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Acute intermittent porphyria (AIP) is an autosomal dominant metabolic disorder characterized by a deficiency in heme biosynthesis. Heme biosynthesis occurs throughout the body, but it is most prominent in the erythroblastic system and liver. AIP is a hepatic porphyria whereby the liver is the source of toxic heme metabolites. Clinical manifestations of AIP result from a genetic mutation that leads to partial function of porphobiliogen deaminase (PBGD). This causes an accumulation of upstream, neurotoxic metabolites. Symptoms include but are not limited to peripheral neuropathies, autonomic neuropathies and psychiatric manifestations. AIP can be life threatening and clinical signs and symptoms are often heterogeneous and non-specific. Therefore, it is important to be able to recognize these patients to make a prudent diagnosis and offer appropriate therapy. Here, we review the epidemiology, pathophysiology, clinical presentation, diagnosis, and management of AIP including the role of liver transplantation.

Migrant and seasonal farmworkers in the United States are a growing population that are at an increased risk for illness and injury compared to the average American. Farmworkers operate dangerous machinery, perform arduous farm labor, and are exposed to potentially harmful agricultural and chemical toxins on a daily basis. Additionally, they severely underutilize health care due to sociocultural, financial, linguistic, and logistical obstacles. There are currently over 3 million Latino farmworkers in the United States and over 80,000 currently reside in North Carolina. A systematic review was performed on health outcomes affecting North Carolina migrant and seasonal farmworkers since 2000 which cover issues such as mental health, occupational health, eye conditions, skin conditions, and dental health. Results showed that there are high self-reported rates of these conditions however little effect on quality of life. More research must be performed on mental health and its implications on farmworker well-being as articles investigating mental health did not report quality of life measures. Another study was performed which analyzed 2013 primary clinic data from the North Carolina Farmworker Health Program to get a better understanding of health care utilization patterns and the most prominent health issues facing migrant and seasonal farmworkers in North Carolina. Results showed that almost half (47%) of the North Carolina farmworker population accessed health services in 2013. Seasonal farmworkers accessed significantly more health care services than migrant farmworkers. Among the study population, rates of chronic disease such as hypertension and diabetes were significantly lower than those found among Americans. This result indicates that chronic disease among farmworkers often goes underreported and therefore unmanaged while they work in the United States. Further research must be performed to gain accurate prevalence rates of chronic diseases among farmworkers to help organizations such as the North Carolina Farmworker Health Program target health interventions such as education and clinic referrals.