Prevalence of Burnout in residents of obstetrics and gynecology: A systematic review and meta-analysis

Background: Burnout is currently a major concern among physicians due to their high level of stress at work. There are several reports on various levels of burnout in residency programs due to several predisposing factors. The aim of this systematic review was to estimate a more precise prevalence of burnout among residents of obstetrics and gynecology. Methods: PubMed, Science Direct and Scopus were searched to identify peer-reviewed Englishlanguage studies published from January 1974 to 2005 reporting burnout among residents of obstetrics and gynecology. The key words used in the search were as follows: Residents, gynecology and obstetrics, professional burnout, depersonalization, distress, anxiety, or emotional exhaustion. Relevant additional articles were identified from the lists of the retrieved articles. Results: We identified 12 studies which met our criteria. A total of 2509 participants were included in this meta-analysis. The overall prevalence rate of burnout on all the three subscales was 44% (95% CI: 30 - 57) in this group of residents. Conclusion: This meta-analysis revealed a high prevalence of burnout syndrome in residents during obstetrics and gynecology residency program. Therefore, it is recommended to consider and address this important issue to develop solutions and interventions which could improve the work condition of the medical residents.     

Natural products with SGLT2 inhibitory activity: Possibilities of application for the treatment of diabetes

Diabetes mellitus currently affects as many as 400 million people worldwide, creating a heavy economic burden and stretching health care resources. A dysfunction of glucose homeostasis underlies the disease. Despite advances in the treatment of diabetes, many patients still suffer from complications and side effects; hence, development of more effective treatments for diabetes is still desirable. SGLT2 is the principle cotransporter involved in glucose reabsorption in the kidney. SGLT2 inhibition reduces glucose reabsorption by the kidney and ameliorates plasma glucose concentration. The interest in natural products that can be used for the inhibition of SGLT2 is growing. The flavonoid phlorizin, which can be isolated from the bark of apple trees, has been used as lead structure due to its inhibitory activity of SGLT1 and SGLT2. Some phlorizin‐derived synthetic compounds, including canagliflozin, dapagliflozin, empagliflozin, ipragliflozin, and ertugliflozin, are approved by the food and drug administration to treat type 2 diabetes mellitus (T2DM), whereas others are under clinical trials investigation. In addition, other natural product‐derived compounds have been investigated for their ability to improve blood glucose control. The present review summarizes the natural products with SGLT2 inhibitory activity, and the synthetic compounds obtained from them, and discusses their application for the treatment of diabetes.     

New 6(17)-epoxylathyrane diterpene: aellinane from Euphorbia aellenii induces apoptosis via mitochondrial pathway in ovarian cancer cell line

Euphorbia species have been used in traditional medicine in many countries for the treatment of cancer. This article aims to evaluate the capability of a new lathyrane diterpene isolated from Euphorbia aellenii to induce apoptosis in the Caov-4 cell line to determine the underlying mechanism of its anticancer effects. A new 6(17)-epoxylathyrane diterpenes: aellinane from Euphorbia aellenii was evaluated for viability of Caov-4 cells by MTT method. Apoptosis induction by lathyrane diterpene was confirmed by annexin V-FITC/PI staining, and caspase-6 activation. The Bcl2 and Bax protein content were detected by Western blot analysis. Finally, we employed the fluorescent ROS detection kit and fluorochrome JC-1 to determine ROS levels and loss of mitochondria membrane potential (ΔΨm) in Caov-4 cells, respectively. The results show that lathyrane diterpene has significant cytotoxic effect against Caov-4 cells. The IC50 value was 45?μM. Annexin V/propidium iodide (PI) staining and caspase-6 activity assay confirmed that lathyrane diterpene is able to induce apoptosis in Caov-4 cells. The results also demonstrate that lathyrane diterpene up-regulated Bax and down-regulated Bcl-2 proteins. Moreover, apoptotic effect of lathyrane diterpene was also related to ROS production and loss of mitochondrial membrane potential (ΔΨm). This study demonstrated that lathyrane diterpene has profound activity against Caov-4 cells. Analysis of apoptosis-related proteins revealed that lathyrane diterpene triggered the mitochondrion-mediated apoptosis pathway, which led to the loss of mitochondrial membrane potential (ΔΨm) and activation of caspase-6. Therefore, we believe that lathyrane diterpene might be a promising natural compound in ovarian cancer therapy.     

Polyphenolic contents and antioxidant activities of two medicinal plant species, <Emphasis Type="Italic">Mentha piperita</Emphasis> and <Emphasis Type="Italic">Stevia rebaudiana</Emphasis>, cultivated in Iran

Mentha piperita (peppermint) and Stevia rebaudiana (stevia) are now widespread in cultivation worldwide. However, reports about the contents of these two plant species are scarce. To establish the polyphenolic contents and antioxidant activity of these plants by ferric ion-reducing activity (FRAP) and 2,2-diphenyl-1-picrylhydrazyl (DPPH) methods, local plants were harvested in flowering stage. Samples without any previous treatments were analyzed using high-performance liquid chromatography (HPLC) to determine the polyphenolic contents. Also, their antioxidant properties were determined using FRAP and DPPH methods. Six phenolic compounds including quercetin, p-coumaric acid, trans-ferulic acid, hesperidin, hesperetin, and rosmarinic acid were identified and quantified in peppermint. However, hesperidin, eugenol, coumarin, and vanillin were the most component in stevia. Peppermint showed better antioxidant properties than stevia in both FRAP and DPPH assessments. Our findings demonstrated that these two plants contain high polyphenolic compounds and are potent antioxidant species. Further studies on the therapeutic properties of these plants in animal and human models of diseases are recommended.     

