Introduction: SARS-Cov-2 virus pandemic causes serious emotional consequences. It has occurred widespread medical courses suspension, and graduations were anticipated. Field hospitals, set up to treat patients with mild to moderate COVID-19, were the main workplaces of newly graduated doctors. Objective: To assess the impact of SARS-Cov-2/COVID-19 pandemic on mental health of medical interns and newly graduated doctors. Method: This is a cross-sectional study performed using a digital platform. Links to forms were sent in two moments: moment 1 (M1), at the beginning of the pandemic, in the first half of April/2020 and moment 2 (M2), after six months of pandemic, in the second half of September/2020. All students from the medical internship and all doctors graduated since 2018 from the three medical schools in Sergipe-NE-Brazil were invited. Results: 335 forms were answered in April and 148 in September. In M1 88.9% considered themselves exposed to excess of information about COVID-19, which was associated with anxiety symptoms (p = 0.04). Long family physical distance was also associated with these symptoms, as increased appetite (p = 0.01), feeling shortness of breath (p = 0.003) and sweating (p = 0.007). Fear of acquire COVID-19 was reported as intense by almost half of participants, and of transmitting by 85.7% in M1. In M2 41.2% reported the death of friends or relatives. Psychiatric illness was described by 38.5% and psychotropic drugs use by 30.1% in M1, especially those who lived alone (p = 0.03) and the single ones (p = 0.01). Alcohol intake was reported by 54.3%, and among doctors graduated in 2020 it increased from 50% in M1 to 85% in M2 (p = 0.04). Conclusion: The pandemic had a negative impact on the mental health of medical students and newly graduated doctors. Exposure to excessive COVID-19 information and family physical distance were associated to anxiety symptoms. Among doctors graduated in 2020, alcohol intake increased during pandemic evolution.
Muscle contracture is a common symptom of valproate. However, there is no report in the literature of lockjaw (trismus) associated with this drug. We therefore present a case of lockjaw during valproate treatment in a patient with bipolar disorder and hypoparathyroidism.A 62-year-old Caucasian female was admitted on November, 2015 at a psychiatric unit during a manic episode. Patient was previously diagnosed with bipolar disorder and had manic and depressive episodes in the past. She underwent a total thyroidectomy three months prior to her admission, for suspicion of malignancy (not confirmed by biopsy) and has been since then in treatment for hypothyroidism and iatrogenic hypoparathyroidism with levothyroxine, calcitriol and calcium carbonate. She had no cognitive impairment and no relevant findings in laboratory exams. A cerebral perfusion scintigraphy was performed showing slight hypoperfusion in the frontal lobe and posterior cerebellar areas. It is noteworthy that the patient did not tolerate lithium carbonate due to severe extremity tremors. Therefore, valproate was initiated and gradually increased up to 1000 mg/day. She developed lockjaw three days after. She was unable to open her mouth and also fractured two teeth. She had difficulty in diction and in chewing food. No painful symptom or other muscular manifestation had been reported. Biperiden and clonazepam were prescribed without response. She had no prior symptoms of muscular spasm and she denied previous use of valproate. The diagnosis of valproate-induced trismus was made after other causes of trismus, such as infections, neurological illness and oro-dental abnormalities were excluded. The laboratory tests show no alterations on serum levels of TSH, PTH, phosphate and calcium. Thus, the valproate was replaced by olanzapine, which lead to symptom resolution. Patient has been in follow-up for two years and did not have any trismus symptoms since valproic acid withdrawal.Trismus is defined as a tonic contraction of the muscles of mastication with mouth opening of ≤ 35 mm 1 . It can result in difficulty in activities such as biting, chewing, swallowing and speaking and may further lead to poor oral hygiene, pain and weight loss 2 . Some of the causal factors implicated in this condition are tumors, infections, surgery and radiotherapy complications, and drugs side effect 3 . There are case reports of trismus induced by succinylcholine 4 and duloxetine 5 , but none regarding this side effect with valproate. A recent systematic review of the untoward effects of valproate showed that drug-induced parkinsonism is a relatively common side effect in elderly women 6 . It's known that valproate can safely be used in patients with thyroid and parathyroid dysfunction, once it does not interfere on these hormone levels 7 . The mechanism of how valproate can induce trismus is unclear. A preclinical study found that low concentrations of valproate can induce muscle contractions, which were abolished by indomethacin.8 Therefore, prostaglandins may be implicated in...
Resumo: Introdução: A pandemia de Covid-19 impactou negativamente a saúde mental de médicos e estudantes de Medicina. Muito tem sido discutido sobre as lições aprendidas, no que se refere a aspectos clínicos, de diagnóstico, tratamento e prevenção. Entretanto, os médicos são treinados para o cuidado dos pacientes, o que envolve técnica e humanidade. Objetivo: Este estudo apresenta e discute as lições e reflexões aprendidas por internos de Medicina e médicos recém-formados durante a pandemia de Covid-19. Método: Trata-se de um estudo quali-quantitativo realizado durante a segunda quinzena de setembro de 2020 (seis meses após o início da pandemia) por meio de formulário em plataforma digital. Todos os alunos do internato e todos os médicos formados desde 2018 nas três faculdades de Medicina de Sergipe foram convidados a participar da pesquisa. Resultado: Obtiveram-se 148 questionários respondidos, dos quais quatro não continham respostas nos campos abertos. Quanto ao estágio de formação universitária, 36,5% eram recém-formados (n = 54), dos quais 90,7% trabalharam na linha de frente do atendimento aos pacientes com Covid-19. Ao serem questionados sobre os principais aprendizados que a pandemia havia trazido, 41 respostas estiveram voltadas para a paciência, a imprevisibilidade do futuro e a resiliência no enfrentamento das adversidades. Aproximadamente 42% (n = 62) dos participantes conheciam ao menos uma pessoa que faleceu por Covid-19, e isso se associou à necessidade de aproveitar o tempo, a vida e as pessoas (p = 0,009). Um total de 34 respostas (23%) demonstrou uma atitude positiva de reaprendizado e esperança quando os participantes foram perguntados sobre como imaginavam o trabalho e o ensino médico após pandemia. A necessidade de um retorno cauteloso foi citada em 34 (23%) respostas. Conclusão: Os estudantes de Medicina e os médicos recém-formados relataram aprendizados relacionados à paciência e resiliência. A perda de familiares e amigos por Covid-19 esteve relacionada à necessidade de aproveitar o momento presente.
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