Student-Led Effort to Incorporate Social and Structural Determinants of Health into Undergraduate Medical Education: Civic Engagement, Advocacy, and Anti-Racism.

Background: The recent wave of student and physician activism created a space to discuss racism in healthcare with a more critical lens. Students are interrogating the environment in which they will provide healthcare and the social and structural determinants of health—one being the lack of anti-racist education in undergraduate medical education (UME). Objective: The Black History Month Speaker Series (BHMSS) was formulated to highlight racism in healthcare. Participants learned about race and healthcare policy (RHP), maternal mortality (MM), racial health equity (RHE), voting barriers and civic engagement (CE), distrust of medical institutions among communities of color (D), and health disparities (HD). A list of national and local partner organizations was provided after the series to all participants with contact information and volunteer resources to encourage active community engagement and apply what they had learned. Methods: Students organized a five-lecturer series for February 2021. Pre-BHMSS and post- BHMSS Qualtrics surveys assessed overall knowledge and comfort measured on a 4-point scale (1=very uncomfortable/no knowledge and 4=very comfortable/knowledgeable). Two-tailed unpaired t-test was utilized. Results: The pre-BHMSS population (n=247) included primarily medical students (49%); post- BHMSS respondents (n=61) were majority female (80%) and Caucasian (63%). Post-BHMSS reported increased “knowledge” for RHP, MM, RHE, CE, D, and HD (μ difference=0.71 [95% CI=0.47, 0.95] p<0.001; 0.58 [0.32, 0.84] p<0.001; 0.49 [0.21, 0.77] p<0.001; 0.61 [0.20, 1.0] p<0.01; 0.64 [0.40, 0.87] p<0.001; 0.22 [0.057, 0.38] p<0.01). Post-BHMSS exhibited increased “comfort” addressing RHP, MM, RHE, CE, and D (0.55 [0.30, 0.80] p<0.001; 0.40 [0.14, 0.66] p<0.01; 0.46 [0.18, 0.74] p<0.01; 0.47 [0.053, 0.87] p<0.05; 0.35 [0.09, 0.61] p<0.01); however, there was no change in HD “comfort.” Conclusion: Comfort and knowledge significantly increased across nearly all topics, suggesting insufficient prior awareness and the urgent need for integration of anti-racism education in UME. BHMSS represents an innovative option for the incorporation of historical racial context that influences current medical practices and education. Knowledge acquired may foster valuable relationships between providers and patients and represents a potential solution to improved care for marginalized groups

Hyperprolactinemia Secondary to Paliperidone: Considerations for Women of Childbearing Age

CASE DESCRIPTION: A 27 year old female with past medical history significant for schizoaffective disorder, borderline personality disorder, major depressive disorder, and catatonia was admitted following a suicide attempt. During her admission, she revealed that she has had a persistent delusion of believing she was pregnant despite not being sexually active in several months and having multiple negative pregnancy tests. After the patient was started on paliperidone, she stopped menstruating, further perpetuating this delusion. The patient also expressed concerns for infertility in the future. CONCLUSION: Paliperidone has a high incidence of hyperprolactinemia which can lead to reproductive concerns including menstrual irregularity and infertility. These side-effects highlight the critical need for shared decision making in discussions about fertility in patients with psychotic disorders. Further complicating this issue is the significant increase in psychosis risk during the perinatal period. There are other alternatives that exist and may be better options for some patients but changing medications to oral options should be balanced with medication adherence needs. CLINICAL SIGNIFICANCE: Through shared decision-making, the selection of antipsychotic maintenance therapy should consider a variety of patient and physician goals. A younger age of initial psychotic break has strong indications for reproductive counseling, which should remain consistent with patients’ goals and be reassessed as goals evolve throughout their lifetime. Patients who struggle with medication adherence may benefit from long acting injectable antipsychotic medications. However, some of these injections, like paliperidone, can cause hyperprolactinemia and contribute to infertility. Prolactin levels can be monitored and lowering medication doses can be effective for mitigating hyperprolactinemia. There are oral medications available that have a lower chance of causing hyperprolactinemia. However, oral only medication options must be balanced with patient medication adherence concerns

The structure of CrgA from Neisseria meningitidis reveals a new octameric assembly state for LysR transcriptional regulators

LysR-type transcriptional regulators (LTTRs) form the largest family of bacterial regulators acting as both auto-repressors and activators of target promoters, controlling operons involved in a wide variety of cellular processes. The LTTR, CrgA, from the human pathogen Neisseria meningitidis, is upregulated during bacterial–host cell contact. Here, we report the crystal structures of both regulatory domain and full-length CrgA, the first of a novel subclass of LTTRs that form octameric rings. Non-denaturing mass spectrometry analysis and analytical ultracentrifugation established that the octameric form of CrgA is the predominant species in solution in both the presence and absence of an oligonucleotide encompassing the CrgA-binding sequence. Furthermore, analysis of the isolated CrgA–DNA complex by mass spectrometry showed stabilization of a double octamer species upon DNA binding. Based on the observed structure and the mass spectrometry findings, a model is proposed in which a hexadecameric array of two CrgA oligomers binds to its DNA target site

