"It's Time to Do It, to Make It a Major Part of Medicine": Faculty Experience With a Shift Toward an Antioppressive Medical School Curriculum.

PURPOSE: Health inequities compel medical educators to transform curricula to prepare physicians to improve the health of diverse populations. This mandate requires curricular focus on antioppression, which is a change for faculty who learned and taught under a different paradigm. This study used the Concerns-Based Adoption Model (CBAM) to explore faculty perceptions of and experiences with a shift to a curriculum that prioritizes antioppressive content and process. METHOD: In this qualitative study, authors interviewed faculty course directors and teachers at the University of California, San Francisco School of Medicine from March 2021 to January 2022. Questions addressed faculty experience and understanding regarding the curriculum shift toward antioppression, perceptions of facilitators and barriers to change, and their interactions with colleagues and learners about this change. Using the CBAM components as sensitizing concepts, the authors conducted thematic analysis. RESULTS: Sixteen faculty participated. Their perceptions of their experience with the first year of an antioppression curriculum initiative were characterized by 3 broad themes: (1) impetus for change, (2) personal experience with antioppressive curricular topics, and (3) strategies necessary to accomplish the change. Faculty described 3 driving forces for the shift toward antioppressive curricula: moral imperative, response to national and local events, and evolving culture of medicine. Despite broad alignment with the change, faculty expressed uncertainties on 3 subthemes: uncertainty about what is an antioppressive curriculum, the scientific perspective, and fear. Faculty also reflected on primary facilitators and barriers to accomplishing the change. CONCLUSIONS: The shift to an antioppressive curriculum compels faculty to increase their knowledge and skills and adopt a critical, self-reflective lens on the interplay of medicine and oppression. This study's findings can inform faculty development efforts and highlight curricular leadership and resources needed to support faculty through this type of curricular change.

Producing Fluorine- and Lubricant-Free Flexible Pathogen- and Blood-Repellent Surfaces Using Polysiloxane-Based Hierarchical Structures.

High-touch surfaces are known to be a major route for the spread of pathogens in healthcare and public settings. Antimicrobial coatings have, therefore, garnered significant attention to help mitigate the transmission of infectious diseases via the surface route. Among antimicrobial coatings, pathogen-repellent surfaces provide unique advantages in terms of safety in public settings such as instant repellency, affordability, biocompatibility, and long-term stability. While there have been many advances in the fabrication of biorepellent surfaces in the past two decades, this area of research continues to suffer challenges in scalability, cost, compatibility with high-touch applications, and performance for pathogen repellency. These features are critical for high-touch surfaces to be used in public settings. Additionally, the environmental impact of manufacturing repellent surfaces remains a challenge, mainly due to the use of fluorinated coatings. Here, we present a flexible hierarchical coating with straightforward and cost-effective manufacturing without the use of fluorine or a lubricant. Hierarchical surfaces were prepared through the growth of polysiloxane nanostructures using n-propyltrichlorosilane (n-PTCS) on activated polyolefin (PO), followed by heat shrinking to induce microscale wrinkles. The developed coatings demonstrated repellency, with contact angles over 153° and sliding angles <1°. In assays mimicking touch, these hierarchical surfaces demonstrated a 97.5% reduction in transmission of Escherichia coli (E.coli), demonstrating their potential as antimicrobial coatings to mitigate the spread of infectious diseases. Additionally, the developed surfaces displayed a 93% reduction in blood staining after incubation with human whole blood, confirming repellent properties that reduce bacterial deposition.

8q22.2q22.3 Microdeletion Syndrome Associated with Hearing Loss and Intractable Epilepsy.

8q22.2q22.3 microdeletion syndrome has been described in only seven patients. We present a new case from Colombia. The characteristics of this condition are developmental delay, microcephaly, seizures, and typical facial dysmorphism. We discuss the clinical phenotype of the patient presenting relevant findings like hearing loss and severe epilepsy and the possible relations between the phenotype and the genes involved in the microdeletion. We describe a female with developmental delay, microcephaly, epilepsy, severe short stature, impaired speech, facial dysmorphism, and congenital deafness. A minimal/maximal deletion of 5.238 Mb and 5.374Mb, respectively, at 8q22.2q22.3 was diagnosed using a genome-wide array. The clinical phenotype is similar to the others seven patients previously reported; however, the severity of epilepsy and the concomitant hearing loss is remarkable, characteristics previously observed independently in only two patients. The KCNS2 gene is located in the deleted regions (8q22.2). Therefore it is a possible candidate for explaining the complex neurologic phenotype.

Urea Cycle Defects: Early-Onset Disease Associated with A208T Mutation in OTC Gene-Expanding the Clinical Phenotype.

Ornithine transcarbamylase deficiency (OMIM: 311250) is the most common disorder of urea cycle disorders, accounting for nearly 50% of all cases. We report a case of a two-month- old male patient, who attends our medical genetics consultation because of low citrulline levels and elevated glutamine to citrulline ratio detected by expanded newborn screening with tandem mass spectrometry. He is an asymptomatic male with a normal physical examination and appropriate neurodevelopmental milestones. The patient has a family history of one older brother who died at 18 months old from severe and sudden hyperammonemia and a maternal aunt who suddenly died at two years old. He had high plasma ammonium concentration and a confirmed OTC mutation (p.A208T). Usually, this mutation causes OTC deficiency of late onset in adult males. However, this report raises awareness about mutations previously described as a late-onset causing disease, which can cause severe hyperammonemia and high risk of dying at an early age.

