Background: With increasing workload and dismal working conditions, healthcare professionals (HCPs) in India often suffer from burnout. Understanding the extent of these problems and the contributing factors is necessary to build a healthy workforce capable of serving the society. The purpose of this study was to systematically review and analyze: 1) the prevalence of burnout among HCPs in India and 2) the factors associated with burnout in this population. Methods: A systematic search of MEDLINE and EMBASE, from the inception of these databases to October 2019, was conducted using keywords. The search results were screened to identify studies evaluating burnout among HCPs in India using a standard burnout tool. Using a random effect model, the pooled prevalence of burnout was estimated using Maslach Burnout Inventory (MBI) in three domains: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Risk factors for burnout were assessed qualitatively. Results: A total of 15 studies assessing burnout in 3845 Indian HCPs were identified. The pooled prevalence of burnout was 24% in the EE domain, 27% in the DP domain, and 23% in the PA domain. Younger age, female gender, unmarried status, and difficult working conditions were associated with increased risk of burnout. Conclusion: Burnout is highly prevalent among Indian HCPs, with close to one-fourth of them suffering from burnout. A number of personal and professional factors are associated with burnout, and these should be considered while developing solutions to tackle burnout.

Background Quora is a popular question and answer (Q&A) website that enables people to connect with others and clear their doubts about the coronavirus disease (COVID-19). In this study, we analysed the content, type and quality of Q&As in Quora regarding this pandemic, and compared the information with that on World Health Organization (WHO) website. Methods We conducted a systematic search to include 964 questions in Quora. The tone of the question was categorized as either positive (questions with a primary intent to obtain information), negative (questions which represent panic or are related to misconception/false information) or ambivalent. The two most helpful answers of each question were graded for accuracy, authority, popularity, readability, and relevancy. Results 462 (48%) questions were classified as positive, while 391 (41%) were negative. Number of views were higher for negative questions (11421 vs 7300, p=0.004). Majority of the questions were on social impact (N=217, 23%), followed by politics (N=122, 13%) and disease management (N=96, 10%). Positive questions had more accurate, but less popular answers (p<0.05). Information related to 229 (28%) questions were present on WHO website, while partial information was present for 103 (11%) questions. Discussion Higher views with negative questions suggest that false and panic promoting information is more likely to get public attention. A substantial amount of questions was related to the present and future effects of COVID-19 on social and personal lives of the users which were not readily available on official health websites.

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Swallow syncope is a rare type of neurally-mediated syncope which is frequently associated with lifethreatening bradyarrhythmias. We present a case of recurrent presyncope which was subsequently diagnosed as swallow syncope.CASE PRESENTATION: A 35-year-old male with a history of polysubstance abuse (intravenous heroin, cocaine, tobacco, and alcohol) presented to the emergency department with pain affecting the right lower extremity, left shoulder, and lower back. CT chest, abdomen, and pelvis as well MRI spine revealed multiple abscesses in the right psoas, left shoulder, and lumbar vertebrae. Blood cultures were positive for methicillin-sensitive Staphylococcus aureus. Transthoracic echocardiogram revealed echogenic masses on the anterior mitral leaflet and the tricuspid leaflet suggestive of vegetations. The patient was diagnosed with infective endocarditis (IE) with septic emboli and was treated with intravenous antibiotics. Subsequently, the patient had an episode of presyncope preceded by hiccups while drinking a beverage. Telemetry revealed complete heart block with junctional escape rhythm and transient asystole with the longest pause lasting 6 seconds. Similarly, he developed bradycardia with a heart rate of 36 beats per minute when the transesophageal probe for the echocardiogram was inserted. No evidence of perivalvular abscess was noted. He was diagnosed with swallow syncope and was discharged on a 30-day event monitor with a plan for pacemaker placement.DISCUSSION: Swallow syncope is a neurally-mediated transient loss of consciousness that occurs upon ingestion of solids, liquids or both. It is associated with cardiac arrhythmias including atrioventricular conduction blocks, sinus bradycardia, sinus arrest, and asystole. It exhibits male predominance and is strongly associated with esophageal disorders like esophageal strictures, achalasia, esophageal carcinoma, and hiatal hernia. Diagnosis is based on clinical presentation and confirmed with provocative testing to reproduce the symptoms. Permanent pacemaker placement is the treatment of choice and results in complete resolution of symptoms in most patients. Other treatment options include anticholinergic agents, sympathomimetic agents, and denervation of the esophagus.CONCLUSIONS: Swallow syncope is a rare cause of syncope that should be considered in patients presenting with episodic syncope or presyncope. Physicians should have a high degree of suspicion in order to ensure timely diagnosis and prompt treatment and prevent the catastrophic consequences of life-threatening arrhythmias.

