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.

Eficacia de la tintura de ajo al 20 por ciento en pacientes asmáticos. Policlínico 13 de Marzo. 2018 –2019 / Efficacy of 20% garlic tincture in asthmatic patients. Polyclinic March 13. 2018–2019

Se realizó un estudio prospectivo, con modelo cuasi experimental en los pacientes asmáticos pertenecientes del Policlínico 13 de Marzo, con el objetivo de evaluar la eficacia de la tintura de ajo al 20 por ciento en el tratamiento intercrisis del Asma Bronquial, en el período comprendido de enero de 2018 a mayo de 2019. El Universo estuvo representado por 88 pacientes asmáticos entre 20-59 años de edad dispensarizados en el consultorio 25. La muestra quedó constituida por 84 pacientes que cumplieron con los criterios de inclusión y de exclusión. Los pacientes fueron distribuidos de forma aleatoria, en dos grupos control y experimental, utilizando la tabla de números aleatorios computarizados, en una proporción pareada de 1:1. Se empleó la prueba de diferencia de proporciones para muestras independientes y se trabajó con un nivel de significación p=0,05. Con este proyecto se contribuyó al desarrollo de la medicina natural y tradicional en nuestro país. Se demostró la eficacia de la tintura de ajo en el 97.6 por ciento de los pacientes. Los hombres fueron los más afectados por las crisis y se reportaron 3 efectos adversos de forma leve(AU)

A prospective study was carried out, with a quasi-experimental model in asthmatic patients belonging to the 13 de Marzo Polyclinic, with the aim of evaluating the efficacy of the 20 percent garlic tincture in the inter-crisis treatment of Bronchial Asthma, in the period from January from 2018 to May 2019. El universo was represented by 88 asthmatic patients between 20-59 years of age dispensed in the office 25. The sample consisted of 84 patients who met the inclusion and exclusion criteria. The patients were randomized into two control and experimental groups, using the table of computerized random numbers, in a paired ratio of 1: 1. The difference of proportions test was used for independent samples and the level of significance was p = 0.05. This project contributed to the development of natural and traditional medicine in our country. The efficacy of garlic tincture was demonstrated in 97.6 percent of patients. Men were the most affected by the seizures and 3 mild adverse effects were reported(EU)

A Respiratory Therapist-Driven Asthma Pathway Reduced Hospital Length of Stay in the Pediatric Intensive Care Unit.

BACKGROUND: Asthma is a common reason for admissions to the pediatric intensive care unit (PICU). Since June 2014, our institution has used a pediatric asthma clinical pathway for all patients, including those in PICU. The pathway promotes respiratory therapist-driven bronchodilator weaning based on the Modified Pulmonary Index Score (MPIS). This pathway was associated with decreased hospital length of stay (LOS) for all pediatric asthma patients; however, the effect on PICU patients was unclear. We hypothesized that the implementation of a pediatric asthma pathway would reduce hospital LOS for asthmatic patients admitted to the PICU. METHODS: We retrospectively reviewed the medical records of all pediatric asthma subjects 2-17 y old admitted to our PICU before and after pathway initiation. Primary outcome was hospital LOS. Secondary outcomes were PICU LOS and time on continuous albuterol. Data were analyzed using the chi-square test for categorical data, the t test for normally distributed data, and the Mann-Whitney test for nonparametric data. RESULTS: A total of 203 eligible subjects (49 in the pre-pathway group, 154 in the post group) were enrolled. There were no differences between groups for age, weight, gender, home medications, cause of exacerbation, medical history, or route of admission. There were significant decreases in median (interquartile range) hospital LOS (4.4 [2.9-6.6] d vs 2.7 [1.6-4.0] d, P < .001), median PICU LOS (2.1 [1.3-4.0] d vs 1.6 [0.8-2.4] d, P = .003), and median time on continuous albuterol (39 [25-85] h vs 27 [13-42] h, P = .001). Significantly more subjects in the post-pathway group were placed on high-flow nasal cannula (32% vs 6%, P = .001) or noninvasive ventilation (10% vs 4%, P = .02). CONCLUSION: The implementation of an asthma pathway was associated with decreased hospital LOS, PICU LOS, and time on continuous albuterol. There was also an increase in the use of high-flow nasal cannula and noninvasive ventilation after the implementation of this clinical pathway.

