War-torn Areas Research Articles

Conceptual Design and Non-Linear Analysis of Triphibian Drone

Drones are increasingly used to replicate human presence and are extremely capable whether it is in terms of delivering aid to war torn areas or carrying reconnaissance missions beyond borders. Due to their increasing demand in all forms, an arsenal of drones has to be maintained and there is a need to make existing drones capable of maneuvering wherever the need be. Design of drone with land, water and air affinity is proposed along with non-linear analysis of drone structure. Physical contacts in the drone structure and gravity is accounted for and simulated. Weight carrying capacity of the drone is measured by increasing the weight of the components in each simulation run till the point of failure. Landing capability, structural integrity and stress is studied to ensure the structure doesn't collapse. Effective visualization tool for variable thrust, rpm and forward speed of the drone is developed, which is able to generate real time data regarding the drone's flight by plotting a three dimensional surface plot of varying thrust, rpm and forward flight speed. Model of the drone is used to study the flight plan of the drone with gravity considerations in non-linear analysis.

Primary care in the Calais Jungle.

Last summer our small medical team visited the Calais ‘Jungle’. Since that time much has changed and the camp is being demolished and by the time this article is read, it will probably be long gone. Some youngsters are finally being brought to the UK under the ‘Dubs’ amendment. However, once this camp is cleared it will not solve the ongoing flight of refugees from war torn areas: other camps are already appearing. A young Afghan man caught his finger on a sharp point while trying to cross a barbed wire fence. The finger was partially degloved. He attended the local hospital, where they placed a few sutures, but now, 2 weeks later, the skin is necrotic and the underlying tissue looks infected. He is in danger of losing his finger. A middle-aged Sudanese man has been having rigors and is generally unwell. He says it is similar to when he last had malaria. A young Ukrainian woman complains of lower back pain and urinary frequency. The paths of these three people may never have crossed; yet here they are, denizens of the Calais Jungle. They turn up to a makeshift primary care ‘clinic’ that we set up in the heart of the unofficial refugee camp one weekend in July 2016. With only basic medical supplies, we are immediately challenged by what we see. How can we arrange secondary care for the young Afghan in danger of losing his finger? We try to persuade him to return to the original local hospital, but he is reluctant. It was not a good experience for …

People with Disabilities and Their Representation in Public Spaces: A Case Study of Post-War Jaffna

People with disabilities have become an important topic for discussion in the post-war Sri Lanka due to many reasons. In Northern Sri Lanka, different age group of the population in war-torn areas are often direct or indirect victims of violence, and witnesses to various issues associated with war disaster. Over three decades of war in Sri Lanka has changed the traditional views of disability and replaced it with a view of disability as a social oppression. This study, therefore, looks to understand the social background of people with disabilities. The main objective of this study is to consider the meaning of disabilities in public spaces in post-war Jaffna[1]. The chosen field was undertaken in Thenmaradchi Divisional Secretariat of Jaffna district. This paper has reported on the experiences of 59 people with disabilities who were disabled during the war period. The primary data were collected from interviews and surveys with predetermined case study, non-direct and participant observation and key informant interviews through purposive sampling. It is in this context; an attempt is made to understand the meaning of people with disabilities through their day-to-day life events, situations, and their experiences. This paper discusses the meaning of disabilities under three factors namely, Religious Discourse, Family Structure and Women Status based on grounded theory method. Moreover, these socio-cultural interpretations of people with disabilities are linked with other important factors such economic and political aspects. The finding of the study was that the people with disabilities depicted there are usually crippled and socially excluded or hidden in the limited public spaces in post-war Jaffna. Since disability issues have become a central part of the development and social work discourse in the post-war Tamil society, the researcher hopes that this research will contribute to policy formation for people with disabilities and the effective implications of the post-war reintegration process and development process. Finally, it is hoped that the study will create social awareness and mobilize people with disabilities and strengthen the disabled in society.

Soil Ecosystem Responses to Depleted Uranium Contamination

Military operations of the past two decades have used depleted uranium missiles and equipment, which have contaminated the soils of war-torn areas. Once in the soil, the metal corrodes to oxidized forms whose solubility depends on soil conditions. This paper reviews the literature on the effects of depleted uranium contamination on bacteria, fungi, and plants to synthesize the research. This will enable soil microbiologists to understand the impact of uranium contamination on the ecosystem as a whole. Some bacteria thrive in high-uranium environments, but many do not, so uranium contamination selects for the bacteria that can survive. Fungi can often tolerate it quite well, to the extent that some grow on depleted uranium chips and encourage faster corrosion. Some plants can accumulate uranium, but most can only tolerate it if the pH of the soil is high enough to keep the uranium insoluble and not bioavailable. Remediation techniques include natural attenuation, ex situ processing, and bioremediation, but none of these are perfect and the correct approach depends on the site. The negative human health effects associated with uranium contamination make further research and remediation work vitally important.

