Calling on health technology industry leaders.

The human mind and body is a wonderful miricle in itself. The amazing way in which our immune system works, the million of different proteins and the equally numerous ways in which the interact and the amazing metabolic chemical reaction that take place at every given moment to provide energy, to store energy and numerous other functions that they serve are all nothing short of a miricle.

The human mind and consciousness is even more mind boggling. The feeling we have from the most intense pleasure to the most profound sorrow we feel are equally miriculous.

From within we extend our human connection out to our fellow humans and to the plants and animals creating societies with rules and laws and regulations and protocol and culture and customs. Deep down the intent of all these things that we create are to create a situation that has the net outcome of enhancing individual pleasure. While this selfish pursuit for self gratification and pleasure of the self is view by many as hardwired into our human psychs. If we take this view as true, as individuals, family, church, work groups, tribes, villages, cities how then do we reconcile these tendencies to only care about ourselves without caring for the people around us. Note that is a genuine question that I don’t know the answer to but I’m sure there are scholars out there who have dedicated there lives to the inquiry of this very question.

At this time, PNG is unarguably going through it’s most testing time, a time that history will look back and say that the unfolding tragedies unfolding most spectacularly in the highlands and also in many parts of the country was a time that either made or broke us.

It saddens me even more that I feel helpless to the many that are currently going through what must be the most profound feeling of anguish and despair. At the same time I feel a tinge of guilt living in relative saftey and comfort in Port Moresby yet we do have our share of anguish here too.

But why am I writing this perhaps to feed my own pursuit of pleasure who knows maybe that’s it…but if that is so then it would give me much pleasure to see and even more pleasure to be part of easing people’s sorrow.

I have been arguing to myself about whether I have been doing enough and whether there is anything more I can do and I’ve physically and mentally exhausted myself, imploded somewhat by weight of the conversations I have with myself.

So I must come to a conclusion, something that is amicable within myself and connects me with my world.

Yes I have done enough, I have done a lot. Now I need to reach out and connect with people who are having the same conversation some for even longer than I have and perhaps have given even more of their lives to enhance other people’s health and well-being.

So here goes:

Dear reader,

Are you in a position where you’d like to be a part of recreating and transforming how healthcare is delivered to more people in a young country that in my view collectively are relatively naive to the type of healthcare that is possible for them?

If so, talk to me, ask me questions, if you think it’s something you feel worthwhile then let’s form and develop a partnership t promote and deliver appropriate health enhancing technologies and systems into this vastly diverse and intriguing part of the world.

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Why Just Telling Doctors To Be More Resilient Isn’t The Answer

I thought while reading this i thought about PNG’s comparatively immature and very fragmented systems of administration that does not lend itself well to rational/logical discourse about the best way(s) forward to improve the health and well-being of our citizens.

The disaster up unfolding in our highlands at the moment, and the stories of the social upheavals that are happening and which are sure to escalate will bring out the resilience of individuals and in the media we have already seen and will continue to see and hear stories of great individual resilience. However as a nation it saddens me to say that unlike Rottadam’s story of unification amidst a national tragedy, ours may be less positive of a story.

But this is not to say that we will not come together and show resilience, only our story will be different.

It’s all in the hands of firstly ours political leaders and strong willed and tenacious people within our government and business community as well as our communities to determine and write what will become a very prominent part of PNG history.

https://wp.me/p8RTKA-qD

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A dream about how primary healthcare can improve in PNG.

Here is a dream we are dreaming and wish for it to become our new reality in primary care practice. As a primary health practitioner as well as a Pathologist I personally have the view that the standard of overall healthcare would improve immensely if the primary Care practioners around our country were better equipped with appropriate diagnostic tools. Not only the physical tools but also the mental, spiritual, thinking systems tools to deliver what the people truly deserve.

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Calling on investors.

We want to grow our clinic and medical diagnostic technologies supplies business and are looking for investors that share our passion to provide an uncompromising primary health service that adds to the bottom line by growing and establishing a chain of more affordable yet high quality primary health care and a quality Pathology service.

