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How does a Pacific country deal with someone who is HIV positive? What support can be expected from society and family if one is infected by HIV? How does the rhetoric of being a family-oriented and caring society fit with the realities of what happens to HIV positive people? This presentation talks about the experience of an HIV positive woman. Peati Maiava is from Samoa. She was married in June 1992 and subsequently had two sons. Her youngest son, Fiti, died after much suffering of an undiagnosed disease in January 1996. Her husband died, after being diagnosed with AIDS in April 1996. Before he died, he pleaded for forgiveness for the chaos he had brought to the family. Looking back, Peati strongly suspects that Fiti also died from an AIDS-related condition--although there was no medical confirmation at the time. Before he died, Peati's husband was plagued with influenza, diarrhea, fevers, boils on his face, throat, and body, immense pain and headaches, violent temper, and incredible loss of body weight. This man was once one of MANU Samoa's best flankers (footballers) ever. He died a skeleton in the wake of AIDS. In the aftermath of the two untimely deaths in the family, living with her only remaining son Natal was unbearable; Peati knew she was HIV-positive and that it was only a matter of time before she would face a similar death. Her life became intolerable--after the death of her husband she was forced from her employment when her employer learned of her positive status. Some of her so-called friends and relatives also turned their back on her. With no employment and HIV-positive status she considered suicide. But her love of God and the love of her son she could not forsake. Peati did forgive her husband before he died but the scars and bitter memories are hard to overcome at times. Peati thanked the conference for the sponsorship, which allowed her to attend the conference. The moral and financial support offered to by her friends, and to Andrew Peteru who was instrumental in helping her to participate in the conference.
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PMID:Samoa: the realities of living with HIV in Samoa. 1229 67

To estimate the incidence of, identify risk factors for, and describe the clinical presentation of travel-associated African tick bite fever (ATBF), a rapidly emerging disease in travel medicine, we prospectively studied a cohort of 940 travelers to rural sub-Equatorial Africa. Diagnosis was based on suicide polymerase chain reaction and the detection of specific antibodies to Rickettia africae in serum samples by multiple-antigen microimmunofluorescence assay, Western blotting, and cross-adsorption assays. Thirty-eight travelers, 4.0% of the cohort and 26.6% of those reporting flulike symptoms, had ATBF diagnosed. More than 80% of the patients had fever, headache, and/or myalgia, whereas specific clinical features such as inoculation eschars, lymphadenitis, cutaneous rash, and aphthous stomatitis were seen in < or = 50% of patients. Game hunting, travel to southern Africa, and travel during November through April were found to be independent risk factors. Our study suggests that ATBF is not uncommon in travelers to rural sub-Saharan Africa and that many cases have a nonspecific presentation.
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PMID:African tick bite fever in travelers to rural sub-Equatorial Africa. 1276 36

Acute ingestion of copper sulfate has been reported to cause gastrointestinal injury, hemolysis, methemoglobinemia, hepatorenal failure, shock; or even death. The toxicity of organocopper compounds, however, remains largely unknown. A 40-y-old man attempted suicide by ingesting some 50 ml of Sesamine fungicide. He immediately developed headache, vomiting and abdominal pain, followed by progressive dyspnea, cyanosis, dark urine and diarrhea. Severe methemoglobinemia and hemolysis were documented, and treatment with ascorbic acid and hydration was commenced. He was referred to our service 3 d later for methylene blue treatment. Despite the above treatment, his symptomatology persisted and it was not until 5 d post-ingestion that the implicated fungicide was identified as copper-8-hydroxyquinolate. BAL therapy and plasma exchange were instituted, which decreased his plasma hemoglobin from 1,300 mg/dL to 29.1 mg/dL, and lowered his methemoglobin level from 20.9% to 1.1%. His serum and urine copper concentration dropped from 238 microg/dL to 96 microg/dL and from 112 microg/dL to 16 microg/dL, respectively. He was discharged uneventfully 18 d post-ingestion. Pre-existing glucose-6-phosphate dehydrogenase (G6PD) deficiency as well as copper-induced inhibition of G6PD activity was documented during hospitalization. Organocopper compounds may cause prolonged hemolysis and methemoglobinemia through oxidative stress, especially among patients with G6PD deficiency. Antidotal therapy with methylene blue is not likely to be effective in this setting: treatment with intensive supportive measures and other therapeutic options, such as plasma exchange, should be sought.
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PMID:Prolonged hemolysis and methemoglobinemia following organic copper fungicide ingestion. 1558 50

