Direct Observation of Photoinduced Tautomerization in Single Molecules at a Metal Surface.

Molecular switches are of fundamental importance in nature, and light is an important stimulus to selectively drive the switching process. However, the local dynamics of a conformational change in these molecules remain far from being completely understood at the single-molecule level. Here, we report the direct observation of photoinduced tautomerization in single porphycene molecules on a Cu(111) surface by using a combination of low-temperature scanning tunneling microscopy and laser excitation in the near-infrared to ultraviolet regime. It is found that the thermodynamically stable trans configuration of porphycene can be converted to the metastable cis configuration in a unidirectional fashion by photoirradiation. The wavelength dependence of the tautomerization cross section exhibits a steep increase around 2 eV and demonstrates that excitation of the Cu d-band electrons and the resulting hot carriers play a dominant role in the photochemical process. Additionally, a pronounced isotope effect in the cross section (∼100) is observed when the transferred hydrogen atoms are substituted with deuterium, indicating a significant contribution of zero-point energy in the reaction. Combined with the study of inelastic tunneling electron-induced tautomerization with the STM, we propose that tautomerization occurs via excitation of molecular vibrations after photoexcitation. Interestingly, the observed cross section of ∼10(-19) cm(2) in the visible-ultraviolet region is much higher than that of previously studied molecular switches on a metal surface, for example, azobenzene derivatives (10(-23)-10(-22) cm(2)). Furthermore, we examined a local environmental impact on the photoinduced tautomerization by varying molecular density on the surface and find substantial changes in the cross section and quenching of the process due to the intermolecular interaction at high density.

[Dopamine receptors of the corneal epithelium and endothelium]. / Dopaminrezeptoren des Hornhautepithels und -endothels.

BACKGROUND: Dopamine is a major neurotransmitter and its two receptor subgroups, termed D1-like and D2-like receptors, are found both in the central and peripheral nervous systems. D1-like receptors signal through increases, D2-like receptors through decreases in cAMP production. Reports about the presence of dopamine receptors in the cornea are rare and inconsistant. The aim of this study was to examine if native bovine corneal epithelial and endothelial cells express dopamine receptors and whether these receptors belong to the D1-like or D2-like group. MATERIALS AND METHODS: Dopamine receptors were studied using polyclonal antibodies. The cAMP concentration after receptor stimulation with dopamine was determined by means of an enzyme immunoassay. RESULTS: In bovine corneal epithelium and endothelium immunohistochemical staining was positive for D1-like receptors but not for D2-like receptors. Stimulation of corneal D1-like receptors with dopamine revealed a dose-dependent increase of the intracellular cAMP concentration which was blocked by SCH23 390 (a selective D1-like antagonist). CONCLUSION: Our data demonstrate that bovine corneal epithelium and endothelium express a functional D1-like receptor positively coupled to adenylyl cyclase and cAMP production. However, at the present time the physiological role of this receptor remains a matter of speculation.

[Effect of brimonidine on central corneal thickness]. / Einfluss von Brimonidin auf die zentrale Hornhautdicke.