If you are reading this and think you may want to invest into something, an idea, a vision that can see a vast improvement in people’s lives in PNG through a private entity that contact us and let initiate a dialogue.

We are absolutely confident that we have to right formula for the type of primary healthcare service people deserve at the right cost.

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Korobosea Medical Clinic – Business Profile.

Business Address:

Sec 84, Lot 22, Doreen Place, Korobosea, NCD, Papua New Guinea Ph: 73304080, 72450527

email: southpacdxt@gmail.com

Postal Address:

PO Box 1238, Waterfront,

Konedobu, NCD, Papua New Guinea

Contact person: Dr. Poyap J Rooney

Our logo:

The area that is now the suburb of Korobosea was an area that the traditional Motu-Koitabu land owners used to forage around for eggs of the flightless bird they called ‘Koro’. ‘Bosea’ is the word for basket, because the nest of the Koro bird resembled a basket.

South Pacific Diagnostic Technologies Ltd (SPDT Ltd) was established to venture into the diagnostic technology supply industry in PNG.  Our early market research showed that the market was held by a handful of mostly foreign owned, locally registered companies.

We felt that we could have competitive advantage through proper user need assessment and sourcing out the most appropriate available diagnostic technology in the market to suit PNG’s low resource setting without compromising quality.

Currently we have a well-established relationship with 2 major internationally reputable manufacturers of diagnostic equipment.

Alere (Now Abbot)

We have been the authorised distributor of several point of care (POC) test analyser for Alere since 2014. (See below).  We have sold several of these analyser to our PNG customers who continue to order test consumables from us. While these orders quantities have been low we are confident that we will see increase in sales in the nexts few months to years as more and more healthcare provider see that benefit of having these tests available.

NB: Alere has only recently in Novemeber 2017 been acquired by Addott diagnostics.

H3 Diagnostic and YHLO

More recently, in early 2017 we sign our second major distributorship agreement with H3 diagnostic, an Australian-based company that represents the manufacture of various analysers that have entered the market and seeing strong growth internationally (see below).

So far we have not yet sold any YHLO products however we do use their UNION Immunoanalyser at our primary healthcare facility, Korobosea Medical Clinic and Laboratory Services.  The UNION analyser has allowed us to expand our testing capabilities and because we are ordering directly from the manufacturers we are able to offer these tests at a competitive price compared to our competitors.

 

  1. The epoc blood analyser.

A robust hand held analyser (reader) and computer designed to give laboratory quality results for blood gas, electrolytes, creatinine, lactate and glucose (and other calculated parameters) at the point of care using compact tests card that incorporate all necessary reagents and stored at room temperature..

11 critical tests on a single card                  

pH          pO2        K+           Cl-           Lac          Hct

pCO2     Na+        Ca++      Glu         Crea

Calculated values                             

AGap     cHCO3 –                BE(ecf) cSO2      eGFR

AGapK cTCO2   BE(b)     cHgb      eGFR-a            

A1729 v2 Alere epoc Training Presentation_Page_01    

2. Triage MeterPro analyser

The Alere Triage MeterPro is utilised in thousands of healthcare facilities worldwide. With a variety of individual tests and panels, the Triage system provides rapid results at the point of care, supporting accelerated treatment decisions.

Lab Quality at POC Speed

  • Built-in Quality Controls
  • Lot-specific assay calibration
  • QC material available
  • Operator ID and QC lockouts
  • Ability to run batch testing
  • Whole blood, plasma or

MeterPro

These test are essential for the proper evaluation of critically ill patients presenting to emergency.  Both the epoc and the triage meterPro analysers allow doctors caring for these patients to perform these important blood test and have results ready in less than 15 minutes, which helps them make quick potential lifesaving treatment decisions.

3. The Afinion AS100 Analyzer provides valuable near patient testing for today’s busy healthcare professionals who understand the value of knowing now. The Alere Afinion Test System utilises the latest technology and provides a simple, fast and reliable method to bring more to your in-office evaluations.