Two-piece implants with turned versus microtextured collars

Implant companies have been promoting two-piece implants with microtextured collars in the interest of hard tissue preservation and/or soft tissue integration. However, this rationale may not be justified. Based on comparative studies currently available, it is unclear whether microroughened implant necks reduce crestal bone loss. A possible effect may be overruled by the establishment of a biologic width or by other factors influencing crestal bone remodeling. In addition, the orientation and attachment of the collagen fibers in the peri-implant mucosa are a little different because the surface roughness varies at the level of the implant neck. The clinician should be cautious when using these modified implants because the impact of microtextured collars on the initiation and progression of peri-implant pathology is currently unknown.     

Risk for endometrial cancer in relation to occupational physical activity: A nationwide cohort study in Sweden

Notwithstanding its biologic plausibility, the association between physical activity and endometrial cancer has been analyzed in only a few epidemiological studies. Retrospective assessment of exposure and small sample size often hampers interpretation of published data. We studied risk for endometrial cancer in relation to physical activity at work in a large cohort of Swedish women identified in the nationwide censuses in 1960 and 1970, with jobs that could be consistently classified into one of 4 levels of physical demands. Follow-up from 1971 through 1989 was accomplished through record linkages. Multivariate Poisson regression models were used to estimate relative risk. The risk for endometrial cancer increased regularly with decreasing level of occupational physical activity (p for trend < 0.001), and was associated more strongly with activity in 1970 than in 1960. In multivariate analyses, adjusted for age at follow-up, place of residence, calendar year of follow-up, and social class, the relative risk among women with the same physical activity level in 1960 and in 1970 was 30% higher for sedentary as compared with high/very high activity level; (p for trend = 0.04). The protective effect of physical activity appeared to be confined to women aged 50 to 69, among whom sedentary work was associated with a 60% higher risk than that observed among women estimated to be physically most active. The excess seemed to disappear within 10 years after a change in physical activity level. Although confounding cannot be ruled out in our data, occupational physical activity appears to reduce the risk for endometrial cancer. Int. J. Cancer 76:665–670, 1998.© 1998 Wiley-Liss, Inc.     

Ultra-Processed Food Consumption and Adult Diabetes Risk: A Systematic Review and Dose-Response Meta-Analysis

(1) Background: Recent individual studies have demonstrated that consumption of ultra-processed food (UPF) may be related to type two diabetes mellitus (T2DM). We aimed to synthesize the results from these individual studies by conducting an updated systematic review and meta-analysis of observational studies evaluating the association between UPF consumption and the risk of T2DM. (2) Methods: A systematic search was conducted using ISI Web of Science, PubMed/MEDLINE and Scopus electronic databases from inception up to August 2021. Data were extracted from five studies (one cross-sectional study and four cohort studies, totaling 230,526 adults from four different countries). Risk ratios (RR) of pooled results were estimated using a random-effects model. (3) Results: Our results revealed that higher UPF consumption was significantly associated with an increased risk of T2DM (RR = 1.74; 95% CI: 1.36, 2.22; I² = 68.9%; p < 0.001; n = 5). Linear dose-response analysis indicated that each 10% increase in UPF consumption (kcal/d) was associated with a 15% higher risk of T2DM (RR = 1.15; 95% CI: 1.06, 1.26; I² = 86.0%; p < 0.001; n = 5) among adults. Non-linear dose-response analysis demonstrated a positive linear association between UPF consumption and T2DM (p_nonlinearity = 0.13, p_{dose-response} < 0.001; n = 5) among adults. (4) Conclusions: A higher intake of UPF was significantly associated with an increased risk of T2DM. However, underlying mechanisms remain unknown and future experimental studies are warranted.     

Neck circumference and blood pressure among children: a systematic review and meta-analysis

Emerging evidence suggested that large neck circumference (NC) in children and adolescents may be an indicator of increased blood pressure. We sought to conduct a systematic review and meta-analysis regarding the association between NC and blood pressure in children. Pertinent studies were identified by searching PubMed and Scopus databases, up to January 2018. Studies which reported the correlation coefficient between NC, systolic blood pressure and diastolic blood pressure in children (aged <18 years) were selected. Fifteen studies met eligibility criteria for the quantitative synthesis. Overall, NC was significantly correlated with systolic blood pressure (effect size (z) = 0.39; 95% confidence interval [CI] = 0.29–0.49; P < .001; meta r = 0.371; r² = 0.13) and diastolic blood pressure (effect size (z) = 0.25; 95% CI = 0.19–0.32; P < .001; meta r = 0.0.245; r² = 0.06). NC had a positive relationship with the risk of hypertension (odds ratio [OR] = 1.35; 95% CI: 1.05–1.75). Furthermore, studies conducted in Western regions (OR = 1.55; 95% CI: 1.12–2.14) reported higher risk of hypertension in association with NC than those conducted in the Eastern regions (OR = 1.14; 95% CI: 1.03–1.25).NC seems to be a novel anthropometric measurement in children and adolescents. It can be a good predictor of elevated blood pressure, especially in the Western population.