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Introduction: Intra-articular hyaluronic acid (HA) is widely utilized in the treatment of knee osteoarthritis whereas platelet rich plasma (PRP) enhances the regeneration of articular cartilage. This study analyses the efficacy of HA and PRP in grade III and IV knee osteoarthritis. Methodology: This is a cross sectional study with retrospective review of 64 patients (101 knees) which includes 56 knees injected with HA+ PRP, and 45 knees with HA only. Results: During the post six months International Knee Documentation Committee (IKDC) evaluation, HA+PRP group showed marked improvement of 24.33 compared to 12.15 in HA group. Decrement in visual analogue score (VAS) in HA+PRP was 1.9 compared to 0.8 in HA group. Conclusion: We propose intra-articular HA and PRP injections as an optional treatment modality in Grade III and IV knee osteoarthritis in terms of functional outcome and pain control for up to six months when arthroplasty is not an option.

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Tun Dr Mahathir Mohamad was a medical student at the King Edward VII College of Medicine from 1947 to 1953. He described his student days with fondness; he made many friends while he was at the College. He recounted his early days as a doctor before he entered politics in 1964. He became the fourth and longest serving Prime Minister of Malaysia for 22 years from 1981 to 2003. He concluded "The contribution of my Medical College days in Singapore to the racial harmony, peace and prosperity of Malaysia is tangible but unquantifiable."

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PIP: In Asia, an economic crisis has occurred simultaneously with an immense increase in the prevalence of HIV/AIDS fueled by inadequate responses to the epidemic. This response has been further weakened by sudden budget cuts and changes in government priorities, and the situation has been exacerbated by its suddenness and by the fact that large numbers of people are at risk and are unemployed. Also, Asian countries are now seeking entry into the pool of countries where donors support HIV/AIDS prevention and treatment programs just as donors are reducing their aid budgets. Prevention programs are being severely compromised even before they became effective, and efforts to secure treatment are hindered by high prices, by devalued national currencies, and by an increasing trend towards the privatization of health care. In the long run, efforts to restore economic stability will be hindered by the socioeconomic impact of the HIV/AIDS pandemic. In order to improve future prospects, the leadership of all national AIDS programs must reexamine the cost effectiveness of their priorities. Such a move would target marginalized groups, reduce use of expensive mass media campaigns, increase international cooperation over issues dealing with migrant workers, create programs recognizing the crucial role of women, increase the involvement of infected people in prevention programs, recognize the long-term socioeconomic benefits of providing adequate and equitable care and treatment, and recognize the benefits of prioritizing HIV/AIDS funding.^ieng

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PIP: Although many people believe that mainly men get infected with HIV/AIDS, women are actually getting infected at a faster rate than men, especially in developing countries, and suffer more from the adverse impact of AIDS. As of mid-1996, the Joint UN Program on AIDS estimated that more than 10 million of the 25 million adults infected with HIV since the beginning of the epidemic are women. The proportion of HIV-positive women is growing, with almost half of the 7500 new infections daily occurring among women. 90% of HIV-positive women live in a developing country. In Asia-Pacific, 1.4 million women have been infected with HIV out of an estimated total 3.08 million adults from the late 1970s until late 1994. Biologically, women are more vulnerable than men to infection because of the greater mucus area exposed to HIV during penile penetration. Women under age 17 years are at even greater risk because they have an underdeveloped cervix and low vaginal mucus production. Concurrent sexually transmitted diseases increase the risk of HIV transmission. Women's risk is also related to their exposure to gender inequalities in society. The social and economic pressures of poverty exacerbate women's risk. Prevention programs are discussed.^ieng

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PIP: In Asia, attempts to control HIV/AIDS through education have not achieved the necessary behavior changes. This is especially true for young women who are unable to apply their knowledge to their sex behavior because of inequalities in gender relations. Thus, the impact of AIDS on women is significantly greater in settings where the status of women is low. Women in developing countries are at greatest risk because the epidemic is fueled by poverty, lack of information, and lack of autonomy. Prosperity in a developing country, such as Malaysia, entails its own risks because it creates new social norms and values that exist in tandem with debilitating old norms, such as the patriarchy that disempowers women and a resurgence in polygamy and wife abandonment. Subservient gender roles not only increase women's chances of infection, they also target women as the primary caregivers for infected individuals. Young girls may have to abandon school to care for infected parents, and female health care providers are assigned to the lowest ranks of the profession. While most women have been infected by their husbands, they must also bear the stigma of being considered immoral infectors of their husbands. The futures of AIDS widows and orphans is jeopardized by the discrimination that attends the disease, and if the mother dies, her young children face a higher death rate. In settings new to the epidemic, it is difficult to convince men of the importance of addressing women's needs and of seeking the input of women in policy and program development. Only by empowering both sexes to work together to protect society will there be a reasonable chance of reducing the impact of HIV/AIDS.^ieng

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Inexorably, the epicentre of the global HIV pandemic is moving from Africa to Asia. Despite many years of much-publicised analysis of the African epidemic, most countries in Asia and many in the Pacific have not introduced the public health strategies known to minimise the spread of HIV. What must be done now, and how can the developed countries in the region, such as Australia, assist their neighbours?

PIP: In the Asia-Pacific region, almost 5000 people become infected with HIV every day. The leading mode of HIV transmission is heterosexual intercourse. Sharing of injecting equipment among drug users is also a major mode of HIV transmission. Myanmar is the epicenter of the HIV epidemic in Asia. The political tensions there interfere with attempts to curb the spread of HIV in-country and to neighboring countries. The lack of effective cross-border programs has resulted in an explosive situation in China's south Yunnan province, especially among drug abusers. In many countries in the region, the blood supply is unsafe. Thailand is the only country politically committed to curbing HIV transmission. Government-facilitated massive education programs and other interventions preceded a decline in the overall rate of sexually transmitted diseases (STDs) in Thailand. Key strategies in Thailand include detailed epidemiologic studies to determine the incidence and prevalence of HIV infection nationwide, promotion of safer sex practices in commercial sex establishments (e.g., 100% condom campaign), and official willingness to work with nongovernmental organizations. The government of India has not responded appropriately to the HIV/AIDS epidemic and the outcome has been disastrous. India will likely soon have more HIV-infected people than any other Asia-Pacific country. Preventive programs may spare western Pacific countries, where HIV incidence is low. Obstacles to tackling the HIV epidemic include poverty, poor facilities for the treatment of STDs, failure to address discrimination against those infected with HIV, and problems associated with the very low status of women. Many years of national development can be lost to the HIV epidemic. Australia has model HIV prevention and control policies and can help its Asia-Pacific neighbors fight HIV/AIDS. Health professionals in only Thailand, Australia, and New Zealand are prepared for the future AIDS caseload. Australia offers clinical programs for the region's health professionals. Greater political commitment is needed in the region to minimize the HIV/AIDS epidemic.

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