  • Muliple analytes on one system – HbA1c,
  • Lipid Panel, ACR and CRP
  • 3 minute HbA1c
  • 5 minute Albumin/Creatinine Ratio (ACR)
  • Short test time provides the opportunity for

more timely treatment changes

  • Easy sample collection and operation, minimal training required
  • Reliable, laboratory-quality results

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Afinion

 

More details about the above analysers can be found on the enclosed brochures and on the Alere website on

www.alere.com.au

 

4 The YHLO Union automated enzyme linked immunosorbent assay (ELISA).

In early 2017 we entered an agreement with H3 DIAGNOSTICS, an Australian company that represents the Chinese diagnostic manufacturing company YHLO.

South Pacific Diagnostic Technologies ltd is now the official sub distributor of YHLO diagnostic products in PNG.

The main analyser from YHLO that we are using at our pathology laboratory is the YHLO UNION Immunoanalyser.

The UNION analyser takes an old testing principle, i.e the ELISA, and puts it on an automated platform making it easier to perform ELISA testing in small to medium size laboratory. The cost per test is affordable and the analyser itself is robust and has low maintenance requirements.

Union.jpg

 

5. Hemocue 201 Hb point of care analyser

Uncompromising Accuracy

Providing lab accuracy and ease of use, the HemoCue ® Hb 201+ system has become a standard in Hb point-of-care testing. Healthcare providers around the world rely on the immediate results so they can make the right decisions when they need them most — right at the point of care.

hemocue 201.jpg

 

6. The Innovative Difference for Faster Care

With groundbreaking technology, the HemoCue WBC DIFF makes it possible to get not only lab-accurate white blood cell counts but also five -part differentials at the point of care. In just five minutes, you have accurate counts for neutrophils,  lymphocytes, monocytes, eosinophils and basophils. Fitting seamlessly into a variety of clinical applications and even remote field clinics, the benefits are clear.

Immediate WBC DIFF counts can mean the difference between waiting and taking action at the point of care — helping you move from assessment to treatment within minutes rather than hours or days.

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Primary Healthcare and Pathology testing services.

In 2016 we opened our small community-based primary healthcare and pathology testing facility, Korobosea Medical Clinic.   We are located short distances away from Port Moresby General Hospital, and two other major PNG Hospitals.

 

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THE ORANGE STAR IS WHERE WE ARE!!!!!

We offer general practice (GP) services which includes the facilitation of consultation by our our specialist associates admission to Hospital if required.  Currently Dr Rooney is seeing patients by appointments only mainly after 4pm, during weekdays and on Saturday mornings.

The fact that we order directly from manufacturers means that we can offer our tests at very competitive prices. We believe our services will create much needed competition in an otherwise small private healthcare and pathology testing market.  This can only be of benefit to the people of PNG.

Primary Healthcare services:

Specialist consultation and referral for elective cases.

We enjoy a good collegial working relationship with several hospital-based, specialist medical doctors who consult patient at the clinic and also can arrange hospital admission if required.

Occupational Health.

We believe a healthy workforce will be a productive one. We offer several health programs for organisations who have made the health of their workers a priority.  We can give seminars at business houses and even conduct health checks either onsite or at the clinic.  We believe this area of occupational health will grow when the PNG economy starts to pick up again.

 Aviation Medicine

Rooney has a post graduate diploma in aviation medicine and is awaiting appointment as a Designated Aviation Medical Examiner (DAME) by the civil aviation safety authority (CASA). Once DAME status has been given we can start marketing of services for pilots and other aviation industry personnel who require regular medical examination for the license renewal.

Chronic disease management:

Chronic diseases are medical conditions that a person will have for the rest of their lives. This group of diseases include – Diabetes, High blood pressure, high blood cholesterol, asthma, chronic obstructive airway disease, and many others.

Chronic diseases require a different approach to acute sicknesses that a patient may have for short periods of time onle.  For example in diabetes the promotion of self care and the education of patients about their own condition is very important so that they can also participate in their own care.