Facilitating mental health screening of war-torn populations using mobile applications.

War-torn populations are often hard to screen for mental health disorders. Classical data collection approaches, such as paper-based, online, or SMS-operated, are either infeasible or lack accuracy due to a variety of challenges associated with dynamics and consequences of war. In this paper, we introduce a novel approach for accurate and fast screening using free open-source software, Open Data Kit (ODK) mobile application. This approach was developed by the Palestine Children's Relief Fund (PCRF) to assess the mental health symptoms of 986 Palestinian children (age 6-18) in the aftermath of Israel's Operation Protective Edge (OPE) in 2014. The organization developed assessment questionnaires and trained local field workers on the use of the mobile application, and on recruiting and interviewing war victims. War-affected children were found to suffer from several alarming symptoms associated with post-traumatic stress disorder (PTSD), depression, and somatic symptoms. Children with highest number of psychological symptoms were referred for further evaluation and treatment. The use of ODK mobile technologies facilitated efficient screening of affected children in war zones. The offline data collection capability was crucial for handling the difficult conditions associated with war-torn areas, enabling timely intervention for urgent cases. Further applications of the novel mobile technology are to be explored.

Women, war, and reproductive health in developing countries

ABSTRACTGlobally, millions of people are affected by war and conflicts every year. However, women have increasingly suffered the greatest harm by war in more different ways than men. We conceptualize a reproductive rights approach toward examining the effects of war on women’s reproductive health in developing countries. Given the rising concerns of exclusion to adequately address women’s rights, sexual and gender-based violence, and post-conflict accountability, we specifically focus on the limitations of the Minimum Initial Service Package, a UN-sponsored reproductive health service program in conflict zones while offering a broad reproductive rights-based conceptual lens for examining reproductive health care services in war-torn areas. In addition, we discuss the roles social workers may play at both micro and macro levels in war-torn areas to bring about both short term and long term gains in women’s reproductive health.

Epidemiology and Clinical Burden of Malaria in the War-Torn Area, Orakzai Agency in Pakistan.

BackgroundMilitary conflict has been a major challenge in the detection and control of emerging infectious diseases such as malaria. It poses issues associated with enhancing emergence and transmission of infectious diseases by destroying infrastructure and collapsing healthcare systems. The Orakzai agency in Pakistan has witnessed a series of intense violence and destruction. Military conflicts and instability in Afghanistan have resulted in the migration of refugees into the area and possible introduction of many infectious disease epidemics. Due to the ongoing violence and Talibanization, it has been a challenge to conduct an epidemiological study.Methodology/Principal FindingsAll patients were sampled within the transmission season. After a detailed clinical investigation of patients, data were recorded. Baseline venous blood samples were taken for microscopy and nested polymerase chain reaction (nPCR) analysis. Plasmodium species were detected using nested PCR (nPCR) and amplification of the small subunit ribosomal ribonucleic acid (ssrRNA) genes using the primer pairs. We report a clinical assessment of the epidemic situation of malaria caused by Plasmodium vivax (86.5%) and Plasmodium falciparum (11.79%) infections with analysis of complications in patients such as decompensated shock (41%), anemia (8.98%), hypoglycaemia (7.3%), multiple convulsions (6.7%), hyperpyrexia (6.17%), jaundice (5%), and hyperparasitaemia (4.49%).Conclusions/SignificanceThis overlooked distribution of P. vivax should be considered by malaria control strategy makers in the world and by the Government of Pakistan. In our study, children were the most susceptible population to malaria infection while they were the least expected to use satisfactory prevention strategies in such a war-torn deprived region. Local health authorities should initiate malaria awareness programs in schools and malaria-related education should be further promoted at the local level reaching out to both children and parents.

Vaccine Science Diplomacy: Expanding Capacity to Prevent Emerging and Neglected Tropical Diseases Arising from Islamic State (IS)--Held Territories.

