A HIV positive diagnosis greatly affects the psychological and emotional well-being of the person receiving the blood test results. The newly diagnosed patient is usually in shock even though they may be subconsciously aware that they have put themselves at risk. Immediate counselling must be provided by trained counsellors to ensure that the patient has access to timely support and correct information specific to the patient‟s needs in order to increase understanding and acceptance of the diagnosis. The establishment of hospital based Hospital Peer Support Programmes (HPSP) and development of non-hospital based Support Services; be it Self-help Groups or Support Groups; to strengthen the treatment services provided at Treatment Centres. People Living with HIV (PLHIV), including those representing various marginalised communities, are trained and equipped with the skills and knowledge to provide the much needed support services. Challenges still abound in the efforts to increase acceptance to the set-up and running of PLHIV provided HPSP services; as well as address resistance toward the presence of non-medically trained personnel in a healthcare setting. Benefits of having targeted community-specific HPSP counsellors available at Treatment Centres can assist in ensuring acceptance of diagnosis; enhance observance to follow-up and monitoring appointments; greater comprehension to treatment procedures; increased readiness to commencing HAART; and encourages improved adherence and compliance. Concerted efforts must be placed on actively recruiting and providing training to PLHIV from various marginalised communities in order to strengthen the support services currently available at Treatment Centres. It is essential that the Ministry of Health, Director Generals of all hospitals, as well as doctors and nurses of Infectious Diseases clinics understand the benefits of putting in place Community-specific HPSP services.

Until recently cholera had never been reported in Papua New Guinea despite the close proximity of cholera-endemic countries and the presence of environmental and social characteristics that are considered risk factors for cholera outbreaks. The current outbreak began in July 2009 and rapidly spread throughout the coastal regions of the country. Initial characterization studies using variable-number tandem repeat analysis indicate that the outbreak was a recent clonal incursion from South-East Asia. By mid-2011 the outbreak had resulted in the reporting of more than 15 500 cases of cholera and over 500 deaths: a case fatality ratio (CFR) of approximately 3.2%. Following an outbreak of cholera, interventions such as the introduction of oral rehydration therapy aim to reduce the CFR to below 1%. This elevated CFR is likely a reflection of the inaccessibility of much of the country, the lack of health care services available in remote regions and the general unpreparedness for an outbreak of this kind. This premise is supported by the differences in CFRs between the relatively well-serviced National Capital District (0.1%) and more remote regions such as the Western Province (8.8%).

Loin pain haematuria syndrome (LPHS) is an uncommon clinical entity that has divided renal physicians, pain practitioners, and even psychiatrists since its initial description. A relative paucity of data exists regarding the condition, with best practice guidelines lacking amid the existing threads of anecdotal experiences and variable follow-up observations. The aim of this article was to review the cumulative published experience of pain relief strategies for LPHS.
Analgesia ; Denervation ; Follow-Up Studies ; Pain Management* ; Practice Guidelines as Topic ; Psychiatry

Plantar fasciitis is a common cause of heel pain in adults. Although it is usually a self-limiting condition, the pain may become prolonged and severe enough to cause significant distress and disruption to the patient's daily activities and work. PubMed and Cochrane Central Register of Controlled Trials databases were searched for randomised controlled trials (RCTs) and a total of ten RCTs were selected for evaluation. These RCTs involved the use of either palpation- or ultrasonography-guided corticosteroid injections in patients diagnosed with plantar fasciitis. All placebo-controlled RCTs showed a significant reduction in pain with the use of corticosteroid injections. Some studies also showed that corticosteroid injections yielded better results than other treatment modalities. However, it is evident from these studies that the effects of corticosteroid injections are usually short-term, lasting 4-12 weeks in duration. Complications such as plantar fascia rupture are uncommon, but physicians need to weigh the treatment benefits against such risks.
Adrenal Cortex Hormones ; administration & dosage ; therapeutic use ; Adult ; Evidence-Based Medicine ; Fasciitis, Plantar ; drug therapy ; Heel ; injuries ; Humans ; Middle Aged ; Pain ; drug therapy ; Pain Measurement ; Palpation ; Patient Satisfaction ; Randomized Controlled Trials as Topic ; Rupture ; Treatment Outcome ; Ultrasonography