Many times with chronic disease a multidisciplinary approach is needed and it is important that the referral on communication between the different health professionals involved in a person’s condition is coordinated so that care is as efficiant and effective as possible.

Electronic patient medical records Papua New Guinea

Most of our records, medical, financial and inventory are on a computer network with a dedicated server and is backup on a regular basis.  The software program we use is called Patient Manager Advanced (PMA) from the European-based software publishing company called VeriKal.  We are also the authorised distributor of this and other software produced by VertiKal in PNG.

This system allows our front desk staff to schedule appointments and reminders, send messages from the software via mobile SMS or email.  This has been a very worthwhile investment as we have found it very useful.

VertiKal.jpg

More information can be found on here however if you purchase from us you will get a 30% discount for the very useful software.

Building and environment

Offices

The clinic itself is very comfortable with a reception and waiting room to fit 10 people comfortably.  It has a central coffee table with assorted magazines and other interesting reading material and a television. The doctors room is fully kitted for a primary healthcare setting and emergency resuscitation equipment should a patients develops an emergency after arriving.  The pathology area is located towards the back of the clinic and contains all our laboratory analysers and equipment.

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Car parking and outdoor waiting areas

We have a secure car parking area to fit 3 cars and a separate emergency ambulance bay. Clients also have the option to use the outdoor waiting area should they wish. This area is furnished with seats and tables, vegetation and a small water fountain and has plenty of shade.  It has a designated smoking and chewing area.

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Future plans.

We have grown steadily over the last few years and have consolidated our relationship with our suppliers, agents and our customers and clients.  We are continuously working at improving our systems and the quality of the services we provide.

We are hopeful that the next 5 years will see even more steady growth and expansion of our services.

We are passionate about what we do and have a genuine desired to see the improvement of the health status of our individual clients as well as the wider community.

We have already contributed to the training and professional development of the numerous employees we have seen pass through and we hope to formalised our training and partnership with the bigger hospitals and the University of PNG so that we can contribute more in the future to the development of the different cadre of health professional in the country.

We also plan to explore the potential of developing relationship with rural health facilities as part of our social responsibility and our desire to see the improvement in health even in rural based communities.  This is something that has always been part of our vision.  We have already started preliminary discussions with a couple of rural communities and hope to develop a working relationship soon.

We recently landed another sale of the epoc and the triage Meterpro analyser to Gerehu Hospital and see this as a major achievement as we anticipate that they will utilise these two analyser more for the benefit of their patients.

We know that these two analysers are the best and most appropriate analysers for emergency departments, intensive care units and operating theatres throughout the country and hope to see its uptake in the coming years.

Our pathology testing capabilities

TEST FEE
HbA1c K75
Urine Albumin: creatinine ratio K75
Lipid profile K85
C- reactive protein K75
Troponin I K75
Creatinine (eGFR) K75
Electrolytes (Na+, Cl-, K+) K75
Full blood examination K75
Total PSA K75
Thyroid Function  
TSH K125
fT4 K125
Serum VitB12 K175
Serum Folate K175
Ferritin K75
Vitamin D 25-OH K75
Malaria (RDT) K25
Dengue N2 antigen (RDT) K55
Dengue IgM K55
Dengue IgG K55
Microscopy +/- gram stain K75
HIV – Ig/Ag combo (Alere) K75
Syphilis K75
HepBsAg K75
AFP K75
CEA K75
CA125 K75
CA15.3 K75
CA19.9 K75
FSH K125
hCG K125
PRL K125
AMH K225
Anti-TG-IgG K175
Anti-MPO-IgG K175
Anti-TPO-IgG K175
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A review of the diagnosis and management of peripheral neuropathy in type 2 diabetes.

The prevalence of diabetes worldwide has risen tremendously over the last few decades and parallels the rise in obesity and sedentary lifestyle that is now widespread in our modern society.

