The outpatient management of hypertension at two Sierra Leonean health centres: a mixed-method investigation of follow-up compliance and patient-reported barriers to care

Background: Sub-Saharan Africa faces an increasing burden of non-communicable diseases. In particular, hypertension and its therapeutic control present a challenge and opportunity for health practitioners and health systems within the region. Aim: This study sought to assess an initiative conducted by two health clinics to begin treatment of hypertension amongst their patient populations by reviewing medication possession rates and documenting patient-reported barriers to care in the provision of chronic hypertension management. Setting: Two private, outpatient health clinics in Sierra Leone recently beginning hypertension management initiatives. Methods: A retrospective chart review identified 487 records of patients with diagnosed hypertension and assessed for medication adherence through calculation of medication possession ratios from pharmacy refill data. Surveys were conducted on a convenience sample of 68 patients of the hypertension treatment programme to discern patient-reported barriers of care. Results: Medication possession rates were found to be less than 40% in 82% (399/487) of patients, between 40% and 79% in 12% (60/487) of patients and 80% or greater in 6% (28/487) of patients. In surveys of individuals being treated by the programme, patients were most likely to cite transportation (81%, 55/68), financial burden (69%, 47/68) and schedule conflicts with work or other prior commitments (25%, 17/68) as barriers to care. Conclusions: In this newly instituted outpatient hypertensive management initiative, 82% of patients had medication possession ratios under 40%, which is likely to impact the clinical effectiveness of the initiative. The most frequent patient-reported barriers to care in surveys included transportation, financial burden and schedule conflicts

Generation and analysis of expressed sequence tags from Botrytis cinerea

Botrytis cinerea is a filamentous plant pathogen of a wide range of plant species, and its infection may cause enormous damage both during plant growth and in the post-harvest phase. We have constructed a cDNA library from an isolate of B. cinerea and have sequenced 11,482 expressed sequence tags that were assembled into 1,003 contigs sequences and 3,032 singletons. Approximately 81% of the unigenes showed significant similarity to genes coding for proteins with known functions: more than 50% of the sequences code for genes involved in cellular metabolism, 12% for transport of metabolites, and approximately 10% for cellular organization. Other functional categories include responses to biotic and abiotic stimuli, cell communication, cell homeostasis, and cell development. We carried out pair-wise comparisons with fungal databases to determine the B. cinerea unisequence set with relevant similarity to genes in other fungal pathogenic counterparts. Among the 4,035 non-redundant B. cinerea unigenes, 1,338 (23%) have significant homology with Fusarium verticillioides unigenes. Similar values were obtained for Saccharomyces cerevisiae and Aspergillus nidulans (22% and 24%, respectively). The lower percentages of homology were with Magnaporthe grisae and Neurospora crassa (13% and 19%, respectively). Several genes involved in putative and known fungal virulence and general pathogenicity were identified. The results provide important information for future research on this fungal pathogen.

A Lux-like Quorum Sensing System in the Extreme Acidophile Acidithiobacillus ferrooxidans

The genome of the acidophilic, proteobacterium Acidithiobacillus ferrooxidans, contains linked but divergently oriented genes, termed afeI and afeR, whose predicted protein products are significantly similar to the LuxI and LuxR families of proteins. A possible promoter and Lux box are predicted upstream of afeI. A cloned copy of afeI, expressed in E. coli, encodes an enzyme that catalyzes the production of a diffusible compound identified by gas chromatography and mass spectrometry as an unsubstituted N-acyl homoserine lactone (AHL) of chain length C14. This AHL can be detected by a reporter strain of Sinorhizobium meliloti Rm41 suggesting that it is biologically active. The reporter strain also responds to extracts of the supernatant of A. ferrooxidans grown to early stationary phase in sulfur medium indicating that a diffusible AHL is produced by this microorganism. Semi-quantitative RT-PCR experiments indicate that afeI and afeR are expressed maximally in early stationary phase and are more expressed when A. ferrooxidans is grown in sulfur- rather than iron-containing medium. Given the predicted amino acid sequence and functional properties of AfeI and AfeR it is proposed that A. ferrooxidans has a quorum sensing system similar to the LuxI-LuxR paradigm.

Metodologías alternas en el control y prevención de la malaria (Estudio realizado en el caserio "Las Majadas", Distrito Sucre, Estado-Bolívar, 1986) / Methods in the prevention and control of the malarie (Study made in the caserio \"Las Majadas\", Disctrit Sucre, Bolivar-State, 1986)

Un grupo de investigadores de la Universidad de Carabobo y Maravén, llevaron a cabo un experimento involucrando a los 350 pobladores del caserio Las Majadas en el control y prevención de la malaria mediante la educación sanitaria, organización comunal y uso del mosquitero impregnado con Permetrina. En mayo de 1986 con la ayuda de la comunidad, se impregnaron 33 de los 55 mosquiteros existentes. Seis meses más tarde, en octubre, el equipo volvio a la comunidad y entrevistaron a 21 de las 33 personas que habían contraido la malaria en al intervalo enero-octubre, 1986. Se encontro que hubo un brote serio en el mes de junio que solo produjo 22 casos. Catorce de las victimas dormian en sitios sin ninguna protección contra el mosquito..