War and the ensuing health system breakdowns in the Islamic State (IS)–occupied Syria and Iraq significantly increase the risk of a new wave of infectious disease epidemics in the Middle East and North Africa (MENA). Proactive engagement to enable health system capacity and resilience—including expanding immunization programs and building biotechnology capacity for vaccines that specifically target diseases in the region—would help minimize the impact if and when outbreaks occur. A program of vaccine science diplomacy with selected countries in the MENA region could help to avert an international public health crisis possibly similar in scope and magnitude to the 2014 Ebola virus outbreak in West Africa. The 2014 Ebola outbreak emphasized strong links between the forces of poverty, depletions in public health and environmental degradations as a result of long-standing conflicts in West Africa, and the emergence of a catastrophic neglected tropical disease (NTD). A stark reality is that such links between poverty, war, and NTDs are not new, but have been reoccurring for decades [1]. For example, beginning in the 1970s and lasting throughout much of the 20th century, hundreds of thousands of people may have perished from African sleeping sickness—human African trypanosomiasis, a parasitic infection transmitted by tsetse flies—in Angola, Democratic Republic of Congo, and Sudan because of civil wars in those countries and the inability to mount effective public health control measures [2]. Kala-azar—visceral leishmaniasis, another parasitic infection but transmitted by sandflies—killed an estimated 100,000 people in conflict-ridden southern Sudan between 1986 and 1995 [3]. Because journalists had limited access to these war-torn areas, both epidemics went mostly unrecorded and unacknowledged. The latest example is the collapsed health systems of post-conflict Liberia and Sierra Leone that were unable to cope with an Ebola epidemic that infected more than 20,000 people and caused approximately 10,000 deaths by the early part of 2015.

When the Going Gets Tough… Monitoring Missions and a Changing Conflict Environment in Sri Lanka, 2002–2008

This article analyzes how the conflict environment in which a civilian monitoring mission is deployed influences the monitors' assessment of the operation. It draws on unique empirical material from the experience of the Sri Lanka Monitoring Mission (SLMM), deployed to oversee a ceasefire agreement in Sri Lanka 2002–2008. With material from a survey and in-depth interviews, experiences of the monitors are analyzed and changes over time are traced in relation to the monitors' assessment of the mandate and organizational set-up of the mission. The study points to the difficulty of monitoring missions to address escalation during an ongoing peace process. Its function is dependent on the goodwill of the parties. In essence, monitoring missions have the potential to strengthen peace when there is momentum in favor of progress, but when relations between the parties turn sour and the conflict escalates a civilian monitoring mission basically loses its potential. During the final stages of the war, which saw a very large number of civilian casualties, the war-torn areas were closed to international observers. Moreover, international pressure for a short-term ceasefire to alleviate the humanitarian situation was dismissed by the Sri Lankan government, which also saw the backing of several important actors, not the least China.

Parental care protects traumatized Sri Lankan children from internalizing behavior problems.

BackgroundResearch in war-torn regions has mainly focused on the impact of traumatic experiences on individual mental health and has found high prevalence rates of psychiatric disorders in affected adults and children. However, little is known about the possible protective factors occurring in children’s environments in the aftermath of mass trauma. Therefore, we conducted a cross-sectional study with families in Northern Sri Lanka, a region that had been shattered by a long-lasting civil war and devastated by the Asian tsunami in 2004.MethodsSchoolchildren aged 7 to 11 (N = 359) were interviewed on the basis of standardized measures to assess children's exposure to traumatic events, mental health symptoms, and parenting behavior as perceived by children. All interviews were carried out by local senior counselors.ResultsLinear regression analyses identified exposure to mass trauma and family violence as significant risk factors of child mental health whereas parental care emerged as a significant factor associated with fewer behavior problems. In addition, parental care significantly moderated the relationship between mass trauma and internalizing behavior problems.ConclusionsFamily characteristics seem to be strongly associated with children’s mental health even in regions severely affected by mass trauma. This finding is particularly relevant for the development of targeted psychosocial interventions for children and families living in war torn areas.

The War of Words: Confederate Rhetoric in the Healdsburg Squatter War

Although California was relatively unaffected by the destruction of the Civil War, California's new statehood and Gold Rush brought thousands of migrants from the war-torn areas. These migrants brought with them their ideologies--and sometimes their slaves. In Northern California's Sonoma County, the battle of civil war ideologies was fought over land rights. Southern Squatters settled in Sonoma County, voted for the pro-slavery Democratic Party, sang Dixie, and after the start of the Civil War, fought off sheriffs and residents trying to remove them and their politics. In Northern California, the rhetoric of the Civil War was played out in the "Healdsburg Squatter War." Opportunistic landowners used the Civil War as a political, moral, and ideological weapon to eject Southern squatters from profitable Sonoma County lands