*CD Mathers and D Loncar (2006) as cited by the WHO (2017), state that ‘the number of people with diabetes worldwide has risen from 108 million in 1980 to 422 million in 2014’. Unfortunately diabetes prevalence has been rising more rapidly in middle- and low-income countries, countries that have least capacity to deal with the many problems associated with diabetes.

In Papua New Guinea (PNG) for instance, according to the International Diabetes Federation (IDF) out of the estimated 3,952,000 adults 12.9% of them are living with diabetes.  This equates to about 507,900 adults with diabetes, *IDF (2017).

This is a staggering increase from the mere 0.2% prevalence reported in very early studies in PNG. In the early 1960s, Hingston and Prince found ‘no cases of diabetes in 407 adults in the Hula district of Central Province and only 2 of the 1057 adult subjects tested in four suburban communities in Port Moresby (PNG’s Capital City) had diabetes’ *Hingston and Prince (1962) as cited by G D Ogle (2001).  .

Long term, uncontrolled diabetes leads to a number of complications that cause morbidity and early loss of lives. These complications can be divided into macrovascular and microvascular complications.

Macrovascular complications include coronary artery disease, peripheral vascular disease and cerebrovascular disease while the microvascular complications include retinopathy, diabetic kidney disease (formally termed diabetic nephropathy) and diabetic neuropathy.

There are number of factors at play in the pathogenesis of microvascular complications of diabetes.  The underlying common factor seems to be chronic hyperglycemia which leads to hyperglycemia inside various tissue cells which absorbs glucose through insulin independent mechanisms. Intracellular hyperglycemia in these tissues triggers various other pathological processes that ultimately leads to dysfunctional vascular epithelial function which further leads to the development of other pathological process, *K Vithian and S Hurel (2010).

Diabetic neuropathy are a group of microvascular complications of diabetes that affect the nerves and the following classification of diabetic neuropathy is based on a modification of the classification proposed by PK Thomas by J G Llewelyn (2003).

Classification of Diabetic Neuropathy

  • Generalised neuropathy
    • – hyperglycaemic neuropathy
    • – symmetric distal polyneuropathy with/without autonomic neuropathy
    • – acute painful sensory neuropathy variants
  • Focal and multifocal neuropathy
    • –cranial neuropathies
    • –focal limb neuropathies
    • –thoracolumbar radiculoneuropathy
    • –lumbosacral radiculoplexus neuropathy (Bruns-Garland syndrome)

This report is focused diabetic peripheral neuropathy (DPN) which is the most common type of diabetic neuropathy. The pain that can arise from DPN ‘can be one of the most distressing and debilitating of all the complications of diabetes’ AJM Boulton (2005).  Therefore for a general practitioner who cares for people with diabetes it is an important condition to be familiar with and confident in diagnosing and managing.

 

From an international consensus meeting attended by various professional from ‘diabetologists, neurologists, primary care physicians, podiatrists and diabetes specialist nurses’ AJM Boulton et al (1998) as cited by AJM Boulton (2005) define diabetic peripheral neuropathy as “the presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes after the exclusion of other causes”

This definition highlights that in people with diabetes the patient’s clinician, before making the diagnosis DPN must exclude other causes (which we shall discuss briefly later) of signs and/or symptoms of peripheral nerve dysfunction.

DPN can be divided into acute sensory neuropathy and chronic symmetrical sensorimotor neuropathy which is the most common form of DPN, AJM Boulton (2005).

In daily clinical practice a confident diagnosis of chronic symmetrical sensorimotor neuropathy can be made by the use of one of several approaches using well-validated questionnaires and clinical examination tools.

One such approach includes the use of Michigan Neuropathic Screen Instrument (MNSI) (Fig1) coupled with quantitative neurological examinations and if required a nerve conduction study (NCS) can be done however in most cases a NCS is not essential, AJM Boulton (2005).

