Hospitalization, African

Obialo Cl, Okonofua EC,Tayade AS, Riley LJ. Epidemiology of de novo acute renal failure in hospitalized African Americans. Arch Intern Med 2000 160 1309-1313,... 

Obialo Cl, Crowell AK, Okonofua EC. Acute renal failure mortality in hospitalized African Americans age and gender considerations. J Natl Med Assoc 2002 94(3) 127-134. 

More recently, the value of adding the combination of isosorbide dinitrate 40 mg and hydralazine 75 mg three times daily to therapy including ACE inhibitors, P-blockers, digoxin, and diuretics was evaluated in a prospective, randomized trial26 The study enrolled only African-American patients and demonstrated a significant reduction in mortality, as well as first hospitalization for HF. Quality-of-life scores were also improved over placebo. Combination therapy with hydralazine and isosorbide dinitrate is an appropriate substitute for angiotensin II antagonism... 

Daumit et al. (2003) conducted a series of cross-sectional analyses of outpatient physician visits from 1992-2000 where antipsychotics were prescribed. The data was collected from the National Hospital Ambulatory Medical Care Survey conducted by the National Center for Health Statistics. African Americans had half the odds of receiving an SGA and Hispanics had 40% of the odds, compared with Whites in the early 1990s. During 1998-2000, the frequency of SGA use for non-psychotic disorders in African Americans was equivalent to Whites but still 25% lower when patients were receiving treatment for a psychotic disorder. The use of SGAs in Hispanics increased and was equal to that of Whites in the late 1990s for all psychiatric diagnoses. 

Malaria cases in Sicily exceeded battle casualties. At some West African airbases, personnel averaged an infection and a relapse yearly. The disease was an important factor in the fall of Bataan in the Philippines and in other early Pacific war disasters. For each battle casualty early in the New Guinea campaign, six to eight malaria patients had to be evacuated. An entire division of U.S. Marines was withdrawn from the front after more than half contracted malaria in the summer of 1942. Unless malaria could be controlled, General Douglas MacArthur said that he would have one division of men hospitalized with malaria and another division recuperating from it for every combat-ready division. 

The combination of nitrates and hydralazine improves the composite endpoint of mortality, hospitalizations for HF, and quality of life in African Americans who receive standard therapy. A fixed-dose combination product is available that contains ISDN 20 mg and hydralazine 37.5 mg (BiDil). Practice guidelines recommend adding ISDN and hydralazine as part of standard therapy in African Americans with moderately severe to severe HF. The combination may also be reasonable for patients of other ethnicities with persistent symptoms despite optimized therapy with an ACE inhibitor (or ARB) and /Tblocker. The combination is also appropriate as first-line therapy in patients unable to tolerate ACE inhibitors or ARBs because of renal insufficiency, hyperkalemia, or possibly hypotension. 

Fagbule D, Joiner K. 1992. Kerosene poisoning in childhood a 6-year prospective study at the University of Ilorin Teaching Hospital. West African Journal of Medicine 11(2) 116-121. 

Isosorbide Dinitrate Hydralazine (BiDil) [Antianginal, Antihypertensive/Vasodilator, Nitrate] Uses HF in African Amer-icans improve survival functional status, prolong time between hospitalizations Action Relaxes vascular smooth muscle peripheral vasodilator Dose Initially 1 tab tid PO (if not tol ated reduce to 1/2 tab tid), titrate >3-5 d as tolerated Max 2 tabs tid Caution [C, /-] recent MI, syncope, hypovolemia, hypotension, hep impair Contra For children, concomitant use w/ PDE5 inhibitors (sildenafil) Disp Tabs SE HA, dizziness, orthostatic hypotension, sinusitis, GI distress, tach, paresthesia, amblyopia Interactions t Risk of severe hypotension W/ antihypertensives, ASA, CCBs, MAOIs, phenothiazides, sildenafil, tadalafil, vardenafil, EtOH X pressor response Wf i -1- effects W7 NSAIDs EMS Use ASA, antihypertensives and CCBs w/ caution, may t hypotension concurrent Viagra-type drug use can lead to profound hypotension concurrent EtOH use can t effects OD May cause N/V, profound hypotension, skin flushing, HA from ICP, bradycardia, confusion, and circulatory collapse activated charcoal may be effective, epi use is contraindicated... 

