FAIMER Global Faculty Development: A Sustainable Partnership Model to Advance Health Professions Education.

The Foundation for Advancement of International Medical Education and Research (FAIMER), a member of Intealth, offers longitudinal faculty development programs (LFDPs) in health professions education (HPE) and leadership through its International FAIMER Institute (IFI) in the United States and FAIMER Regional Institutes (FRIs) globally. FAIMER fosters mutual collaboration and delineates shared responsibilities for FRI development in partnership with local institutions, using an adapted hub-and-spoke organizational design. This paper describes FAIMER's model, its sustainability, and its impacts at individual, institutional, and national levels. IFI was launched in 2001 in Philadelphia, Pennsylvania, as a 2-year part-time hybrid LFDP; with the COVID-19 pandemic onset, IFI transitioned to a fully online program. Since FAIMER's launch, 11 FRIs developed in Brazil, Chile, China, Egypt, India, Indonesia, and South Africa, each modeled on the IFI curriculum and adapted to local context. The more than 1,600 IFI and FRI graduates (fellows) from over 55 countries now form a global community of health professions educators who have shared exposure to HPE methods and assessment, leadership and management, educational scholarship and research, and project management and evaluation. Across all global locations and program formats, fellows self-reported a similar increase in knowledge and skills in HPE. All programs center on the fellows' institutional projects as experiential learning; these projects have focused primarily on educational methods and curriculum revisions. An increased quality of education was reported as the top impact resulting from fellows' projects. As a result of these programs, fellows have influenced education policy in their countries and established academic societies for HPE, thus contributing to recognition of the HPE academic specialty. FAIMER has successfully developed a sustainable model for advancing HPE globally, creating a vibrant network of health professions educators who have influenced country-specific educational policy and practice. FAIMER's model offers one approach to building global capacity in HPE.

Randomized trial of early corticosteroid reduction vs. regular-dose corticosteroid maintenance in combination with tacrolimus and mycophenolate mofetil in living donor kidney transplant recipients: the Brazilian CORRETA trial.

This multicenter, randomized trial aimed to compare the safety and efficacy of an early reduction in corticosteroid dose vs. long-term maintenance in Brazilian patients on an immunosuppressive regimen based on tacrolimus and mycophenolate mofetil (MMF). In the control arm, prednisone was progressively reduced from days 8 to 90 and then kept for 12 months. In the experimental arm, prednisone was given for 12 months at the dose of 5 mg every other day. Endpoints were the composite occurrence of death, graft loss, or Banff III acute rejection, and safety. A total of 83 patients were enrolled, and 77 were analyzed for efficacy safety. One death occurred in each group. There were no cases of graft loss and one case of grade 3 acute rejection in the early reduction arm. There was no difference in the rate of the composite primary endpoint between both arms (p=0.215), and there were no significant differences between both arms in terms of adverse events. Except for higher incidence of hypertriglyceridemia levels among patients in the regular-dose arm, there were no significant differences between both arms in terms of adverse events. The results of this trial suggest that early reduction of corticosteroid can be feasible and safe within a timeframe of 12 months in patients receiving tacrolimus and MMF.

Aloimunidade contra antígenos HLA de classe I em pacientes com síndromes mielodisplásicas e anemia aplástica / Aloimmunity against HLA class I antigens in patients with myelodisplastic syndrome and aplastic anemia

As síndromes mielodisplásicas (SMD) e a anemia aplástica (AA) apresentam citopenias periféricas necessitando, com freqüência, de reposições transfusionais contínuas de concentrados de hemácias e/ou de concentrados de plaquetas. O objetivo do presente estudo foi verificar a ocorrência de anticorpos anti-HLA de classe I em pacientes portadores das SMD e AA atendidos no ambulatório de Hematologia do Hemoce/UFC. Foram analisados 110 pacientes, sendo 70 com SMD e 40 com AA. A pesquisa de anticorpos anti-HLA de classe I foi realizada frente a um painel (PRA), utilizando-se a técnica de microlinfocitotoxicidade dependente do complemento. Vinte (28,6 por cento) dos 70 pacientes com as SMD e 18 (45 por cento) dos 40 pacientes com AA desenvolveram anticorpos anti-HLA contra o PRA. Esses pacientes que receberam uma carga de antígenos estranhos advindos de múltiplas transfusões de vários doadores de CH e/ou CP, geralmente desenvolvem aloanticorpos contra os antígenos HLA presentes na superfície das plaquetas e dos leucócitos que contaminam esses concentrados. A produção desses anticorpos pode trazer sérias complicações para o tratamento dos pacientes com SMD e AA. As avaliações sistemáticas para detecção de anticorpos anti-HLA após a reposição transfusional podem ser valiosas para adoção de estratégias transfusionais mais adequadas para esta população de pacientes.

