Expanding Health Professional Education in the Rio Grande Valley during the COVID-19 Pandemic

Purpose: The COVID-19 Pandemic has prompted innovation in health professional education, such that learners are able to recognize and mitigate healthcare disparities in the outcomes of vulnerable populations. The objective of our project was to increase education on preventing, preparing for, and responding to COVID-19 and other locally prevalent infectious diseases that disproportionately affect RGV communities. Description: This project had 3 goals: (1) provide learners with virtual patient-interaction simulations (2) provide interactive training modules on the identification, prevention, and treatment of infectious diseases affecting South TX and strategies to increase child vaccinations, and (3) provide learners an opportunity to coordinate community health promotion via PPE and COVID-19 information distribution. Partners: Collaborative stakeholders included the AHEC Scholars Program and the Department of Pediatrics at UTRGV SOM. Both functioned as sponsoring bodies overseeing this operation. Mursion and Nearpod were consulted regarding how the use of their technologies could advance Goals 1 & 2. UT Health RGV patients and RGV colonia populations were the rationale for completion of Goal 3 and the project as a whole, as we sought to aid in improving their overall health. Looking Ahead: Our approach integrated content learning and practice with regard to identifying, preventing, and addressing regionally prevalent infectious/non-infectious diseases and sensitive health topics affecting all age groups. The multifaceted nature of the project helped to solidify the knowledge gleaned and revealed possible avenues for health professional curriculum that can further learning in areas that are difficult to address in a traditional standardized manner, from pediatric patient encounters to community health interventions

Case Report: Kidney Transplant Pyelonephritis

Background: Individuals with end-stage kidney disease (ESKD), and especially those who have received kidney transplants, are at an increased risk of developing urinary tract infection (UTI). UTI, especially recurrent UTI, is a common problem occurring in \u3e75% of kidney transplant (KTX) recipients. Progression of infection can have significant consequences on the functioning of the transplanted kidney. It may be challenging to distinguish complicated UTI from acute or chronic rejection when patients present with fever and abdominal pain at the transplanted location. In this case study, we present the clinical scenario of a patient with a history of hypertension and ESKD who has one functioning transplanted kidney and went on to develop a UTI that progressed to pyelonephritis. Case presentation: A female patient, 55 years old, with a medical history including appendectomy, hypertension (HTN), recurrent urinary tract infections (UTI), and end-stage kidney disease (ESKD) following a kidney transplant in 2017, is currently taking post-transplant anti-rejection medications, namely Tacrolimus and Mycophenolate. She visited the emergency department seeking evaluation for pain in the lower right abdomen that radiates to the back. She also reported intermittent fevers, chills, and increased urinary frequency. During the physical examination, tenderness was noted in the lower right quadrant. Laboratory tests revealed leukocytosis, a slightly elevated Creatinine level of 1.8 mg/dl, and the presence of numerous bacteria in the urine. A CT scan of the abdomen showed atrophic native kidneys and a transplanted kidney in the lower right quadrant without hydronephrosis. In the previous month, the patient had been diagnosed with a complicated UTI caused by pan-sensitive Escherichia coli (E. Coli). She received three days of intravenous Cefepime and was discharged with Cephalexin. Since her kidney transplant six years ago, she has been consistently taking Tacrolimus and Mycophenolate to prevent rejection of the transplanted organ. Her blood pressure has been well controlled, and chronic allograft rejection is considered less likely as the cause of her symptoms. Considering her history of recurrent UTIs and previous use of a fourth-generation cephalosporin, Zosyn (Piperacillin-Tazobactam) is a suitable choice of antibiotic for the current infection. This is particularly relevant as the urine culture results showed that the E. Coli strain is resistant to multiple drugs but susceptible to Zosyn. The patient responded positively to the antibiotic therapy and was discharged with plans for ambulatory infusion follow-up using intravenous Zosyn at home. Conclusion: Escherichia coli (E. coli) continues to be a prevalent pathogen responsible for urinary tract infections (UTIs), both in individuals without underlying health conditions and in patients who have undergone kidney transplantation. When dealing with suspected complicated UTIs, it is crucial to rule out the possibility of acute or chronic renal allograft rejection. In addition, it is important to gather information about the patient\u27s healthcare settings, such as nursing homes, as this can aid in guiding antibiotic therapy. Utilizing broad-spectrum antimicrobials may be necessary while awaiting the results of urine culture and sensitivity testing to ensure appropriate treatment

Cultural Competence Guides for COVID-19 Messaging in Hispanic Communities

Purpose: The Rio Grande Valley in South Texas comprises 5% percent of Texas\u27s population yet 17%of Texas\u27s COVID-19 deaths. We aimed to address underlying mistrust and systemic racism in our Hispanic community that contributes to health inequities by developing a cultural competence guide for public health messaging. Methods: We employed a mixed method design (e.g., focus groups, surveys, interviews) to develop and implement a cultural competence guide in an iterative community-informed process. We created a general cultural competence guide, one for the Hispanic community and one for the hard-of-hearing community. Results: Our cultural competence guides provide an interpretation as to whether the message is culturally competent or requires revisions. The guides have the following five categories: content and clarity, emotions and values, audience and inclusivity, call to action, and gestalt. Conclusions: The Hispanic community needs more culturally competent public health messaging to address a key root cause of health inequities surrounding COVID-19. Our novel, concise guides can help organizations and individuals seeking to create culturally sensitive and, therefore, more effective public health messaging for Hispanic or deaf and hard-of-hearing communities