Student-Led Effort to Incorporate Social and Structural Determinants of Health into Undergraduate Medical Education: Civic Engagement, Advocacy, and Anti-Racism

Background: The recent wave of student and physician activism created a space to discuss racism in healthcare with a more critical lens. Students are interrogating the environment in which they will provide healthcare and the social and structural determinants of health—one being the lack of anti-racist education in undergraduate medical education (UME). Objective: The Black History Month Speaker Series (BHMSS) was formulated to highlight racism in healthcare. Participants learned about race and healthcare policy (RHP), maternal mortality (MM), racial health equity (RHE), voting barriers and civic engagement (CE), distrust of medical institutions among communities of color (D), and health disparities (HD). A list of national and local partner organizations was provided after the series to all participants with contact information and volunteer resources to encourage active community engagement and apply what they had learned. Methods: Students organized a five-lecturer series for February 2021. Pre-BHMSS and post- BHMSS Qualtrics surveys assessed overall knowledge and comfort measured on a 4-point scale (1=very uncomfortable/no knowledge and 4=very comfortable/knowledgeable). Two-tailed unpaired t-test was utilized. Results: The pre-BHMSS population (n=247) included primarily medical students (49%); post- BHMSS respondents (n=61) were majority female (80%) and Caucasian (63%). Post-BHMSS reported increased “knowledge” for RHP, MM, RHE, CE, D, and HD (μ difference=0.71 [95% CI=0.47, 0.95] p<0.001; 0.58 [0.32, 0.84] p<0.001; 0.49 [0.21, 0.77] p<0.001; 0.61 [0.20, 1.0] p<0.01; 0.64 [0.40, 0.87] p<0.001; 0.22 [0.057, 0.38] p<0.01). Post-BHMSS exhibited increased “comfort” addressing RHP, MM, RHE, CE, and D (0.55 [0.30, 0.80] p<0.001; 0.40 [0.14, 0.66] p<0.01; 0.46 [0.18, 0.74] p<0.01; 0.47 [0.053, 0.87] p<0.05; 0.35 [0.09, 0.61] p<0.01); however, there was no change in HD “comfort.” Conclusion: Comfort and knowledge significantly increased across nearly all topics, suggesting insufficient prior awareness and the urgent need for integration of anti-racism education in UME. BHMSS represents an innovative option for the incorporation of historical racial context that influences current medical practices and education. Knowledge acquired may foster valuable relationships between providers and patients and represents a potential solution to improved care for marginalized groups

Efficacy of antiepileptic isomers of valproic acid and valpromide in a rat model of neuropathic pain

1. Antiepileptic drugs (AEDs) are often utilized in the treatment of neuropathic pain. The major AED valproic acid (VPA) is of particular interest as it is thought to engage a variety of different neural mechanisms simultaneously. However, the clinical use of VPA is limited by two rare but life-threatening side effects: teratogenicity and hepatotoxicity. 2. We synthesized VPA's corresponding amide: valpromide (VPD), two of VPAs isomers and their corresponding amides; valnoctic acid (VCA), valnoctamide (VCD), diisopropyl acetic acid (DIA), diisopropylacetamide (DID), and VPD's congener: N-methyl-VPD (MVPD). VCD, DID and VPD are nonteratogenic, potentially nonhepatotoxic, and exhibit better anticonvuslant potency than VPA. 3. In this study, we assessed the antiallodynic activity of these compounds in comparison to VPA and gabapentin (GBP) using the rat spinal nerve ligation model of neuropathic pain (SNL, Chung model). 4. VCA and MVPD were inactive. However, VPD (20–100 mg kg(− 1)), VCD (20–100 mg kg(− 1)) and DID (20–90 mg kg(− 1)) produced dose-related reversal of tactile allodynia with ED(50) values of 61, 52 and 58 mgkg(− 1), respectively. All the amides were more potent than VPA (ED(50)=269 mgkg(− 1)). The antiallodynic effect of VPA, VPD, VCD and DID was obtained at plasma concentrations of 125, 24, 18 and 7 mg l(− 1), respectively, with a good pharmacokinetic–pharmacodynamic correlation and a minimal lag response. 5. VCD and DID were found to have minimal motor and sedative side effects at analgesic doses, and were equipotent to GBP, currently the leading drug in neuropathic pain treatment. Consequently, VCD and DID have potential to become new drugs for the treatment of neuropathic pain

Mining for Microbial Gems: Integrating Proteomics in the Postgenomic Natural Product Discovery Pipeline

Microbial Biotechnolog

Provitamin A biofortification of crop plants: a gold rush with many miners

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