Attitudes of Newly Hired Medicine Faculty Regarding Mentorship and Developmental Networks.

Prior research shows that most Schools of Medicine faculty consider mentorship the most crucial factor in faculty development and retention. Many faculty are establishing developmental networks in lieu of hierarchical dyadic mentoring relationships. Clinicians are less likely than other newly hired faculty groups to seek mentorship despite having assigned mentors. The study's purpose was to determine the attitudes of newly hired faculty at the University of New Mexico School of Medicine (UNM SOM) regarding mentorship and developmental networks. Within their first year of hire, all newly hired faculty at UNM SOM are required to participate in a two-day orientation to the institution event called 'Quikstart.' During seven such events, new faculty [N=131] were surveyed anonymously on six single-response questions about their attitudes regarding mentorship and developmental networks, administered via online polls between September 2018 and July 2022. In this descriptive study, summary characteristics were analyzed. Newly hired faculty mentees reported that creating a developmental network was hampered by difficulties finding multiple mentors (55.3%), receiving conflicting advice from multiple mentors (22.4%), and gathering many mentors at the same location at the same time (11.8% ). Lack of clarity regarding faculty mentee needs (55.5%), mentors' unavailability (17.6%), and failure to find mentors (14.3%) were the most often mentioned difficulties during the initiation stage of mentorship (Hitchcock et al., 1995). Although the literature advocates moving from hierarchical dyadic mentoring relationships to developmental networks, this transition for Medicine faculty mentees will likely be hindered by a shortage of adequately trained mentors. Institutions need to identify and train mentors, incentivize and support mentorship, and encourage the creation and maintenance of self-selected development networks, possibly under the leadership of a transitional mentor.

Cryptococcal Infection in Transplant Kidney Manifesting as Chronic Allograft Dysfunction.

Invasive fungal infections (IFIs) are a significant cause of morbidity in solid organ transplant (SOT) recipients. Common causes among them are Aspergillus, Candida, and Cryptococcus. Antifungal prophylaxis has led to decrease in overall incidence of IFI; however, there is very little decline in the incidence of Cryptococcal infections of SOT recipients because effective prophylaxis is not available against this infectious agent. Spectrum of manifestation of Cryptococcal infection varies in immunocompetent and immunocompromised host with subclinical and self-limiting with lungs being the primary site in immunocompetent and central nervous system as the most common site in an immunocompromised host. Other preferred sites are cutaneous, pulmonary, urinary tract (prostate) and the bone. Herein, we describe a young adult renal transplant recipient male diagnosed as a rare case of biopsy proven Cryptococcal infection in transplant kidney manifesting as chronic allograft dysfunction.

Dabigatran (Pradaxa(®)): surgeon's friend or foe?

All clinicians, whether in primary or secondary care settings, are likely to encounter patients on this new anticoagulant. Therefore, it is imperative that clinicians are aware of the risks and benefits associated with dabigatran.

Use of the Internet by patients attending hospital for oral and maxillofacial procedures.

Information obtained on the Internet regarding medical procedures is largely unregulated and can be confusing. The aims of this study were to assess use of the Internet by patients attending hospital for oral and maxillofacial procedures, and to assess the quality of information provided at consultation. Data were collected prospectively using a confidential questionnaire, which was distributed to consecutive patients attending for elective operations at 2 oral and maxillofacial units: Crosshouse Hospital, Kilmarnock, and Queen Alexandra Hospital, Portsmouth (n=100 at each unit). All the distributed questionnaires were returned. At both units, 95% of patients thought that discussion at the initial consultation was good or very good, and 84% at both units stated that they had access to the Internet. Internet access was consistently high among all age groups up to the age of 65, but in those aged over 65 it was considerably lower. A total of 22/84 patients (26%) at Crosshouse, and 14/84 (17%) at Queen Alexandra used the Internet to gain further information regarding their condition or procedure. All of those (n=14) at Queen Alexandra, and 21/22 at Crosshouse had used Google to search for the information. Those who used the Internet to find information on their medical condition or procedure found it to be a useful resource, but they also stated that the information caused some concerns. With use of the Internet and access to it increasing we highlight the need for regulated and appropriate websites to which patients should be directed.

Nucleic acid-mediated cleavage of M1 gene of influenza A virus is significantly augmented by antisense molecules targeted to hybridize close to the cleavage site.

