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When a JAMA Network Open study reported earlier this year that suicide remains the leading cause of death among medical residents, many experts were saddened but unsurprised.

“It signals that there are underlying problems that we should solve,” said Srijan Sen, MD, PhD, director of the Frances and Kenneth Eisenberg and Family Depression Center and professor of depression and neurosciences at the University of Michigan, Ann Arbor, Michigan.

Aditee Narayan, MD, MPH, pointed to the challenges that exist in today’s healthcare system for all physicians, including residents.

“This system may escalate moral injury among our residents — they want to do more for our patients but are limited to what is available for them,” said Narayan, vice dean for Medical and Health Professions Education at the Duke University School of Medicine in Durham, North Carolina.

According to the JAMA Network Open study, the actual incidence of suicide, while higher from 2000 to 2014 than from 2015 to 2021, was still relatively rare. In fact, the study noted that the suicide rate in the 30- to 34-year-old age group was 70% lower than in the same age group in the general population.

That doesn’t mean that it should be ignored or dismissed, said Christine Moutier, MD, chief medical officer of the American Foundation for Suicide Prevention.

“My hope is that we would not be inured to this tragic public health concern,” she said.

Instead, efforts to address mental health among residents should be intentional and proactive, she said.

Intentional Efforts to Address Mental Health

Stress can push even well-adjusted people to the limit, and plenty of stress exists in the life of most medical residents. However, there are a number of perceived barriers to accessing care, including lack of time, concerns over confidentiality, stigma, uncertainty about where to access care, cost, a preference to receive care outside their own organization, and others, according to research.

As a result, despite the high-pressure environments in which they work and high stress levels, residents report a low use of mental health services, according to a 2024 study in the Journal of Graduate Medical Education.

In response, a growing number of programs are not waiting for their residents to reach a crisis point.

Some programs have experimented with opt-out programs for mental health support for residents to reduce barriers to accessing care and to minimize stigma. For example, Riverside Community Hospital, a clinical rotation site for the University of California, Riverside School of Medicine in Southern California, found that residents were more likely to access free, confidential teletherapy sessions when the initial appointment was already scheduled for them.

At the University of Texas Health Science Center at San Antonio, new residents are asked to voluntarily complete a form that helps assess their risk for factors that could take a toll on their psychological health and well-being: the Transition to Residency Risk Index. Their score shows whether they are low, medium, or high risk, and resources are made available to them.

Jon Alan Courand, MD, who created the index, said the first few months of the postgraduate year 1 are considered the highest risk period, according to the latest research.

“There’s a lot of turmoil that happens in these transitions,” said Courand, professor of pediatrics and the assistant dean for Wellbeing for Graduate Medical Education at the University of Texas Health Science Center at San Antonio.

Making sure that residents know that multiple kinds of support are available is also crucial. The program has recently added an opt-out program for incoming residents called Circle of Care as another possible way to reach them and offer support.

“We might be preventing one very negative outcome, and that might be enough to justify everything else that we’re doing,” said Adriana Dyurich, PhD, LPC, who helped edit and validate the risk index. “We don’t have to look for super high numbers because the meaning of one or two suicides is devastating for institutions, for programs, for everyone that is around.”

Case Study: Columbia

As soon as interns begin their training at Columbia University Irving Medical Center, New York City, they encounter Laurel Mayer, MD. Mayer, a professor of psychiatry, is a faculty member for the CopeColumbia program, and she talks to all the new interns during orientation about stress, burnout, and risk factors for suicide. She shows them statistics.

“If you take care of yourself, and you are working as your best self, you will take better care of your patients,” she tells them.

Then she tells them to call her. In fact, she encourages them to put her phone number into their phones so they don’t have to ask anyone how to contact her if they need help.

“I’ve actually had a number of residents call me,” said Mayer. “Not even just internship year, but later. They say, ‘I had your information in my phone.’”

Mayer can help connect residents with therapists, and she and her team make sure that the providers are educated about the unique issues associated with caring for physicians in training. She’s also working to address cost and confidentiality concerns: Through the organization’s Cope GME program, residents can receive eight therapy sessions per year at no charge. Beyond that, Mayer works to make sure that residents are connected with providers who accept their insurance. While care may be documented in the resident’s own electronic medical record, the information is flagged and protected for privacy.

They’re also piloting a new opt-out program based on a series of one-on-one check-ins, where everyone gets a 30-minute session with someone on her team. It’s not a psychiatric evaluation — just time to talk.