Domestic violence (DV) is a serious risk for women's health. So far, little attention has been paid to this area in research and medical care in Germany. Acknowledging this deficit, the S.I.G.N.A.L.-Intervention Project has started to develop a program to improve the medical care for victimized women. For the first time in Germany, data on the health care needs of victimized women have been collected within the S.I.G.N.A.L.-Evaluation Research Project. This article presents the results of a female patient survey (n=806) on DV conducted in the emergency department (ED) of a university hospital in Berlin. The results demonstrate that 36.6% of women reported at least one episode of DV after the age of 16. A total of 4.6% were victims of DV over the past year, and 1.5% of women came to the ED for treatment of injuries caused by violence. A total of 57% of the victims of at least one episode of DV in their lifetime after the age of 16 described a negative impact on their health. The most frequently reported sequelae were head injuries, haematomas and fractures, gastrointestinal disorders, headache/migraine and heart disease. The psychological symptoms were anxiety, depression and suicide/self-mutilation attempts. Some 52% of the victims who reported health consequences had received medical care. In case of DV occurring, 67% of all women said that they would discuss it with their physicians. Approximately 80% of all respondents favoured a routine inquiry for DV as part of the medical history protocol of the ED.
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PMID:[Domestic violence against women and health care demands. Results of a female emergency department patient survey]. 1576 6

In the prevention of relapses and disability by interferon subcutaneously in multiple sclerosis (PRISMS) study, 560 patients with relapsing-remitting multiple sclerosis were randomized to receive subcutaneous interferon (IFN) beta-1a, 22 or 44 mug three times weekly, or placebo, for 2 years. Patients receiving placebo were then re-randomized to one of the two doses of IFN beta-1a for a further 2 years, whilst patients receiving active treatment continued their original treatment. Safety assessments were performed throughout the study. The most common adverse events for patients originally randomized to active treatment were injection-site inflammation (72% of patients had at least one event), headache (71%) and influenza-like symptoms (69%). These were generally mild in nature and most frequent during the first month of treatment. The 4-year adverse event profiles for the two IFN beta-1a doses were comparable with those observed during the initial phase of the study and, for the most part, with each other. There was no association between IFN beta-1a and depression or suicide/attempted suicide. The most common laboratory abnormalities were asymptomatic lymphopenia and elevated serum liver transaminase levels. These were generally mild and resolved spontaneously. Therapy with subcutaneous IFN beta-1a three times weekly for up to 4 years was well tolerated without dose-limiting safety concerns.
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PMID:The long-term safety and tolerability of high-dose interferon beta-1a in relapsing-remitting multiple sclerosis: 4-year data from the PRISMS study. 1605 75

A case of a 23-year-old female, after renal transplant, who had tried to commit suicide with 100 mg of Prograf was described. In the presented case despite the relatively high tacrolimus blood concentration level (>30 microg/l) only severe 5-hour lasting headache and short-term mild hyperglycaemia (7.22 mmol/l), hyperkalemia (5.4 mmol/l) and considerable leukocytosis (19.52 x 10(3)) were observed. In this case there was mild clinical course of intoxication despite tacrolimus high blood concentration. It could not be excluded that early administration of gastric lavage and activated carbon was partly responsible for mild course of poisoning.
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PMID:Acute suicidal intoxication with tacrolimus in a kidney transplant patient. 1622 10

Major depression is a mood disorder characterized by a sense of inadequacy, despondency, decreased activity, pessimism, anhedonia and sadness where these symptoms severely disrupt and adversely affect the person's life, sometimes to such an extent that suicide is attempted or results. Antidepressant drugs are not always effective and some have been accused of causing an increased number of suicides particularly in young people. Magnesium deficiency is well known to produce neuropathologies. Only 16% of the magnesium found in whole wheat remains in refined flour, and magnesium has been removed from most drinking water supplies, setting a stage for human magnesium deficiency. Magnesium ions regulate calcium ion flow in neuronal calcium channels, helping to regulate neuronal nitric oxide production. In magnesium deficiency, neuronal requirements for magnesium may not be met, causing neuronal damage which could manifest as depression. Magnesium treatment is hypothesized to be effective in treating major depression resulting from intraneuronal magnesium deficits. These magnesium ion neuronal deficits may be induced by stress hormones, excessive dietary calcium as well as dietary deficiencies of magnesium. Case histories are presented showing rapid recovery (less than 7 days) from major depression using 125-300 mg of magnesium (as glycinate and taurinate) with each meal and at bedtime. Magnesium was found usually effective for treatment of depression in general use. Related and accompanying mental illnesses in these case histories including traumatic brain injury, headache, suicidal ideation, anxiety, irritability, insomnia, postpartum depression, cocaine, alcohol and tobacco abuse, hypersensitivity to calcium, short-term memory loss and IQ loss were also benefited. Dietary deficiencies of magnesium, coupled with excess calcium and stress may cause many cases of other related symptoms including agitation, anxiety, irritability, confusion, asthenia, sleeplessness, headache, delirium, hallucinations and hyperexcitability, with each of these having been previously documented. The possibility that magnesium deficiency is the cause of most major depression and related mental health problems including IQ loss and addiction is enormously important to public health and is recommended for immediate further study. Fortifying refined grain and drinking water with biologically available magnesium to pre-twentieth century levels is recommended.
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PMID:Rapid recovery from major depression using magnesium treatment. 1654 86