Does community poverty reduce children’s school attendance more at primary education than at secondary education? Evidence from post-conflict Sierra Leone

In Sierra Leone, the number of primary schools is almost seven times more than junior-secondary schools (JSS). Living in a poor community has been shown to reduce children’s school attendance because of lower access and poorer quality of education in these communities. However, it is unclear whether living in a poor community reduces attendance at primary school more than at JSS, given the wide disparities in school supply between the two educational tiers. Random effects logistic regression models are applied to the 2008 Sierra Leone Demographic and Health Survey for analyses. The results show that living in a poor community reduces primary school attendance but increases attendance at JSS. These results reflect post-war reconstruction in Sierra Leone where: (1) primary schools were rapidly reconstructed without inspection, leading to poor-quality schools; and (2) the redevelopment of JSS was concentrated in war-torn areas, which had minimal access to post-primary education in the pre-war era.

Entomological investigations on malaria vectors in some war-torn areas in the trincomalee district of sri lanka after settlement of 30-year civil disturbance.

Background. Malaria was an endemic problem in Trincomalee District, Eastern Province of Sri Lanka. Very few recent data concerning Anopheles are available which transmit malaria. Therefore, the aim of this study is to identify various Anopheles species and the dynamics of anophelines including malaria vectors in Trincomalee District for effective vector control under the current malaria elimination program embarked in the country. Method. Entomological surveys were conducted on a monthly basis, using five entomological techniques, namely, indoor hand collection (HC), window trap collection (WTC), cattle-baited net collection (CBNC), and cattle-baited hut collection (CBHC) from June 2010 to June 2012 in 32 study areas under five entomological sentinel sites. Results. Seventeen anopheline species were encountered, of which Anopheles subpictus was the predominant species in all sampling methods. It is noted that A. culicifacies and A. subpictus have adapted to breed in polluted water in urban settings which may cause serious implications on the epidemiology of malaria in the country. Conclusions. It is important to determine the abundance, biology, distribution, and relationship with climatic factors of main and secondary malaria vectors in Sri Lanka in order to initiate evidence based controlling programs under the current malaria elimination program in Sri Lanka.

House4hack: STIMULATING TECHNICAL AND PRACTICAL INNOVATION FOR SOCIAL GOOD

John Burger, the founding member of house4hack, despite his passion for social good using practical innovation, was fully aware of the cost of getting people and organizations actively involved in social enterprises. The successful electrical and electronics engineer with a number of academic (PhD and Masters – cum laude) and corporate accolades (executive in a top firm) had already been at the top of the corporate ladder. But despite the success, his stronger desire to see South Africa become a net producer of IT and technical artifacts rather than a net importer had led him to rethink his entire life strategy. After deep discussions on the merits of free and open source software development with two friends, they decided to start house4hack as a non-profit organization. The main purpose of house4hack was to provide an innovative environment, a hacker space, where members could conceptualise and create innovative technical artifacts which are well suited for the South African and African environment. The emphasis of house4hack was on making available technical equipment and working space so that members had an environment in which they could experiment and develop technical artifacts. An example of a technical artefact that emerged from house4hack is Robohand. Robohand is a mechanically driven artificial hand printed using 3D technology. Robohand has depended exclusively on donations to develop and distribute artificial hands to people who cannot afford them, such as in the war torn areas of South Sudan. It was now three years since house4hack started. The hacker space was exciting, new ideas and opportunities kept emerging at the Tuesday meet ups where members and visitors networked and collaborated on new techniques or technology they had come across. But despite the liveliness, there were some key questions and critical decisions on John’s mind: 1. How do we get more people involved in creating artifacts? 2. Where do we find seed funding to support house4hack? 3. Are we serving Africa well enough with relevant artifacts? 4. Am I falling right back into the corporate work lifestyle trap?

