The Mount Sinai journal of medicine, New York
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Boston Health Care for the Homeless Program (BHCHP) physicians conduct a primary care clinic twice a week at Massachusetts General Hospital (MGH). The MGH clinic is part of a city-wide network of BHCHP clinics providing primary care services to indigent patients. Despite this network, long term control of chronic illnesses such as hypertension (HTN) continues to challenge the clinic staff. ⋯ A greater proportion of patients with concomitant psychiatric diagnoses exhibited blood pressures < or = 140/90 mm Hg than patients without mental illness. The increased frequency of visits at the onset of treatment may confer a positive effect on long term control of HTN among homeless patients attending outpatient hospital-based clinics.
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Approximately 50,000 pregnant women undergo nonobstetric surgery each year in the United States. Administering anesthesia during such surgery is one of the only situations in which anesthesia impacts on more than one individual (mother and fetus) at the same time. Providing a safe anesthetic to the pregnant woman requires an understanding of the physiologic changes of pregnancy and the impact of anesthesia and surgery on the developing fetus. The following review will consider the risks of the mother and to the fetus during nonobstetric surgery.
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An effective response to injury or inflammation requires leukocyte migration from the endovascular compartment into areas of inflammation. This process requires the appropriate expression of adhesion molecules, which mediate cell-cell and cell-extracellular matrix interactions. ⋯ The role of cell adhesion molecules in a variety of pathological conditions, including graft rejection, reperfusion injury, and acute lung injury are discussed. In addition, some recent studies that explore therapeutic uses of adhesion molecules are summarized.
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The normal levels of immunoglobulin and IgG subclasses in African American and Hispanic populations are uncertain. To determine immunoglobulin and IgG subclass levels in this community, we measured serum IgG, IgM, and IgA levels along with IgG subclasses in 303 African American and Hispanic patients in a general medical clinic and an allergy/asthma clinic in East Harlem in New York City. ⋯ Altogether, our data indicate that humoral immunoglobulin and IgG subclass levels below the lowest normal values occur in the low socioeconomic African American and Hispanic populations, especially in patients with asthma in East Harlem.