The Doctor's Consultation:
by Dr. Iain Corness
Anaphylaxis. Anna who? Anna what?
The difficult sounding name of
Anaphylaxis is just a fancy word for the most severe form of allergic
reaction you can have. Those people who have experienced this will attest to
just how frightening it can be. And they have good reason to be frightened -
it is classed as a medical emergency as people can die from this reaction.
It is also much more common than you would imagine. The quoted figures from
America are that Anaphylaxis occurs at an annual rate of 30 per 100,000.
The causes are multiple and include food allergy,
penicillin, cephalosporin and sulfur drugs, intravenous contrast medium
(used in some special X-Rays), aspirin and non-steroidal anti-inflammatory
drugs, walnuts, cashews and pistachios and insect stings.
The commonest food allergy is peanuts and again going to
the American figures, peanuts cause 30,000 documented cases of Anaphylaxis
every year and 200 deaths within that figure. (And you never imagined that
those nuts on the bar were killers, did you? Just another reason why your
mother wanted you to stay out of those bars of ill repute.)
The symptoms include a very sudden and severe breathing
problem (bronchospasm - the basis of asthma), itching around the mouth,
flushing of the skin with large swellings, plus swelling of the face, tongue
and mouth, some gut pains and sometimes nausea and vomiting and finally a
lowering of blood pressure (which can cause a loss of consciousness) and
increasing difficulty in breathing.
Although Anaphylaxis does mimic an asthmatic attack, the
difference is in the speed of the attack and the rapid progression of the
bronchospasm, plus the skin effects that come with it.
With Anaphylaxis, the patient should be hospitalized,
even if they appear to have recovered from the acute symptoms as there is
something we call the “biphasic reaction” which sees a recurrence of the
symptoms. This can be even more severe than the initial attack, so we
recommend that patients be kept in hospital under observation for 12 hours,
in case there is this biphasic reaction.
The treatment of the acute phase is injection of
Adrenaline 1/1000 strength, oxygen by mask or by tube if the swelling is
producing too much of an obstruction, intravenous saline to boost the blood
pressure plus intravenous steroids and even some antihistamines. Not the
sort of things you keep at home in the cupboard above the bathroom sink!
The management of the condition from the long term point
of view goes into trying to find out and eliminate the allergen causing the
problem. With the food allergies this is very difficult, and usually
involves withdrawing each “perhaps a problem” food from the diet, one at a
time. But start with peanuts, if peanuts are something commonly eaten, and
something that was eaten on the day of the last attack. Do not suppose that
the triggering item is bananas if you didn’t have a banana before the last
episode of Anaphylaxis.
So what should you do if you are a person who suffers
from these acute allergic responses? Well, if it were me, I would alert
those around me to the dangers and advise them on what to do - mainly to get
you to the hospital as soon as possible - remember that this is a medical
emergency. I would also be looking at keeping a supply of 1/1000 Adrenaline
injectable for immediate use. There are commercially available auto
injectors in some overseas countries called “Epipens” for this purpose. And
I would also be consulting the nearest allergist (a branch of internal
medicine) and following this doctor’s advice. I repeat, Anaphylaxis is a
life threatening medical emergency.
Heart to Heart
I am writing to you with a sad cautionary tale. Briefly, a lady from
Buriram who I met in 2003 worked as a masseuse in various shops and we
became friends platonically. She was genuine (no extras) and with two
sons to support I was glad for her when a Swedish man invited her to
share his life in his Jomtien Condo in 2004, she could continue working
but not late at night. I rarely met her and had not seen her for a long
time so when we met by chance in a local Boots shop I invited her to
visit me for a coffee and a chat after a daily English lesson at school.
She was happy with her life and told me she had finally finished
building a new home in Buriram paid for over time with her own money but
had no cash left for any furniture. As it happened I had ordered a new
settee due for delivery in a few days and I was in a quandary how to get
rid of my current one which I inherited with the Condo so I offered it
to her free if she could arrange to collect it. No problem, two of her
friends from school arrived and the settee had a new owner so we were
both pleased. So far so good, but evidently the word TRUST is unknown
Yesterday she sent an SMS requesting immediate help. She and her Swede
had visited her home and he had volunteered to buy some furniture for
her very bare home but on seeing my old settee he became enraged and
accused her of much wrong doing saying no one gives something for
nothing in return! He returned alone and when she eventually arrived he
told her to get out, she had no money and asked if I could give her
enough to cover a months rent for a room, she would immediately look for
work of course. I was glad to, what are friends for? The attitude of her
guy gave me a sour taste, he assumed wrongly that as I had given her a
present she had been playing around with other men - this after three
years living as his wife. She was very philosophic about it all but who
can SHE trust again? If you print this as a warning giving gifts
sometimes brings a lot of grief.
