Clinical Efforts Double Disparity for Nonphysician URiM Faculty: Implications for Academic Family Medicine.

With a new definition of high-quality primary care and the shift in nonphysician faculty's role as core faculty members in family medicine residency programs, new attention is needed on the delineation of clinical efforts and clinical efforts disparities across disciplines (eg, psychology, marriage and family therapy, pharmacy) within departments of family medicine. Additionally, those who identify as underrepresented in medicine (URiM), specifically those who are nonphysician faculty, are dually impacted by the clinical efforts double disparity. This paper examines the current landscape of clinical efforts in academic family medicine for physician faculty and nonphysician faculty as well as discusses how to build equity in clinical efforts for nonphysician faculty and URiM faculty within academic family medicine impacted by the double disparity.

The Comorbidities, Radiographic Findings, Age, and Lymphopenia (CORAL) Tool: A Diagnostic Ally for Emergency Physicians Created for the COVID-19 Crisis and Beyond.

BACKGROUND: This study aimed to develop a novel clinical approach to predict intensive care unit (ICU) admission and mortality among coronavirus disease 2019 (COVID-19) patients in the emergency department (ED). METHODS: A retrospective cohort study was conducted including adults ≥ 18 years diagnosed with COVID-19 in the emergency department and admitted to the ICU between March and July 2020 in an academic hospital. The outcome variables were mortality and ICU admission. Additional variables that were collected included sex, age, comorbidities, symptom phenotype, and laboratory (lymphopenia) and imaging findings. A logistic regression model was used to construct and validate the risk models. RESULTS: A total of 808 patients were included in the study; 61.9% were men. The mean age was 57.8 ± 15.9 years, and high blood pressure (HBP) was the most prevalent comorbidity (31.8%). Seventy-six (9.4%) patients were admitted to the ICU. Age ≥ 60 years, chronic obstructive pulmonary disease (COPD), lymphopenia, and imaging findings correlated with mortality. Age ≥ 60 years, lymphopenia (<1,000 cells per microliter), and hypothyroidism correlated with ICU admission. These variables were incorporated into a scoring system (Comorbidities, Radiographic findings, Age, and Lymphopenia (CORAL) tool) to predict mortality and ICU admission. CONCLUSIONS: Our Comorbidities, Radiographic findings, Age, and Lymphopenia (CORAL) tool is a practical tool for different clinical settings independent of access to advanced medical resources or technologies. CORAL is suitable for emergency physicians in low- and middle-income countries.

Specific combinations of biallelic POLR3A variants cause Wiedemann-Rautenstrauch syndrome.

BACKGROUND: Wiedemann-Rautenstrauch syndrome (WRS) is a form of segmental progeria presenting neonatally, characterised by growth retardation, sparse scalp hair, generalised lipodystrophy with characteristic local fatty tissue accumulations and unusual face. We aimed to understand its molecular cause. METHODS: We performed exome sequencing in two families, targeted sequencing in 10 other families and performed in silico modelling studies and transcript processing analyses to explore the structural and functional consequences of the identified variants. RESULTS: Biallelic POLR3A variants were identified in eight affected individuals and monoallelic variants of the same gene in four other individuals. In the latter, lack of genetic material precluded further analyses. Multiple variants were found to affect POLR3A transcript processing and were mostly located in deep intronic regions, making clinical suspicion fundamental to detection. While biallelic POLR3A variants have been previously reported in 4H syndrome and adolescent-onset progressive spastic ataxia, recurrent haplotypes specifically occurring in individuals with WRS were detected. All WRS-associated POLR3A amino acid changes were predicted to perturb substantially POLR3A structure/function. CONCLUSION: Biallelic mutations in POLR3A, which encodes for the largest subunit of the DNA-dependent RNA polymerase III, underlie WRS. No isolated functional sites in POLR3A explain the phenotype variability in POLR3A-related disorders. We suggest that specific combinations of compound heterozygous variants must be present to cause the WRS phenotype. Our findings expand the molecular mechanisms contributing to progeroid disorders.

Control autonómico del ritmo cardiaco, lactato sanguíneo y aceleración durante un combate simulado en atletas de taekwondo de elite / Autonomic control of heart rate, blood lactate and acceleration during combat simulation in taekwondo elite athletes

Propósito: el objetivo del estudio fue determinar la frecuencia cardiaca de recuperación (FCR), lactato sanguíneo y aceleración pico (ACCp) durante un combate simulado de atletas de taekwondo de elite. Métodos: doce (n = 12) sujetos varones, seleccionados nacionales y con más de cinco años de práctica en esta disciplina participaron en el estudio. Los atletas realizaron un combate simulado de tres asaltos de dos minutos con un minuto de pausa entre ellos, evaluando los siguientes parámetros: (¡) lactato sanguíneo al final de cada minuto de descanso entre asaltos; (¡¡) FCR a los treinta y sesenta segundos en cada minuto de descanso; (¡¡¡) ACCp en cada asalto disputado. El nivel de significancia se propuso a un valor de p 0,05) a los treinta y sesenta segundos en ninguna de las pausas, en el delta de lactato sanguíneo al final de cada pausa (p > 0,05), en la aceleración pico por round (p > 0,05) y en la aceleración promedio del combate (p = 0,18). Tampoco se encontraron correlaciones entre delta de lactato y FCR (r = -0,23; p = 0,18), entre delta de lactato y ACCp (r = 0,01; p = 0,93), y entre ACCp y FCR (r = 0,003; p = 0,98). Conclusiones: los datos sugieren que las variables estudiadas no serían determinantes en el resultado final de un combate simulado. Otros factores, como variables técnico/tácticas o psicológicas, podrían influir de manera significativa en el rendimiento deportivo (AU)

