Many countries worldwide are currently struggling with medical workforce shortages and unequal distribution of healthcare workers between urban and rural areas. Medical deserts are defined as areas with insufficient access to healthcare services due to a shortage of qualified professionals. The emergence of medical deserts is attributed to physicians’ lower willingness to work in rural areas due to factors such as overburdened work conditions, lack of recognition, insufficient financial aspects, professional isolation, and socio-demographic factors like finding jobs for spouses or ensuring quality education for children. To address this issue effectively, understanding the motivations and decisions of future doctors is crucial. The choice of physicians’ specialization is complex and influenced by factors such as work conditions, prestige, economic conditions, personal interests, and psychological aspects. Altruism, curiosity, and a desire for prestige often drive a career in medicine, but these motivations are tempered by financial considerations, job market competition, and the availability of specialized training opportunities. The choice of medical specialization is further shaped by personality traits, research interests, and the demand for specific expertise in the healthcare system. Additionally, family influence, mentorship, and socialization play critical roles in shaping career trajectories, with parents’ professions and teachers’ attitudes often steering students toward particular fields. Addressing medical deserts requires a multi-faceted approach that understands these factors and develops policies and strategies encouraging future doctors to work in underserved regions.
Drug-induced liver injury (DILI) must be taken into consideration when a pregnant woman takes medications and presents symptoms of acute or chronic hepatitis, hepatocellular, cholestatic or mixed, as it poses a danger to both mother and fetus. Among causative medications, paracetamol is the most common, followed by antibiotics. There is a case report of a 24-year-old pregnant woman admitted to the Obstetrics and Gynecology Clinic with presentation of yellow discoloration of the skin and whites of the eyes, pruritus of the skin and clinical suspicion of gestational cholestasis. Due to skin lesions, stiff neck, cold sores, fever, and the presence of ANA and anti-Ro antibodies since the 21st week of gestation, the patient was treated with prednisone and hydroxychloroquine and was symptomatically treated with paracetamol. At the time of admission to the Clinic, laboratory tests showed elevated values of liver parameters and CRP. During hospitalization, an enlarged liver with dilatation of the hepatic ducts was revealed. The patient was consulted dermatologically and hepatologically, and tests for viral liver diseases were negative. Based on overall case analysis and the atypical clinical course, a drug-induced liver injury was suspected. After paracetamol and hydroxychloroquine were discontinued, the complete normalization of liver parameters was achieved. It must be underlined that DILI remains a diagnosis of exclusion, and thus testing for other causes of hepatic injury such as autoimmune hepatitis, acute viral hepatitis, ischemic liver injury, and Budd-Chiari syndrome is crucial. In case of a confirmed medical history of treatment with potentially hepatotoxic drugs, there is no need to perform a liver biopsy.