Adult-onset Still's disease (AOSD) is a rare autoinflammatory disease that typically presents with a triad of fever, evanescent rash, and arthritis. There is often a delay in diagnosis of AOSD due to its nonspecific clinical presentation, which may mimic other infectious, rheumatological disorders, and malignancies. Corticosteroids have been the cornerstone for the management of AOSD for the past many years. However, with the expanding understanding of its pathogenesis, novel therapeutic options targeting various cytokines are being increasingly recognized. Herein, we present a case of AOSD that was successfully treated with tocilizumab, a monoclonal antibody against the interleukin-6 (IL-6) receptor. For the purpose of this article, we also conducted a literature search to review the current therapeutic options available for the treatment of AOSD.

BackgroundRecruitment of candidates is a cost- and effort-intensive aspect of rheumatology fellowship programs. For program leaders to efficiently use the available resources and improve recruitment outcomes, it is imperative to understand the attributes that influence the candidates’ choice of a program. Previous studies have examined the type and relative importance of the factors that candidates use in selecting other fellowship programs (1, 2). However, no such studies have been conducted in the field of rheumatology.ObjectivesTo examine the factors that influence the selection of fellowship programs by rheumatology applicants.MethodsAn anonymous, web-based survey comprised of 13 questions was shared with rheumatology fellowship applicants on messaging applications and online forums. The survey was open from 10/29/2021-11/06/2021. Participation was voluntary and informed consent was implied through the participants’ response. Three reminders to complete the survey were sent. Four domains of the applicant’s perception in relation to their preference of ranking rheumatology programs were assessed: (1) program prestige, (2) program structure, (3) interview day experience, and (4) career path of the alumni. The survey questions were devised in one of the following formats: (1) 5-point Likert scale, (2) rank order questions, (3) yes/no questions, (4) multiple choice questions, and (5) open-ended questions.ResultsThirty-two rheumatology applicants responded to the survey. The prestige of the program was reported to be extremely important by 16%, very important by 19%, somewhat important by 44%, and little or not important by 21% responders. The opportunity to see a diverse patient population was reported to be important by 97% respondents. The call schedule and higher number of fellows were considered important by 88% of the respondents. 66% preferred programs with higher number of faculty members. 69% favored programs with an ultrasound curriculum. The availability of clinician-educator track (18%), MCR/MPH (14%), and T32 grand (4%) were considered less important. 69% reported that the opportunity to train at a Veterans Administration hospital did not influence their choice. Regarding interview day experience, interaction with the faculty (63%) and the fellows (17%) were considered important factors influencing program ranking. Respondents preferred programs with alumni in academic clinician track (45%) and private practice (43%) compared to programs with alumni in academic research (13%) or industry pathway (4%). The geographical location of the program including the cost of living and location of significant others also influenced the applicants’ choice.ConclusionTo the best of our knowledge, this is the first survey to assess the attributes that influence a candidate’s choice of a rheumatology fellowship program. Our survey demonstrated that a positive interview day experience and program attributes including the opportunity to interact with a diverse patient population, relaxed call schedule, higher number of fellows and faculty, the presence of an ultrasound curriculum, and the location were the dominant factors influencing applicants’ choice of a program. The main limitation of our study is the lack of generalizability due to selection bias. Understanding the factors involved in decision making of the rheumatology fellowship applicants can provide valuable information for both the applicants and the programs and therefore lead to a better match.References[1]Kelm DJ, Skalski JH, Nelson DR, Kashani KB, Lee AS, Wesselius LJ, et al. Attributes Influencing the Selection of Fellowship Programs by Pulmonary and Critical Care Applicants: A Pilot Study. Ann Am Thorac Soc. 2016;13(4):572-4.[2]Caiola E, Litaker D. Factors influencing the selection of general internal medicine fellowship programs: a national survey. J Gen Intern Med. 2000;15(9):656-8.Disclosure of InterestsNone declared