Inverse correlation between endothelin-1-induced peripheral microvascular vasoconstriction and blood pressure in glaucoma patients

• Background: The potent vasoconstrictor peptide endothelin-I has been shown to participate in the control of peripheral vascular tone and in the regulation of ocular perfusion. In glaucoma patients vasospasms and arterial hypotension have been identified as risk factors for the progression of glaucomatous damage, and the regulation of endothelin-1 release is disturbed in some of these patients. The aim of this study was to assess the relationship between resting blood pressure and cutaneous vascular responsiveness to endothelin-1 and phenylephrine in patients with glaucoma and in matched controls. • Methods: In 9 patients with primary open-angle glaucoma (POAG), 7 patient with normal tension glaucoma (NTG), and 16 age- and sex-matched controls, endothelin-1 and phenylephrine responses were assessed in the human forearm microcirculation using laser Doppler flowmetry during intra-arterial drug administration. Blood pressure was measured intra-arterially. • Results: In contrast to α1-adrenergic effects, endothelin-1 responses were inversely correlated to both systolic (r 2 = 0.27,P = 0.05) and diastolic (r 2 = 0.54,P = 0.001) blood pressure in glaucoma patients, whereas there was no such correlation in controls. Patients with lower blood pressure values were more sensitive to the vasoconstrictor effects of endothelin-1. Cutaneous responsiveness to endothelin-1 and phenylephrine was similar in glaucoma patients and in controls. • Conclusion: These results reveal that glaucoma patients appear to have peripheral microvascular abnormalities which are exhibited as altered responsiveness to endothelin-1. Thus, this study supports the hypothesis that endothelin-l-related microvascular dysfunction may be involved in the pathogenesis of glaucomatous damag

Adaptations dans l’enseignement aux étudiants en médecine suisses depuis la pandémie du SARS-Cov-2

Et si la crise du SARS-Cov-2 était une occasion de se dire merci entre enseignants, cliniciens et étudiants pour les expériences aussi inattendues qu’originales vécues ensemble en une année de pandémie? Après analyse du vécu des étudiants, il se dégage comme une énergie vivifiante, où la plus-value découle de l’esprit d’initiative et d’innovation que le climat hostile semble, contre toute attente, avoir stimulé. Cet article aborde quelques retours d’expériences d’une année d’enseignement en période de crise

One-on-one long-term tutorials in general practitioners' practices - a successful new teaching concept in primary care medicine

To improve teaching in practical and communicative skills and knowledge in day-to-day medical practice, in 1997 we introduced one-on-one tutorials in general practitioners' offices as a mandatory part of medical students' academic education. Students participate actively half a day per week in their 3rd and 4th academic years (out of 6) in the office or clinic of a trained personal tutor. We recruited 270 general practitioners in town or from surrounding rural areas for this purpose. 85% of students choose general practitioners as their tutors and 15 % tutors in hospitals. To test whether the tutorials' aims were achieved, in 2005 we performed a detailed questionnaire evaluation after seven years' experience of one-on-one tutorials. All 236 students involved were asked to participate. The response rate was almost complete (98%). 233 anonymous questionnaires were analysed. Students reported improvement in knowledge, social and communicative skills and personal motivation. The overall rating of the one-on-one tutorials obtained 5.3 on a 6 point scale and achieved the top ranking among all university medical faculty classes. In-practice long-term one-on-one medical student-general practitioner tutorials can be recommended for implementation

Superviser un-e étudiant-e au cabinet du médecin généraliste, quels enjeux?

Résumé pour la pratique : Il est nécessaire pour tous nos instituts de considérer le développement des compétences pédagogiques des cliniciens enseignants dans une perspective longitudinale de professionnalisation et de développement des pratiques, en s’appuyant sur les cadres conceptuels qui définissent ces bonnes pratiques