BACKGROUND: Brimonidine, an alpha-2 adrenoceptor agonist, is widely used in glaucoma treatment. Although it is known that it is quickly taken up by the cornea following topical administration and although it is well established that the cornea expresses alpha-2 adrenoceptors there are only few studies available on the impact brimonidine has on the cornea. The aim of the present study was to show if topical application of brimonidine leads to an interaction with corneal alpha-2 adrenoceptors in terms of an increase in central corneal thickness. MATERIALS AND METHODS: Ten healthy test persons (five female and five male subjects) - mean age 30 ± 7years - were tested in a pilot study. Measured were intraocular pressure, epithelial, stromal and endothelial thickness before as well as ten minutes, 24, 48, 72 and 96 hours after administration of brimonidine 0.1 % eye drops twice daily. To check the impact of this medication, sodium hyaluronate eye drops were administered to the other eye twice daily. RESULTS: Administration of brimonidine 0.1 % resulted in a reduction of intraocular pressure from an initial value of 17 ± 2 mmHg to 13 ± 4 mmHg after four days (p = 0.001) as well as an increase in total corneal thickness from 559 ± 8 µm from the time of the baseline examination to 581 ± 11 µm (p < 0.001), an increase of epithelial thickness from 61 ± 1 µm to 68 ± 7 µm (p = 0.008) and stromal thickness from 488 ± 8 µm to 503 ± 8 µm (p < 0.001) after two days each. Another two days later total corneal thickness was 566 ± 10 µm (p = 0.032), epithelial thickness 64 ± 3 µm (p = 0.104) and stromal thickness 492 ± 8 µm (p = 0.139), which means that the values had returned more or less to the initial values measured. In contrast, endothelial thickness did not vary following administration of brimonidine 0.1 % (p = 0.109). CONCLUSION: Topical administration of brimonidine 0.1 % results in a reversible increase in corneal thickness. The question as to whether this increase is of clinical significance has to be answered by larger studies.

Mechanical behavior of nanocrystalline NaCl islands on Cu(111).

The mechanical response of ultrathin NaCl crystallites of nanometer dimensions upon manipulation with the tip of a scanning tunneling microscope (STM) is investigated, expanding STM manipulation to various nanostructuring modes of inorganic materials as cutting, moving, and cracking. In the light of theoretical calculations, our results reveal that atomic-scale NaCl islands can behave elastically and follow a classical Hooke's law. When the elastic limit of the nanocrystallites is reached, the STM tip induces atomic dislocations and consequently the regime of plastic deformation is entered. Our methodology is paving the way to understand the mechanical behavior and properties of other nanoscale materials.

A high fructose diet impairs spatial memory in male rats.

Over the past three decades there has been a substantial increase in the amount of fructose consumed by North Americans. Recent evidence from rodents indicates that hippocampal insulin signaling facilitates memory and excessive fructose consumption produces hippocampal insulin resistance. Based on this evidence, the present study tested the hypothesis that a high fructose diet would impair hippocampal-dependent memory. Adult male Sprague-Dawley rats (postnatal day 61) were fed either a control (0% fructose) or high fructose diet (60% of calories). Food intake and body mass were measured regularly. After 19 weeks, the rats were given 3 days of training (8 trials/day) in a spatial version of the water maze task, and retention performance was probed 48 h later. The high fructose diet did not affect acquisition of the task, but did impair performance on the retention test. Specifically, rats fed a high fructose diet displayed significantly longer latencies to reach the area where the platform had been located, made significantly fewer approaches to that area, and spent significantly less time in the target quadrant than did control diet rats. There was no difference in swim speed between the two groups. The retention deficits correlated significantly with fructose-induced elevations of plasma triglyceride concentrations. Consequently, the impaired spatial water maze retention performance seen with the high fructose diet may have been attributable, at least in part, to fructose-induced increases in plasma triglycerides.

Medications for chronic pain practical review.

This review is confined to the drug management of chronic pain, and is specifically adapted to the resource-poor environment and the HIV pandemic of sub-Saharan Africa. A brief classification of chronic pain is followed by a discussion of the different classes of medications in use, including those used in migraine. An approach to the rational drug management of neuropathic pain is presented. In conclusion some general principles for prescribing in this setting are derived.

Rare labial ulcer related to the use of all-trans retinoic acid in a patient with acute promyelocytic leukemia.

Acute promyelocytic leukemia (APL) is a subtype of acute myeloid leukemia (AML). All-trans retinoic acid (ATRA) is the first-choice therapy for the treatment of this disease, but has been associated with side effects, the most serious of which is retinoic acid syndrome (RAS). RAS is characterized by unexplained fever, dyspnea, pulmonary infiltrate, leukocytosis and nephropathy. Genital ulcers have been described in some cases, but only two cases of oral ulcers related to this syndrome have been described in the literature. This paper describes the third case of oral ulceration related to ATRA in a 32-year-old white man with diagnosis of APL. Clinicians should know the side effects of ATRA and identify oral ulcers resulting from this therapy. The prompt identification of these ulcers enables the institution of appropriate treatment and can therefore contribute to continuation of the patient's cancer treatment.

