Afro-Caribbeans

Genetic deficiency of glucose-6-phosphate dehydrogenase, with consequent impairment of the generation of NADPH, is common in populations of Mediterranean and Afro-Caribbean origin. The defect is manifested as red cell hemolysis (hemolytic anemia) when susceptible individuals are subjected to oxidants, such as the an-timalarial primaquine, aspirin, or sulfonamides or when... 

Which class of drug would be appropriate first-line treatment for Mr HA How would this treatment choice be affected if the patient had been of Afro-Caribbean origin ... 

Angiotensin-converting enzyme inhibitors (ACE inhibitors) would be the appropriate initial choice in this patient. If the patient had been of Afro-Caribbean origin then a thiazide diuretic or calcium channel blocker would be an appropriate choice. 

AW, a 25-year-old Afro-Caribbean man, has been admitted to your ward with a sickle cell crisis. AW has a raised temperature and complains of severe pain in his limbs, chest and lower back. His regular medications are ... 

Mr WD, 42-year-old Afro-Caribbean man, presents to his GP with six-week history of headaches and lethargy. On examination the following is noted ... 

The constant is 1 for a white male, and is multiplied with 0.742 for females and multiplied with 1.21 for Afro-Caribbeans. 

In a retrospective study in a psychiatric hospital in Curasao, Netherlands Antilles, 133 Afro-Caribbean inpatients (mean age 52 years), with no organic disorders and a history of current use of neuroleptic drugs for at least 3 months, were assessed for tardive dyskinesia (291). The prevalence was 36%. When the number of interruptions to neuroleptic drug therapy was split into up to two and more than two, the resulting adjusted odds ratio was 3.29 (95% Cl = 1.27, 8.49). Thus, the number of interruptions turned out to be the second risk factor after age. Cumulative dosages of neuroleptic or anticholinergic drugs were not risk factors. 

A boy weighing 4 kg was born by spontaneous normal delivery at 39 weeks to a 38-year-old Afro-Caribbean woman, whose pregnancy was complicated by essential hypertension treated with amlodipine. On day 1 the child developed firm, red, pea-sized nodular lesions on the face, buttocks, back, shoulders, and arms. 

Hemorrhage in the globus paUidus occurred in a 50-year-old Afro-Caribbean alcoholic man after ethylene glycol poisoning there was evidence of lactic acidosis and the ethylene glycol concentration was 6.06 mmol/1 (31). 

A 39-year-old Afro-Caribbean man with stage IVB T cell Ijmphoma due to HTLV-1 infection had invasive Strongyloides hyperinfection that did not respond to oral ivermectin plus albendazole because of concurrent ileus. He was treated with two 6 mg doses of a veterinary formulation of ivermectin subcutaneously. There were no adverse effects, apart from pain at the injection site. 

Fraser PA, Yunis EJ, Alper CA Excess admixture proportion of extended major histocompatibility complex haplotypes of Caucasian origin among rheumatoid arthritis associated haplotypes in African Americans and Afro-Caribbeans. Ethnicity and Health 1(2) 153-159,1996 Fuhr U Drug interactions with grapefruit juice extent, probable mechanism and clinical relevance. Drug Saf 18 251-272,1998 Garrity JA, Gay PE (eds) The Columbia History of the World. New York, Harper Row, 1972... 

Barnes KC, Neely JD, Duffy DL, et al Linkage of asthma and total serum IgE concentration to markers on chromosome 12q - Evidence from Afro-Caribbean and Caucasian populations. Genomics 1996 37 41-50. (Ill)... 

Marked ethnic differences in infant mortahty and respiratory morbidity have been reported (130). Prematnrely dehvered Afro-Caribbean infants are less likely to develop the respiratory distress syndrome (RDS) than white infants of similar gestational age (131), which snggests that the respiratory system is either more matnre or that airway function is enhanced in black preterm infants (132). Some of these differences may be attributed to differences in nasal anatomy, since the lower total airway resistance found in Afro-Caribbean infants when compared with Caucasian infants of similar age and weight (101) was accounted for by their lower nasal resistance (23). Such differences would be expected to influence both breathing patterns and the distribution of inhaled aerosols. 

Stocks J, Gappa M, Rabbette PS, Hoo A-F, Mukhtar Z, Costeloe KL. Acomparison of function in Afro-Caribbean and Caucasian infants. Eur Respir J 1994 7 11-16. 

A 61-year-old Afro-Caribbean man presented with a 5-year history of tender and inflamed papules and pustules associated with keloid scarring in the beard area extending to the cheeks and posterior scalp. 

Sometimes ethnic origin can play a part in ECG findings. For example widespread T wave inversion (without pain) can be a normal variant for Afro-Caribbean males. 

These techniques have been used in forensic science to identify murder victims. For example, in Ireland, the headless body of a male 35-40 years old was discovered. Skin color and physical characteristics suggested that he was of African/Afro-Caribbean or African-American ancestry. Stable isotope ratios in his hair, bones, and teeth were compared with those of people whose geographic origin and life history were known. From the hair, it was established that he had lived in Ireland for at least 9-12 months before his death. The femur was then tested while ribs remodel in about 10 years, long bones such as the femur take about 20 years. The inner part of the bone reflects the most recent history, and the 0/ 0 profile corresponded to local drinking water. However, the outer, older part of the femur suggested water with a 8 value of... 

---