Purpose: the aim of the study was to measure the heart rate recovery, blood lactate and movement acceleration during simulated taekwondo competition. Methods: twelve male subjects who belong to the national team, with at least five years of experience participated in this research. They performed a simulated combat to evaluate the following variables: (i) Blood lactate after one minute recovery between each round, (ii) Heart rate recovery (HRR) at thirty and sixty seconds in each minute rest between rounds, (iii) Peak acceleration (ACCp) in each round performed. The significance level was set at p 0.05), blood lactate (p > 0.05), peak acceleration (p > 0.05) and the average acceleration of combat (p = 0.18). There was no correlation between delta lactate and ACCp (r = 0.01; p = 0.93), delta lactate and HRR (r = -0.23; p = 0.18), and ACCp and HRR (r = 0.003; p = 0.98). Conclusions: these data suggest that studied variables would not be decisive in the simulated combat outcomes. Other factors such as technical-tactical or psychological variables could have a significant impact on athletic performance (AU)

[AUTONOMIC CONTROL OF HEART RATE, BLOOD LACTATE AND ACCELERATION DURING COMBAT SIMULATION IN TAEKWONDO ELITE ATHLETES]. / CONTROL AUTONÓMICO DEL RITMO CARDIACO, LACTATO SANGUÍNEO Y ACELERACIÓN DURANTE UN COMBATE SIMULADO EN ATLETAS DE TAEKWONDO DE ELITE.

PURPOSE: the aim of the study was to measure the heart rate recovery, blood lactate and movement acceleration during simulated taekwondo competition. METHODS: twelve male subjects who belong to the national team, with at least five years of experience participated in this research. They performed a simulated combat to evaluate the following variables: (i) Blood lactate after one minute recovery between each round, (ii) Heart rate recovery (HRR) at thirty and sixty seconds in each minute rest between rounds, (iii) Peak acceleration (ACCp) in each round performed. The significance level was set at p < 005. RESULTS: the results showed no significant differences between winners and losers in the HRR at both, thirty and sixty seconds (p > 0.05), blood lactate (p > 0.05), peak acceleration (p > 0.05) and the average acceleration of combat (p = 0.18). There was no correlation between delta lactate and ACCp (r = 0.01; p = 0.93), delta lactate and HRR (r = -0.23; p = 0.18), and ACCp and HRR (r = 0.003; p = 0.98). CONCLUSIONS: these data suggest that studied variables would not be decisive in the simulated combat outcomes. Other factors such as technical-tactical or psychological variables could have a significant impact on athletic performance.

Propósito: el objetivo del estudio fue determinar la frecuencia cardiaca de recuperación (FCR), lactato sanguíneo y aceleración pico (ACCp) durante un combate simulado de atletas de taekwondo de elite. Métodos: doce (n = 12) sujetos varones, seleccionados nacionales y con más de cinco años de práctica en esta disciplina participaron en el estudio. Los atletas realizaron un combate simulado de tres asaltos de dos minutos con un minuto de pausa entre ellos, evaluando los siguientes parámetros: (¡) lactato sanguíneo al final de cada minuto de descanso entre asaltos; (¡¡) FCR a los treinta y sesenta segundos en cada minuto de descanso; (¡¡¡) ACCp en cada asalto disputado. El nivel de significancia se propuso a un valor de p < 0,05. Resultados: los resultados muestran que no hubo diferencias significativas entre ganadores y perdedores en la FCR (p > 0,05) a los treinta y sesenta segundos en ninguna de las pausas, en el delta de lactato sanguíneo al final de cada pausa (p > 0,05), en la aceleración pico por round (p > 0,05) y en la aceleración promedio del combate (p = 0,18). Tampoco se encontraron correlaciones entre delta de lactato y FCR (r = -0,23; p = 0,18), entre delta de lactato y ACCp (r = 0,01; p = 0,93), y entre ACCp y FCR (r = 0,003; p = 0,98). Conclusiones: los datos sugieren que las variables estudiadas no serían determinantes en el resultado final de un combate simulado. Otros factores, como variables técnico/tácticas o psicológicas, podrían influir de manera significativa en el rendimiento deportivo.

Receptores nucleares y metabolismo de lípidos: implicaciones cardiovasculares / Nuclear receptors and lipid metabolism: cardiovascular implications

La superfamilia de receptores de hormonas nucleares, es un amplio grupo de proteínas cuya función es actuar como factores de transcripción para modular, de manera positiva o negativa, la expresión de genes involucrados en procesos de diferenciación, crecimiento, reproducción y metabolismo. Dada su participación en procesos fisiológicos claves, las disfunciones asociadas con estos receptores tienen enormes implicaciones en enfermedades de elevada importancia en salud pública como la enfermedad cardiovascular, la diabetes mellitus tipo 2 y el cáncer, entre otras. En este trabajo se revisan algunos aspectos de esta superfamilia de proteínas, incluyendo su estructura, relación con el metabolismo de lípidos e implicaciones cardiovasculares. El trabajo se enfoca en los receptores activados por el proliferador del peroxisoma (PPAR), aunque se da una breve mirada a los receptores X hepáticos (LXR).

Nuclear hormone receptors superfamily are a wide group of proteins which function is to act as transcription factors in order to modulate in a positive or negative way the expression of genes involved in differentiation processes, growth, reproduction and metabolism. Given its participation in key pathologic processes, the disfunctions associated to these receptors have huge implications in diseases of great importance in public health such as cardiovascular disease, diabetes mellitus type 2, and cancer between others. Some aspects of this protein superfamily are reviewed in this study, including its structure, relationship with lipid metabolism and cardiovascular implications. This study focuses on the peroxisome proliferator-activated receptor (PPAR), and briefly on the liver X receptors (LXR).