A highly stable monolithic enhancement cavity for second harmonic generation in the ultraviolet.

We present a highly stable bow-tie power enhancement cavity for critical second harmonic generation (SHG) into the UV using a Brewster-cut ß-BaB2O4 (BBO) nonlinear crystal. The cavity geometry is suitable for all UV wavelengths reachable with BBO and can be modified to accommodate anti-reflection coated crystals, extending its applicability to the entire wavelength range accessible with non-linear frequency conversion. The cavity is length-stabilized using a fast general purpose digital PI controller based on the open source STEMlab 125-14 (formerly Red Pitaya) system acting on a mirror mounted on a fast piezo actuator. We observe 130 h uninterrupted operation without decay in output power at 313 nm. The robustness of the system has been confirmed by exposing it to accelerations of up to 1 g with less than 10% in-lock output power variations. Furthermore, the cavity can withstand 30 min of acceleration exposure at a level of 3 grms without substantial change in the SHG output power, demonstrating that the design is suitable for transportable setups.

Between-Batch Pharmacokinetic Variability Inflates Type I Error Rate in Conventional Bioequivalence Trials: A Randomized Advair Diskus Clinical Trial.

We previously demonstrated pharmacokinetic differences among manufacturing batches of a US Food and Drug Administration (FDA)-approved dry powder inhalation product (Advair Diskus 100/50) large enough to establish between-batch bio-inequivalence. Here, we provide independent confirmation of pharmacokinetic bio-inequivalence among Advair Diskus 100/50 batches, and quantify residual and between-batch variance component magnitudes. These variance estimates are used to consider the type I error rate of the FDA's current two-way crossover design recommendation. When between-batch pharmacokinetic variability is substantial, the conventional two-way crossover design cannot accomplish the objectives of FDA's statistical bioequivalence test (i.e., cannot accurately estimate the test/reference ratio and associated confidence interval). The two-way crossover, which ignores between-batch pharmacokinetic variability, yields an artificially narrow confidence interval on the product comparison. The unavoidable consequence is type I error rate inflation, to ∼25%, when between-batch pharmacokinetic variability is nonzero. This risk of a false bioequivalence conclusion is substantially higher than asserted by regulators as acceptable consumer risk (5%).

Modulation of intestinal cell differentiation in growing pigs is dependent on the fiber source in the diet.

Feeding high-fiber diets decreases cost, but also caloric and nutritional efficiency by modifying intestinal morphology and function. We analyzed the changes in intestinal cell composition, nutrient transporters and receptors, and cell differentiation induced by fibers from different sources. Forty-six finishing pigs (BW 84 ± 7 kg) were fed 1 of 4 diets: corn-soybean (Control; = 12), 23% wheat straw (WS; = 11), 55% corn distillers dried grains with solubles (DDGS; = 11), and 30% soybean hulls (SBH; = 12). Pigs were fed 2 meals daily to an amount equivalent to 2.5% of initial BW for 14 d in metabolism cages. Ilea were collected for histological and gene expression analysis after euthanasia. Data were analyzed using the Kruskal-Wallis test followed by Dunn's multiple comparisons and differences considered significant when < 0.05. The enterocyte marker was increased ( < 0.03) by feeding SBH compared with Control and WS diets. Goblet cells presence was greater ( < 0.01) in pigs fed WS and DDGS compared with Control, and in pigs fed WS compared with SBH ( = 0.02). expression was greater ( < 0.05) in pigs fed DDGS and SBH compared with Control diet. No changes were observed for endocrine and Paneth cells markers, villus and crypt length, or proliferation index. Compared with the Control, gene expression of receptors for oligopeptides, calcium, glucose, fructose, , and and was increased ( < 0.05) by feeding WS and DDGS diets. Feeding SBH diet repressed ( < 0.005) the compared with WS and DDGS diets, while DDGS repressed ( = 0.02) its expression compared with Control. Pigs fed DDGS had reduced ( < 0.001) , and those fed SBH showed increased ( < 0.05) expression compared with WS and DDGS pigs. Feeding WS and DDGS diets induced ( < 0.01) the expression of stem cell marker r-spondin receptor (, while was reduced ( < 0.02) by feeding DDGS compared with Control. The expression of was induced ( < 0.05) by all fibers compared with Control. Transcription factors and were suppressed ( < 0.001) by WS and DDGS compared with Control. In conclusion, feeding diets containing WS and DDGS modulated intestinal differentiation by promoting goblet cells and altered expression of nutrient receptors and transporters in growing pigs, while feeding SBH had less effect.