At-risk registers integrated into primary care to stop asthma crises in the UK (ARRISA-UK): study protocol for a pragmatic, cluster randomised trial with nested health economic and process evaluations.

BACKGROUND: Despite effective treatments and long-standing management guidelines, there are approximately 1400 hospital admissions for asthma weekly in the United Kingdom (UK), many of which could be avoided. In our previous research, a secondary analysis of the intervention (ARRISA) suggested an improvement in the management of at-risk asthma patients in primary care. ARRISA involved identifying individuals at risk of adverse asthma events, flagging their electronic health records, training practice staff to develop and implement practice-wide processes of care when alerted by the flag, plus motivational reminders. We now seek to determine the effectiveness and cost-effectiveness of ARRISA in reducing asthma-related crisis events. METHODS: We are undertaking a pragmatic, two-arm, multicentre, cluster randomised controlled trial, plus health economic and process evaluation. We will randomise 270 primary care practices from throughout the UK covering over 10,000 registered patients with 'at-risk asthma' identified according to a validated algorithm. Staff in practices randomised to the intervention will complete two 45-min eLearning modules (an individually completed module giving background to ARRISA and a group-completed module to develop practice-wide pathways of care) plus a 30-min webinar with other practices. On completion of training at-risk patients' records will be coded so that a flag appears whenever their record is accessed. Practices will receive a phone call at 4 weeks and a reminder video at 6 weeks and 6 months. Control practices will continue to provide usual care. We will extract anonymised routine patient data from primary care records (with linkage to secondary care data) to determine the percentage of at-risk patients with an asthma-related crisis event (accident and emergency attendances, hospitalisations and deaths) after 12 months (primary outcome). We will also capture the time to crisis event, all-cause hospitalisations, asthma control and any changes in practice asthma management for at-risk and all patients with asthma. Cost-effectiveness analysis and mixed-methods process evaluations will also be conducted. DISCUSSION: This study is novel in terms of using a practice-wide intervention to target and engage with patients at risk from their asthma and is innovative in the use of routinely captured data with record linkage to obtain trial outcomes. TRIAL REGISTRATION: ISRCTN95472706 . Registered on 5 December 2014.

Guía de buenas prácticas clínicas: asma bronquial en el niño / Guide to good clinical practices: bronchial asthma in children

El Asma Bronquial es la enfermedad crónica no transmisible de mayor prevalencia en la infancia mundialmente y en Cuba por lo que se considera un problema de salud. Su prevalencia ha aumentado en las últimas décadas siendo mal diagnosticada y tratada. Existe desinformación del personal médico, paramédico, enfermos y familiares sobre su prevención, correcto diagnóstico, pronóstico y tratamiento. Por lo que desde el año 2006 el servicio de respiratorio y alergia del Hospital Pediátrico Universitario de Holguín realiza talleres y cursos de capacitación, con el fin de actualizar los conocimientos y unificar criterios en el manejo integral del niño asmático en todos los niveles de atención y de esta forma mejorar la calidad de vida de los mismos, para lo que se elaboró esta Guía de Buenas Prácticas Clínicas.

