RESUMEN
A 51-year-old male with a history of Cacchi-Ricci disease and long-standing infection with various species of Borrelia, Babesia, and Bartonella presented with recurrent symptoms of right-sided flank pain. Numerous renal calculi were identified on imaging. The etiology of the calculi had not been previously elucidated. Symptoms intermittently date back to 2002 when uric acid stones were identified. Subsequent calculi analysis revealed calcium oxalate stones. Despite the commonality of nephrolithiasis in patients with Cacchi-Ricci disease, the extreme number of calculi and recurrent presentation of symptoms persisted despite a plethora of medical evaluations, dietary changes, and hereditary testing. This case raises questions of etiology including possible immune deficiency and whether his uncommon microbial history contributes to recurrent stone formation.
Asunto(s)
Cálculos Renales , Riñón Esponjoso Medular , Enfermedades por Picaduras de Garrapatas , Masculino , Humanos , Persona de Mediana Edad , Cálculos Renales/complicaciones , Cálculos Renales/diagnóstico , Riñón , Riñón Esponjoso Medular/complicaciones , Enfermedades por Picaduras de Garrapatas/complicaciones , Enfermedades por Picaduras de Garrapatas/diagnósticoRESUMEN
BACKGROUND: Investigating changes in sleep and fatigue metrics during intensive surgical and trauma skills training, this study explored the dynamic association between oculomotor metrics and fatigue. Specifically, alterations in these relations over extended stress exposure, the influence of time of day, and the impact of fatigue exposure on sleep metrics were examined. METHODS: Thirty-nine military medical students participated in 6 days of immersion, hyper-realistic, and high-stress experiential casualty training. Participants completed surveys assessing the state of sleepiness with oculomotor tests performed each morning and evening, analyzing eye movement and pupillary change to characterize fatigue. Participants wore Fitbit TM devices to measure overall time asleep and time in each sleep stage during the training. RESULTS: Fitbit data showed increased average minutes in rapid eye movement, deep sleep, and less time in light sleep from day 1 to day 4. The microsaccade peak velocity-to-displacement ratio exhibited a morning decrease but not in afternoon sessions, indicating repeated but temporary effects of accumulated fatigue. There were no findings regarding pupil reactivity to illumination changes. CONCLUSION: This study describes characteristics of fatigue measured by rapid and individually calibrated oculomotor tests. It demonstrates oculomotor relationships to fatigue in start-of-day testing, providing a direction for timing for optimal fatigue testing. These data suggest that improved sleep could signal resilience to fatigue during afternoon testing. Further investigation with more participants and longer duration is warranted. A deeper understanding of the interrelationships between training, sleep, and fatigue could improve surgical and military fitness.
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Background: The COVID-19 pandemic brought immense changes to medical school curriculums world-wide, such as the widespread adoption of virtual learning. We sought to better understand the impact on medical students' mental health at Rocky Vista University College of Osteopathic Medicine, Parker, CO, United States. This study assessed the impact the pandemic had on anxiety and depression levels of medical students. It also assessed the impact of several domains on student mental health during the pandemic and how various sub-groups within the studied population were affected. Methods: A cross-sectional survey was sent to students through an online anonymous google survey in May to June 2021, centered around the 7-item questionnaire used to screen for Generalized Anxiety Disorder GAD-7, 9-item questionnaire used to screen for depression PHQ-9, and self-designed questions to assess the personal impact of the pandemic. Data obtained were screened for error and analyzed with significance value of p < 0.05. Results: A total of 152 responses were received (25.5% response rate). Of these, 64.1% identified as female, 75.8% were white, 50.3% were between ages 21-25, and 77.8% were first year medical students. During the pandemic, 79.6% of respondents felt more anxious and 65.1% felt more depressed. 67.8% of students reported feeling social isolation amidst the pandemic. Students living with friends were more likely to see a therapist for depression during the pandemic (p = 0.0169) and prescribed an antidepressant (p = 0.0394). Females and students in relationships were more likely to score higher on GAD-7 (p = 0.0194) and (p = 0.0244), respectively. Conclusion: This study investigated the effect of the pandemic on medical students' mental health and the need to address this issue. Results suggest that the pandemic had a negative impact on medical student's mental health and that anxiety and depression levels worsened for pre-clinical medical students at Rocky Vista University. As such, it is imperative to incorporate additional resources to protect the well-being of medical students as they progress through their medical careers.
RESUMEN
Background: The medical school curriculum has imposed psychological stressors on students worldwide, some of which may induce feelings of increased depression and anxiety. Meanwhile, the COVID-19 pandemic has exacerbated the feelings of stress, depression, and anxiety that a portion of medical students experience in their daily life. The aim of this systematic review is to gather concrete data from medical schools around the globe, and further evaluate how the COVID-19 pandemic has impacted medical students' mental health. Materials and methods: Systematic search of data from PubMed, EMBASE, psycINFO, MEDLINE Complete, and Global Health for studies conducted between December 2019 and July 2021 was conducted. Data from 47 different surveys of medical students from various medical institutions throughout the world were included in this review. These surveys, administered in the form of questionnaires that utilized rating scales, measured anxiety, depression, and stress levels in medical students amidst the COVID-19 outbreak. Results: The COVID-19 outbreak was found to have negative effects on medical students, most notably causing emotional and behavioral changes and detrimental mental health impacts. Higher levels of stress, depression, and anxiety have been found in medical students since the outbreak. Conclusion: This systematic review highlights the sustained high prevalence of moderate depression, anxiety and stress among medical students during the COVID-19 pandemic. Appropriate support and research on which interventions could mitigate these risks is essential in order to ensure that future physicians are properly cared for, and ultimately have the adequate tools needed to provide high quality and empathetic care to future patients.