Endogenous insulin signaling protects cultured neurons from oxygen-glucose deprivation-induced cell death.

Curiosity surrounding the physiological relevance of neural insulin signaling has gradually developed since the discovery that nervous tissue contains both the hormone and its receptor. Similar to other receptor tyrosine kinases, ligand interaction with the insulin receptor (IR) activates a variety of intracellular signaling pathways, particularly those relevant to cellular survival. Consequently, one explanation for the presence of the insulin pathway in the brain may involve participation in the response to neuronal injury. To investigate this possibility, the present study began by examining the effect of oxygen-glucose deprivation (OGD), a well-characterized in vitro model of ischemia, on ligand-binding, surface expression, and function of the IR in cultured rat neurons that were prepared under serum-free conditions. Reduced insulin-binding was observed following OGD, although surface expression of the receptor was not altered. However, OGD did significantly decrease the ability of insulin to stimulate phosphorylation of the transmembrane IR beta-subunit, without affecting protein expression of this subunit. Subsequent experiments focused on the manner in which pharmacologically manipulating IR function affected neuronal viability after OGD. Application of the IR sensitizer metformin moderately improved neuronal viability, while the specific IR tyrosine kinase inhibitor tyrphostin A47 was able to dramatically decrease viability; both compounds acted without affecting IR surface expression. Our study suggests that not only does the IR appear to play an important role in neuronal survival, but also that neurons may actively maintain IRs on the cell surface to compensate for the OGD-induced decrease in the ability of insulin to phosphorylate its receptor.

[Choroidal effusion syndrome after embolization of an indirect cavernous sinus fistula via the superior ophthalmic vein]. / Chorioidales Effusionssyndrom nach Embolisation einer indirekten Sinus-cavernosus-Fistel über die V. ophthalmica superior.

Embolization of a cavernous sinus fistula (SCF) via the superior ophthalmic vein (SOV) was reported to be an almost uncomplicated procedure, even after ligature of the vein at the end of the procedure. We report about a complication of this therapy. A 58-year-old female had a successful embolization of a right indirect cavernous sinus fistula via the SOV. At the end of the operation the SOV was ligated because of the danger of bleeding. Directly after surgery she experienced general worsening of the right eye with signs of venous congestion and marked effusion syndrome. The patient underwent total heparinization to achieve an opening of venous collaterals. Under local therapy with atropine 1% eye drops a decrease of the intraocular pressure was observed. The effusion syndrome was completely resolved within 1 month. If embolization of a cavernous sinus fistula is performed via the SOV, the ligature of the vein at the end of the procedure leads to thrombosis, which can reduce the venous stream from the eye and orbit. A secondary effusion syndrome with ocular hypertension because of a ciliolenticular block situation is possible and requires appropriate therapy. It is not possible to assess the capacity and time of opening of the venous collateral system before surgery. Therefore a transient outflow disturbance should be considered.

[Epidemic keratoconjunctivitis. Detecting adenoviruses]. / Keratoconjunctivitis epidemica. Nachweis von Adenoviren.