Asma grave. Tratamiento farmacológico y asistencia respiratoria / Severe asthma. Drug treatment and respiratory assistance

El asma es la enfermedad crónica más frecuente en la infancia y su incidencia está aumentando. Con el diagnóstico y tratamiento precoz de las crisis asmáticas en Atención Primaria y en los Servicio de Urgencia hospitalarios el número de niños con crisis asmáticas que requieren ingreso en el hospital y sobre todo ingreso en las Unidades de Cuidados Intensivos Pediátricos (UCI), ha disminuido sensiblemente. En la UCIP el tratamiento intensivo con broncodilatadores β2 inhalados y/o intravenosos y corticoides y la utilización precoz de ventilación no invasiva ha permitido disminuir el número de pacientes que requieren intubación y acortar el tiempo de estancia en la UCIP. El sulfato de magnesio, el heliox, la teofilina, la ketamina y el óxido nítrico también pueden ser eficaces como tratamientos complementarios. En los pacientes que requieren ventilación mecánica invasiva la utilización de parámetros moderados tolerando una hipercapnia contralada ha logrado reducir mucho la morbimortalidad (AU)

Asthma is the more common chronic disease in children, and its incidence is increasing. The number of children with acute asthma who need admittance in the Hospital and the Pediatric Intensive Care Units (PICU) has decreased because the early diagnosis and treatment in primary health services and Urgency Departments. The intensive treatment with inhaled and/or intravenous β2, bronchodilators and corticosteroids in the PICU and the early use of non-invasive ventilation has permitted diminishing the number of patients who need intubation and reducing the length of PICU stay. Magnesium sulphate, heliox, theophilline, ketamine and nitric oxide can also be useful as complementary treatment . The use of mechanical ventilation with moderate parameters and controlled permissive hypercapnia has diminished the morbimortality (AU)

[Results of an educational program for adults with asthma]. / Resultados de un programa educativo para adultos con asma.

BACKGROUND: Asthma is a world health problem. Education of asthmatic patient has been proposed as a choice for diminishing mortality due to asthma. OBJECTIVE: To demonstrate that educational programs for asthmatic patients help to reduce disease's severity, crises and hospitalizations number and encourage a bigger therapeutic compliance. MATERIAL AND METHODS: 80 asthmatic patients were divided into two groups; first one received educational curse and second one does not. All patients received treatment according to international guides, including monthly consultation, flow-meter, and symptoms day book; an initial and final evaluation was made about disease's knowledge. Course consisted of a workshop including crisis management, use of inhaled medication, flow-metry and relaxation techniques. RESULTS: We studied 76 patients, with a mean age of 34 years; 36 were assigned to group 1 and 40 to group 2. Initial assessment of both groups was of 7.8, while final evaluation of groups 1 and 2 was of 9.3 and 8.4, respectively. Group 1 had lesser number of hospitalizations than group 2 (p-0.005), lesser number of emergency consultations (p-0.005) and a higher overall improvement than group 2, in which only 8 patients got well. A third part of the group 1 abandoned treatment, while patients that abandoned treatment in group 2 accounted for 79% (p < 0.0005). CONCLUSIONS: Educational programs for asthmatic adult patients diminish severity of disease, number of crises and hospitalizations, and also increase therapeutic compliance.

[Perioperative management of a patient with severe bronchial asthma attack].

We report an anesthetic management for Miles' operation in a 50-year-old female who had frequent severe bronchial asthmatic attacks prior to surgery. Because the surgical field was in the lower abdomen, we selected spinal anesthesia combined with epidural anesthesia. For spinal anesthesia, 15 mg of hyperbaric tetracaine with epinephrine was used. Moreover, 3 ml of 2% mepivacaine with epinephrine was injected via an epidural catheter, and then analgesia up to Th 6 was obtained. In order to prevent an asthmatic attack during surgery, the following cares were taken: (1) administration of moisturized oxygen by nebulizer via a nasal canula, (2) intravenous administration of steroid, (3) addition of epinephrine to the local anesthetics, and (4) sedation by music. The surgery was completed safely without asthmatic attacks. Postoperatively, pain control with buprenorphine was managed with a continuous extradural infusion. The patient was discharged 50 days after surgery, and was in a favorable condition without bronchial asthmatic attacks.