The outlook of people living with HIV (PLHIV) has changed for the better. With the discovery of effective drugs HIV is more like a chronic disease. The family doctor has several roles in HIV medicine: find, test, treat, and retain. Find - at risk individuals, and reduce their HIV risks. Test – to diagnosis those with acute HIV infection, to identify the asymptomatic patients, and to identify those with AIDS defining illnesses. Treat - participate in shared care management with HIV specialists. Retain – retain wellbeing of PLHIV - monitor for complications, provide patient education to help them minimise complications. Routine testing for HIV infection is now the practice. For treatment, A combination ART regimen consisting of two NRTIs + one active drug from one of the classes: NNRT, PI, INSTI, or a CCRS antagonist. Retaining the wellbeing of PLHIV requires monitoring for complications, and providing patient education to help them minimise complications.

Ductus Arteriosus, Patent ; drug therapy ; Humans ; Indomethacin ; therapeutic use ; Infant, Extremely Low Birth Weight ; Infant, Newborn

It is aging fast in Korea like other Asian countries. Social care systems, human resources, and appropriate senior products for elderly people are important factors to keep the society ealthy and productive. In this paper, we introduce the current status of senior products and standards in Korea including the Korea Senior Product Association (KSPA); present general status of the senior industry in Korea,long-term care insurance program for the elderly as well as welfare items; discuss problems and importance of standardization in the senior industry, the scope of senior products, and the current status of standardization.

The panic attack is able to mimic the clinical presentation of an acute coronary syndrome (ACS), to the point of being clinically indistinguishable without appropriate investigations. However, the literature actually demonstrates that the 2 conditions are more related than just being differential diagnoses. Through a review of the literature involving epidemiological studies, randomised controlled trials, systematic reviews and meta-analyses found on a Medline search, the relation between panic disorder and ACS is explored in greater depth. Panic disorder, a psychiatric condition with recurrent panic attacks, has been found to be an independent risk factor for subsequent coronary events. This has prognostic bearing and higher mortality rates. Through activation of the sympathetic system by differing upstream mechanisms, the 2 conditions have similar presentations. Another psychiatric differential diagnosis would be that of akathisia, as an adverse effect to antidepressant medications. An overview on the investigations, diagnostic process, treatment modalities and prognoses of the two conditions is presented. Panic disorders remain under-diagnosed, but various interviews are shown to allow physicians without psychiatric training to accurately pick up the condition. Comprehensive multidisciplinary approaches are needed to help patients with both coronary heart disease and anxiety disorder.
Acute Coronary Syndrome ; diagnosis ; physiopathology ; psychology ; Humans ; Panic Disorder ; complications ; diagnosis ; physiopathology ; Risk Factors

A four-month cross-sectional study found five species of parasitoids parasitizing puparia of filth flies breeding at the Taman Beringin landfill in Kepong and a poultry farm in Sungai Pelek, Sepang, Selangor. Effect of monthly rainfalls towards density of flies and percentage of parasitoids emerging from collected puparia were also analyzed. Spalangia sp. was the most common, consisting of Spalangia endius Walker, S. cameroni Perkins and S. gemina Boucek. Other parasitoids collected were Pachycrepoideus vindemmiae Rondani and Exoristobia phillipinensis Ashmead. The parasitized fly hosts were Musca domestica Linn. and Chrysomya megacephala Fabricius. S. endius was the most common parasitoid attacking M. domestica at both locations. M. domestica was the most common fly found at the Sg. Pelek poultry farm whereas C. megacephala was the most numerous at the Taman Beringin landfill. During heavy rainfall month of November 2003, density of flies were high whereas the emerging parasitoids were low at both landfill and poultry farm. The present study revealed the endemic presence of parasitoids especially S. endius in both poultry farm and garbage landfill and the potential of the parasitoid species in fly control in Malaysia.