Inhibidores de la paraproteína convertasa subtilisina/kexina tipo 9: una alternativa de manejo para las dislipidemias / Proprotein convertase subtilisin/kexin type 9 inhibitors: an alternative for treating dyslipidemias

Resumen Las guías de la práctica clínica internacionales recomiendan a las estatinas como la terapia de elección para el manejo de la dislipidemia. No obstante, pese a la evidencia acerca de la importancia del manejo de esta condición, existe un porcentaje significativo de los adultos que no logran las metas en los lípidos con las estatinas. Lo anterior ha estimulado el desarrollo de anticuerpos monoclonales que inactivan la paraproteína convertasa subtilisina/kexina tipo 9. Estos medicamentos han sido aprobados como adyuvantes a la dieta y a las dosis máximas toleradas de la estatina para la hipercolesterolemia familiar o la aterosclerosis clínica en pacientes que requieren disminución adicional de las lipoproteínas de baja densidad. En este artículo revisaremos la evidencia actual acerca de los anticuerpos anti-paraproteína convertasa subtilisina/kexina tipo 9 con el objetivo de optimizar el tratamiento clínico de nuestros pacientes.

Abstract International clinical practice guidelines recommend statins as the treatment of choice for managing dyslipidemias. However, despite evidence regarding the importance of controlling this condition, there is a significant percentage of adults who do not meet their target lipids with statins. This has stimulated the development of monoclonal antibodies that inhibit the proprotein convertase subtilisin/kexin type 9. These drugs have been approved as adjuvants for the diet and the maximum tolerated statin dosage in familial hypercholesterolemia or clinical atherosclerosis in patients requiring an additional reduction of low-density lipoproteins. This article reviews current evidence regarding antibodies against proprotein convertase subtilisin/kexin type 9 with the goal of optimising clinical treatment of our patients.

Inhibición dual de la neprilisina y del receptor de la angiotensina (ARNI): una alternativa en los pacientes con falla cardiaca / Dual angiotensin receptor and neprilysin inhibition (ARNI): an alternative for patients with cardiac failure

La falla cardiaca (FC) es la causa más común de admisión hospitalaria en adultos en el mundo. Además, de su importante prevalencia la FC tiene un alta tasa de mortalidad, se estima que aproximadamente el 50% de los pacientes con FC mueren a los 5 años posterior al egreso hospitalario. Esto ha motivado el desarrollo de nuevas terapias seguras y efectivas para el manejo de esta entidad. El LCZ696 es un inhibidor dual de la neprilisina y del receptor de angiotensina II que demostró en estudios de fase III disminuir el desenlace primario de muerte cardiovascular y hospitalización por empeoramiento de la FC y muerte global. Probablemente el LCZ696 se convertirá en la piedra angular del manejo en pacientes con FC con fracción de eyección deprimida.

Cardiac failure (CF) is the most common cause of hospital admission in adults all over the world. In addition to its important prevalence, CF presents a high mortality rate. It is estimated that approximately 59% of patients with CF die within 5 years after the admission. This has been the motivation for the development of new, safe and effective therapies aimed at the management of this disease. LCZ696 is an angiotensin II receptor-neprilysin inhibitor; phase III studies have shown it decreases the primary outcome of cardiovascular death and admission due to worsening of the CF and global death. LCZ696 could probably become the cornerstone of the management of patients with CF with depressed ejection fraction.

Nutricion enteral en el paciente critico: [revisión] / Enteral nutrition in critical patients: [review]

El soporte nutricional en el paciente critico es de vital importancia por su impacto enla morbimortalidad, estancia y preservacion de la masa tisular entre otros. Se debe garantizar un soporte nutricional a todos los pacientes criticos idealmente por via enteral por la disminucion de la traslocación bacteriana y la estimulacion de la funcion de las vellosidades intestinales. En los ultimos anos se han estudiado inmunonutrientes como la glutamina, arginina, acidos grasos y nucleotidos con efectos esperanzadores (Respuesta inmune, barrera intestinal o cicatrizacion tisular)...

Algas de interes sanitario en embalses del centro - oeste de la provincia de Cordoba-Argentina / Algae capable of affecting sanitary conditions in water reservoirs of the central-western region of the province of Cordoba-Argentina

Las floraciones algales en embalses artificiales producenprofundas modificaciones relacionadas especialmente con elproceso de eutroficación. La eutroficación lleva a continuoscambios en las comunidades fitoplántónicas, aumentando lasfrecuencias y densidades de cianobacterias que desplazan a lasdiatomeas, clorofíceas y dinoflagelados. El problema másimportante relacionado con las cianobacterias es la apariciónde cepas tóxicas y sus consecuencias sobre la salud humana,animales domésticos y sobre el ecosistema acuático en general.Las biotoxinas de las cianobacterias se las ha clasificado dentrode los venenosos más poderosos que se conocen. El objetivo delpresente trabajo es realizar un monitoreo del embalseSanRoque,La Quebrada, La Falda y El Cajón a los fines de identificar lasprincipales algas de interés sanitario que puedan afectar a lasalud...