OBJECTIVE: The validity of the 15-min adenovirus assay SAS Adenotest was evaluated compared with virus detection by polymerase chain reaction (PCR) from conjunctival swabs. METHODS: In 75 patients with assumed epidemic keratoconjunctivitis, adenovirus detection from conjunctival swabs was performed by the immunochromatographic assay SAS Adenotest and PCR. RESULTS: In 25 patients adenovirus was detected by PCR, 18 of whom were detected by the SAS Adenotest and 7 of whom were not. No false positive results occurred. Sensitivity was 72% and specificity was 100%. CONCLUSIONS: The results indicate that rapid adenovirus detection with the SAS Adenotest is a useful tool in early epidemic keratoconjunctivitis. An additional PCR should be performed when clinical symptoms persist for 5 days or more.

Epilepsy in sub-Saharan Africa: its socio-demography, aetiology, diagnosis and EEG characteristics in Harare, Zimbabwe.

OBJECTIVE: To assess epileptics with regard to socio-demographic characteristics, aetiology, EEG results and classification. DESIGN: A descriptive cohort study from 1997 to 2001. SETTING: Parirenyatwa Group of Hospitals in Harare, Zimbabwe. SUBJECTS: A total of 229 consecutive epileptic subjects. RESULTS: The mean (s.d.) follow-up was 3.2 (1.14) years. The mean (s.d.) age of subjects was 23.4(11.8) years and 56% of them were males, over one third (43.1%) were unemployed and had secondary education (48%). Over one fourth (26.6%) of the subjects were first borns and had a family history of epilepsy (25.8%). Most of the subjects had Generalised Tonic Clonic Seizures (TCS). Over half (51.5%) of the subjects had their first onset of seizures after the age of 20 years. Lack of sleep (7.9%) and emotional disturbance (5.4%) were described by subjects as the frequent provoking factors for epileptic attacks. One hundred and fourteen subjects had electroencephalogram (EEG) results. Of these, 96 (41.9%) subjects had abnormal EEG results and only 18 (7.9%) had normal EEG results a majority (43.8%) of whom were of generalised slow waves. Majority of the subjects (52.8%) sought treatments from biomedical drugs, but some started with traditional herbs (20.5%) and then biomedical drugs, whereas others sought biomedical drugs then resorted to traditional herbs (20.1%). Phenobarbital and carbamazepine were taken by over 40% of the subjects. CONCLUSION: The findings of this study seem to suggest that these referrals to a specialised epilepsy outpatient clinic for further management may be attributed to socio cultural issues in our African settings about the actual nature of the condition, hence the delay in treatments and diagnosis of seizures as well as under diagnoses of non-epileptic seizure disorders that may lead to the condition becomes uncontrollable. Inexpensive drugs such as phenobarbital and phenytoin can be able to control most of the epileptic seizures, if they can be made available in primary health care centres.

Breaking the silence: an HIV-related educational intervention for medical students in Zimbabwe.

PROBLEM: A culture of silence surrounding HIV is a major contributor to continued HIV transmission and poor care for people living with HIV/AIDS. AIM: To encourage medical leadership in addressing stigma and fear related to HIV at individual and community levels OBJECTIVE: To pilot a mini-course for final year medical students in Zimbabwe that demonstrates stigma-reduction knowledge and skills needed to communicate information about HIV to patients, to address ethical implications of testing versus not testing for HIV, to increase awareness of the medical and preventive benefits of knowing one's HIV status and showing people how to cope with the emotional burden of dealing with HIV everyday. DESIGN: Methods of proven effectiveness for training medical students in ethics and communication skills were used such as presentations by well respected role models and opinion leaders, role-playing, small group discussions, accompanied by materials indicating local resources, in three afternoon teaching sessions. SETTING: University of Zimbabwe College of Medicine. PARTICIPANTS: 60 medical students, six lecturers, two facilitators and a group of actors. MAIN OUTCOME MEASURES: Evaluation of the course by students showed appreciation of the course as measured on a scale of one to five for content and usefulness with requests for further inputs into the curriculum; model of mini-course that can be used by other medical schools in the southern Africa region and other areas of emerging HIV epidemics. CONCLUSIONS: A brief educational intervention can help medical students to cope with the extraordinary challenge of providing care in high HIV prevalence countries and may contribute towards better leadership in addressing HIV epidemics.

