Evaluation of the Diversity, Equity, and Inclusion Curriculum of a Pediatrics Residency Program.

OBJECTIVES: Diversity, equity, and inclusion (DEI) training is essential to graduate medical education, but it lacks standardization. Although the impact of providers' biases and cultural competency on patient outcomes is well documented, the value of and satisfaction with DEI curricula in Pediatrics residency training programs is not well studied. This study aimed to complete a cross-sectional evaluation of the current DEI curriculum at a large Pediatrics-focused academic institution and identify areas of perceived deficiency among Pediatrics trainees. METHODS: Residents and residency program directors completed surveys in 2020. Respondents evaluated the DEI curriculum of the program and the competency of residents to complete patient care related to specific DEI-oriented actions. Our analysis used descriptive statistics. RESULTS: In total, 48 of 137 resident trainees (35%) and 7 of 9 program leaders (78%) completed the survey. Respondents were most dissatisfied with current education related to implicit bias, refugee/immigrant health, and lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other health topics. Respondents reported low resident competency in DEI-focused patient care tasks and did not view residents as competent to address the healthcare needs of patients and families experiencing racism. CONCLUSIONS: Pediatrics residents and program directors consider DEI topics important and express a need for more robust DEI curricula.

Ribonuclease 7 polymorphism rs1263872 reduces antimicrobial activity and associates with pediatric urinary tract infections.

Ribonuclease 7 (RNase 7) is an antimicrobial peptide that prevents urinary tract infections (UTI); however, it is yet unknown how RNASE7 genetic variations affect its antimicrobial activity and its mitigation of UTI risk. This study determined whether the RNASE7 SNP rs1263872 is more prevalent in children with UTI and defined how rs1263872 affects RNase 7's antimicrobial activity against uropathogenic E. coli (UPEC). We performed genotyping for rs1263872 in 2 national UTI cohorts, including children enrolled in the Randomized Intervention for Children with Vesicoureteral Reflux trial or the Careful Urinary Tract Infection Evaluation study. Genotypes from these cohorts were compared with those of female controls with no UTI. To assess whether rs1263872 affects RNase 7's antimicrobial activity, we generated RNase 7 peptides and genetically modified urothelial cultures encoding wild-type RNase 7 and its variant. Compared with controls, girls in both UTI cohorts had an increased prevalence of the RNASE7 variant. Compared with the missense variant, wild-type RNase 7 peptide showed greater bactericidal activity against UPEC. Wild-type RNase 7 overexpression in human urothelial cultures reduced UPEC invasive infection compared with mutant overexpression. These results show that children with UTI have an increased prevalence of RNASE7 rs1263872, which may increase UTI susceptibility by suppressing RNase 7's antibacterial activity.

Evidence of Early Diabetic Nephropathy in Pediatric Type 1 Diabetes.

Background: Diabetic nephropathy (DN) is one of the most common microvascular complications in type 1 diabetes Mellitus (T1D). Urinary markers of renal damage or oxidative stress may signal early stages of DN. The association of these markers with blood pressure (BP) patterns and glycemic variability (GV) in children is yet to be explored. Methods: Subjects between the ages of 10 and 21 years with T1D were enrolled. Continuous glucose monitoring (CGM) and ambulatory blood pressure monitoring (ABPM) were performed on each subject. Urine samples were collected and analyzed for albumin, creatinine, neutrophil gelatinase-associated lipocalin (NGAL) and pentosidine. Results: The study included 21 subjects (62% female) with median age of 16.8 (IQR: 14.5, 18.9). Median HbA1C was 8.4 (IQR: 7.5, 9.3). While microalbuminuria was negative in all but one case (4.8%), urinary NGAL/Cr and pentosidine/Cr ratios were significantly elevated (P<0.001) in diabetic patients despite having normal microalbuminuria, and they correlated significantly with level of microalbumin/Cr (r=0.56 [CI: 0.17, 0.8] and r=0.79 [CI: 0.54, 0.91], respectively). Using ABPM, none had hypertension, however, poor nocturnal systolic BP dipping was found in 48% of cases (95% CI: 28-68%). Urinary NGAL/Cr negatively correlated with nocturnal SBP dipping (r=-0.47, CI: -0.76, -0.03). Urine NGAL/Cr also showed a significant negative correlation with HbA1c measurements, mean blood glucose, and high blood glucose index (r=-0.51 [CI: -0.78, -0.09], r=-0.45 [CI: -0.74, -0.03], and r=-0.51 [CI: -0.77, -0.1], respectively). Median urinary NGAL/Cr and pentosidine/Cr ratios were higher in the high GV group but were not significantly different. Discussion: This pilot study explores the role of ABPM and urinary markers of tubular health and oxidative stress in early detection of diabetic nephropathy. GV may play a role in the process of this diabetic complication.

