Animal models of hematopoietic and gastrointestinal acute radiation syndromes (ARS) have been characterized to develop medical countermeasures. Acute radiation-induced decrease of intestinal absorptive function has been correlated to a decrease in the number of intestinal crypt cells resulting from apoptosis and enterocyte mass reduction. Citrulline, a noncoded amino acid, is produced almost exclusively by the enterocytes of the small intestine. Citrullinemia has been identified as a simple, sensitive and suitable biomarker for radiation-induced injury associated with gastrointestinal ARS (GI-ARS). Here we discuss the effect of radiation on plasma citrulline levels in three different species, C57BL/6 mice, Göttingen minipigs and rhesus nonhuman primates (NHPs), measured by liquid chromatography tandem mass spectrometry (LC-MS/MS). The effects of experimental study conditions such as feeding and anesthesia were also examined on plasma citrulline levels in the NHPs. Both the mice and Göttingen minipigs were partial-body irradiated (PBI) with doses from 13–17 Gy and 8–16 Gy, respectively, whereas NHPs were total-body irradiated (TBI) with doses from 6.72–13 Gy. Blood samples were taken at different time points and plasma citrulline levels were measured in the three species at baseline and after irradiation. Basal plasma citrulline concentrations (mean 6 SEM) in mice and minipigs were 57.8 ± 2.8 μM and 63.1 ± 2.1 μM, respectively. NHPs showed a basal plasma citrulline concentration of 32.6 ± 0.7 μM, very similar to that of humans (~40 μM). Plasma citrulline progressively decreased after irradiation, reaching nadir values between day 3.5 and 7. The onset of citrulline recovery was observed earlier at lower radiation doses, while only partial citrulline recovery was noted at higher radiation doses in minipigs and NHPs, complete recovery was noted in mice at all doses. Plasma citrulline levels in NHPs anesthetized with ketamine and acepromazine significantly decreased by 35.5% (P = 0.0017), compared to unanesthetized NHPs. In the postprandial state, citrulline concentrations in NHPs were slightly but significantly decreased by 12.2% (P = 0.0287). These results suggest that plasma citrulline is affected by experimental conditions such as anesthesia and feeding.

To date, numerous projects have demonstrated that an ongoing limited access to nutritionally dense food (i.e., "food insecurity") plays a key role in the overall health and wellbeing of lower income at-risk populations. METHODSFor this 2019-2020 pilot project, the resident physician authors first created and administered a simple five-item questionnaire screening process to systematically identify food insecure patients in their metropolitan Detroit residency clinic. A sample of patients who had been identified as food insecure and pre-diabetic were then provided improved access to healthy foods, supplemented by a six-week program of nutritional education classes using a nationally recognized "Cooking Matters'' six-week long curriculum with a licensed chef and nutrition educator RESULTSAfter institutional review board approval, the authors enrolled a sample of 10 adults. The authors successfully measured both pre-and post-program Hemoglobin A1c (HbA1C) levels for all participants who completed the required course and subsequent clinic follow up visits. Using a series of initial non-parametric Wilcoxon Signed Rank matched pair tests, post-program follow-up at three months revealed statistically significant reductions in documented HbA1c levels from baseline for six enrolled patients (W=1, Z = -2.226, p = 0.026) and six-month follow up (i.e., more than four months after completion of the program) (W = 1, Z = -2.060, p = 0.039). In post-program surveys, each respondent indicated that they found the class content to be generally beneficial to increase their nutritional knowledge. CONCLUSIONSIn the authors' setting, this food insecurity program has subsequently led to a more formal screening process to evaluate and identify food insecure patients. The authors discuss the scheduling difficulties they experienced from the COVID-19 pandemic for their sample patients. However, these pilot results suggest that prolonged benefits may require ongoing "virtual" teaching sessions with pre-diabetic patients to address the complex factors influencing food insecurity levels identified in similar inner-city settings.Ghouse A, Gunther W, Sebastian M. Evaluation of a COVID-influenced Curriculum to Address Food Insecurity in a Detroit Family Medicine Residency Clinic. SMRJ. 2020;5(2).

A high proportion of people who have suffered from COVID-19 report, after recovery from the acute phase of the disease, clinical manifestations, both subjective and objective, that continue beyond 3 weeks or even 3 months after the original clinical disease. There is still no agreed nomenclature to refer to this condition, but perhaps the most commonly used is post-COVID syndrome. The Scientific Committee on COVID of the Madrid College of Physicians (ICOMEM) has discussed this problem with a multidisciplinary approach in which internists, infectious disease specialists, psychiatrists, pneumologists, surgeons, geriatricians, pediatricians, microbiologists, family physicians and other specialists have participated, trying to gather the existing information and discussing it in the group. The clinical manifestations are very variable and range from simple fatigue to persistent fibrosing lung lesions with objective alterations of pulmonary function. Post-COVID syndrome seems to be particularly frequent and severe in adults who have required admission to Intensive Care Units and has a peculiar behavior in a very small group of children. The post-COVID syndrome, which undoubtedly exists, is at first sight not clearly distinguishable from clinical manifestations that which occur after other acute viral diseases and after prolonged stays in ICUs due to other diseases. Therefore, it offers excellent research opportunities to clarify its pathogenesis and possibly that of other related entities. It is possible that progressively there will be an increased demand for care among the millions of people who have suffered and overcome acute COVID for which the health authorities should design mechanisms for the agile management of care that will possibly require well-coordinated multidisciplinary groups. This paper, structured in questions on different aspects of the post-COVID syndrome, attempts to stage the current state of this problem

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The evolution of a curriculum involves changes at many different levels such as daily changes to reflect questions or areas of interest of a particular class, improvements to an established course based on observations from the professor, or more significant changes to streams of courses at a departmental level, or adaptation to suggested accreditation guidelines such the recent new Canadian Engineering Accreditation Board (CEAB) graduate attributes and outcomes. Most educational institutions have means of collecting data and assessing individual courses or streams of courses based on student performance, course evaluations, and professor assessments. However, since more can be done to gauge the collective effect of changes before students get to their final year capstone project or go into industry, a student-run curriculum forum has been established.This paper presents some of the lessons learned from the bi-annual student-run curriculum forums in the Department of Electrical and Computer Engineering at the University of Manitoba. Based on the experience acquired so far, this paper outlines the organization of the curriculum forums, suggestions on guided discussions, ways to present feedback, and means of communicating to students how their feedback is being used to improve the curriculum.