Journal of the Association for Academic Minority Physicians : the official publication of the Association for Academic Minority Physicians最新文献

Health services researchers face a challenge when analyzing populations that include patients of Hispanic cultural heritage. Definitions of Hispanic have changed over the past 25 years. Methods of ascertaining race and ethnicity are flawed, particularly within health care institutions. This study was designed to address these problems by applying a new and unique methodology for identifying Hispanics in a clinical practice. Physicians in a hospital-based academic group practice were asked to identify all Hispanics in their patient panels. A random sample of patients identified as Hispanics were then surveyed by telephone to establish country of origin, length of time in the United States, and bilinguality. This demonstrated a great diversity of country of origin among Hispanics. The 2630 Hispanic patients identified by these methods were compared with non-Hispanics in terms of demographics, case mix, and health care utilization. Health services researchers should consider identification by physicians as a useful method for identifying Hispanics in clinical practice settings.

Esophageal disease is a common and important cause of morbidity and mortality in patients with human immunodeficiency virus (HIV) infection. The etiology of HIV-related esophageal ulceration varies. After all known etiologies are excluded, a subgroup of patients remains with esophageal ulceration known as idiopathic esophageal ulceration (IEU). Establishing a diagnosis of IEU is critical and precludes unnecessary treatment with antiviral, antifungal, or antibiotic agents. A review of the current literature indicates that there are no prospective, placebo-controlled, randomized, double-blind trials on the specific treatment of IEU. Several preliminary reports suggest that corticosteroids and thalidomide may be effective. The incidence and natural history of IEU are incompletely known. It is important to establish that any potential therapeutic agents employed to treat IEU do not increase viral replication or provide viral protection. There is a need for well-designed, placebo-controlled, prospective studies to assess the risks and benefits of corticosteroids, thalidomide, and other agents in the treatment of idiopathic esophageal ulceration.

Diabetes significantly affects cardiac performance, as does ethanol. To assess whether insulin treatment alters the inotropic response to acute ethanol exposure and reverses diabetes-induced myocardial dysfunction, male Wistar rats were made diabetic using streptozocin, 55 mg/kg intravenously. The inotropic effect of ethanol on normal, diabetic, and insulin-treated (8 weeks) diabetic animals was studied using isolated, left-ventricular papillary muscle preparations superfused with Tyrode's solution under isometric conditions. Peak tension developed, time to peak tension (TPT), time to 90% relaxation (RT90), maximum rate of tension developed (+VT), and maximum rate of fall in tension (-VT) were determined in the absence and presence of clinically relevant concentrations of ethanol for 10 minutes. In insulin-treated diabetic muscles, baseline developed tension, +VT, and -VT were enhanced, and the prolongation of TPT and RT90, characteristic of diabetic myocardium, was attenuated. The magnitude of the reduction in developed tension in response to ethanol, 80 mg/dL, was slightly greater in untreated diabetic myocardium. Higher concentrations of ethanol (120 to 240 mg/dL) decreased tension in all groups and was of similar magnitude. The negative inotropic effect of higher ethanol concentrations was associated with shortening of TPT and RT90, as well as a diminution of +VT and -VT. It is concluded that with insulin treatment, the mechanical properties of diabetic myocardium are normalized; however, neither the myocardium's sensitivity to ethanol nor the overall magnitude of ethanol's negative inotropic effect is modified by insulin treatment.

Ulcerative colitis is a chronic inflammatory disease of the colon that affects the rectum and a variable length of contiguous colon. The disease is characterized by rectal bleeding and diarrhea during periods of exacerbation; these symptoms usually abate with treatment. The pathogenic mechanism of ulcerative colitis is believed to be an aberrant immune response in which antibodies are formed against colonic epithelial protein(s). The disease usually presents during the second and third decades of life, with a smaller peak after the age of 60 years. There is a genetic component to ulcerative colitis, with a higher incidence among family members and, particularly, first-degree relatives. Diagnosis depends on several factors, most notably symptoms, demonstration of uniformly inflamed mucosa beginning in the rectum, and exclusion of other causes of colitis, such as infection. There is no medical cure for ulcerative colitis, but medical therapy is effective and can improve or eliminate symptoms in more than 80% of patients. Surgery offers a cure but carries the high price of total colectomy. New surgical methods, such as ileoanal anastomosis, allow for maintenance of bowel continuity and better patient satisfaction.

