African-American inflammatory bowel disease in a Southern U.S. health center

<p>Abstract</p> <p>Background</p> <p>Inflammatory Bowel Diseases (IBD) remain significant health problems in the US and worldwide. IBD is most often associated with eastern European ancestry, and is less frequently reported in other populations of African origin e.g. African Americans ('AAs'). Whether AAs represent an important population with IBD in the US remains unclear since few studies have investigated IBD in communities with a majority representation of AA patients. The Louisiana State University Health Sciences Center in Shreveport (LSUHSC-S) is a tertiary care medical center, with a patient base composed of 58% AA and 39% Caucasian (W), ideal for evaluating racial (AA vs. W) as well and gender (M vs. F) influences on IBD.</p> <p>Methods</p> <p>In this retrospective study, we evaluated 951 visits to LSUHSC-S for IBD (between 2000 to 2008) using non-identified patient information based on ICD-9 medical record coding (Crohn's disease 'CD'-555.0- 555.9 and ulcerative colitis 'UC'-556.0-556.9).</p> <p>Results</p> <p>Overall, there were more cases of CD seen than UC. UC and CD affected similar ratios of AA and Caucasian males (M) and females (F) with a rank order of WF > WM > AAF > AAM. Interestingly, in CD, we found that annual visits per person was the highest in AA M (10.7 ± 1.7); significantly higher (* -p < 0.05) than in WM (6.3 ± 1.0). Further, in CD, the female to male (F: M) ratio in AA was significantly higher (*- p < 0.05) (1.9 ± 0.2) than in Caucasians (F:M = 1.3 ± 0.1) suggesting a female dominance in AACD; no differences were seen in UC F: M ratios.</p> <p>Conclusion</p> <p>Although Caucasians still represent the greatest fraction of IBD (~64%), AAs with IBD made up >1/3 (36.4%) of annual IBD cases from 2000-2008 at LSUHSC-S. Further studies on genetic and environments risks for IBD risk in AAs are needed to understand differences in presentation and progression in AAs and other 'non-traditional' populations.</p

in: Damage Control Resuscitation

Airway care of the patient with life threatening haemorrhage presents many challenges during damage control resuscitation. The essential requirements are to maintain oxygenation at all stages of care and when necessary deliver general anaesthesia to facilitate invasive haemorrhage control procedures. In the remote, pre-hospital setting, providers must be able to assess the airway and intervene with a range of strategies to prevent hypoxaemia. These interventions may vary from basic airway opening manoeuvres to advanced techniques such as drug-assisted rapid sequence intubation. The initial delivery of these skills in remote settings will be the responsibility of whichever medical provider is present, and so their training, equipment and decision-making skills must reflect the challenges they will face. Rapid sequence intubation skills may not be widely available in remote environments and so providers must be equipped with alternative airway management strategies including cricothyrotomy and use of extraglottic airway devices. When invasive haemorrhage control procedures are required for patients with life threatening haemorrhage, rapid sequence intubation will need to be performed. This procedure carries significant risk in the presence of haemorrhagic shock. Providers must be aware of the hypotensive effects of induction agents and the adverse impact of positive pressure ventilation upon cardiac output in the presence of life threatening haemorrhage. The risks of intubation should be minimised with appropriate blood production administration and ventilation techniques as part of a coordinated damage control resuscitation strategy