Mortalidad infantil por enfermedades infecciosas intestinales en Venezuela, 1996-2008 / Infant mortality due to intestinal infectious diseases in Venezuela, 1996-2008

Objetivo: Estudio de la Mortalidad por Enfermedades Infecciosas Intestinales (CIE-10: A00-A09) (EII) en los menores de 1 año en Venezuela según tiempo, persona, etiología y lugar durante 1996-2008. Materiales y métodos utilizados: Las fuentes son los Anuarios de Mortalidad del Min. Salud y del Instituto Nacional de Estadística. Análisis en números absolutos y cálculos de tasas específicas de menores de 1 año según sexo, etiología, entidad federal y tiempo, promedios, razones y proporciones. Correlación de Pearson entre tasa de mortalidad infantil por EII con Índice de Desarrollo Humano (IDH) (p < 0,05). Análisis con Microsoft Excel 2010 y SPSS.13.00. Resultados: Las muertes disminuyeron mucho, las tasas del primer trienio pasan de 3,18 por mil a 0,66; cayeron casi 5 veces. El índice de masculinidad es 1,33; estable en el lapso. Las EII son diarreas y gastroenteritis de presunto origen infeccioso; bacterianas (94,3%): Salmonella, Shigella e intoxicaciones intestinales bacterianas (1,5%); amebiasis y protozoarios (3,8%); el resto virales (0,05%). Las tasas varían en extremo por entidades federales. El último trienio, Delta Amacuro alcanza una tasa de 6,45; 10 veces por arriba de la tasa nacional, seguido a distancia por Zulia 2,64; Amazonas 2,28 y Apure 2,03. Se encontró una correlación de Pearson moderada (-0,416; p=0,03) inversamente proporcional entre la tasa de mortalidad y el IDH. Conclusiones: La mortalidad infantil por EII está descendiendo mucho en cifras absolutas y relativas. Es necesario mejorar el diagnóstico etiológico. Los estados con mayor población rural e indígena tienen las tasas más elevadas; abordando sanitariamente estos, tendríamos un gran impacto en la carga de muertes.

Objective: Study of the Mortality for Infectious Intestinal Diseases (IID) in 1-year-old minors in Venezuela according to time, person, etiology and place during 1996-2008. Materials and Used Methods: The sources are the Yearbooks of Mortality of the Min. and the National Institute of Statistics.Analysis are presented in absolute and relative numbers and calculations of specific rates of 1-year-old minors accordingto sex, etiology, federal entity and time, averages, rates and proportions. Pearson Correlation between rate of infant mortality for IID with Index of Human Development (IDH) (p<0.05). Analysis with Microsoft Excel 2010 and SPSS.13.00. Results: The deaths diminished very much, the rates of the first triennium dropped from 3.18 for thousand to 0.66; rates fell almost 5 times. The index of masculinity is 1.33, timelystable. The IID (94.3%) are diarrheas and gastroenteritis of presumable infectious origin; bacterial: Salmonella, Shigella and intestinal bacterial poisonings (1.5%); amebiasis and protozoans (3.8%); the rest viral (0.05%). The rates change much among the states. The last triennium, Delta Amacuroreaches a rate of 6.45, 10 times over of the national rate, followed distantly by Zulia 2.64, Amazonas 2.28 and Apure 2.03. There was a moderate correlation (-0.416; p=0.03) inversely proportional between the rate of mortality and the IDH. Conclusions: The infant mortality for IID is descending very much in absolute and relative numbers. It is necessary to improve the etiological diagnosis. States with high proportion of rural and indigenous population have the highest rates; tackling sanitarily these states, would have a great impact inthe load of deaths.