Hypertension ; Complementary Therapies

<b>Introductionb>
 Recent strategic plans for HIV/AIDS control in Sri Lanka have stressed the need to focus prevention interventions on most-at-risk populations and similarly laid out the importance of improving HIV/AIDS awareness among the general population. Programmatic attention has to be strengthened to effectively change AIDS-related poor knowledge, low risk perceptions and risky sexual practices at the individual level, and avert an epidemic. While current data on at-risk populations are available to inform interventions, there is paucity of latest evidence for the general population programs.
<b>Methodsb>
 In April-May 2009, a cross-sectional study involving 1,239 population-based and randomly selected respondents aged 15-49 was completed in Kandy, Sri Lanka (response rate=87.2%). The study collected data on HIV/AIDS knowledge, perceptions and sexual practices among the general population to supply current information for the intervention. Data were analyzed using univariate, bivariate and multivariate approaches.
<b>Resultsb>
 While almost all respondents were aware of HIV/AIDS, sizeable proportions (44.7-76.2%) knew little about the types of sexually transmitted infections, and about the transmission modes and prevention methods of HIV/AIDS. Although 80% of respondents had low risk perceptions and were mostly at low risk behaviorally, their knowledge of HIV/AIDS was inadequate. They assessed their risks and practiced unsafer sex without the benefit of having evidence-based knowledge. The knowledge, perceptions and practices were significantly associated with gender, marital status, education, religion, and/or residence.
<b>Conclusionsb>
 The gaps in substantive knowledge on HIV/AIDS suggest that no effective information and other related types of support have been provided to the general population in Sri Lanka. In the context of the need to contribute to sustaining the low prevalence of HIV in the country, a base of scientific knowledge and wider advocacy programs should be developed.

Adolescent ; Adult ; Asthma ; drug therapy ; Czechoslovakia ; History of Medicine ; Humans ; Injections, Subcutaneous ; Isoquinolines ; administration & dosage ; Mental Disorders ; drug therapy ; Psychiatry ; history ; Terbutaline ; administration & dosage ; therapeutic use ; Tranquilizing Agents ; history ; therapeutic use ; Tretoquinol ; administration & dosage ; therapeutic use

Adsorption ; Child ; Child, Preschool ; Female ; Humans ; Liver Failure, Acute ; therapy ; Liver, Artificial ; Male ; Membranes, Artificial ; Retrospective Studies ; Sorption Detoxification

Background: Neuropathic symptoms and signs are common in the elderly and are often considered normal fi ndings. However, symptomatic polyneuropathy may contribute to disability and falls in the elderly. The prevalence of peripheral neuropathy in the elderly in Malaysia has not been previously reported. The objective of this pilot study is to determine the frequency of symptomatic sensory polyneuropathy in a group of elderly subjects in the community and their possible associated factors. Methods: Cross sectional survey of subjects aged 65 years and above, carried out in an urban neighbourhood in Petaling Jaya. Using a standardised questionnaire, subjects were asked about sensory neuropathic symptoms, associated medical conditions and social habits. They were examined for the ankle refl ex, vibration, joint position, and pinprick sensations. Possible symptomatic sensory polyneuropathy was defi ned as bilateral distal neuropathic symptoms, loss of pinprick sensation and proprioception sense. Results: Of the 100 subjects, 63% had neuropathic symptoms and signs and 20% had possible symptomatic sensory polyneuropathy. Subjects with polyneuropathy complained of more postural instability and giddiness and distal weakness. Diabetes mellitus was associated with the presence of neuropathic symptoms and signs but not with polyneuropathy. Age was signifi cantly associated with polyneuropathy. Conclusion: The frequency of symptomatic sensory polyneuropathy in a group of elderly subj

OBJECTIVE: Symptomatic thoracic disc herniation often requires prompt surgical treatment to prevent neurological deterioration and permanent deficits. Anterior approaches offer direct visualization and access to the herniated disc and anterior dura but require access surgeons and are often associated with considerable postoperative pain and pulmonary complications. A disadvantage with using posterior approaches in the setting of central calcified thoracic disc herniation however, has been the limited visualization of anterior dura and difficulty to accurately assess the extent of decompression. METHODS: We report our experience with intraoperative ultrasound (US) guidance during a modified posterior transpedicular approach for removal of a central calcified thoracic disc herniation with a review of pertinent literature. RESULTS: The herniated thoracic disc was successfully removed with posterior approach with the aid of intraoperative US. The patient had significant neurological improvement at three months follow-up. CONCLUSION: Intraoperative ultrasound is a simple yet valuable tool for real-time imaging during transpedicular thoracic discectomy. Visualization provided by intraoperative US increases the safety profile of posterior approaches and may make thoracotomy unnecessary in a selected group of patients, especially when a patient has existing pulmonary disease or is otherwise not medically fit for the transthoracic approach.
Decompression ; Diskectomy ; Follow-Up Studies ; Humans ; Intervertebral Disc Displacement ; Lung Diseases ; Pain, Postoperative ; Thoracotomy ; Ultrasonography