Impact of HIV infection on meningitis in Harare, Zimbabwe: a prospective study of 406 predominantly adult patients.

OBJECTIVE: To determine the causative organisms and characteristics of patients presenting with features of meningitis. DESIGN: A prospective cross-sectional study. SETTING: Two tertiary university-affiliated hospitals in Harare, Zimbabwe. PATIENTS: Four-hundred and six patients clinically suspected to have meningitis. MAIN OUTCOME MEASURES: Causative organisms of meningitis; clinical and cerebrospinal fluid characteristics. RESULTS: Four-hundred and six predominantly adult (95% were aged > or = 18 years) patients were suspected to have meningitis. Of the 200 patients confirmed to have meningitis, 89 (45%) had cryptococcal meningitis (CM), 54 (27%) had mononuclear meningitis (MM), 31 (16%) had pyogenic meningitis (PM), 24 (12%) had tuberculous meningitis (TBM) and 2 (1%) had undefined meningitis. HIV seropositivity was 100% in CM, 83% in MM, 81% in PM and 88% in TBM patients. In-hospital mortality rate was 38.8% for CM, 34.9% for MM, 68% for PM and 66.7% for TBM. HIV seropositivity was 80% in the 206 patients not found to have meningitis. CONCLUSIONS: All patients suspected to have meningitis had a high HIV sero positivity irrespective of whether they were later confirmed to have meningitis or not. CM was the most common type of meningitis seen. In-hospital mortality was high irrespective of the cause of meningitis.

Chloroquine administration in mice increases beta-amyloid immunoreactivity and attenuates kainate-induced blood-brain barrier dysfunction.

The anti-malarial drug chloroquine (CHL) has been reported to cause the accumulation of beta-amyloid peptide containing fragments (fA beta) of the amyloid precursor protein within lysosomes in vitro. However, the significance of this finding with regards to the development of Alzheimer's disease (AD) pathology in vivo is not known. Hence, we investigated the effects of chronic CHL administration in the mouse. Systemically administered CHL caused an astrocytic response and an increase in intracellular A beta immunoreactivity throughout the brain, but no plaque-like pathology. Pharmacological challenge with the excitotoxin kainic acid (KA) revealed a mild proconvulsant effect of CHL pretreatment (P < 0.06). Interestingly, CHL protected the blood-brain barrier from characteristic KA-induced dysfunction. Given the hypothesized involvement of both excitotoxic processes and the vascular system in AD, the observed interactions may assist in elucidating the pathogenesis of AD.

An evaluation of the management of epilepsy by primary health care nurses in Chitungwiza, Zimbabwe.

In order to design an effective training program for nurses on the management of epilepsy in Zimbabwe, the drug management of epilepsy by community health nurses without prior training in epilepsy management was evaluated. Epilepsy patients in Chitungwiza, a high-density suburb of Harare, were routinely managed at four health clinics run by nurses. The patients also attended a monthly epilepsy support group (ESG) program, which provided them with vocational and social rehabilitative support. Neurologists evaluated the drug therapy of all patients attending this support group program over a 2-year period. The specialist interventions required to drug therapy in patients with inadequate seizure control or drug side effects were noted. A total of 114 epilepsy patients (age range 8-56 years, M:F=1:1.2) were seen, of these 84.2% had generalized seizures, 40.3% of patients had been seizure-free for at least 6 months, 71.9% of patients were on phenobarbitone, while 59.6% were on monotherapy. No drug intervention was required to on-going drug therapy in 43% of patient consultations. The most important intervention in patients with inadequate seizure control was an increase in drug dose, required in 29% of consultations. Of serum drug level estimations in clinically indicated cases, 58% were below the therapeutic ranges. This tendency to sub-therapeutic dosing with AED amongst nurses implied that a written AED drug therapy protocol specifying optimal maintenance doses and dose increment schedules may be beneficial to the community-based nursing management of epilepsy.