Influenza A virus genome segment 7 encodes protein M1, which is the matrix protein playing crucial role in the virus life cycle. Any antiviral strategy that aims at reducing, in particular, the expression of this genome segment should, in principle, reduce the infectivity of the virus. We developed a specific antiviral approach at the molecular level and designed several novel 10-23 DNAzymes (Dz) and hammerhead ribozymes (Rz), specifically targeted to cleave at the conserved domains of the influenza virus M1 RNA. We sought to use antisense molecules with the hope that it will facilitate the ribozyme-mediated cleavage. We observed that the Mg(2+)-dependent sequence-specific cleavage of M1 RNA was achieved by both the Dz and Rz in a dose-dependent manner. This combination of catalytic Dz and Rz with antisense molecules, in principle, resulted in more effective gene suppression, inhibited the whole virus replication in host cell, and thus could be exploited for therapeutic purposes.

Difficult intubation during rapid sequence induction in a parturient with Ehlers-Danlos syndrome, hypermobility type.

There have been several reports of resistance to local anaesthetic agents in women with Ehlers-Danlos syndrome, hypermobility type, also known as Ehlers-Danlos syndrome Type III. General anaesthesia with rapid sequence induction was performed for caesarean section due to prolonged second stage of labour, but intubation proved to be difficult. We propose that intubation difficulty probably arose from collapse of fibro-elastic tissues and adjoining C-shaped cartilages of the trachea with appropriately applied cricoid pressure. We found no other case reports of difficult intubation in patients with Ehlers-Danlos syndrome, hypermobility type. There are reports of cervical spine instability and temporomandibular joint dysfunction in patients with this syndrome suggesting a potential for difficult airway management. Additional anaesthetic problems associated with Ehlers-Danlos syndrome involve patient positioning and vascular access.

Psychological implications in ENT diseases.

We are sometimes faced with psychic derangement or overlay in some of the ENT diseases and the link between patient's psyche and any ENT disease at times becomes signifi cant and troublesome. The conditions in the fi eld between otorhinolaryngology and psychiatry can be classifi ed as psychiatric symptoms resulting from ENT diseases or interventions and those expressing themselves as ENT symptoms due to mental ailment. The former include hearing impairment, dizziness, tinnitus, choked airway, bad oral breath, stuffy nose, traumatic interventions and external nasal deformities. The later include exaggerated and diminished pharyngeal refl ex, globus hystericus, speech disorders, vasomotor rhinitis, nose picking, choked feeling, dizziness and headache. At times diseases originate in the human mind (consciousness), causing negative thoughts like jealousy, anger, and depression due to frustration. p ]A healthy mind in a healthy body generates sound and noble thoughts. Once a healthy body-mind relationship is established, we can be reasonably sure that greater happiness and success is within our reach. Patient seeking help from ENT surgeons to change their physical appearances and or function may not understand that the ultimate goal of surgery is to bring about psychological change by modifying the physical change, which is important aspect in septorhinoplastic surgery. At times patients asking for corrective rhinoplasty for minor external nasal deformities may have underlying psychological disturbance and use even slight external nasal deformity as scapegoat for psychological upset. Males are more diffi cult patients psychologically for any facial cosmetic surgery. These days some patients read about their diseases or treatment on the Internet and get more confused and psychologically disturbed due to rare causes of their illness, rare complications and diversity of treatment available.

Voter models on heterogeneous networks.

We study simple interacting particle systems on heterogeneous networks, including the voter model and the invasion process. These are both two-state models in which in an update event an individual changes state to agree with a neighbor. For the voter model, an individual "imports" its state from a randomly chosen neighbor. Here the average time TN to reach consensus for a network of N nodes with an uncorrelated degree distribution scales as N mu1 2/mu2, where mu k is the kth moment of the degree distribution. Quick consensus thus arises on networks with broad degree distributions. We also identify the conservation law that characterizes the route by which consensus is reached. Parallel results are derived for the invasion process, in which the state of an agent is "exported" to a random neighbor. We further generalize to biased dynamics in which one state is favored. The probability for a single fitter mutant located at a node of degree k to overspread the population-the fixation probability--is proportional to k for the voter model and to 1k for the invasion process.

Traumatic aneurysm (pseudoaneurysm) of the superficial temporal artery.

The most common presentation of a pseudoaneurysm of the superficial temporal artery is from trauma as a pulsatile cystic lesion in the region of the temple, which tends to enlarge steadily, accompanied by a persistent throbbing headache. Histologically they are dissimilar from true aneurysms as they do not contain all three layers of the arterial wall and 95% of these lesions are traumatic in origin. Diagnosis of the lesion can be made by duplex ultrasound scan, ultrasound and CT, CT scan with contrast and angiography. Treatment of this lesion varies within institutions but most commonly a complete excision is preferred with ligation of the proximal and distal vessels, which provides a better cosmetic result.

Retrospective Analysis of Thyroid Cancer Patients.