<B>IntroductionB>
Whereas the numbers of new HIV infections and deaths due to AIDS have been reduced or stabilized, they remain high in sub-Saharan Africa. To further control the generalized epidemics and their consequences, countries have continued strengthening their programs to prevent new infections and deaths: however, program outcomes and impact at the national level are not well understood. The purpose of the review was to describe the country-level outcomes and impact of HIV/AIDS programs in eight sub-Saharan African countries in order to highlight future action agenda to meet universal access and policies related to Millennium Development Goals (MDGs).
<B>MethodsB>
The review used 16 of the 25 program outcome and impact indicators prescribed by the United Nations General Assembly Special Session (UNGASS). The review reported on the percentages accomplished by each country in their programs, categorized these figures into high (80% and higher), moderate (50-79%) and low (below 50%), and highlighted the domains in which outcomes and impact were high.
<B>ResultsB>
Across countries, with the exception of Tanzania, programs had achieved nearly universal or universal outcomes and impact, but their coverage was limited to 2-5 program domains. Moreover, in domains with multiple target groups, such as in the provision of antiretroviral therapy and in the promotion and distribution of condom use, the programs were unable to produce high-end results for the affected populations. To further reduce their infections and deaths and to advance towards universal access and MDGs, countries must make their program outcomes and impact comprehensive and equitable.
<B>ConclusionB>
Almost all national programs have high level accomplishments, but they must broaden their domain and audience coverage to further control the generalized epidemics and deaths in the eight countries. National responses must collect and analyze all the UNGASS data systematically and regularly in order to determine current HIV/AIDS knowledge and behaviors, ascertain program effects, and inform future actions.

OBJECTIVE: The object of this study was to assess the accuracy of dipyridamole stress intravenous (IV) myocardial contrast echocardiography (MCE) using pulse inversion harmonic imaging and PESDA in the detection of perfusion defect in the patients with coronary artery disease in comparison with dipyridamole stress Tc-99m sestamibi SPECT. METHODS: Total 46 patients (29 males, mean age 64 years old) were consecutively enrolled. Patients with prior myocardial infarction were excluded. MCE and Tc-99m sestamibi SPECT were performed at the same day during rest and after 0.56 or 0.84mg/Kg dipyridamole infusion. Continuous IV infusion of PESDA (2-5 mL/min) was administered while obtaining triggered (1:1) end-systolic apical 2, 4 chamber and long axis views. Tc-99m sestamibi was injected 3 minutes after dipyridamole. Tc-99m sestamibi SPECT images were obtained one hour later. Coronary angiography was followed within two days in all patients. Tc-99m sestamibi SPECT images were matched to the sixteen segments of left ventricle according to American Society of Echocardiography for segmental comparison. Both images were analyzed visually. Results Using coronary angiography as the standard, MCE showed overall sensitivity of 70.7%, specificity of 95.8%, positive predictive value (PPV) of 87.8% and negative predictive value (NPV) of 88.5% in the detection of coronary atherosclerosis (70% stenosis). Tc-99m sestamibi SPECT showed sensitivity of 75.6%, specificity of 98.9%, PPV of 96.8% and NPV of 90.6%. The overall concordance rate between MCE and Tc-99m sestamibi SPECT for the detection of perfusion defects was 86.9% (Cohen's kappa value 0.63) according to the coronary territory and 86.8% (Cohen's kappa value 0.55) according to segmental analysis. CONCLUSION: Dipyridamole stress IV MCE using pulse inversion harmonic imaging and PESDA is feasible and comparable to Tc-99m sestamibi SPECT in identifying significant coronary stenosis and inducible myocardial perfusion defects in the patients with coronary artery disease. MCE using pulse inversion harmonic imaging seems to be a promising modality for assessing myocardial perfusion in the patients with suspected coronary artery disease.
Axis, Cervical Vertebra ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis ; Dipyridamole ; Echocardiography* ; Heart Ventricles ; Humans* ; Male ; Myocardial Infarction ; Perfusion* ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon*

Hypoglycemia sometimes manifests as focal neurologic deficits simulating cerebrovascular disease. Symptoms are usually resolved by glucose infusion, but persistent hemiplegia is rarely reported. A 68-year-old diabetic woman on oral hypoglycemic agent(OHA) was admitted with right hemiplegia and global aphasia. Blood glucose level was 29 mg/dl on admission. No evidence of cerebral infarct or underlying brain disease could be found on initial brain CT and follow up MRI. Focal stenosis or occlusion was also absent on MR angiography. Hemiplegia and aphasia were not improved despite adequate therapy. Hypoglycemic hemiplegia should be suspected in all diabetic patients using insulin or OHA with stroke-like episode, and we suggest that prolonged hypoglycemia may be related to persistence of neurologic deficits.
Aged ; Angiography ; Aphasia ; Blood Glucose ; Brain ; Brain Diseases ; Constriction, Pathologic ; Female ; Follow-Up Studies ; Glucose ; Hemiplegia* ; Humans ; Hypoglycemia ; Insulin ; Magnetic Resonance Imaging ; Neurologic Manifestations

Recent reports on growth hormone (GH) therapy have shown that GH has various beneficial effects in GH deficient adults. In most of these studies, GH was administered daily. Because GH is still expensive and has to be delivered by subcutaneous injection, we studied the 6-month therapeutic effects of thrice weekly GH injection therapy and compared it with daily therapy. Twenty eight adult patients with GH deficiency were randomly assigned into group 1 (ten cases, thrice weekly injections of GH), group 2 (nine cases, daily injections), and group 3 (nine cases, placebo injections). Lean body mass, serum basal GH levels, and insulin-like growth factor 1 levels significantly increased after six months of GH therapy in both groups 1 and 2. According to computed tomography, the mean mid-thigh muscle mass significantly increased in group 1, while the visceral fat mass significantly decreased in group 2. GH levels significantly increased exercise rate-pressure product and hand grip strength only in group 1. These results suggest that thrice weekly injections of GH are as effective as daily injections in GH deficient adults.
Adult ; Anthropometry ; Body Composition/drug effects ; Bone Density/drug effects ; C-Peptide/blood ; Carbohydrate Metabolism ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Exercise/physiology ; Female ; Growth Hormone/*administration & dosage/adverse effects/*deficiency ; Humans ; Insulin/blood ; Insulin-Like Growth Factor I/metabolism ; Lipids/blood ; Male ; Middle Aged ; Tomography, X-Ray Computed