is a prominent force challenging medical students' well-being, with concerning implications for the continuation of burnout into residency and beyond. To address this highly prevalent condition, educators must first develop greater awareness and understanding of burnout, as well as of the factors that lead to its development. Interventions focusing on generating wellness during medical training are highly recommended.

BACKGROUND Genetic and environmental factors interact in determining the risk of venous thromboembolism (VTE). The risk associated with the polymorphic variants G1691A of factor V (Factor V Leiden,FVL), G20210A of prothrombin (PT20210A) and C677T of methylentetrahydrofolate reductase (C677T MTHFR) genes has been investigated in many studies. METHODS We performed a pooled analysis of case-control and cohort studies investigating in adults the association between each variant and VTE, published on Pubmed, Embase or Google through January 2010. Authors of eligible papers, were invited to provide all available individual data for the pooling. The Odds Ratio (OR) for first VTE associated with each variant, individually and combined with the others, were calculated with a random effect model, in heterozygotes and homozygotes (dominant model for FVL and PT20210A; recessive for C677T MTHFR). RESULTS We analysed 31 databases, including 11,239 cases and 21,521 controls. No significant association with VTE was found for homozygous C677T MTHFR (OR: 1.38; 95% confidence intervals [CI]: 0.98–1.93), whereas the risk was increased in carriers of either heterozygous FVL or PT20210 (OR=4.22; 95% CI: 3.35–5.32; and OR=2.79;95% CI: 2.25–3.46, respectively), in double hterozygotes (OR=3.42; 95%CI 1.64-7.13), and in homozygous FVL or PT20210A (OR=11.45; 95%CI: 6.79-19.29; and OR: 2.79; 95%CI: 2.25 – 3.46, respectively). The stratified analyses showed a stronger effect of FVL on individuals ≤45 years (p-value for interaction = 0.036) and of PT20210A in women using oral contraceptives (p-value for interaction = 0.045). CONCLUSIONS In this large pooled analysis, inclusive of large studies like MEGA, no effect was found for C677T MTHFR on VTE; FVL and PT20210A were confirmed to be moderate risk factors. Notably, double carriers of the two genetic variants produced an impact on VTE risk significantly increased but weaker than previously thought.

Congenital HCMV infection impairs placental development and functions and should be considered as an underlying cause of IUGR, regardless of virus transmission to the fetus.

The presence of histological chorioamnionitis significantly increases the risk of earlier delivery and neonatal mortality. Vascular and coagulation placental findings increase the risk of necrotizing enterocolitis.

Microaggressions entail everyday brief, low-intensity events that convey negative messages toward marginalized groups. A systematic review of the literature on microaggressions in the learning environment of higher education was performed from 1998 to 2018 using a modified PRISMA outline. Forty articles on racial microaggressions were categorized as microaggression experiences of all races/ethnicity (27.5%), microaggression experiences of minorities (22.5%), difficult racial dialogues (10%), coping strategies for microaggressions (17.5%), and system interventions strategies (22.5%). Microinsults were reported in 82.5%, microinvalidations in 4.5%, microassaults in 20%, and institutional microaggressions in 27.5%. Microaggressions were prevalent and "invisible" in colleges with minority students seemingly worn down by ongoing strategies used to confront the inherent associated stresses. Difficult racial dialogues were characterized by intense emotions in both professors and students that interfered with successful learning experiences. Coping strategies that correlated positively with microaggression and psychological stress included disengagement, cultural mistrust, stigma for seeking psychological help, alcohol use, and intolerance of uncertainty. Factors tending to ameliorate microaggression and psychological stress included engagement, dispositional forgiveness, help-seeking attitudes, self-efficacy in coping with daily hassles, and social connectedness. Political activism was helpful in Latinx, but exacerbated microaggression related stress in African American students. Multicultural curricula were associated with increased racial awareness. Innovative intervention strategies included brief video interventions and utility of mobile apps. Microaggressions are associated with ongoing major negative impact on the learning environment. By ameliorative coping mechanisms and institution intervention strategies, the associated toll and stresses from microaggressions may be reduced.

Branched chain amino acids are known markers of insulin resistance and strongly predict future diabetes development. The analysis provides independent evidence linking insulin resistance and late-PE and suggests a potentially important therapeutic role for pharmacologic agents that reduce insulin resistance for late-PE.

OBJECTIVE We sought to identify trends, demographics, and pre-pregnancy and peripartum morbidities of eclampsia in California. STUDY DESIGN We identified cases of eclampsia by International Classification of Diseases, Ninth Revision code using California health discharge data from 2001 through 2007. Cases with missing race/ethnicity as well as age <15 years or >55 years were excluded. Among the remaining cases, patients with eclampsia (n = 1888) were compared against those without (n = 2,768,983). Adjustments were performed for potential confounding variables using logistic regression. Significance was set at P < .05. RESULTS The incidence of eclampsia decreased over time, from 8.0 cases per 10,000 deliveries in 2001, to 5.6 cases per 10,000 deliveries in 2007 (P < .001). There was a bimodal distribution in age-related risk, with the highest risks at the extremes of age. Non-Hispanic blacks were associated with the highest risk of eclampsia while Asians had the lowest risk. Several antepartum morbidities had increased associations with eclampsia, including preexisting cardiac disease (adjusted odds ratio [OR], 6.84; 95% confidence interval [CI], 5.40–8.66), lupus erythematosus (adjusted OR, 3.68; 95% CI, 1.53–8.86), and twin gestations (adjusted OR, 3.28; 95% CI, 2.70–3.99). Peripartum complications increased in eclampsia included cerebrovascular hemorrhage/disorders (adjusted OR, 112.15; 95% CI, 77.47–162.35), peripartum cardiomyopathy (adjusted OR, 12.88; 95% CI, 6.08–27.25), amniotic fluid embolism (adjusted OR, 11.94; 95% CI, 3.63–39.21), and venous thromboembolism (adjusted OR, 10.71; 95% CI, 5.14–22.32). CONCLUSION This large population database confirms that there is a decline in eclampsia over time. However, there are extremely morbid complications associated with eclampsia, emphasizing the need for its close monitoring and prevention.