BACKGROUND: Thyroid cancer is a spectrum of neoplasms and manifests in varied forms. The issues related to presentation, management and outcome of patients with thyroid malignancy are highlighted. METHODS: Retrospective analysis of 70 patients and survival analysis for event free survival was done. RESULT: Papillary carcinomas constituted 88 percent followed by follicular cancers at nine percent of all cancers. Females were affected more than males in the ratio of 2.2: 1. Mean age of presentation for papillary cancer was 39 years and for follicular 50 years. Sixteen percent patients had regional and 10 percent distant metastases. Seventeen percent showed raised serum thyroglobulin and 29 percent had an abnormal whole body scan during the follow up. Relapse rate were similar in those receiving 30 mCi of radioiodine and in those receiving more than 30 mCi. CONCLUSION: The study shows that tumour marker thyroglobulin has higher negative predictive value. Overall prognosis for differentiated thyroid cancers is good.

Progressive multifocal leukoencephalopathy--as a presenting manifestation of AIDS.

Progressive multifocal leukoencephalopathy (PML) is an opportunistic demyelinating disease caused by the ubiquitous, usually non pathogenic JC Polyomavirus. We report a case of PML as a presenting manifestation of AIDS in a forty five year old man on the basis of clinical features and neuroradiology.

Evolutionary dynamics on degree-heterogeneous graphs.

The evolution of two species with different fitness is investigated on degree-heterogeneous graphs. The population evolves either by one individual dying and being replaced by the offspring of a random neighbor (voter model dynamics) or by an individual giving birth to an offspring that takes over a random neighbor node (invasion process dynamics). The fixation probability for one species to take over a population of N individuals depends crucially on the dynamics and on the local environment. Starting with a single fitter mutant at a node of degree k, the fixation probability is proportional to k for voter model dynamics and to 1/k for invasion process dynamics.

Voter model on heterogeneous graphs.

We study the voter model on heterogeneous graphs. We exploit the nonconservation of the magnetization to characterize how consensus is reached. For a network of N nodes with an arbitrary but uncorrelated degree distribution, the mean time to reach consensus T(N) scales as Nmu(2)1/mu(2), where mu(k) is the kth moment of the degree distribution. For a power-law degree distribution n(k) approximately k(-nu), T(N) thus scales as N for nu > 3, as N/ln(N for nu = 3, as N((2nu-4)/(nu-1)) for 2 < nu < 3, as (lnN)2 for nu = 2, and as omicron(1) for nu < 2. These results agree with simulation data for networks with both uncorrelated and correlated node degrees.

Functional equivalence of the uridine turn and the hairpin as building blocks of tertiary structure in the Neurospora VS ribozyme.

Mutational, kinetic, and chemical modification experiments show that one of the three-way helical junctions in the Neurospora VS ribozyme contains a uridine turn that is important for organizing the functional three-dimensional structure of this junction. Disruption of the uridine turn disrupts the structure of the junction and decreases the self-cleavage activity of the ribozyme; however, substitution of the uridine turn with a variety of different hairpins, thereby transforming the three-way junction into a four-way junction, maintains catalytic activity. Chemical modification structure probing reveals that both the native junction and the hairpin-containing junction support the same tertiary interactions required elsewhere in the ribozyme for catalysis. These observations show that functionally equivalent three-dimensional RNA structures can be built from different secondary structure elements.

Stereoselective synthesis, in vitro, and initial in vivo evaluation of 1-methylpiperidin-4-yl alpha-hydroxy-alpha-(1-iodo-1-propen-3-yl)-alpha-phenylacetate (IPIP): a novel radioiodinated molecular probe with high affinity for the muscarinic receptor.

1-Methylpiperidin-4-yl alpha-hydroxy-alpha-(1-iodo-1-propen-3-yl)-alpha-phenylacetate (IPIP, Fig. 1) was investigated as a potential radioiodinated molecular probe targeted to the muscarinic receptor complex. The IPIP stereoisomers were synthesized via a chiral intermediate in >95% enantiomeric excess. The R-isomers demonstrated a M(1) to M(2) subtype selectivity of approximately 3 to 1 and the S-isomers demonstrated non-subtype selective binding in vitro. IPIP was radiolabeled with iodide-125 with an average radiochemical yield of 74.4% (+/-14.8, n = 5), specific activities >800 mCi/micromol, and radiochemical purities >97%. In vivo the Z-isomers demonstrated high uniform cerebral uptake suggesting non-subtype selective binding. In contrast, E-R-IPIP, after allowing a low uptake in M(2) rich areas to clear, demonstrated a retention of activity in M(1) and M(4) rich cerebral regions. In addition, the cerebral uptake of E-R-IPIP and Z-S-IPIP were inhibited by 70-90% via pretreatment with R-QNB, an established muscarinic antagonist. An ex vivo metabolism study demonstrated Z-S-IPIP was stable at the receptor site with an absence of radiolabeled metabolites.

