Equipment Design ; Gastrostomy ; instrumentation ; methods ; Humans

Wilson disease is an autosomal recessive disorder of copper metabolism that is rarely reported among Filipinos. Four children with Wilson disease presenting with various hepatic manifestations, namely, an asymptomatic elevation of transaminase levels, prolonged jaundice and acute liver failure are presented. The diagnosis was based on a combination of clinical and biochemical findings. Early recognition and management is important as effective treatment could reverse the damage caused by copper toxicity.

The inflammatory nature of atherosclerosis has long been postulated, and though currently widely accepted, the concept is difficult to disseminate and to translate into concrete public health measures. Through the years, it has been discerned that low density lipoprotein (LDL) cholesterol serves as the stimulus for the inflammatory response when it is deposited into the subendothelium. LDL stimulates the migration of the inflammatory cells into the subendothelium; a sequelae of cellular immune responses and a cascade of cytokines ensue, eventually resulting in the formation of a vulnerable plaque. Inflammatory cells, particularly macrophages and lymphocytes, and their cytokines play a role in all stages of the atherosclerotic process, modulating the vascular remodeling process as more LDL cholesterol is absorbed into the subendothelial space and forms an ever enlarging lipid core. When inflammatory cells release metalloproteinases into the fibrous cap separating the lipid core from the lumen, plaque becomes vulnerable to rupture especially with increased shear stress from luminal blood flow resulting in thrombosis; clinically acute coronary syndromes become manifest. The role of mast cells, macrophage apoptosis, and the role of the vasa vasorum in plaque progression has recently been delineated. Pharmacologic intervention to aggressively lower LDL cholesterol culminated in the discovery of statins which were proven in large landmark trials to lower the morbidity and mortality associated with the atherosclerotic process. Several generations of statins have evolved; however, residual mortality is observed despite aggressive therapy. A recent trial showing the beneficial effects of statins in patients with acceptable or normal lipid profiles but with elevated high sensitivity C reactive protein (hsCRP) augurs a change in the paradigm of treatment for atherosclerosis. Inflammatory biomarkers such as hsCRP and lipoprotein-associated phospholipase A2 (Lp-PLA2) are anticipated to change guidelines and treatment algorithms, and public health policy. The implication of infectious processes as triggers of inflammation in the atherosclerotic process is also discussed, particularly the role of periodontal disease, the role of flu vaccination, and the role of bacteria such as Chlamydia and Helicobacter. 

Persons with HIV infection are vulnerable to mental health problems. The most common mental health problems among those infected with HIV are Depressive Disorders and Anxiety Disorders. HIV infection can also have direct effects on the central nervous system resulting in neuropsychiatric consequences like HIV encephalopathy, depression, mania, cognitive disorder and dementia. Substance use disorders are also common co-morbid conditions present among HIV infected persons. Refugees and asylum seekers are at a greater risk to develop mental health problems compared to the general population. Depressive Disorders, Anxiety Disorders and Post Traumatic Stress Disorder are commonly detected among refugees who seek health care. Thus being a refugee and also being infected by HIV increases the risk of developing mental health problems. Mental health problems have implications on treatment seeking behaviours and treatment adherence. There is a reluctance to report psychological distress because of the stigma associated with psychiatric illnesses especially for HIV infected individuals who are already living with the stigma of HIV. The lack of skill of many health care professionals in detecting psychological symptoms also impacts on the making of diagnoses of psychiatric disorders in this population of patients. These factors are of importance because mental health issues have a negative impact on treatment adherence. This presentation will aim to explore mental health issues pertinent to refugees who are infected by HIV utilizing a few case studies.

With increasing globalization and a trend towards international harmonization of standards for the care and use of animals in research and testing,there is a significant need to assist and support countries to develop training programs for laboratory animal veterinarians. Although formal educational opportunities for training laboratory animal veterinarians exist through well-established specialty colleges of laboratory animal medicine such as ACLAM,ECLAM,JCLAM,and KCLAM or through other professional organisations,such as the Federation of European Laboratory Animal Science Associations ( FELASA ),opportunities for participating in these programs are often limited to veterinarians in North America,Western Europe and specific regions of Asia. Creative thinking is required to develop cost-effective,practical,entry-level and advanced continuing education and applied training programs for veterinarians working in the field of laboratory animal medicine around the world.This paper will describe one potential solution for this issue,the use of a distance education program that provides theoretical information in a virtual classroom with applied training modules to deliver knowledge and practical skills to laboratory animal veterinarians.This type of program takes advantage of the online learning environment and can be an effective means to deliver training at the grassroots level to adult learners.