Another useful approach that can be easily and quickly performed in a clinical practice setting employs the use of a modified Neuropathy Disability Score (MNDS), (Fig 2.). According to E L Feldman (1994) this approach consists of firstly a clinical neurological examination followed by routine nerve conduction measurements including vibratory threshold perception, pain, and light touch which were assessed with a 128 Hz tuning fork, a pin, and a 10-g filament, respectively.

 

The maximum score using the MNDS is 10 while a score of 6 or above has been shown to increase the risk of insensate foot ulcerations.

According to EL Feldman et al (1996) as cited by Porte D, S S Robert, Ellenberg M and Rifkin H (1997) in the 5th Edition of Ellenberg and Rifkin’s Diabetes Mellitus (1996), some common and easily excludable causes of peripheral neuropathy other than diabetes include but not limited to:

  • VitB12 and of Folic acid deficiency
  • Hypothyroidism
  • Chronic alcoholism
  • Systemic Lupus Erythematosus (SLE)
  • Paraneoplastic syndrome (especially due to small cell carcinoma of the lung)
  • Dysproteinemias and paraproteinemias
  • Amyoloidosis
  • Gullen Barre’s Syndrome
  • Sarcoidosis
  • Heavy metals (lead, mercury, arsenic)

It is prudent to exclude these other causes of peripheral neuropathy and in general a:

Good history taking (alcohol, family history of neuropathy, drug history, etc) and a few basic blood tests such as: Vitamin B12 and folate values serum protein electrophoresis, antinuclear antibodies (ANA), extractable nuclear antigen (ENA) double stranded DNA (dsDNA) , rheumatoid factor (RF), Thyroid function test (TFT), full blood count (FBC), erythrocyte sedimentation rate (ESR) and C-Reactive protein (CRP), Urea, and electrolytes creatinine (UECs) and liver function tests (LFTs) should be enough to secure diabetes peripheral neuropathy and exclude other serious and most treatable causes, J G Llewelyn (2003).

Once the diagnosis of diabetic peripheral neuropathy is confidently made and other more sinister causes of PN ruled out the appropriate management can then be provided and treatment response be monitored using the same tools described above.

Firstly the patient needs to be educated on his or her the diagnosis and they should be advise about the various treatment options available.  They should also be advised about the need for monitoring their response to treatment and reassured that with proper treatment they will experience improvement in their symptoms.

A number of pharmacological agents have been shown to be effective in the treatment of painful DPN and the most common ones used include:

  • tricyclic agents like amitriptyline at dosages of 25 to 150 mg daily and Imipramide at dosages of 25 to 150 mg daily.
  • Selective serotonin reuptake inhibitors (SSRI) like Paroxitene at a dose of 40 mg daily and citalopram at a dose of 40mg daily.
  • Anticonvulsants like Gabapentine at dosages of 900 to 1800 mg daily, Pregabalin at dosages of 160 to 600mg daily, Lamotrigine at dosages of 200 to 400mg daily and carbamezapine up to 800mgs daily.

The anticonvulsants have the best side effect profile out of these pharmalogical agents, AJM Boulton (2005)

The two landmark studies in type 1 diabetes mellitus and type 2 diabetes mellitus, the Diabetes Control and Complications Trial (DCCT) DM, Nathan et al (1993) and the United Kingdom Prospective Diabetes Study (UKPDS) Group (1998) respectively, both demonstrated that the intensive management of blood glucose led to a huge reduction in the incidence of microvascular complications

Newer pharmacological agents that have been shown to be effective yet requiring more research especially on their side effect profile include local anaesthetic arrhythmic agents in particular mexiletine, STM Krishnan et al 2004 as cited by AJM Boulton (2005), NMDA receptor antagonist, C N Sang (2002) and the opioids analgesics tramadol ‘has been confirmed to be efficacious in a randomized, controlled trial, and a follow-up study suggests that it can be used safely for up to 6 months of sustained pain relief’ Y Harati (2002) as cited by AJM Boulton (2005).

Together with the use of the above agents the usual advise about well fitting footware and care when walking to avoid injury to the feet must be given as well as general advise about exercise and healthy living.