Indeed a sad cautionary tale, but I believe there is more to all this
than meets the eye. However, please do not think that I am sitting here
as judge and jury, but I am trying to look dispassionately, Petal. The
lady had been living in a marital situation for three years, but the
trust between them was obviously simply not there. I wonder why, and
what prompted the outburst from the husband? Perhaps there were other
events leading up to this? You are only giving me one side of the story
(the one you are being given by the lady), and in any relationship there
are always two sides. You have not been made privy to the Swede’s side.
You also wonder whom this woman could trust again. She seems to be able
to trust you, and you trust her, even giving her money for rent, so
“trust” still exists in both of your minds. You say she is philosophic
about it all and this could either mean that she is applying Buddhist
principles to her life, or even the fact that there was little spark
left between she and her Swedish husband. If there had been much
communication between them, he would have known about the settee long
before making the trip to Buriram.
Once a week I have a night out with the boys at work. Usually this
means I get home in the wee small hours (2 a.m. closing time these days)
and sometimes I am a little the worse for wear as a couple of the lads
are top drinkers. My girlfriend is starting to crack up a bit about this
one night a week. I reckon she is being unreasonable, as I used to get
home even later before the crackdowns. What can I tell her to make her
see that this is just harmless fun with the lads and is a break for me
from family responsibilities?
I want you to change roles with your girlfriend for one night. She is
going to go out with the girls from work and is going to come home at
something past two, decidedly the worse for wear. In other words, very
drunk. Are you going to happily sit back and let this happen every week?
Will you calmly sit at home and not wonder where she is? Will you sit
there watching the Thai TV soap operas about cheating husbands and wives
(that’s all there is on local TV) and not worry? Or are you going to
crack up about it? It is only Scottish stags that are the “monarchs of
the glen”. I think you should reconsider your responsibilities to the
young lady. And some people told me that chauvinism was dead!
Camera Class: by
past the local camera shop, one camera really caught my eye.
This was the Samsung NV3, an all-black, slim camera that
appeared to offer much, at a price that was not exorbitant. In
this day and age, B. 13,990 is not at all over the top for a
better range digital compact.
However, was the feature of this camera merely that
of an attractive appearance, or did it have some worthwhile technology
as well? Or too much technology?
There was no doubting the attractiveness when you
have the Samsung NV3 in your hands. It is no lightweight, despite the
very small overall dimensions, being only 17.5 mm thick. It has a
minimum of extrusions and knobs, and the design is definitely clean and
As a compact digital, it has 7.2 mega-pixels, which
is more than enough for good resolution, but it has more. It also acts
as an MP3 player using a special audio processing chip delivering 3D,
Jazz, Rock, and other sound effects. Listen to the music via the
built-in stereo speakers or included headphones. The NV3 includes a
Portable Multimedia Player (PMP) to watch downloaded movies. The NV3
also doubles as a digital camcorder with MPEG-4 TVD (720x480) 20fps and
VGA (640x480) 30fps, Auto Gain Control (AGC) technology minimizes zoom
noise during video recording. A text viewer allows the user to read text
on the LCD, or to use as an e-book, whilst the multi-tasking ability
enables you to listen to music while taking pictures!
On paper, this to me looks like the microwave oven
that also tells the time, slices meat and scrambles eggs, doubles as a
TV set and works as an infra-red burglar alarm.
However, it looks so good, let’s look at its ability
as a camera, forgetting for the time being all the MP3, PMP, AGC and
MPEG-4 TVD stuff.
On the top of the camera is a simple rotary knob for
the various modes available, including an Auto everything, Program,
Advanced Shake Reduction (ASR).
The ASR technology prevents the degradation of image
clarity and color common to flash photography. With ASR the effects of
camera shake are reduced in lower light conditions. You can even take
well exposed, sharper pictures in low light without using a flash at
all. It guarantees brighter and more natural pictures, says Mr. Samsung.
The camera has many other good features, including,
Wise Shot in which the camera takes the same shot twice, once with ASR
and the other with flash. It then compares the results and lets you have
the best picture of the two (i.e. flash shot if it is better than the
ASR shot, and vice versa).
The NV series has an auto sensitivity feature that
automatically adjusts sensitivity according to the ambient exposure
conditions up to ISO 1000. The high sensitivity setting of ISO 1000
enables you to take clear indoor pictures in the dark without camera
shake and image blurring.
There are other features such as the Red-eye Fix
function, which is an algorithm programmed into the camera that
automatically eliminates red eye in shoot and play modes, allowing you
take a natural portrait photo.
There are also various ‘scene modes’ such as Night
Scene, Portrait, Children, Landscape, Text Recognition, Sunset, Dawn,
Backlight, Fireworks, Beach and Snow.
According to the Samsung press release, the NV Series
was developed following a two year consumer research study to gain
insight into the lifestyle and needs of consumers and their
picture-taking interests. Samsung claims that as well as offering
practical technology and easy usability, the new NV Series stands for
individuality and style.
Recharging can be done using a cradle or a 24 pin USB
cable, as well as by using a detachable cable. Connect the camera to a
PC using a 24 pin USB cable, use the adaptor cable to plug it into a
power supply, or use any other convenient method to recharge it.