How low can you go? Chronic hypoglycemia versus normal glucose homeostasis.

BACKGROUND: Set point errors in glucose homeostasis that result in chronic, mild hyperglycemia in the setting of maturity onset diabetes of the young have been described. Similar set point errors may exist that result in chronic, asymptomatic glucopenia. CASE: A healthy 39-year-old female was referred for evaluation of chronic, persistent, and asymptomatic glucopenia that persisted over the prior several years with a record of numerous random plasma glucose concentrations between 35 and 45 mg/dL. She denied ethanol intake and family history of hypoglycemia or diabetes. She was not taking any medications known to cause hypoglycemia, and a urine sulfonylurea screen was negative. Fasting insulin and C-peptide levels were not elevated, and pancreatic imaging studies were normal. We hypothesized that this patient possessed an error in glucose metabolism that resulted in chronic, asymptomatic glucopenia. RESULTS: In a series of clinical studies, we demonstrated a nadir plasma glucose concentration of 35 mg/dL in the absence of symptoms during a 60-hour fast. C-peptide secretion was appropriately suppressed during symptomatic hypoglycemia with exogenous insulin infusion, and counterregulatory hormone secretion was intact during insulin-induced symptomatic hypoglycemia. Finally, the patient demonstrated an incremental increase in insulin concentration in response to minimal increases in plasma glucose during a sequential, stepped infusion of 10% dextrose. CONCLUSIONS: We conclude that this patient exhibits features of a set point error in glucose homeostasis that manifests as chronic, asymptomatic glucopenia. Although the mechanism for this condition remains to be elucidated, such set point errors do exist and should be considered in the differential diagnosis of chronic hypoglycemia.

Role of oral vitamin D3 analogues in the treatment of psoriasis.

Oral vitamin D3 analogues 1 alpha hydroxy cholecalciferol and 1,25 dihydroxy cholecalciferol were compared with placebo in the treatment of psoriasis. Three groups of 15 patients each were given 1 α hydroxy cholecalciferol at 1 ug/ day 1,25 dihydroxy cholecalciferol at 0.5 ug/d and multi vitamins other than Vit A and Vit D, respectively. Patients were followed up for 3-6 months. Assessment of severity and response was done by Psoriasis Area Severity Index (PASI). Both Vit D, analogues 1 α hydroxy vitamins D3 and 1,25 (OH)2 D3 were found to be effective. Serum and urinary calcium remained within normal limits.

In vitro and in vivo m2 muscarinic subtype selectivity of some dibenzodiazepinones and pyridobenzodiazepinones.

Alzheimer's disease (AD) involves selective loss of muscarinic m2, but not m1, subtype receptors in cortical and hippocampal regions of the human brain. Emission tomographic study of the loss of m2 receptors in AD has been limited by the absence of available m2-selective radioligands, which can penetrate the blood-brain barrier. We now report on the in vitro and in vivo m2 muscarinic subtype selectivity of a series of dibenzodiazepinones and pyridobenzodiazepinones determined by competition studies against (R)-3-quinuclidinyl (S)-4-iodobenzilate ((R,S)-[125I]IQNB) or [3H]QNB. Of the compounds examined, three of the 5-[[4-[(4-dialkylamino)butyl]-1-piperidinyl]acetyl]-10, 11-dihydro-5-H-dibenzo[b,e][1,4]diazepin-11-ones (including DIBA) and three of the 11-[[4-[4-(dialkylamino)butyl]-1-phenyl]acetyl]-5, 11-dihydro-6H-pyrido [2,3-b][1,4]benzodiazepin-6-ones (including PBID) exhibited both high binding affinity for the m2 subtype (/=10). In vivo rat brain dissection studies of the competition of PBID or DIBD against (R,S)[125I]IQNB or [3H]QNB exhibited a dose-dependent preferential decrease in the binding of the radiotracer in brain regions that are enriched in the m2 muscarinic subtype. In vivo rat brain autoradiographic studies of the competition of PBID, BIBN 99, or DIBD against (R,S)[125I]IQNB exhibited an insignificant effect of BIBN 99 and confirmed the effect of PBID and DIBD in decreasing the binding of (R,S)[125I]IQNB in brain regions that are enriched in the m2 muscarinic subtype. We conclude that PBID and DIBD are potentially useful parent compounds from which in vivo m2 selective derivatives may be prepared for potential use in positron emission tomographic (PET) study of the loss of m2 receptors in AD.