Background and Objectives: Anticoagulation clinics are widely used for anticoagulation management in many countries, but have only recently began to gain acceptance in Taiwan. Our service model is a physician-managed outpatient clinic collaborating with clinical pharmacist and nurse. This study aimed to evaluate the adequacy of anticoagulation and rates of warfarin-related complications before and after referral to our collaborative anticoagulation clinic (CAC). Methods: Stroke patients taking warfarin from the neurology department were identifi ed and referred to the CAC during the 12-month period from February 2009 to January 2010. Quality markers include percentage of international normalized ratio (INR) values in the therapeutic range, frequency of INR monitoring, and frequency of follow-up visits and the mean interval of next INR monitoring after non-therapeutic INRs were compared one year before and after management in the CAC. Using studied patients as self-control, they were included in the analysis if patients had at least 3 months follow-up or 3 INR values both before and after referral. Results: A total of 44 stroke patients were included: mean age of 75.0 ± 9.7 years, with a CHADS2 score of 3.71 ± 0.69. The adequacy of anticoagulation was signifi cantly greater during CAC care compared with the period before referral; the percentage of INR within expanded therapeutic range was 60.9% versus 53.7%, respectively (p=0.049). Reduction in sub-therapeutic INR values from 31.8% to 24.2% (p=0.023) contributed mostly to the improved quality of care. The time interval of next INR monitoring after non-therapeutic INRs ( 4.0 or 1.5) was also signifi cantly shorter. However, there was no signifi cant difference in the rates of thromboembolic and hemorrhagic events which may be attributed to a small sample size. Conclusion: Based on results of our study, a CAC may be the optimal structure for anticoagulation management service in the future.

We report a case of closure of the coronary artery fistula with polytetrafluoroethylene (PTFE)-covered stent at the proximal left anterior descending artery along with simultaneous stenting at the stenosed middle segment of the left anterior descending artery. The successful experience proved that this kind of stent is a feasible and safe supplement to catheter-based devices in treating coronary artery fistula, although further evaluation is needed.
Angioplasty, Balloon, Coronary ; Arteries* ; Coronary Vessels* ; Fistula* ; Polytetrafluoroethylene ; Stents* ; Vascular Fistula

Adult ; Aged ; Antimalarials ; therapeutic use ; Female ; Humans ; Immune Reconstitution Inflammatory Syndrome ; drug therapy ; JC Virus ; immunology ; Leukoencephalopathy, Progressive Multifocal ; drug therapy ; Male ; Mefloquine ; therapeutic use ; Middle Aged ; Treatment Outcome

The initial presentation of non-alcoholic steatohepatitis (NASH) is hepatic steatosis. The dysfunction of lipid metabolism within hepatocytes caused by genetic factors, diet, and insulin resistance causes lipid accumulation. Lipotoxicity, oxidative stress, mitochondrial dysfunction, and endoplasmic reticulum stress would further contribute to hepatocyte injury and death, leading to inflammation and immune dysfunction in the liver. During the healing process, the accumulation of an excessive amount of fibrosis might occur while healing. During the development of NASH and liver fibrosis, the gut-liver axis, adipose-liver axis, and renin-angiotensin system (RAS) may be dysregulated and impaired. Translocation of bacteria or its end-products entering the liver could activate hepatocytes, Kupffer cells, and hepatic stellate cells, exacerbating hepatic steatosis, inflammation, and fibrosis. Bile acids regulate glucose and lipid metabolism through Farnesoid X receptors in the liver and intestine. Increased adipose tissue-derived non-esterified fatty acids would aggravate hepatic steatosis. Increased leptin also plays a role in hepatic fibrogenesis, and decreased adiponectin may contribute to hepatic insulin resistance. Moreover, dysregulation of peroxisome proliferator-activated receptors in the liver, adipose, and muscle tissues may impair lipid metabolism. In addition, the RAS may contribute to hepatic fatty acid metabolism, inflammation, and fibrosis. The treatment includes lifestyle modification, pharmacological therapy, and non-pharmacological therapy. Currently, weight reduction by lifestyle modification or surgery is the most effective therapy. However, vitamin E, pioglitazone, and obeticholic acid have also been suggested. In this review, we will introduce some new clinical trials and experimental therapies for the treatment of NASH and related fibrosis.

Humans ; Continuous Positive Airway Pressure ; Anesthesia, General