Long-term efficacy and safety of paliperidone extended-release tablets (3-12 mg/day) were evaluated in pooled data from 52-week open-label extension (OLE) phases of three 6-week, placebo-controlled, double-blind (DB) trials involving 1083 schizophrenia patients. Forty-seven percent of patients completed the OLE phase. Outcome measures included Positive and Negative Syndrome Scale and Personal and Social Performance scale scores. Improvements observed on both scales in active treatment groups during the DB phases were maintained during the OLE phase. Most commonly (> or =10% patients) reported adverse events (AEs) were insomnia, headache, and akathisia. One or more serious AEs were reported by 16% of patients; two patients had a treatment-emergent AE that resulted in death (suicide). Extrapyramidal symptom-related AEs were reported by 25% of patients. Median maximum movement disorder rating scale scores indicated no severity change during the OLE. Mean (+/-SD) increase in body weight from OLE baseline to end point was 1.1+/-5.47 kg across treatment groups and there were no clinically meaningful changes for plasma glucose, insulin or lipid levels. This analysis shows that paliperidone extended-release can maintain improvements in symptoms and functioning and is generally well tolerated for up to 52 weeks in schizophrenia patients.
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PMID:Efficacy and safety of oral paliperidone extended-release tablets in the treatment of acute schizophrenia: pooled data from three 52-week open-label studies. 1885 23

The goals of this study were to assess the validity and usefulness of a new scale and to assess disability in a sample of patients with chronic daily headache. Participants were a convenience sample of 61 adult outpatients admitted to the Department of Medical Sciences of the Sant'Andrea Hospital in Rome, between September 2007 and May 2008. Inclusion criteria were, a diagnosis of chronic daily headache (illness duration >5 years). Patients were administered the Beck Hopelessness Scale (BHS), a specific section of the Mini-International Neuropsychiatric Interview (MINI) assessing suicidal intent, the Gotland Male Depression Scale (GMDS), and a scale devised to measure the degree of disability caused by the headache [Italian Perceived Disability Scale (IPDS)]. Analyses indicated that the IPDS had good internal consistency (Cronbach alpha = 0.93; average inter-item correlation = 0.40), and good convergent validity, with moderate to strong associations with measures assessing emotional distress (BHS, r = 0.47; P < 0.0001; GMDS, r = 0.72; P < 0.001). A single-item, logistic regression analysis indicated that the IPDS is able to predict suicide intent (Wald chi(2) = 5.04; P < 0.05) in chronic daily headache patients. The IPDS is a brief instrument that is useful for comparisons with other chronic illnesses, and it may be used both for basic research and clinical applications when screening for comorbidity with emotional distress and disorders.
J Headache Pain 2009 Feb
PMID:The validation of the Italian Perceived Disability Scale (IPDS) in chronic daily headache sufferers. 1885 20

To evaluate the relationship among quality of life, temperament, illness perception, and mental turmoil in patients affected by chronic daily headache with concomitant medication overuse headache. Participants were 116 consecutive adult outpatients admitted to the Department of General Medicine of the Sant'Andrea Hospital in Rome, between January 2007 and December 2007 with a diagnosis of chronic daily headache (illness duration >5 years). Patients were administered the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-autoquestionnaire version (TEMPS-A), the Beck Hopelessness Scale (BHS), the Hamilton Rating Scale for Depression (HAM-D), the Mini-International Neuropsychiatric Interview (MINI), the Revised Illness Perception Questionnaire (IPQ), the Suicide Score Scale (SSS), and the Quality of Life Index (QL-Index). Twenty-eight percent of the patients evidenced moderate to severe depression, and 35% evidenced severe hopelessness. Analyses also indicated that quality of life, temperament, illness perception, and psychological turmoil are associated. However, a hierarchical multivariate regression analysis with quality of life as dependent variable indicated that only a model with mental turmoil variables may fit data; further, only the MINI suicidal intent resulted associated with quality of life (standardized regression coefficient = -0.55; t = -3.06; P < 0.01). Suicide risk may play a central role in affecting the quality of life of patients with chronic headache. The investigation of the interplay of factors that precipitate suicide risk should include assessment of chronic headache and its effects on wellbeing.
J Headache Pain 2008 Dec
PMID:Mental turmoil, suicide risk, illness perception, and temperament, and their impact on quality of life in chronic daily headache. 1895 88


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