Black patients with systemic lupus erythematosus (SLE) have a lower prevalence of photosensitivity rashes than white patients. The reasons for this are unknown, but some studies suggest a correlation between the presence of antinuclear antibodies and protection from photosensitivity. In our study, we determined serum antinuclear-antibody profiles, including anti-dsDNA, anti-Sm, anti-RNP, anti-Ro/SS-A, and anti-La/SS-B antibodies, in 91 black Jamaican patients with SLE. All 91 serum samples from SLE patients (100%) were positive in the fluorescent antinuclear-antibody test. Using the crithidia luciliae immunofluorescence test, anti-dsDNA was found in 27.5% of the samples. By a double immunodiffusion method, anti-Sm antibodies were found in 15.4%, anti-RNP in 18.7%, anti-Ro/SS-A in 9.9%, and anti-La/SS-B in 11.0%. However, no statistically significant differences were observed in the seroprevalence of these antinuclear antibodies when sera from patients of the following groups were compared: only photosensitivity rashes (n = 17), photosensitivity and other rashes (n = 23), other rashes without photosensitivity (n = 27), and patients with no skin rash of any type (n = 24). These results suggest that photosensitivity in black Jamaican patients with SLE is not associated with antinuclear-antibody specificity.

By every measure, we live in exciting times, when opportunity knocks and offers us the challenge to rise above ourselves, to achieve through our common efforts what we thought to be impossible. Let us renew our commitment to make things happen!

In 1993, the National Institutes of Health published the recommendations of the fifth, and most recent, US Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure. Many believe that this report advocates the use of inexpensive diuretics and beta-adrenergic-receptor blocking agents as first-line agents in the pharmacologic treatment of hypertension. It has been argued that this recommendation is engendered by primary concerns about costs rather than efficacy or patient satisfaction. The contrary view, however, contends that new, more expensive therapeutic drugs have not demonstrated long-term reductions in morbidity and mortality. For those who train physicians in the treatment of hypertension in African Americans, awareness of this dispute is pivotal so that informed decisions will be made by both the physician and patient.

While cocaine abuse in pregnancy is associated with a number of negative outcomes for both mothers and infants, it is unclear to what extent cocaine is specifically responsible for these negative outcomes and how its effects are distinct from those associated with substance abuse in general. Use of other drugs commonly associated with cocaine abuse, such as alcohol, marijuana, and tobacco, has also been associated with adverse pregnancy outcomes. Untoward pregnancy effects often ascribed to cocaine abuse in pregnancy may be more appropriately attributed to these or other drugs or to the unhealthy life-style associated with the long-term abuser rather than to cocaine itself. Epidemiologic data concerning cocaine use in pregnancy describe only associations of drug use and do not prove causality. Future research and longitudinal studies are needed to examine the roles of maternal and environmental factors in predicting differences in cocaine-exposed and nonexposed pregnancies.

Recent dramatic advances have been made in our understanding of the genetic basis of diseases. One result will be an increase in the number of pregnant women considered potential candidates for prenatal diagnosis. At the same time, the invasive techniques by which fetal specimens for prenatal diagnosis are obtained have come under increasing scrutiny in the lay press. Practicing obstetricians must have sufficient knowledge of the benefits, risks, and limitations of these techniques to respond to patient inquiries. This article reviews the commonly used invasive prenatal diagnostic methods, including amniocentesis, chorionic villus sampling, and fetal blood sampling, as well as less widely available techniques, such as fetal skin and liver biopsies. Such relevant issues as indications, timing, and fetal risks are covered.