To Marry a Dog

I was the photographer/ journalist on an international medical education team, sponsored by The Center for Asian and International Bioethics of Ben Gurion University of the Negev that went to Kadalur, in Tamil Nadu, India to teach rural Untouchable women basic mother and child health care. Two violations of human rights which came to my attention, one an Untouchable child’s, and one an Untouchable widow’s are the focus of this documented photographic essay which explores the historical, social and religious roots of the repression of the Untouchables of India today. Though male Untouchables are certainly victims of this oppression, female Untouchables are victimized even more. For this reason, having a girl-child in the Untouchable population is considered a calamity. Untouchable mothers and fathers deal with this in extraordinary ways. One way inspired the title of this essay, “To Marry a Dog.” Although to an outsider the patriarchal Untouchable society may seem to have made desperate adaptations to its structural, historical, and religious confines, Untouchable women have played a role in shaping these adaptations. Nonetheless, there is much about Untouchable women to be admired. It is truly the women who hold Untouchable families together. They are bright-eyed, strong and optimistic. Strangely enough they love life, and taught me, a spoiled westerner, how to find happiness in little things. This essay is a tribute to them

Pamphlets - homoeopathic.

-- Work of the National Association of Homoeopathic Members of Examining and Licensing Boards / H.M. Paine -- Pabula Neonatorum, a guide to the feeding of infants / G.B. Peck -- Treatment of scarlatina and measles / G.B. Peck -- Flotsam and jetsam / O.S. Runnels -- Constitution and by-laws, code of ethics, officers and members / Southern Homoeopathic Medical Association -- Science and homoeopathy / F.P. WebsterLetter to the members of the American Institute from A.B. Norton / American Institute of Homeopathy -- Important notice to the members of the American Institute of Homoeopathy in relation to the repertory of the Cyclopaedia of Drug Pathogenesy / R. Hughes -- Constitution and by-laws / American Institute of Homeopathy -- Code of medical ethics, constitution, by-laws, and list of members of the American Institute of Homoeopathy / American Institute of Homeopathy -- Homoeopathy in the public service / B.F.Bailey -- Proof of the law of similia from the electro-chemico-physiological standpoint / E.H.S. Bailey -- Two cases of brain tumor : a contribution to cerebral surgery / C. Bartlett -- Concerning Hensel's Tonicum... / Boericke & Tafel -- Homoeopathy : some observations in regard to its progress for forty years / G.W. Bowen -- Tubercular cystitis / B.G. Carleton -- Proving of the Apis Mellifica / Central New-York Homoeopathic Society -- On supra-pubic cystotomy and catheterization as a guide in perineal section for obliterative urethritis / H. Crutcher -- Test at the bed-side / P. Dudley -- Dietetic, climatic and hygienic treatment of tuberculosis / F.A. Faust -- Concordance repertory, of the well proven and most reliable symptoms of the homoeopathic Materia Medica / W.D. Gentry -- Sanitation on the farm / W.B. Hinsdale -- June number of the New England Medical Gazette...contains a paper... / Editor of Homoeopathic Recorder -- Samuel Hahnemann : a lecture / H.P. Holmes -- Urine of uro-genital tuberculosis / G.F. Laidlaw -- Plea for homeopathic solidarity and independent work / S. Leavitt -- Ups and downs of a doctor's life, being the closing lecture of the course delivered in the Hahnemann Medical College for the session of 1863-64 / R. Ludlam -- Study of Materia Medica / C. Mohr -- Twentieth century homoeopathy / J.H. Moore -- Spinal Affections / E.A. Murphy, M.D. -- Yellow fever, its treatment and prevention / E.A. Murphy, M.D.Mode of access: Internet

Enhanced infection prophylaxis reduces mortality in severely immunosuppressed HIV-infected adults and older children initiating antiretroviral therapy in Kenya, Malawi, Uganda and Zimbabwe: the REALITY trial

Meeting abstract FRAB0101LB from 21st International AIDS Conference 18–22 July 2016, Durban, South Africa. Introduction: Mortality from infections is high in the first 6 months of antiretroviral therapy (ART) among HIV‐infected adults and children with advanced disease in sub‐Saharan Africa. Whether an enhanced package of infection prophylaxis at ART initiation would reduce mortality is unknown. Methods: The REALITY 2×2×2 factorial open‐label trial (ISRCTN43622374) randomized ART‐naïve HIV‐infected adults and children >5 years with CD4 <100 cells/mm3. This randomization compared initiating ART with enhanced prophylaxis (continuous cotrimoxazole plus 12 weeks isoniazid/pyridoxine (anti‐tuberculosis) and fluconazole (anti‐cryptococcal/candida), 5 days azithromycin (anti‐bacterial/protozoal) and single‐dose albendazole (anti‐helminth)), versus standard‐of‐care cotrimoxazole. Isoniazid/pyridoxine/cotrimoxazole was formulated as a scored fixed‐dose combination. Two other randomizations investigated 12‐week adjunctive raltegravir or supplementary food. The primary endpoint was 24‐week mortality. Results: 1805 eligible adults (n = 1733; 96.0%) and children/adolescents (n = 72; 4.0%) (median 36 years; 53.2% male) were randomized to enhanced (n = 906) or standard prophylaxis (n = 899) and followed for 48 weeks (3.8% loss‐to‐follow‐up). Median baseline CD4 was 36 cells/mm3 (IQR: 16–62) but 47.3% were WHO Stage 1/2. 80 (8.9%) enhanced versus 108(12.2%) standard prophylaxis died before 24 weeks (adjusted hazard ratio (aHR) = 0.73 (95% CI: 0.54–0.97) p = 0.03; Figure 1) and 98(11.0%) versus 127(14.4%) respectively died before 48 weeks (aHR = 0.75 (0.58–0.98) p = 0.04), with no evidence of interaction with the two other randomizations (p > 0.8). Enhanced prophylaxis significantly reduced incidence of tuberculosis (p = 0.02), cryptococcal disease (p = 0.01), oral/oesophageal candidiasis (p = 0.02), deaths of unknown cause (p = 0.02) and (marginally) hospitalisations (p = 0.06) but not presumed severe bacterial infections (p = 0.38). Serious and grade 4 adverse events were marginally less common with enhanced prophylaxis (p = 0.06). CD4 increases and VL suppression were similar between groups (p > 0.2). Conclusions: Enhanced infection prophylaxis at ART initiation reduces early mortality by 25% among HIV‐infected adults and children with advanced disease. The pill burden did not adversely affect VL suppression. Policy makers should consider adopting and implementing this low‐cost broad infection prevention package which could save 3.3 lives for every 100 individuals treated