A detailed study of the ecology of subsistence agriculture in the Tari Basin was conducted to investigate the stability of intensive agroecosystems in the highlands of Papua New Guinea. The highly intensive agricultural systems that have evolved in the wetland environments in the lowest parts of the basin were found to be extremely stable and capable of further intensification. Both soil fertility and sweet potato yields showed no signs of degradation even though some areas had been under continuous cultivation for hundreds of years. In the dryland environments with volcanic ash soils there was evidence of ecological instability in the form of declining soil fertility and sweet potato yields over time and the progressive replacement of forest vegetation with grasslands having a much lower biomass and nutrient content. Higher altitude dryland environments were the most susceptible to degradation due to lower fertility soils, higher rainfall and higher rates of soil loss by erosion. The Huli people have responded to these differences in ecological stability by concentrating their agricultural activities increasingly on to the more fertile wetland areas. Much of this movement into the lower parts of the basin is thought to have occurred in the period since European contact, over the last 50 years. These findings have implications for much of the Papua New Guinea highlands where volcanic ash soils occur. Although these soils are highly suitable for growing sweet potato and have been able to support large rural populations with their pigs, they are unable to remain productive under continuous cultivation even though the cropping practices of most highland groups are well adjusted to conserving soil fertility and maximizing crop yields. The chemical fertility of volcanic ash soils is being progressively depleted and much greater efforts are needed to promote the restoration of soil fertility during the fallow period. Much greater emphasis is needed on improving fallow practices such as the promotion of woody regrowth and forest regeneration and the growing of leguminous cover crops to protect soils against erosion and to provide a large volume of nutrient-rich plant material suitable for composting.
Fertility ; Soil ; Asymmetric Septal Hypertrophy ; Ecology ; Agriculture

In this 6 months study the researchers measured the challenges of people with epilepsy who were all members of the Epilepsy Support Foundation in Harare, Zimbabwe. Possible challenges arising from the various aspects of life of 60 people with epilepsy were measured using a Problem Index Questionnaire for People with Epilepsy adapted from Dr. John Collings Problem Index method which was used at Leeds Polytechnic in 1990 to develop the British Epilepsy Association’s Charter for Epilepsy. The method uses a short questionnaire that has a set of problem areas with three possible responses, ‘no problem’, ‘some problems’ and ‘serious problems’. The index was found by combining ‘some problems’ and ‘serious problems’ and refl ects the degree to which an aspect of life was problematic. Results from interviews and observations were also utilised. The study shows that the people with epilepsy’s major life challenges are psychosocial, followed by economic and lifestyle. The most common issues regarded as problematic are: securing adequate income (93%), society’s attitude (87%), stigma (87%), standard of living (83%), memory (83%), overprotection (78%), fi nding and maintaining employment (78%).

Amputation ; adverse effects ; Amputation Stumps ; physiopathology ; surgery ; Analgesics ; administration & dosage ; Chronic Pain ; etiology ; physiopathology ; therapy ; Combined Modality Therapy ; Female ; Humans ; Hypnosis ; methods ; Middle Aged ; Pain Management ; Phantom Limb ; etiology ; physiopathology ; therapy ; Reoperation ; Treatment Outcome ; Upper Extremity ; injuries ; surgery

Objective To quantitatively compare the effects of bleach and peracetic acid reprocessing on the clearance and surface charge characteristics of Fresenius F80B polysulfone dialyzers. Methods Clearance experiments were performed using urea, vitamin B_12, and polydisperse dextrans in an in vitro dialysis circuit. Clearance, ultrafiltration coefficient and zeta potential were obtained on a new F80B dialyzer, after exposure to plasma in a 3 h in vitro dialysis session, and after cleaning with bleach and peracetic acid.Results Bleach was able to remove the protein deposit, restoring the clearance characteristics, but there was a significant increase in the net negative charge of the membrane due to chemical reaction with the bleach. In addition, longer time exposure to bleach altered the membrane transport characteristics, increasing the solute clearance. Dialyzers cleaned with peracetic acid had significantly lower clearance of the larger dextrans due to the presence of residual protein on or within the membrane. Conclusion Cleaning with bleach and peracetic acid may have dramatically different effects on the clearance and surface charge characteristics of F80B polysulfone dialyzers.

AIM: To study the clinical features, histology and immunohistochemical properties of gastrointestinal stromal tumours (GISTs); and establish any parameters that can help prognosticate the malignant potential. METHODS: Twenty-six patients with GISTs who were seen in Sultanah Aminah Hospital Johor, Malaysia from 1999 to 2003 were selected for study. Patient, clinical characteristics and outcome based on surgical records were analysed. Tumour variables (tumour size, cellularity, mitotic count, necrosis and haemorrhage) were compared between very low to low risk groups and intermediate to high risk groups. The immunohistochemical properties of GISTs were also studied. RESULTS: Patients with GISTs presented mainly with pain, palpable mass or gastrointestinal tract bleeding. The tumours were seen in stomach (50%) followed by small intestine (38.5%) and rectum (11.5%). In the period of study, six patients had metastasis, mainly in the liver or peritoneum. Immunoreactivity for CD117, CD34, vimentin, S100, neuron specific enolase, alpha-smooth-muscle-actin and desmin were observed in 100%, 76.9%, 61.5%, 46.1%, 80.8%, 11.5% and 0% of tumours respectively. The behaviour of GISTs was largely dependent on tumour size and number of mitosis. Necrosis and haemorrhage were seen in tumours with high risk potential.
Gastrointestinal ; Clinical ; Risk ; Hemorrhage ; SIZES