Patterns of Psychiatric Morbidity Before and After a War in Lebanon at Twelve Months Following Cessation of Hostilities

Objective: This study is a reassessment of the prevalence and predictors of psychiatric disorders in a general population from South Lebanon conducted one year after the July war in 2007, and was thereafter compared to an assessment conducted one year pre-war in 2005 on the same population. This study aims to (1) assess for PTSD, depression and general health in South Lebanon 1 year after the month-long July war, and (2) to report on the results and compare them to pre-war findings in the same population. Method: This study assessed PTSD, depression, and general health (GHQ) using the Beck Depression Inventory, Harvard Trauma Questionnaire and General Health Questionnaire. The sample consisted of 681 citizens from six villages in South Lebanon using a cross sectional design through random sampling. This sample was compared to another sample of 632 Lebanese citizens interviewed in 2005 before the outbreak of the July war. Results: Findings revealed a drop in PTSD symptoms in the 2007 sample at a rate of 17.9% from 24.1% in 2005. There was no significant change in depression except in the 60 and above age group. A drop in GHQ-28 scores in 2007 was also observed (4.2 in 2007 from 6.7 in 2005, p value = <0.001). Conclusion: This reassessment is further evidence that prevalence of mental disorders is difficult to capture in war-torn areas. Social contexts may play a more important role in mental health outcomes of trauma events experienced in developing countries whose civilians suffer continuous armed conflict.

Education in War Affected Areas (Internally Displaced Persons communities) in Eastern Sudan

This exploratory study investigated the status of education in war torn communities of Eastern Sudan. A questionnaire was sent out to all the principals of the schools in four communities in war torn area of Eastern Sudan. There were also two visits to each of the schools. The study focused on these questions- (a) What are the levels, quality and the type of education provided to 5-16 year olds in the war affected towns/ areas of Eastern Sudan? (b) What are the gender make-up of teachers and principals and the educational qualification of teachers? (c) What are the numbers of subjects taught by grade level and the availability of textbooks for the subjects taught? (d) Are the textbooks written at the level of the students? (e) What are most threatening things to the education of the learner? (f) What are the numbers of school days for the school year and how much work are teachers able to cover during a school year with little or no conflicts compared with a school year with conflicts and natural disasters? Data was collected mainly by interviews of principals in the schools of the study area. An analysis of data from seven principals for all the schools in the area showed four of the schools were built by NGO’s, while three were built by the Government; that more than 57 percent of teachers had a bachelor’s degree with a teaching certificate, that the average teaching experience for male teachers was 15 plus years and for female teachers, it was a little more than 6 years. In the areas of English Language, Mathematics and Science, it was found that textbooks were not available for about 50 percent of the students and that these textbooks were not at the level of the student. There were several threats to the continued education of the learner, the three most important being lack of feeding during the school day for students, lack of family support and early marriages for the girls. Recommendations in the study included campaigns to encourage students to stay in school, and the possibility of some law that will discourage parents from allowing early marriages (for ages less than 16) for the girls.

Efficacy of narrative exposure therapy in the treatment of children and adolescent patients with posttraumatic stress disorder: a systematic review protocol

Review question/objective The objective of this review is to identify the efficacy of narrative exposure therapy in the treatment of children and adolescent patients with posttraumatic stress disorder. Background The most prominent disorder related to traumatic experiences is posttraumatic stress disorder (PTSD) that has specific symptoms which occur in response to trauma exposure as determined by the Diagnostic Staticall Manual (DSM). Among individuals exposed to trauma, approximately 25% to 30% develop PTSD with the rate of the disorder depending on the experience of trauma.1 PTSD is often caused by traumatic events like sexual abuse, physical maltreatment, car accidents, criminal attacks, bombings, rape or torture.2 It has been estimated that most Americans (81.7%) will be exposed to a trauma during their lifetime3 and 6.8% will meet criteria for PTSD at some point in their lives.4 Epidemiologic community surveys in war-torn areas found PTSD point prevalence rates between 15% and 50% among different refugee populations.5 Studies have suggested functional impairment occurs in traumatized children including problems with cognitive and school performance. A survey on trauma-related impairment in children in Sri Lanka showed that 25% of the severe trauma experienced children met the criteria for a diagnosis of PTSD. The traumatized children reported problems with their daily life such as problems in school performance, social withdrawal, depressive symptoms and poor physical health.6 Randomized controlled treatment trials have revealed that trauma-focused treatments can effectively ease symptoms in patients who suffer from PTSD.2,7 Narrative exposure therapy (NET) was recently developed as a standardized, short-term treatment that focuses exclusively on the reconstruction of episodic trauma memory through a detailed and emotional narration of the biography, with particular emphasis on the traumatic events and a focus on achieving habituation to the emotional responses at the end. Therefore, this treatment can potentially preclude a mixture of therapeutic methods such as the application of both psychotherapy and pharmacotherapy in a single patient. University of Konstanz, Germany studied the efficacy of NET as evaluated in a randomized controlled trial in Sudanese refugees living in a Ugandan refugee settlement who were diagnosed as suffering from PTSD. The results indicated that NET is an approach that shows potential for the treatment of PTSD in refugees living in unsafe conditions.8 Instead of asking the patient to define a single event, which is difficult in repeated and multiple traumas, asking the patient to construct a narrative of their whole life with therapist assistance is encouraging.9 Thus, this idea indicates NET is better in assessing many traumatic life events in a patient's life in a more timely and organized way than other psychotherapies. Since PTSD is a problem, there is no clear first choice treatment for the problem. Several randomized controlled trials have showed the efficacy of NET; however there is no existing evidence based review on this topic so this review will be important.

