Does the High Prevalence of Vitamin D Deficiency in African Americans Contribute to Health Disparities?

African Americans have higher incidence of, and mortality from, many health-related problems than European Americans. They also have a 15 to 20-fold higher prevalence of severe vitamin D deficiency. Here we summarize evidence that: (i) this health disparity is partly due to insufficient vitamin D production, caused by melanin in the skin blocking the UVB solar radiation necessary for its synthesis; (ii) the vitamin D insufficiency is exacerbated at high latitudes because of the combination of dark skin color with lower UVB radiation levels; and (iii) the health of individuals with dark skin can be markedly improved by correcting deficiency and achieving an optimal vitamin D status, as could be obtained by supplementation and/or fortification. Moderate-to-strong evidence exists that high 25-hydroxyvitamin D levels and/or vitamin D supplementation reduces risk for many adverse health outcomes including all-cause mortality rate, adverse pregnancy and birth outcomes, cancer, diabetes mellitus, Alzheimer's disease and dementia, multiple sclerosis, acute respiratory tract infections, COVID-19, asthma exacerbations, rickets, and osteomalacia. We suggest that people with low vitamin D status, which would include most people with dark skin living at high latitudes, along with their health care provider, consider taking vitamin D3 supplements to raise serum 25-hydroxyvitamin D levels to 30 ng/mL (75 nmol/L) or possibly higher.

[Non-compliance resulting in fatal asthmatic attack in a 27-year-old woman]. / Trudna, ciezka astma: zgon w stanie astmatycznym u 27-letniej kobiety wczesniej odmawiajacej przewleklego leczenia przeciwzapalnego.

We describe a case of fatal asthmatic attack in 27-year-old woman with type II brittle asthma and pollinosis. Despite recurrent episodes of severe asthmatic attacks she refused prolonged therapy with the exception of beta 2-agonists used when needed. The day prior to the fatal attack she was intensively exposed to pollens. She ineffectively tried to manage the attack with high doses of beta 2-agonists administered by MDI and jet nebulizer. After being intubated and transferred to the hospital, she was ventilated mechanically and treated intensively with high doses of corticosteroids, beta 2-agonists, both intravenously and in nebulisation, and nebulised with anticholinergics, but remained unresponsive to the therapy. She gradually deteriorated and died after nine hours of treatment. We conclude that the unresponsiveness to the treatment was mainly due to down-regulation of beta 2-receptors and point out the necessity of regular treatment with inhaled corticosteroids in patients with brittle asthma type II, even in the absence of symptoms.

[Influenza vaccination and asthma]. / Vaccination antigrippale et asthme.

A double investigation was carried out on the respiratory tolerance of IV in the asthmatic patient: 1. Retrospective based on case history in 87 mature adults (mean age 61 years) previously vaccinated once or several times. This showed poor respiratory tolerance in 21 patients (24%), as shown by difficulty in breathing (8 cases), paroxystic dyspnea (5 cases), an acute episode of asthma (8 cases), occurring soon after vaccination. 2. Clinical and respiratory functional prospective study of bronchial reactivity to carbachol (CBL) and flow-volume curves before and after administration of inactivated polyvalent vaccine, compared in 8 control subjects, 12 asthmatic patients, 19 cases of non-spactic chronic obstructive airway disease, 7 patients with sequelae of pulmonary tuberculosis or operated bronchial cancer, investigated immediately before (day 0), 2, 6, 8 or in some cases 20 or 30 days after IV (D2, D6, D8, D20, D30): 2 of 8 controls showed a decrease in CBL sensitivity threshold at D2 or D6; 6 of 12 asthmatics reacted to the vaccine: 2 showed increased CBL reactivity, 1 lowered sensitivity threshold, 2 a decrease in the 50% and 25% flows at D2 and D6, 1 decreased MMFR and distal flows at D2; 4 of 19 cases of COPD, 1 of 7 cases of tuberculous sequelae showed various reactions at D2, D6, D8.(ABSTRACT TRUNCATED AT 250 WORDS)