Sexual health competence of international medical graduate psychiatric residents in the United States.

OBJECTIVE: Currently in the United States, more than one in three psychiatric residents are international medical graduates (IMGs). In light of forecasts of physician shortages, this proportion is likely to continue growing. Although central to psychiatric care, sexual health competence levels of IMGs may be lower than those of U.S. graduates. METHODS: The authors conducted a nonsystematic review of the literature and online data to establish the learning needs of IMGs in this area. RESULTS: Data on five areas are summarized: demographic and sociocultural data of IMGs in the United States; the need for sexual medicine competence for practicing psychiatrists; how sexual health is currently taught in foreign medical schools; attitudes toward sexuality and sexual problems among physicians and patients of different cultures; and the management of sexual issues, including sexual boundaries, by IMGs. CONCLUSION: The authors found evidence suggesting that IMGs from areas most culturally dissimilar to the United States are likely to benefit from sexual medicine curricula in the context of cultural competence training. The diversity and resilience of IMGs are emphasized. Implications for immediate training and future research are outlined.

The role of FABP2 gene polymorphism in alcoholic cirrhosis.

Hypertriglyceridemia and dietary lipids have been suggested to modulate the severity of alcoholic liver disease and the progression to alcoholic cirrhosis (AC). The intestinal fatty acid binding protein (IFABP) is the main transporter of dietary fatty acids into the enterocyte and has a genetic polymorphism, FABP2 A54T that has been associated with hypertriglyceridemia. We determined the frequency of the FABP2 gene polymorphism using PCR-RFLP and measured serum triglycerides, HDL, LDL, total lipids and cholesterol in 67 patients with AC and in 124 unrelated healthy individuals. Frequencies of genotypes and alleles were similar between the two groups. The healthy subjects, who were homozygous for the Thr54 genotype had significantly higher mean triglyceride serum concentrations than those homozygous for the Ala54 genotype (P<0.05). However, AC patients who were homozygous for the Thr54 genotype, had lower mean triglyceride serum concentrations (P<0.01), and had a significantly longer period of continued alcohol abuse prior to the diagnosis of liver cirrhosis compared to the AC patients homozygous for the Ala54 genotype (P<0.05). Our data suggests that the polymorphism Thr54 of the FABP2 gene is associated with a later onset of AC in the lower economic status Mexican population studied.

The epsilon4 allele of apolipoprotein E gene is a potential risk factor for the severity of macular edema in type 2 diabetic Mexican patients.

PURPOSE: The objective of this study was to determine the relationship between APOE polymorphism and the severity of retinal hard exudates in Mexican patients with type 2 diabetes. METHODS: We studied 36 patients with diabetic retinopathy and 22 unrelated and apparently healthy age-matched individuals. Blood samples for DNA genotyping and lipid profile were taken. Genotyping of polymorphic APOE alleles was done after polymerase chain reaction amplification of genomic DNA, digestion with HhaI, and agarose gel electrophoresis. Stereoscopic 35 degrees color fundus photographs were taken of seven standard fields. Diabetic retinopathy, macular edema and hard exudates were graded according to a standardized procedure. RESULTS: The results showed that the lipid profile was higher but not statistically significant (p > 0.05) in e4 allele carriers, with the exception of total lipids (p > 0.05). The frequency of severe retinal hard exudates was higher in those epsilon4 allele carriers (p < 0.05). The higher frequency of visual impairment (VA < 0.5 Log MAR) in epsilon4 carriers showed a tendency towards statistical significance (p = 0.057). CONCLUSION: Our results suggest that the epsilon4 allele of the ApoE gene is a potential risk factor for the severity of retinal hard exudates and visual loss in type 2 diabetic Mexican patients with diabetic retinopathy.