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BACKGROUND: Burnout is a psychological syndrome that is very common among medical residents. It consists of emotional exhaustion (EE), depersonalization (DP) and reduced personal accomplishment (PA). OBJECTIVE: To estimate burnout among different medical residency specialties. METHODS: A systematic review with meta-analysis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of bibliographic databases and grey literature was conducted, from inception to March 2018. The following databases were accessed: Embase, PubMed, Web of Science, Google Scholar and Scopus, and 3,575 studies were found. Methodological quality was evaluated by Agency for Healthcare Research and Quality Methodology Checklist for Cross-Sectional/Prevalence Study. In the final analysis, 26 papers were included. Their references were checked for additional studies, but none were included. RESULTS: 4,664 medical residents were included. High DP, EE and low PA proportions were compared. Specialties were distributed into three groups of different levels of burnout prevalence: general surgery, anesthesiology, obstetrics/gynecology and orthopedics (40.8%); internal medicine, plastic surgery and pediatrics (30.0%); and otolaryngology and neurology (15.4%). Overall burnout prevalence found for all specialties was 35.7%. CONCLUSION: The prevalence of burnout syndrome was significantly higher among surgical/urgency residencies than in clinical specialties. PROSPERO REGISTRATION: CRD42018090270.

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Primary necrotizing fasciitis (NF) of the breast is extremely rare. It progresses rapidly and can lead to sepsis and multi-organ failure without prompt medical and surgical management. Herein we describe the case of a healthy 42-year-old woman on the 10th day after cesarean section, who was admitted to the intensive care unit (ICU) with a painful and swollen right breast. It evolved rapidly in the ICU into septic shock and nipple discharge. She underwent immediate resuscitation followed by muscle-sparing right mastectomy. She was managed postoperatively in the ICU with intravenous antibiotic therapy. Complications included acute renal failure and anuria, leading to death on the fourth day after surgery. Prompt resuscitation and an aggressive surgical approach are critical to the successful management of this life-threatening pathology. Despite this, NF still carries a high mortality rate

A fasciíte necrosante primária (FN) da mama é extremamente rara. Ela progride rapidamente e pode levar à sepse e à falência de múltiplos órgãos sem pronto atendimento médico e cirúrgico. Aqui descrevemos o caso de uma mulher saudável de 42 anos de idade no décimo dia pós cesárea, que foi admitida na unidade de terapia intensiva (UTI) com a mama direita dolorida e inchada. O quadro evoluiu rapidamente na UTI a choque séptico e descarga mamilar. Ela foi submetida a ressuscitação imediata seguida de mastectomia de mama direita com preservação muscular. Foi administrada terapia endovenosa com antibióticos na UTI durante o período pós-operatório. Complicações incluíram insuficiência renal aguda e anúria, levando à morte no quarto dia após a cirurgia. A reanimação imediata e uma abordagem cirúrgica agressiva são fundamentais para o sucesso do manejo dessa patologia que é ameaçadora. Apesar disso, a FN ainda carrega uma alta taxa de mortalidade.

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PURPOSE: To evaluate the risk factors for morbidity and mortality in an obstetric intensive care unit at a university hospital. METHODS: Observational cross-sectional study with 492 pregnant/puerperal women. Patients were admitted to the obstetric intensive care unit over a period of one year, being informed about the proposals of the study and a questionnaire was applied. The analysis was performed using Microsoft Excel 2013 and GraphPad Prism 6. To evaluate risk factors, χ2 tests were used. RESULTS: The main risk factors to near miss were: non-white race (OR=2.5; PR=2.3); marital status (married women) (OR=7.9; PR=7.1), schooling (primary) (OR=3.1; PR=2.8), being from the countryside (OR=4.6; PR=4.0), low income (OR=70; PR=5.5), gestational hypertensive disorders (OR=16.3; PR=13.2), receiving prenatal care (OR=5.0; PR=4.254) and C-section before labor (OR=39.2; PR=31.2). CONCLUSIONS: The prevalence of near miss was associated with socioeconomic/clinical factors and care issues, revealing the importance of interventions to improve these indicators. Additionally, we suggest a better curriculum insertion of this subject in the discipline of the medical course due to the importance of avoiding the near miss using adequate medical education. The importance of correct prenatal care is emphasized in order to identify potential risks, to provide nutritional support to pregnant women, to treat potential diseases and to establish a maternal immunization program, as well as providing better care regarding the clinical features of the patients, in order to reduce obstetrical and neonatal risk.

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OBJETIVO:Avaliar os fatores determinantes da morbimortalidade em unidade de terapia intensiva obstétrica de um hospital universitário.MÉTODOS:Estudo observacional de corte transversal com 492 gestantes ou puérperas. Foram selecionadas pacientes internadas na unidade de terapia intensiva obstétrica no período de um ano, sendo informadas sobre as propostas do estudo e realizada aplicação do questionário. A análise foi feita através do Microsoft Excel 2013 e GraphPad Prism 6. Foram empregados testes do χ2 para verificar associação entre os fatores de risco para morbimortalidade materna grave.RESULTADOS: Foram encontrados como riscos relativos significativamente elevados para desenvolvimento de near missquando comparada à morbidade materna grave, a raça não branca (OR=2,5; RP=2,3); pacientes casadas (OR=7,9; RP=7,1), escolaridade até 2º grau incompleto (OR=3,1; RP=2,8), procedente do interior (OR=4,6; RP=4,0), renda familiar menor que 1 salário mínimo (OR=7,0; RP=5,5), distúrbios hipertensivos gestacionais (OR=16,3; RP=13,2), realização do pré-natal (OR=5,0; RP=4,2) e a via de parto cesárea (OR=39,2; RP=31,2).CONCLUSÕES: Questões socioeconômicas, clínicas e assistenciais mostraram-se relacionados à prevalência de near miss, revelando a importância de intervenções amplas para melhorar esses indicadores. Reforça-se a importância da realização de pré-natal para identificação de riscos potenciais, garantia de um suporte nutricional à gestante, tratamento de doenças e estabelecimento de programa de imunização materna, assim como uma melhor assistência no que tange aos aspectos clínicos das pacientes, objetivando diminuir o risco obstétrico e neonatal.

PURPOSE: To evaluate the risk factors for morbidity and mortality in an obstetric intensive care unit at a university hospital.METHODS: Observational cross-sectional study with 492 pregnant/puerperal women. Patients were admitted to the obstetric intensive care unit over a period of one year, being informed about the proposals of the study and a questionnaire was applied. The analysis was performed using Microsoft Excel 2013 and GraphPad Prism 6. To evaluate risk factors, χ2 tests were used.RESULTS: The main risk factors to near miss were: non-white race (OR=2.5; PR=2.3); marital status (married women) (OR=7.9; PR=7.1), schooling (primary) (OR=3.1; PR=2.8), being from the countryside (OR=4.6; PR=4.0), low income (OR=70; PR=5.5), gestational hypertensive disorders (OR=16.3; PR=13.2), receiving prenatal care (OR=5.0; PR=4.254) and C-section before labor (OR=39.2; PR=31.2).CONCLUSIONS: The prevalence of near miss was associated with socioeconomic/clinical factors and care issues, revealing the importance of interventions to improve these indicators. Additionally, we suggest a better curriculum insertion of this subject in the discipline of the medical course due to the importance of avoiding the near miss using adequate medical education. The importance of correct prenatal care is emphasized in order to identify potential risks, to provide nutritional support to pregnant women, to treat potential diseases and to establish a maternal immunization program, as well as providing better care regarding the clinical features of the patients, in order to reduce obstetrical and neonatal risk.

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