Learners Engaging with Hispanic Communities to address COVID19 Inequities by Developing a Cultural Competence Guide for Public Health Messaging

Introduction: The Rio Grande Valley (RGV) has the highest rates of obesity and diabetes nationwide which have compounded the impact of COVID-19. We propose addressing underlying mistrust and systemic racism through a resident-and-student-learner-led, community-engaged, educational public health campaign targeting the Hispanic community in the RGV. Methods: Twelve students were provided interdisciplinary leadership skills in a community-engaged public messaging campaign covering issues of COVID-19 inequities. Learners used these skills to engage with clinic community partners in qualitative interviews regarding the patient population to guide the creation of a culturally competent public health messaging rubric for the Hispanic community. Results: Pre-intervention survey results showed that the patient population was 97% Hispanic/Latino with a 73% language preference for Spanish and a 98% uninsured status. Clinic leaders described 67% of their patient population as being high risk for COVID-19 with multiple underlying risk factors, including obesity, hypertension, and diabetes. Surveyed clinic leaders selected that PSAs need to have clarity of the message and availability in the patient’s preferred language. Our team created two focused, culturally competent rubrics for the Hispanic community. Discussion: This research has shown that it is imperative to be able to evaluate which PSAs are effective in delivering their intended message as well as being able to monitor the effects on their target audience. The Hispanic and Spanish-speaking communities needs more effective public health messaging to decrease testing fears, improve contact tracing, motivate individuals to seek medical care, and to ultimately address the rampant COVID-19 inequities that exist

The Development of FVIII Inhibitor in Hispanic American Patients with Hemophilia A Critically Impacts Coagulation Potential

Background: Hemophilia A (HA) is caused by deficiencies in plasma-FVIII and heterogeneous factor-VIII-gene mutations that impair intrinsic coagulation amplification. In severe hemophilia A patients (HAPs), FVIII infusions are begun at toddlerhood to prevent hemarthrosis induced crippling. However, approximately 30% of these patients develop FVIII inhibitors. Gain-of-function mutations in the common pathway of coagulation increases coagulation potential and decreases bleeding and FVIII-utilization in HAPs which should decrease FVIII-inhibitor-risk. We identified loss-of-function mutations in this pathway which decrease coagulation-potential as they increase FVIII-inhibitor risk in HAPs. Methods: We screened Mexican-American-pedigrees of the South-Texas-Family-Study (STFS) for protein-altering-variants. Subjects were genotyped using Illumina-exome-24-chip. Protein-altering-variants were analyzed for associations with FII:C, PT, and aPTT. Linear-mixed-model-analyses was performed to estimate trait-heritability and examine single-nucleotide-variations (SNVs) for gene association. Significant associations’ p-values fell below Bonferroni-adjusted significance level. Results: Heritability-estimates for FII:C, aPTT, and PT were highly-significant with p-values of 0.49, 0.49, and 0.54 (for all, pT in the FII-gene (F2)—which encodes 543R\u3eL and has a large effect-size on each trait (for all, pT have lower FII:C levels but correspondingly prolonged aPTT and PT times. Conclusion: We hypothesize that FII-543R\u3eL (Prothrombin-RGV) likely contributes to the high-incidence of FVIII-inhibitor-development in HA-patients of Mexican-ancestry, resulting in higher risk of developing anti-tFVIII-antibodies than patients without the variant. Patients with the RGV variant are likely to bleed more which can require surgery, further increasing the development of FVIII inhibitor development

Variant of FII Gene Plays a Critical Role in Coagulation Potential in Mexican-Americans

Background: Disruption in the balance between coagulation and bleeding can result in varying phenotypes such as hypercoagulability and can lead to the development of cardiovascular disease. In our study utilizing extended families of Mexican-Americans from South Texas, we performed a search for protein-altering variants influencing coagulation potential. Methods: Mexican-Americans in the study were genotyped using Illumina-(human)-exome-24 chip to screen for protein-altering variants. Variants were analyzed for their association with FII activity, aPTT, and PT. Linear-mixed-model analysis was performed to estimate trait heritabilities and to interrogate single nucleotide variations (SNV) for evidence of genetic association. To control for multiple testing, associations are considered significant if their p-value falls below the Bonferroni-adjusted significance level. Results: Heritability-estimates for FII, aPTT, and PT were found highly significant with estimates of 0.49, 0.49, and 0.54 (for all, pTable). All three traits were significantly associated with the same SNV (rs143064939) located on Chromosome 11 leading to a 1628G\u3eT in the FII-gene, F2(for all, p Conclusion: Individuals with this SNV, Prothrombin-RGV, consistently present with lower levels of FII activity and correspondingly prolonged aPTT and PT. Carriers require increased coagulation time, suggesting a potential protective role of this inherited variant in the development of venous thromboembolism (VTE) and possibly arterial thromboembolism (ATE). This variant is most frequently found in populations of Mexican origin and may be a genetic determinant in individual variability concerning coagulation potential

We Need to Know: A Call for Interdisciplinary Education on COVID-19

COVID-19 disrupted numerous disciplines which led to widespread misinformation on the virus. Thirteen students from across the USA designed a web-based conference, or “webinar,” to minimize the misinformation among student populations. Professionals presented the current and possible future impacts of COVID-19 in their respective fields. Pre- and post-conference surveys were administered to the attendees to gauge the impact of the conference. Survey results demonstrated increased knowledge and a lower degree of feeling overwhelmed by COVID-19 information overall, indicating a niche use for webinars during the COVID-19 pandemic and beyond