Patients with myelodysplastic syndromes (MDS) or aplastic anemia (AA) present peripheral cytopenias and require continuous transfusions of red cell and/or platelet concentrates. The objective of this study is to verify the existence of anti-HLA class 1 antibodies in patients with MDS and AA treated at the hematology Out patient Clinic of Hemoce/UFC. A total of 110 patients were analyzed, 70 with MDS and 40 with AA. Anti-HLA class 1 antibody detection was achieved with an antibody reactivity panel using the complement-dependent microlymphocytotoxicity technique. A total of 20 (28.6 percent) of the 70 patients with MDS and 18 (45 percent) of the 40 patients with AA developed anti-HLA antibodies against the antibody panel. In general, patients who received a load of foreign antigens originating from multi-donor red cell and platelet concentrate transfusions, developed alloantibodies against the HLA antigens that exist on the surface of platelets and on white blood cells that contaminate these concentrates. The production of these antibodies may cause serious complications in the treatment of MDS and AA patientss.

Pionefrose em paciente comcálculo ureteral infectado sem comprometimento do estado geral / Pyonephrosis in a patient with infected ureteral calculus without general state deterioration

Relatamos o caso de uma paciente de 34 anos que apresentou há 2 anos episódios de cólica renal, sendo diagnosticada litíase renal. Há 1 mês houveintensificação dos episódios de dor lombar à esquerda com irradiação para genitália, disúria, polaciúria, urgência urinária, febre alta e calafrios. IniciouCiprofloxacina sem melhora significativa dos sintomas, tendo sido internada para investigação diagnóstica e tratamento. Ao exame físico encontrava-sehipocorada, taquicárdica e febril. Abdômen doloroso à palpação e presença de massa palpável em hipocôndrio esquerdo. Os exames da admissãomostraram Hemoglobina 6,5g/dL, Leucócitos 17.100/mm3, Plaquetas 656.000/mm3, Creatinina 1,0mg/dL. A ultrassonografia abdominal evidenciounefrolitíase e hidronefrose à esquerda. Foi realizada nefrectomia do rim esquerdo. Na cirurgia o rim esquerdo estava aumentado e com consistênciacística, sem áreas de parênquima normal, com ureter dilatado e grande quantidade de secreção purulenta espessa e esverdeada. No examemicroscópico foram vistos glomérulos retraídos, atrofia tubular, intenso infiltrado inflamatório misto no interstício e áreas abscedadas atingindo inclusivea pelve renal. A paciente apresentou evolução favorável, recebendo alta com função renal normal e sem complicações no seguimento.

We report the case of a 34 years-old woman who had episodes of renal colic and a diagnosis of renal calculi. One month before admission she notedexacerbation of left-side lumbar pain, which irradiated to genital region, dysuria, polacyuria, urinary urgency and high degree fever, with chills. Treatmentwas started with Ciprofloxacin, but she had no clinical improvement and was admitted to investigation. At physical examination she was pale, tachycardicand febrile. Her abdomen was tender, with a palpable mass on left hypochondrium. The laboratorial tests showed hemoglobin 6.5g/dL, white blood cells17100/mm3, platelets 656,000/mm3, and creatinine 1.0mg/dL. The abdominal ultrasound showed left-side nephrolitiasis and hydronephrosis. It wasperformed left nephrectomy. The surgical description was: left kidney with increased size, with cystic consistence, without areas of normal parenchyma, withdilated ureter and large amount of thick and greenish secretion. At microscopic examination, protracted glomeruli, tubular atrophy and intense interstitialinflammatory infiltrate were observed, with areas of abscesses reaching renal pelvis. The patient had a favorable course and was dismissed with a normalrenal function. She did not present any complication during the follow-up.