“We have data that 96% of the residents, at the end of that check-in, thought it was helpful and thought it should become part of the residency curriculum,” Mayer said, noting that her team is now evaluating if those check-ins facilitate access to mental health treatment.

Additional Resources and Strategies

The Accreditation Council for Graduate Medical Education (ACGME) offers a Mental Health and Well-Being During Transitions tool kit, among other resources, to help programs start new or bolster existing efforts to address the mental health and well-being of their resident workforce.

Nicholas Yaghmour, MPP, director of the Resident Experience, Well-Being, and Milestones Research at the ACGME, suggested that residency programs also consider providing annual physicals to their residents. Yaghmour was also the leading author of the JAMA Network Open study.

“We may be able to catch more undiagnosed mental health problems like depression and anxiety,” he said. “We also may prevent the other causes of death and disease, such as neoplastic diseases and infectious diseases.”

Individuals in training program leadership roles who commit to setting positive examples can also be a part of suicide prevention efforts, according to Mark Olfson, MD, PhD, professor of epidemiology and professor of psychiatry, medicine, and law at Columbia University Medical School in New York City.

“We need to set examples, if we’re involved with training physicians, to normalize stress and acknowledge when it occurs and talk about it openly, to help set up a culture that lowers the stigma around behavioral healthcare services among medical trainees,” said Olfson, whose research includes a focus on suicide prevention.

Plus, it may also encourage other physicians to access care when they need it.

“The more we can normalize physicians at all professional stages reaching out for mental health care and for emergency support when they feel they are in crisis, the better we can be as a field in preventing deaths by suicide,” said Yaghmour.

Introduction

Historically, ethnomedicine has made extensive use of the plant’s whole spectrum of parts, including its bark, fruit, leaves, stem, and roots, all of which have therapeutic qualities.People recognise the use of herbal medicine and botanical extracts as a substitute for synthetic or pharmaceutical medications, often due to their reduced side effects. The evidence indicates that the application of herbal medicine techniques aligns with a resurgence in natural remedies that typically have fewer or no side effects.^1,2 For thousands of years, this plant has been utilized not only as a preventative and curative measure for various ailments but also as a vegetable with high nutritional value.³ It is extensively described in the Vedic literature for the treatment of various diseases.⁴ Burn injuries constitute a major public health issue globally, particularly in low- and middle-income nations where resources for advanced burn treatment are scarce. The World Health Organisation (WHO) reports that burns result in over 180,000 deaths each year, predominantly in developing regions.⁵ Infection is a significant complication of burn injuries, potentially delaying healing, causing systemic complications, and increasing mortality rates. The impaired skin barrier in burn victims facilitates colonisation and invasion by opportunistic pathogens, including Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Candida albicans.^6,7 The standard method for managing burn wound infections involves the administration of systemic or topical antibiotics. The emergence of multidrug-resistant (MDR) organisms has markedly reduced treatment efficacy and heightened the strain on healthcare systems.^8,9 The increasing challenge of antimicrobial resistance (AMR) has prompted investigations into alternative therapies, particularly those originating from natural sources like medicinal plants.¹⁰ Jatropha curcas L., belonging to the Euphorbiaceae family, has been used in traditional medicine to treat various conditions, including skin disorders, infections, and inflammation. The latex comprises various secondary metabolites, including flavonoids, tannins, alkaloids, saponins, terpenoids, and glycosides, which are recognised for their antimicrobial, anti-inflammatory, and wound-healing properties.^11,12 Herbal medicine has contributed numerous powerful medications to the extensive drug arsenal of contemporary medical research worldwide, both in crude form and as a pure chemical on which modern medicines are structured.¹³ Recent studies have demonstrated the antimicrobial efficacy of J. curcas latex. Kumar et al formulated a topical herbal cream using J. curcas latex, which demonstrated notable inhibition of prevalent burn pathogens and enhanced wound healing in an in vivo rat model.¹⁴ Ikoyi et al demonstrated that ethanol extracts of J. curcas leaves and latex were effective against clinical isolates of S. aureus, E. coli, and C. albicans obtained from surgical wounds.¹⁵ The results corroborate previous research that emphasised the wound-healing capabilities of J. curcas latex, which are attributed to its proteolytic and angiogenic properties.¹⁶ This study contrasts J. curcas latex with established antibiotics, including ofloxacin, tetracycline, and fluconazole, rather than evaluating herbal extracts in isolation as previous research has done. The results indicate that the latex demonstrates either superior or comparable inhibitory effects against certain pathogens, thereby supporting its potential as a complementary or alternative treatment in response to increasing antimicrobial resistance.^9,15 This study associates the antimicrobial activity of latex with its bioactive constituents, including tannins, flavonoids, saponins, and alkaloids. It quantifies this effect using Minimum Inhibitory Concentration (MIC) values, offering mechanistic insights into its efficacy.^11,12 Considering its favourable antimicrobial properties and historical applications, J. curcas latex merits additional research as a possible alternative or complement to standard antimicrobials in the management of burn wounds. This research evaluates the antimicrobial efficacy of J. curcas latex against clinical sample was isolated for this research from infected burn wounds in Sana’a, Yemen, and compares its effectiveness with that of commonly used antibiotics.

