Phamcoble1315

thout a statistically significant difference in patient satisfaction scores, compared to control patients. In order to better measure the effectiveness of multimedia-based patient education interventions, future studies should account for baseline education level, preexisting educational resources available to study patients, socioeconomic factors, and emotional state. The main difficulty of ovarian tissue autograft (OTA) is to preserve as many follicles as possible because the ovarian tissue undergoes warm ischemia during grafting until revascularisation, resulting in significant follicular loss. We describe a two-stage grafting technique to stimulate new vascularisation in order to enhance the revascularization process to reduce the ischemic injuries. Furthermore we performed ovarian patchwork in the laboratory and then grafting with robotic laparoscopy to facilitate surgery and increase precision. This technique is used in the DATOR study with promising results, such as a 40% delivery rate. ETHNOPHARMACOLOGICAL RELEVANCE The use of natural products such as propolis extract (PE) is a promising alternative when topically administered to replace conventional antifungals, mostly due to its therapeutic applications, ease of access and low toxicity. However, despite being the subject of several mycology studies, they focus primarily on exploiting their antimicrobial activity, lacking information on the mechanisms of action of PE on Candida spp., characterizing its antifungal potential. AIM OF THE STUDY To elucidate the bioactivity of PE on the cellular structure of Candida albicans. MATERIALS AND METHODS A total of seven C. albicans clinical isolates plus a reference strain of C. albicans ATCC 90028 were used in this study. The PE was characterized and its effect on C. albicans was determined by susceptibility and growth kinetics assays; interference on C. albicans germination and filamentation; evaluation of the integrity of the C. albicans cell wall and membrane, as well as its mutagenic potential. RESULTS The PE presented strong inhibitory activity, which showed its greatest antifungal activity at 12 h with dose and time dependent fungistatic characteristics, effectively inhibiting and interfering on C. albicans filamentation. In addition, PE caused membrane and cell wall damage with intracellular content extravasation. Moreover, PE was not mutagenic. Fetuin in vivo CONCLUSIONS The bioactivity of PE is mainly related to the loss of integrity membrane as well as the integrity of the cell wall and consequent increase in permeability, without mutagenic effects. STUDY OBJECTIVE Determine the prevalence of burnout and frustration among participants currently completing a Fellowship in Minimally Invasive Gynecologic Surgery (FMIGS) DESIGN Cross-sectional survey SETTING An anonymous survey was distributed to fellows in November 2018 PARTICIPANTS Current FMIGS fellows INTERVENTIONS N/A RESULTS A total of 57 (67.7%) of 83 FMIGS participants in AAGL-accredited programs completed a survey regarding fellowship characteristics and experiences. Overall, 40 participants (70.2%) indicated that they were satisfied with their fellowship program experience. There were 33 fellows (57.9%) who reported burnout, and 38 fellows (66.7%) have experienced anxiety, depression, or extreme fatigue during the last month. Of those who reported burnout, 26 (76.5%) reported they did not receive support from their fellowship program. Fellows who experienced burnout were more likely to be in their second year (p=0.003), spent less time per week doing scholarly activities (p=0.048), and were less satisfied with their fellowship experience (p less then 0.001). Participants who experienced anxiety, depression, or extreme fatigue had more fellows in their program (p=0.031), worked on average more hours per week (p=0.020), and were more often required to practice obstetrics in their fellowship (p=0.022). CONCLUSION Burnout symptoms are common among physicians across multiple specialties. Our findings suggest that this issue is prevalent among FMIGS participants. Additionally, there is lack of access to emotional and psychological support programs for fellows experiencing burnout. We hope that this study will prompt attention to this important topic by both individual programs and AAGL as a society to increase awareness, access to resources, and promote wellness for fellows. Clostridioides difficile is the leading cause of healthcare-associated diarrhea. Although the incidence of C. difficile-associated diarrhea is increasing worldwide, bacteremia due to C. difficile is relatively rare and represents the least frequent extra-colonic manifestation of C. difficile infection. To date, only 60 C. difficile bacteremia cases with detailed clinical patient characteristics have been reported in the literature, and another 77 cases have been identified in epidemiological reports. We report a rare and fatal case of bacteremia due to C. difficile from a Greek hospital. Onychomycosis is one of the most prevalent and severe nail fungal infections, which is affecting a wide population across the globe. It leads to variations like nail thickening, disintegration and hardening. Oral and topical drug delivery systems are the most desirable in treating onychomycosis, but the efficacy of the results is low, resulting in a relapse rate of 25-30%. Due to systemic toxicity and various other disadvantages associated with oral therapy like gastrointestinal, hepatotoxicity, topical therapy is commonly used. Topical therapy improves patient compliance and reduces the cost of treatment. However, due to poor penetration of topical therapy across the nail plate, research is focused on different chemical, mechanical and physical methods to improve drug delivery. Penetration enhancers like Thioglycolic acid, Hydroxypropyl-β-cyclodextrin (HP-β-CD), Sodium lauryl sulfate (SLS), carbocysteine, N-acetylcysteine etc. have shown results enhancing the drug penetration across the nail plate. Results with physical techniques such as iontophoresis, laser and Photodynamic therapy are quite promising, but the long-term suitability of these devices is in need to be determined. In this article, a brief analysis of the treatment procedures, factors affecting drug permeation across nail plate, chemical, mechanical and physical devices used to increase the drug delivery through nails for the onychomycosis management has been achieved.