“Doctors pour drugs of which they know little, to treat diseases of which they know less in patients of whom they know nothing”
Voltaire – French philosopher

After a 3 year stint at this almost Sissyphysean task (definitely more than Herculean), it is my hope that the readership and its court and jury will favorably aquit the book of attaining the a priori objectives elaborated above. It is my anticipation that subsequent editions of Diaspora Medicine will be multi-authored, with the writers or editors drawn from countries of diverse health problems, ethnicity and economic wherewithal. This may be the beginning of an international textbook of medicine.

This book should be useful to all students and practitioners of Internal Medicine, neuropsychiatry and dermatology and obstetricians every where. Major medical diseases in pregnancy are discussed, as is safe and rational drug use in pregnancy and the avoidance of teratogenicity. Although, it is not a textbook of tropical medicine (but has a specific chapter on it) undergraduate students and resident doctors and Attendings who plan to, or are currently practising in West Africa or other tropical environments should find the book a major addition to their library. American Students and doctors sitting the USMLE steps 1, 2 or 3 or the Clinical Skills assessment examination, and those preparing for the American boards in internal medicine, the PLAB or the British Royal College examinations, who need quick up dates on aspects of ethnic medicine, will find the book fully complementary to the older Western Medical texts. Other health professionals, especially nurses and pharmacist should find the aspects on pathophysiology and clinical pharmacology particularly focused to their needs as well. The recent advances in molecular characterization of cytochrome P450 isozymes and their role in polymorphic metabolism, drug interactions and ethnic variation in drug responses is given adequate emphasis.

The book cites by first author name only (or both authors, in case of two authors) nearly 2,000 references on all aspects of internal medicine. This should appeal to researchers, who can easily locate the cited authors and related updates on the PUBMED. http://www.ncbi.nlm.nih.gov

Finally, the book is printed and type set in a student friendly manner, with a combination of lists, tables, figures and italicized words serving as aide-memoirs. Whatever major shortcoming apparent in this printing and edition should kindly be communicated to the author, for the purpose of remedy in subsequent reprints and editions. It is my hope that at the conclusion of this book, the ancient vitriolic vituperation of Voltaire (justified at his time) would have spurred a more cognitive rational and integrated approach to clinical medicine in the 21st century

ADESUYI A LESLIE AJAYI

FOREWARD

Adesuyi Ajayi is one of a new breed of young African medical scientists who, while accepting the basic tenets of traditional medical practice and teaching, also believe that racial differences in the clinical presentation and course of diseases should not be treated as mere curiosities but do have significant clinical and therapeutic relevance. These differences may greatly modify the practice of medicine I Africa and other developing nations. Also, most industrialized nations now contain significant proportions of racial minorities, on whom knowledge of clinical and therapeutic variation is essential to successful intervention.

As Ajayi and member of other medical researchers have shown, racial variation results in major differences in the aetiology, presentation and course of many disorders. More importantly, racial factors have been shown to result in major difference in the pharmacokinetics of many common therapeutic agents, and in the clinical response to them. Important examples that are cited in the book concerning the response to anti-hypertensive agents, differential incidence of Alzheimer’s disease between Africans and African-Americans, the interethnic variation in incidence and severity of auto-immune disorders, especially rheumatoid arthritis. The management of medical diseases in pregnancy is emphasized, as are neglected topics, such as diabetic treatment during Ramadan fasting, and cutting edge topics, including the antiretroviral properties of chloroquine, and its potential utility in the adjunctive treatment of HIV/AIDS.

Professor Ajayi received his medical training at the University of Ife (now Obafemi Awolowo University, Nigeria, one of the foremost African institutions. Subsequently, he specialized in Internal Medicine under the training programme of the West African College of Physicians. He has impeccable postgraduate academic qualifications, including a Ph.D. from Glasgow University, and an M.D from Ife. This combination of sound professional and research training combines with a wealth of clinical experience in Africa and outside it, makes him eminently qualified a write this book.

This book is unique in that it provides a comprehensive account of “cosmopolitan” internal medicine as well as detailed accounts of variations in the Black races. The approach is soundly scientific; right from the first chapter; the scientific principles underlying disease states are clearly documented. The book is extremely well-researched, with over 2000 references.

Medical differences in therapeutic response, an area in which the author has carved a research niche for himself, are well-described. There are extremely well-researched descriptions of conditions in Black races that are rare or absent in other races. This book is a must for residents and specialists alike that deal with Black races, both inside and outside Africa. In addition, it will serve as an invaluable reference to all physicians

Professor Roger A. Makanjuola
Vice-Chancellor,
Obafemi Awolowo University
Ile-Ife, Nigeria.

AUTHOR BIOGRAPHICAL SKETCH

A.A. Leslie Ajayi MD, Ph.D. FWACP, FBPharmacolS, IOM, Adjunct Professor of Medicine, Baylor College of Medicine, 6565 Fannin street, Houston TX 77060

Dr. Adesuyi A. Leslie Ajayi, is an adjunct Professor of Medicine and pharmacology at the Baylor College of Medicine, Houston Texas. After his MD degree from the Obafemi Awolowo University Ile-Ife, Nigeria, he proceeded to the University of Glasgow, Scotland, UK to prosecute and earn his Ph.D. degree in Cardiovascular Clinical Pharmacology. Dr. Ajayi is a fellow of the West African College of Physician (FWACP) following residency and fellowship training in internal medicine and cardiology. In 1992, he became professor of Medicine and Chairman of Medicine of the Obafemi Awolowo University, ile-Ife, Nigeria. Dr. Ajayi has published more than 160 scientific peer-reviewed journal articles and presentations which have been very well cited in high impact journals and textbooks of Medicine. His work has received numerous accolades, including the American Federation for clinical research award for scientific excellence, The outstanding young person of Nigeria Award for academic leadership and accomplishments, The Merck international fellowship in clinical pharmacology and the Wellcome Trust clinical research fellowships in South Carolina in the USA and Nottingham, in the UK respectively.

Dr. Ajayi has served as a visiting professor and Senior Scientist to the NIH funded center for cardiovascular diseases, at the Texas Southern University. Recently, Dr. Ajayi was elected a fellow of the British Pharmacological Society (FBPharmacolS) and a member of the highly select international order of merit (IOM) based at Cambridge, England. He is also a biographee of Marquis “who-is-who in the world”, and that of science and Engineering. He is also on the Editorial board of several journals including Current Diabetes Review. Dr Ajayi is the author of “Angiotensin converting enzyme inhibitors in Nigerians”, “Rapid physical bedside diagnosis and pathophysiology” and monographs on cardiology.