On the Origin of States: Stationary Bandits and Taxation in Eastern Congo

When do states arise? When do they fail to arise? This question has generated scholarship across all social sciences. A dominant view is that states first arise when violent actors impose a “monopoly of violence” in order to extract taxes (Carneiro, 1970, Tilly, 1985). A fundamental fact affects all existing studies: systematic data are the creation of states. There is therefore no statistical evidence on the causes state formation. As a foundation for this study, I organized the collection of village-level panel data on violent actors, managing teams of surveyors, village elders, and households in 380 war-torn areas of DRC. I introduce optimal taxation theory to the decision of violent actors to establish local “monopolies of violence”. The value of such decision hinges on their ability to tax the local population. A sharp rise in the global demand for coltan, a bulky commodity used in the electronics industry, leads violent actors to impose “monopolies of violence” and taxation systems in coltan sites, which persist years after demand collapses. A similar rise in the demand for gold, easier to conceal and more difficult to tax, does not. My findings support the view that the expected revenue from taxation, determined in particular by tax base elasticity, can explain the first stages of state formation, and that temporary changes in the economic environment have persistent effects on local state capacity.

Determining the availability and accessibility of online learning tools for ophthalmic nurses in developing and emerging economy regions of the world

As online education and resources continue to grow at a rapid rate for nurses in developed nations, the knowledge gap between developed and developing nation nurses continues to grow. Computer technology, while accessible and easy to use within developed countries, is new and unchartered territory for many others around the world, and issues such as bandwidth access, cost, local language content, translation and computer literacy, and computer skills remain key elements that need to be addressed before nurses in developing regions of the world can effectively benefit from such technology, otherwise they will be subject to an ever increasing digital divide. This paper will discuss the issues facing many developing nation ophthalmic nurses as they seek current evidence-based practice, evidence-based tools and training, connection with the wider nursing community, and an enhanced ability to apply new knowledge to their own practice advancement and patient care. This paper was compiled during a strategic research development phase for ORBIS Internationals' Cyber-Sight ( www.cyber-sight.org ) online learning tool for nurses. To date, Cyber-Sight has predominantly provided telemedicine and education support to international ophthalmologists around the world. The goal to develop a similar nursing page required initial research to determine the accessibility and availability of this internet resource, as it appeared far more difficult due to the language and affordable-access variances between doctors and nurses. Additionally, this task was considered uncharted waters in ophthalmic online nurse training within developing, emerging economy and war-torn areas of the world. Therefore, as part of a preliminary strategy, ORBIS decided that analysis of the online ophthalmic nursing community was necessary prior to commencing development of their on-line nurse training tools on Cyber-Sight. This paper presents the accumulation of investigations undertaken in order to develop a potential ophthalmic nursing programme for online nurse trainee groups in developing and emerging economy nations.

Functional gastrointestinal diseases in children: Facing the rising tide

However, looking at the overall picture, this study suggests that use of romiplostim is safe and effective as it raised platelet count in 33/35 of the patients, with the majority peaking platelet count between two to three weeks since the first peptide injection. This may help raise platelet counts in CHC patients undergoing antiviral treatment. Currently, most of adverse effects of antiviral therapy with pegylated interferon, ribavirin, and protease inhibitors, such as anemia, leucopenia, fever, body ache, etc can be managed with supportive treatment such as erythropoietin, G-CSF injection, paracetamol, and nonsteroidal anti-inflammatory drugs. Yet no good treatment exists for thrombcyopenia. This study brings hope for CHC patients with thrombocytopenia who are in need of antiviral treatment. Understandingly, this is a phase II study, and the authors rightly caution in the concluding paragraph that further studies in larger group of patients over a longer period of time are warranted in defining the optimal treatment schedule and dosage of romiplostim. Nevertheless, studies on romiplostim will be closely watched by hepatologists like me, as this may bring hope to many patients with advanced fibrosis or cirrhosis from CHC who are excluded from current antiviral treatment due to pre-existing thrombocytopenia.