The involvement of other health professional as part of a multidisciplinary team is also available.  In a patient with DPN who is identified to be at an increased risk of foot ulceration should be referred to a podiatrist for specialized foot care.

In Papua New Guinea most of the pharmacological agents listed above are available but unfortunately relatively expensive and in general are not accessible to the vast majority of the estimated 507,900 adults with diabetes whom are not covered by any form of medical insurance.  Furthermore the quality of diabetes care is greatly hindered by the lack of qualified professionals with an interest in diabetes and a limited resources.  As an example as of the date of writing this report, HbA1c an indispensable test in diabetes care is still not available at Port Moresby General Hospital and at private health facilities the cost of this test is on average around K150 ($45 USD), a price that is simply out of the question for the average Papua New Guinean.  With this sort of situation one can imagine the huge burden that is suffered by people living with diabetes in PNG and calls for urgent action by the relevant authorities.

NSI

Fig 1: MNSl questionnaire. Ref: E L Feldman (1994)

NSI

Fig 2 Modified Neuropathy Disability Score (MNDS),  E L Feldman (1994)

Reference:

AJM Boulton (2005), ‘Management of Diabetic Peripheral Neuropathy’, CLINICAL DIABETES • Volume 23, Number 1, 2005, available at: http://clinical.diabetesjournals.org/content/diaclin/23/1/9.full.pdf, accessed: 10/12/2017

CD Mathers and D Loncar, ‘Projections of global mortality and burden of disease from 2002 to 2030’, PLoS Med, 2006, 3(11):e442. Available at: https://pdfs.semanticscholar.org/0480/2b396ff6ead07f733e3d7cda9bf93def57cf.pdf , accessed: 09/12/2017

K Vithian and Steven Hurel (2010), ‘Microvascular complications: pathophysiology and management’, Clinical Medicine, 2010, Vol 10, No 5: 505–9

International Diabetes Federation (IDF) (2017), ‘IDF Western Pacific members’, available at:

https://www.idf.org/our-network/regions-members/western-pacific/members/112-papua-new-guinea.html , accessed: 9/12/2017

G D Ogle (2001), ‘Type 2 diabetes mellitus in Papua New Guinea – an historical perspective’, PNG Med J 2001 Sep-Dec; 44(3-4):81-87, available at: http://pngimr.org.pg/png_med_journal/Type%202%20-%20Sep-Dec%202001.pdf, accessed: 9/12/2017

UK Prospective Diabetes Study (UKPDS) Group (1998), ‘Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)’, The Lancet, Volume 352, No. 9131, p837–853, 12 September 1998, available at: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(98)07019-6/fulltext accessed: 9/12/2017

DM Nathan et al, (1993), ‘The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus’, N Engl J Med. 1993 Sep 30;329 (14):977-86, available at: http://www.nejm.org/doi/pdf/10.1056/NEJM199309303291401, accessed: 9/12/2017

J G Llewelyn (2003), ‘THE DIABETIC NEUROPATHIES: TYPES, DIAGNOSIS AND MANAGEMENT’ J Neurol Neurosurg Psychiatry2003;74 (Suppl II):ii15–ii19, available at: http://jnnp.bmj.com/content/jnnp/74/suppl_2/ii15.full.pdf, accessed: 9/12/2017

Porte D, S S Robert, Ellenberg M and Rifkin H (1997), Ellenberg & Rifkin’s Diabetes Mellitus, 5th Edn, , USA: McGraw-Hill Professional Publishing, 1997

E L Feldman (1994), ‘A Practical Two-Step Quantitative Clinical and Electrophysiological Assessment for the Diagnosis and Staging of Dianetic Neuropathy’ DIABETES CARE, VOLUME 17, NUMBER 11, NOVEMBER 1994

C N Sang (2002), ‘Dextromethorphan and memantine in painful diabetic neuropathy and postherpetic neuralgia: efficacy and dose-response trials’. Anesthesiology 96:1053–1061, 2002

American Diabetes Association (ADA) and American Academy of Neurology (AAN) (1988),

‘CONSENSUS STATEMENT, Report and Recommendations of the San Antonio Conference on Diabetic Neuropathy’ DIABETES CARE, VOL. 11, NO. 7, JULY/AUGUST 1988

 

 

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The solutions to obesity, diabetes and their many associated problems can only come from ourselves!

