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.

Introduction: The skin acts as the first line of defense for the body against external injuries. With aging, the architecture of the skin undergoes intrinsic changes that impair its capacity for repair. In addition, the aging skin is more susceptible to injury by external stimuli, including ultraviolet rays and environmental pollutants. The combination of these factors predisposes the elderly to a variety of dermatological disorders, including xerosis, pruritus, photoaging, eczematous disorders, and tumors. The elderly (>60 years of age) population in India accounted for 8.6% (104 million) in 2011, and the figure has been projected to increase to 19% by the year 2050. It is imperative to identify the pattern of cutaneous disorders in this population as skin care regimens aimed to improve epidermal function have been shown to be effective in the prevention and treatment of some of these aging-associated cutaneous disorders. Objectives: The objective of the study was to identify the pattern of dermatoses among the elderly population attending the dermatology clinic at a tertiary care hospital in South-east Rajasthan. Materials and Methods: We conducted a cross-sectional descriptive study of patients above the age of 60 years who attended the dermatology clinic at a tertiary care hospital in South-east Rajasthan from May 2018 to May 2020. A combination of history, physical examination, and clinical investigations (when appropriate) were used to establish the diagnosis. Results: A total of 210 patients were included in this study. Most patients were between the age group of 60–65 years (40.47%). One hundred and thirty-eight were male (65.71%) and 72 were female (34.28%), with a male to female ratio of 1.9:1. Our study demonstrated that xerosis was one of the most common diagnoses seen in 126 cases (60%), followed by eczematous skin conditions seen in 82 cases (39%). Conclusion: The elderly constitute an important part of the population. Cutaneous disorders in the elderly range from mild disorders such as cherry angiomas to dermatological malignancies. Therefore, it is important to recognize the pattern of dermatosis in this population so that appropriate therapeutic and preventive strategies could be implemented.

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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.