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Error laden map of death
- Rich Braithwaite (2 December 2008)
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Enteral vs sexual transmission of HIV infections
- Richard G Fiddian-Green (2 December 2008)
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Rich Braithwaite, Specialist Registrar in Psychiatry Orion Centre, Dunsbury Way, Havant, Hants, PO9 5BG
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Dear Madam Roehr's interesting feature is let down by the accompanying map depicting homosexuality laws across the world. Notation of laws concerning same-sex unions in the legend is invisible on the map, but more importantly the map contains serious errors. Specifically, the map wrongly suggests that homosexuality is punishable by death in Gambia, Guyana, Iran, Sierra Leone and, inexplicably, Niger. Although punishable by jail in Gambia, Guyana, Iran and Sierra Leone, there is no law whatsoever against homosexuality in Niger and it is difficult to see how such a mistake has been made. Furthermore, the map fails to recognise the existence of the death penalty for homosexuality in northern Nigeria and Somalia. The cited reference (1) contains the correct information. To clarify, homosexual acts carry the death penalty in the Islamic states of Mauritania, northern Nigeria, Sudan, Somalia, Yemen, United Arab Emirates and, possibly, the Taliban-controlled areas of Afghanistan (2). Additionally, the provocative photograph of two young men being hanged in Iran for the rape of a boy is irrelevant to the article. Although the circumstances of the case are unclear, there has been no evidence to confirm that these men were punished for engaging in consensual sex. Yours sincerely Rich Braithwaite (1) http://www.ilga.org/map/LGBTI_rights.jpg (2) http://en.wikipedia.org/wiki/Homosexuality_laws_of_the_world Competing interests: None declared |
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Richard G Fiddian-Green, FRCS, FACS None
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Gut Associated Lympoid Tissue (GALT) may continue to be a major site of HIV activity, even if drug treatment has reduced HIV count in the peripheral blood (1,2). Might it be a primary site and even the most common site of HIV infection and systemic infection a secondary event? Candidiasis of the oesophagus and bronchi are often the first manifestations of AIDS. This organism thrives in diabetics whose tissues can be expected to have higher levels of glucose than normal subjects, a change that also occurs in reductive stress and may even be a measure of the degree of reductive stress present. In our study of the critically ill the best stand-alone predictors for nosocomial pneumonia were bleeding from stress ulceration [i.e. mucosal damage] (p less than .001), the severity of illness present (p less than .001), and intramucosal acidosis in the stomach [a measure of the degree of reductive stress present] (p = .023)(3). The suggestion that the pneumonias might have been the product of translocation across injured mucosa, rather than aspiration, was subsequently supported by the demonstration in rabbits that the change in gastric mucosal hydrogen ion concentration induced by aortic occlusion "was significantly associated with plasma alanine aminotransferase activity (r2 = .48, p < .01) and bronchoalveolar protein content (r2 = .51, p < .01) (4). In patients having abdominal aortic surgery the development of an intramucosal acidosis in the sigmoid colon was predictive of developing infections from intestinal organisms (5). These organisms may include candida if they have proliferated in the gut. Might, therefore, the prevelance of HIV infections in men who have sex with men, relative to heterosexuals, be a function of their exposure to the intramuminal contents of the rectum? More importantly might metabolic stress in the gastrointestinal mucosa, such as that that commonly induced by alcohol, substance abuse, and exercise (6), and in compromised subjects by eating or even drinking cold water (7), and gastrointestinal infections and infestations, be responsible for the serological changes in HIV antibodies? In the lower socioeconomic class in Hyderabad, India, the frequency of serological evidence of H. pylori infection was greater than 80% by age 20 (8). Mucosal injury, sufficient to permit the translocation of HIV and conversion to seropositivity, in impoverished communities could be very high and even account for the prevalence in heterosexual Caribbean and African populations. 1. Moraima Guadalupe, Sumathi Sankaran, Michael D. George, Elizabeth Reay, David Verhoeven, Barbara L. Shacklett, Jason Flamm, Jacob Wegelin, Thomas Prindiville, and Satya Dandekar. Viral Suppression and Immune Restoration in the Gastrointestinal Mucosa of HIV Type 1-Infected Patients Initiating Therapy during Primary or Chronic Infection Journal of Virology, August 2006, p. 8236-8247, Vol. 80, No. 16 . 2. Anton PA, Mitsuyasu RT, Deeks SG, Scadden DT, Wagner B, Huang C, Macken C, Richman DD, Christopherson C, Borellini F, Lazar R, Hege KM. Multiple measures of HIV burden in blood and tissue are correlated with each other but not with clinical parameters in aviremic subjects. AIDS. 2003 Jan 3;17(1):53-63. 3. Nosocomial pneumonia in the critically ill: product of aspiration or translocation? Fiddian-Green RG, Baker S. Crit Care Med. 1991 Jun;19(6):763-9. 4. Gastric intramucosal pH and multiple organ injury: impact of ischemia-reperfusion and xanthine oxidase. Nielsen VG, Tan S, Baird MS, McCammon AT, Parks DA. Crit Care Med. 1996 Aug;24(8):1339-44. 5. Crit Care Med. 1987 Sep;15(9):835-9. Links Transient episodes of sigmoid ischemia and their relation to infection from intestinal organisms after abdominal aortic operations. Fiddian-Green RG, Gantz NM. 6. Acute stress-related gastrointestinal ischemia. Veenstra RP, Geelkerken RH, Verhorst PM, Huisman AB, Kolkman JJ. Digestion. 2007;75(4):205-7. Epub 2007 Oct 5. PMID: 17921672 [PubMed - indexed for MEDLINE 7. J Cardiovasc Surg (Torino). 1989 Sep-Oct;30(5):852-9. Links Chronic gastric ischemia. A cause of abdominal pain or bleeding identified from the presence of gastric mucosal acidosis. Fiddian-Green RG, Stanley JC, Nostrant T, Phillips D. 8. Graham DY, Adam E, Reddy GT, Agarwal JP, Agarwal R, Evans DJ Jr, Malaty HM, Evans DG. Seroepidemiology of Helicobacter pylori infection in India. Comparison of developing and developed countries. Dig Dis Sci. 1991 Aug;36(8):1084-8 Competing interests: None declared |
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