Basu S, Andrews JR, Poolman EM, Gandhi NR, Shah NS, Moll A et al. Prevention of nosocomial transmission of extensively drug-resistant tuberculosis in rural South African district hospitals an epidemiological modelling study. Lancet 2007 370(9597) 1500-7. 

Clinical benefits and effects on mortality and hospitalization Whether used alone or in combination, hydralazine and isosorbide dinitrate decrease the preload and afterload, decrease mitral regurgitation, improve cardiac output, increase exercise capacity, modestly increase LVEF and prolong survival in patients with HF (63,64). V-Heart Failure Trial (HeFT) II (64) showed that enalapril had a major benefit on survival when compared with the combination of hydralazine-isosorbide dinitrate with enalapril in patients with predominantly NYHA class ll-lll. The African Americans in Heart Failure Trial (A-HeFT) (65) showed a beneficial effect of adding vasodilator therapy to African-American patients already treated with ACE inhibitors, (3 blockers, and spironolactone. There are no results with the same strategy in other patient groups. 

In 1994, doctors at Johns Hopkins Hospital in Baltimore, Maryland, investigated the potential of adding potassium to the diet. They gave potassium supplements to one group of African Americans known to have a high incidence of salt sensitivity and... 

Fear of hospitalization and involuntary commitment is often the reason given for avoiding treatment (Sussman et al. 1987). Unfortunately, there is some truth in that belief. African Americans are more likely to be hospitalized or involuntarily committed (Flaherty and Meagher 1980 Lawson et al. 1994 Lindsey et al. 1989 Paul and Menditto 1992 Strakowski et al. 1995). Consequently, African Americans have a different perception of the mental health system, often not seeing it as a resource for consensual treatment. 

Adebimpe VR Race, racism, and epidemiological surveys. Hospital and Community Psychiatry 45 27-31,1994 Allen IM PTSD among African Americans, in Ethnocultural Aspects of Posttraumatic Stress Disorder Issues, Research, and Clinical Applications. Edited by Marsella AJ, Friedman MJ, Gerrity ET, et al. Washington, DC, American Psychological Association, 1996, pp 209-238... 

Lawson WB Racial and ethnic factors in psychiatric research. Hospital and Community Psychiatry 37 50-54,1986a Lawson WB The black family and chronic mental illness. American Journal of Social Psychiatry 6 57-61,1986b Lawson WB Clinical issues in the pharmacotherapy of African-Americans. Psychopharmacol Bull 32 275-281,1996 Lawson WB Psychiatric diagnosis of African Americans, in Cross Cultural Psychiatry. Edited by Herrera JM, Lawson WB, Sramek JJ. New York, Wiley, 1999, pp 99-104... 

Asthma-related death and life-threatening exacerbations occurred in the Salmeterol Multicenter Asthma Research Trial and may have been associated with regular use of salmeterol [27]. These event are rare, but were observed primarily in African Americans. The US Food and Drug Administration has added a black box warning to LABA labels reflecting the observations from this trial. A meta-analysis of 19 clinical trials to evaluate the safety of LABAs concluded that they were associated with increased hospitalization for asthma exacerbation, severe asthma exacerbation, and asthma-related death [28],... 

Ethnic minorities continue to share the burden of asthma disproportionately. African-Americans and Hispanics have a higher prevalence than whites, but this appears to be a result of urbanization and not race or socioeconomic status. African-Americans are three times as likely to be hospitalized and approximately 2.5 times more likely to die from asthma. In addition, African-Americans and Puerto Ricans living in inner cities are four times more likely to experience emergency department visits than whites. These patterns are likely a result of poor access to care. 

A 25-year-old African-American male with sickle cell anemia, who has been hospitalized several times for painful sickle cell crises, has successfully been free of these crises since he has been on hydroxyurea therapy. Treatment with hydroxyurea results in which of the following ... 

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