Predicting smallpox epidemics: A statistical analysis of two Finnish populations.

We analysis data on death due to smallpox in two subdivided Finish populations, the relatively isolated Åland Islands and the mainland parish of Kitee. The data span a 135-year time period (1750-1885). Logisitic regression and Cox proportional hazards models are used to assess the effects of predictive variables on (1) the probability that an individual subdivision experiences an epidemic and (2) the length of the time period between two epidemics in each subdivision. The predictive variables include population sizes, migration rates, geographic distance, and presence or absence of vaccination. Vaccination was found to be the single most important predicative variable (odds ratio = 6.3 in Åland and 4.4 in Kitee). No other variable were significant predicators in Kitee, while geographic distance was an additional significant predicator in Åland (odds ratio = 1.05). As expected, vaccination and geographic distance were both negatively associated with the probability of epidemic occurrence. The Mantel regression approach was used to evaluate the effects of independent variables on the probability that any two subdivisions experienced the same epidemic. Between-subdivision migration rates were the most important predictive variable here, and population size was an important predictor in Åland but not in Kitee. The differing results in these two populations are explained in terms of differences in ecological setting and social organization.

The impact of epilepsy on the quality of life of people with epilepsy in Zimbabwe: a pilot study.

Epilepsy is a common cause of psychosocial disability and has been perceived to have a profound impact on the social functioning of individuals with epilepsy. In Zimbabwe a combination of developing world economic priorities (with provision of social and health services for disabled people not a major goal) and culturally mediated perceptions of epilepsy as a non-medical and feared stigma may further disadvantage people with epilepsy (PWE) in this respect. In order to assess both the level of psychosocial functioning of individuals with epilepsy and their own perception of it, three groups of people were sampled: attenders at a specialized epilepsy clinic and members of two community-based support groups. All completed a brief quality-of-life questionnaire with activities of daily living added. Those carers present completed the same questionnaire at the time of sampling. The results indicated that 36 of 38 people with epilepsy sampled, and their carers, did not perceive themselves to have sufficient cognitive impairment to interfere with social functioning, work performance or relationships with other as assessed by a subsection of the WHO SIDAM (objective evaluation of cognitive performance) interview. However, an adapted activities of daily Living Questionnaire (ADLQ) showed that three-quarters of carers (and two-thirds of PWE) felt that functioning was mildly to moderately reduced, particularly in the areas of solving daily problems and speed of thinking. One-quarter of PWE experienced problems with relationships to others, just less than one-fifth of PWE reported more than four areas of reduced functioning. Of special interest was the fact that 25 (66%) reported sexual functioning as not applicable, although only four of these were of an age group which is not sexually active (less than 15 years old). In addition one-third of the central Hospital Group reported difficulties with using public transport, but none of the Community Support Group members, implying that the use of Public transport becomes an issue when it is necessary to travel long distances and that PWE curtail their travel but do not necessarily view this as a restriction. The samples chosen were from groups which, compared with PWE as a whole, are likely to include more disabled individuals, because attenders at a specialized epilepsy clinic and members of support groups self-select for more symptomatic epilepsy and a visibility. Therefore the proportion of PWE perceived to have difficulties with ADL in this project is not representative for PWE as a whole. The implications of our study are firstly that there is a significant need for selected groups of PWE in Zimbabwe to receive attention to psychosocial abilities and secondly that there are certain specific areas such as sexual functioning and the use of transport which deserve special attention. A much more detailed inventory of neuro-psychological tests will be of value to plan treatment strategies for those selected by the crude screening instruments used in this project. An important future comparison will be a survey of ADL and psychosocial functioning amongst PWE in rural communities, because it is uncertain whether PWE in rural communities are generally more or less disabled than those in the city.