Methodology

Study Design and Setting

This study was carried out in a laboratory setting in Sana’a City, Yemen. We conducted the study at the Microbiology Laboratories of Ibin Sina Hospital and the National Centre of Public Health Laboratories, with a focus on pathogen isolation. Phytochemical screening and antimicrobial analysis were performed in the Microbiology Laboratory at the Faculty of Medicine and Health Sciences, Sanaa University.

Collection and Identification of Plant Material

We cultivated healthy Jatropha curcas specimens in Sana’a to obtain fresh latex. Botanical authentication was conducted at the Botany Unit within the Department of Plant Biology at Sanaa University. We extracted the latex by incising mature stems, collected the exudate in sterile amber bottles, and stored it at 4°C.

Test Microorganisms

Clinical isolates were obtained from infected wound and burn swabs collected from patients at Ibin Sina Hospital. The microorganisms included:

Staphylococcus aureus

Escherichia coli

Klebsiella pneumoniae

Pseudomonas aeruginosa

Candida albicans.

Standard ATCC Reference Strains Were Also Tested for Comparison

S. aureus ATCC 13704

E. coli ATCC 35218

K. pneumoniae ATCC 10273

P. aeruginosa ATCC 27853

C. albicans ATCC 10231

Identification was confirmed using standard microbiological techniques, including culture, Gram staining, and biochemical tests, as shown in Figures 1–6.

Figure 1 Culture morphology of Escherichia coli.

Figure 2 Culture morphology of Klebsiella pneumonia.

Figure 3 Culture morphology of Pseudomonas aeruginosa.

Figure 4 Culture morphology of Staphylococcus aureus.

Figure 5 Culture morphology of Candida albicans.

Figure 6 Culture morphology of Staphylococcus aureus on agar medium.

Preparation of Latex Extract

The crude latex was diluted with 20% dimethyl sulfoxide (DMSO) to create a stock solution at a concentration of 100 mg/mL. Serial dilutions were conducted for the assessment of Minimum Inhibitory Concentration (MIC).

Antimicrobial Susceptibility Testing

The agar diffusion method using wells was employed to assess antimicrobial activity. Mueller-Hinton agar plates, intended for bacterial cultures, and Sabouraud Dextrose agar plates, designed for fungal cultures, were inoculated with 0.1 mL of a standardised microbial suspension at approximately 10⁸ CFU/mL. Wells with a diameter of 6 mm were filled with 100 μL of latex extract at a concentration of 100 mg/mL. Plates were incubated at 37°C for 24 hours for bacterial cultures and at 25°C for 48 hours for fungal cultures. The inhibition zones were quantified in millimetres. DMSO functioned as a negative control. Standard antibiotics, including ofloxacin (5 µg), tetracycline (30 µg), and fluconazole (25 µg), were used as positive controls. The study was conducted by.¹⁷

Antimicrobial Susceptibility Testing

Agar Well Diffusion Method

The antibacterial activity of J. curcas latex was determined using the agar well diffusion method. To test for bacteria and Candida albicans, 0.1 mL of a standard microbial suspension (about 10⁸ CFU/mL) was added to Mueller-Hinton agar and Sabouraud Dextrose agar, respectively. Agar wells with a diameter of 6 mm were filled with 100 µL of latex extract (100 mg/mL). Plates were left at room temperature for 30 minutes to allow for pre-diffusion before being incubated at 37°C for 24 hours (bacteria) or 25°C for 48 hours (fungi). The sizes of the inhibition zones were measured in millimetres.as shown in Figure 7.

Figure 7 Anti sensitivity test of J. curcas latex on different microorganism (A) Escherichia coli, (B) candida albicans, (C) Pseudomonas aeruginosa, (D) Klebsiella pneumonia, (E) Staphylococcus aureus).