To me, the camera looks excellent, but I wonder how much they could
sell it for, without all the extraneous capabilities, that a
photographer would scarcely ever use? Since we have phones that take
pictures, I am surprised this camera doesn’t make long distance calls!
Money Matters: Graham
Macdonald MBMG International Ltd.
Orbis, Part 2
Last week we had a look at Orbis Investment Management’s
global equity fund and their Japan fund. Finally, let’s have a look at the
Orbis range of market neutral funds. It’s worth comparing their annualised
performance with their benchmarks:
Yen classes were also launched in January this year.
In the Equity Funds that we’ve looked at, value added
through stock selection (Alpha) is measured simply as the difference between
a Fund’s return and that of its benchmark index. In these Absolute Return
Funds, any Alpha we extract is the difference between the return on the
selected equities and the stock index futures used to hedge against
stock-market risk. This collection of stock index futures (hedging basket)
most often does not mirror the benchmarks of the underlying equity
portfolios and thus Orbis’ Market-Neutral funds Alpha can differ from that
of the underlying Equity Funds. The most significant difference in this
regard stems from the fact that the underlying equity holdings in aggregate
often differ substantially in geographic deployment to a global benchmark,
whereas Orbis’ hedging is designed to closely match the geographic
deployment of its underlying equity holdings.
Their hedging starts with a calculation that objectively
and quite mechanically determines how many contracts of the major stock
index futures they should sell in order to neutralise the movement in their
stocks that is entirely due to market factors rather than stock-specific
factors. This initial stage makes the portfolio market-neutral in relation
to those indices and determines the bulk of the hedging basket. They then
allow themselves some leeway to modify the market-neutral hedge.
This incremental positioning can be done for various
reasons, but there are two major ones. Firstly, they might want to reduce
the hedging somewhat in markets where we believe equities are attractive -
i.e. where they believe that exposure to market Beta is attractive, they
might allow that to some extent. Secondly, they might want to shift some of
the hedging from one market to another, as they did some time ago when they
did not fully hedge their selection of Japanese stocks and instead applied
some additional hedging in the US because they considered a decline in the
US stock-market a greater threat to the value of the Fund than a decline in
the Japanese stock-market.
The size of these incremental positions is restricted.
They also apply some judgment to the selection of the constituents in the
market-neutral hedging basket. Orbis have recently made a change to the
market neutral funds’ hedging basket, namely the inclusion of the Russell
2000 Index. To hedge Orbis’ US stock-market exposure in the past, they
typically sold futures contracts using the single most representative, and
most liquid US stock index, the S&P 500. This makes the Fund’s exposure to
US stocks neutral with respect to the S&P 500, but this approach does not
make the portfolio market-neutral with respect to the entire US market.
The S&P 500 mainly reflects the moves of the largest US
stocks by market capitalisation and thus this approach tends to
under-represent the small-cap and mid-cap parts of the US market.
To represent the US market more completely, the hedging
basket should contain some exposure to mid-cap and small-cap indices. While
not true in most stock markets, it is possible to remedy this situation
somewhat in the US. Although the US lacks a liquid mid-cap futures contract,
the futures contract on the Russell 2000 Index (the 2000 stocks that rank
from 1001-3000 of US stocks by market capitalisation) has been reasonably
liquid since the late 1990s and is now the industry standard benchmark for
small-cap stocks. Allowing the Russell 2000 Index to be incorporated into
the Funds’ US hedging basket led Orbis to the conclusion that a 85% : 15%
mix of the S&P 500 and Russell 2000 indices would provide a better hedge
than only using the S&P 500.
We support this enthusiastically and see that there
should be immediate added value - the expected return for small-cap US
stocks minus the expected return for large-cap US stocks. This has been
calculated using Orbis’ re-rated total rate of return (RTRR) model. It shows
that while small-cap stocks have offered higher prospective returns than
large-cap stocks for almost all of the market-neutral Funds’ histories, this
is no longer the case. In fact, analysis suggests that small-cap stocks are
extremely unattractive relative to large-cap stocks on a historical basis.
In addition to this 15% allocation (which will remain a
fixture) Orbis can take a view on the Russell 2000 Index and sell more or
less futures than prescribed by the market-neutral hedge. Such a position,
like the other discretionary increments referred to above, would be regarded
as an incremental position and its size would be limited accordingly.
Whether the equity funds or the market-neutral funds,
Orbis have performed exceptionally well in the past and we expect this to
continue to be the case in the future.
Although the funds are now closed to individual investors, they can be
accessed through the range of MBMG Private Client Portfolios.
The above data and research was compiled from sources believed to be
reliable. However, neither MBMG International Ltd nor its officers can accept
any liability for any errors or omissions in the above article nor bear any
responsibility for any losses achieved as a result of any actions taken or not
taken as a consequence of reading the above article. For more information please
contact Graham Macdonald on [email protected]