Obesity is defined by WHO ‘as abnormal or excessive fat accumulation that presents a risk to health’ (WHO 2017). Several parameters have been proposed as means of defining, grading levels of and communicating obesity and its severity.  In this article the body mass index (BMI) will be used to define and grade obesity.  The BMI is calculated by the following relatively straight forward formula:

BMI = (Weight in kilograms) ÷ {Height (in metres)}²  (Evidence for BMI as good for now)Ref

Other anthropometric parameters used and have been shown to be as effective as BMI include, waist circumference (WC), Hip to waist (circumference) ratio.  In a large Japanese study the level of adiposity as measure by the dexa scan was use as a measure of obesity.

While there are variations in the actual quantitative definition of obesity, a field of ongoing study, ‘the BMI is a good indicator of overall adiposity’, Hu F. (2008) as quoted by Whitlock G et al (2009).  The BMI is the most widely studied parameter in terms of its correlation with ‘risk to health’ and is currently accepted and used by major international bodies involved in developing evidence based clinical practice guidelines for the management of obesity and obesity related co-morbidities.

Whitlock G et al (2009), in a large study published in Lancet, showed strong evidence that:

BMI is in itself a strong predictor of overall mortality both above and below the   apparent optimum of about 22·5–25 kg/m². The progressive excess mortality      above this range was due mainly to vascular disease and is probably largely causal.           At 30–35 kg/m², median survival is reduced by 2–4 years; at 40–45 kg/m², it is      reduced by 8–10 years (which is comparable with the effects of smoking) 

Overweight and obesity according to the World Health Organisation (W.H.O.): are major risk factors for a number of chronic diseases, including diabetes, cardiovascular diseases and cancer. This form of malnutrition (over nutrition) was once considered a problem only in high income countries, however today is dramatically on the rise in low- and middle-income countries, particularly in urban settings. (WHO 2017)

Like many other low to middle income countries the dramatic rise in the prevalence of obesity, seen in Port Moresby and other urban centres in PNG has been brought about by two fundamental changes in society. Firstly, the rapid shift from a traditional, more physically active lifestyle to one that is in general comparably sedentary and secondly, this change in the general level of physical activity in the population has been coupled with a parallel shift in the average diet from a traditional one that is composed of high fibre, unprocessed, low glycaemic foods to one with more processed foods, lower in fibre and higher in saturated fats (mainly animal derived fats).

Modernity and how we are developing is truly a double edged sword, a sword that may be cutting deeper in a way that is detrimental to society rather than in a way that is improving society.  The costs of dealing with obesity and its associated problems is huge, both financially and emotional to the individual, families and the country as a whole. For example the numbers of people turning up to our ill-equipped hospitals with heart attacks, strokes and as a result of acute and chronic complications of obesity and diabetes has risen and will continue to rise in parallel to the rise in obesity. There are not too many people reading this that has not had their lives affected by an obesity or diabetes related condition.  As a young country we have lost and will continue to lose many precious citizens many years before their time.

The situation is grim; there is no rosier way of putting it.  The best way to stem this disastrous trend lies firstly in accepting this grimness, and then coming to terms with the fact that the solutions can only come from us. By putting in place strategies that are simple, immediately doable at an individual and community level yet so fundamental in nature it will encourage a shift towards a much healthier lifestyle on a societal level.

 

  1. WHO (2017), Obesity, available at http://www.who.int/topics/obesity/en/, accessed: 13/01/17

 

  1. Whitlock G, Lewington S, Sherlike P – Prospective Studies Collaboration (2009), ‘Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies’ Lancet, 373: 1083–96 
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