Controls

Negative control: 20% DMSO

Positive controls

• Ofloxacin (5 µg) and Tetracycline (30 µg) for bacterial isolates
• Fluconazole (25 µg) for C. albicans.^17–19

Minimum Inhibitory Concentration (MIC) Determination

As shown in Figures 8 and 9 we assessed the minimum inhibitory concentration (MIC) values using the broth microdilution method on sterile 96-well microplates. Serial two-fold dilutions of latex extract, ranging from 100 to 0.19 mg/mL, were prepared in nutrient broth. Each well was treated with 100 µL of diluted latex and 5 µL of microbial suspension. The plates underwent incubation at 37°C for a duration of 24 hours. The minimum inhibitory concentration (MIC) was defined as the lowest concentration that prevented visible microbial growth. Optical density was assessed at 600 nm using a microplate reader.²⁰

Figure 8 MIC of Jatropha latex against the isolated microorganisms in the band1 in well of ELISA microplate.

Figure 9 MIC of Jatropha latex against the isolated microorganisms in the band2 in well of ELISA. Microplate.

Statistically Analysis

Data were analyzed by using the SPSS program (Social Package of Statistical Science) version 21, were checked for normally distribution, and were expressed as percent, mean ± SD. Differences in variables were tested by using Independent sample T-test and chi- square test. Parametric multiple comparisons between the control and the treatment groups and the significant interrelationships between parameters were, analyzed by using One-way ANOVA. The significant differences were indicated if P-value < 0.05.

Results

Table 1 illustrates that Staphylococcus aureus was the predominant bacterium detected in burn wound infections, succeeded by P. aeruginosa. This research indicates that these two bacteria are significant contributors to wound sepsis in the study population, highlighting the need for effective antimicrobial treatments for both species.

Table 1 Prevalence of the Isolated Pathogens From the Clinical Burn Wounds Samples

Table 2 indicates that latex displayed a stronger inhibitory effect on E. coli than both antibiotics, especially against the standard strain. The evidence demonstrates that the latex possesses significant antibacterial activity against E. coli.

Table 2 Mean of Inhibition Zone (in Mm) of Jatropha Latex and the Studied Antibiotics (Positive Control) Against the Isolated E. Coli From the Clinical Burn Wounds Samples

Table 3 shows that Latex displayed either marginally higher or comparable inhibition relative to Ofloxacin and significantly exceeded Tetracycline, thus confirming its effectiveness against P. aeruginosa, a recognised drug-resistant pathogen.

Table 3 Mean of Inhibition Zone (in Mm) of Jatropha Curcas Latex and the Studied Antibiotics (Positive Control) Against the Isolated Pseudomonas Aeruginosa From the Clinical Burn Wounds Samples

Table 4 illustrates Ofloxacin showed marginally better results; however, the latex displayed significant antimicrobial activity and surpassed tetracycline, which was largely ineffective.

Table 4 Mean of Inhibition Zone (in Mm) of Jatropha Curcas Latex and the Studied Antibiotics (Positive Control) Against the Isolated Klebsiella Pneumonia From the Clinical Burn Wounds Samples

Table 5 indicates that latex exhibited superior antibacterial activity against S. aureus compared to both antibiotics, with inhibition zones exceeding 30 mm.

Table 5 Mean of Inhibition Zone (in Mm) of Jatropha Curcas Latex and the Studied Antibiotics (Positive Control) Against the Isolated Staphylococcus Aureus From the Clinical Burn Wounds Samples

Table 6 demonstrates that Latex exhibits greater antifungal activity than the established treatment, Fluconazole, indicating its considerable antifungal potential.

Table 6 Mean of Inhibition Zone (in Mm) of Jatropha Curcas Latex and the Studied Antibiotics (Positive Control) Against the Isolated Candida Albicans From the Clinical Burn Wounds Samples

Table 7 indicates a statistically significant enhancement (p < 0.05) in the inhibition of S. aureus by latex. K. pneumoniae demonstrated diminished inhibition from latex; however, this effect remained significant, likely due to variability.

Table 7 The Association Between Jatropha Curcas Latex and the Studied Ofloxacin (5mcg) (Positive Control) Against the Isolated Microorganisms From the Clinical Burn Wounds Samples

Table 8 displays in all cases, J. curcas latex demonstrated enhanced efficacy relative to tetracycline, suggesting its potential as a broad-spectrum agent.

Table 8 The Association Between Jatropha Curcas Latex and the Studied Tetracycline (30mcg) (Positive Control) Against the Isolated Microorganisms From the Clinical Burn Wounds Samples

Table 9 indicates that the antifungal efficacy of latex surpassed that of fluconazole (p = 0.002).

Table 9 The Association Between Jatropha Curcas Latex and the Studied Fluconazole (Positive Control) Against the Isolated Candida Albicans From the Clinical Burn Wounds Samples

All strains exhibited sensitivity to latex; however, several strains displayed resistance or an intermediate response to conventional pharmaceuticals, emphasising the advantage of latex in addressing resistant diseases, as demonstrated in Table 10.

Table 10 The Susceptibility of Latex of Jatropha Curcas Against the Isolated Microorganisms From the Clinical Burn Wounds Samples

Tables 11 and 12 exhibit MIC values that validate the effectiveness of latex, especially against E. coli and K. pneumoniae. The increased MICs for S. aureus and P. aeruginosa remain within a therapeutic range.

Table 11 Absorbance of Jatropha Curcas Latex Concentration of Each Cell in the Brands Against the Isolated Microorganisms

Table 12 Minimum Inhibitory Concentration (MIC) of Jatropha Curcas Latex Against the Isolated Microorganisms

Discussions

Because of tissue necrosis, moisture, and immunosuppression, burned wounds provide an ideal environment for microbial colonisation, which usually results in severe infections that impede healing and increase patient morbidity.^6,21 The most common pathogens found in this study were Staphylococcus aureus (33.3%) and Pseudomonas aeruginosa (25%), which supports previous research that found both species to be common in nosocomial burn wound infections.^22,23

According to our findings, Jatropha curcas latex had broad antibacterial activity against all of the wound pathogens that were investigated, including the fungus Candida albicans, Gram-positive bacteria (S. aureus), and Gram-negative bacteria (E. coli, K. pneumoniae, and P. aeruginosa). These results are consistent with other studies that showed the antibacterial efficacy of J. curcas extracts, including those derived from latex and leaves.^12,14

S. aureus had the greatest sensitivity to latex, displaying the largest zone of inhibition (31.3 mm), significantly exceeding those of ofloxacin and tetracycline (p < 0.05). This discovery is important because of the global rise of methicillin-resistant Staphylococcus aureus (MRSA), which poses a considerable challenge in wound treatment.⁸ The latex exhibited significant antifungal efficacy against C. albicans, exceeding that of fluconazole (p = 0.002), which is noteworthy given the increasing resistance to azole antifungals.¹⁰

The Minimum Inhibitory Concentration (MIC) values confirmed the effectiveness of the latex. The minimum inhibitory concentrations (MICs) were determined to be 6.25 mg/mL for E. coli, K. pneumoniae, and C. albicans, while S. aureus and P. aeruginosa required higher concentrations of 25 mg/mL. The observed values correspond with previous studies highlighting species-specific variations in sensitivity to J. curcas extracts.^15,17

The latex is effective against bacteria that are resistant to common antibiotics, particularly tetracycline. In certain instances, the latex produced inhibitory zones for K. pneumoniae and P. aeruginosa, while tetracycline showed none. According to this research, J. curcas latex may be a useful treatment for burn wound infections that are resistant to many drugs, especially in settings with limited resources when second-line antibiotics are not available.^5,9

Conclusions

According to this study, Jatropha curcas latex exhibits potent and wide-ranging antimicrobial activity against the main bacterial and fungal pathogens linked to burn wound infections, including Candida albicans, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, and Staphylococcus aureus. The latex showed exceptional effectiveness against clinical isolates, including those resistant to common antibiotics like tetracycline and fluconazole, in addition to inhibiting the growth of common laboratory strains. The antibacterial qualities of the latex are probably due to the presence of active phytochemicals like flavonoids, tannins, saponins, alkaloids, and terpenoids. Crucially, the study found that J. curcas latex had low minimum inhibitory concentrations (MICs) and was just as effective—and occasionally even more effective—than conventional antibiotics, especially against Gram-negative bacteria and fungi. According to these results, J. curcas latex has a lot of promise as a natural, plant-based antibacterial agent for burn wound infections, especially in places where access to pharmaceutical therapies is restricted and antibiotic resistance is a growing problem. Isolating active compounds, assessing safety and toxicity profiles, and confirming these results in in vivo wound healing models should be the main goals of future research.

Data Sharing Statement

All data included in the manuscript are available upon request.

Consent to Participate

Written informed consent was obtained from all.

Institutional Review Board

The Institutional Review Board of the Ethics Committee of the Faculty of Medicine and Health Science, Sanaa University, Yemen, authorized this study, which was carried out in accordance with the Declaration of Helsinki’s criteria (Research code: REC-25-2024).

Acknowledgments

Our gratitude goes out to every one of the study participants.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Funding

The authors of this study declare that no funding for this study.

Disclosure

The authors of this study report no conflicts of interest.

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