An automated method for the simultaneous measurement of azole antifungal drugs in human plasma or serum using turbulent flow liquid chromatography-tandem mass spectrometry.

Azole antifungal drugs are important in the prophylaxis and treatment of invasive aspergillosis. Therapeutic drug monitoring may be indicated to (1) monitor adherence, (2) guide dosage and (3) minimise the risk of drug-drug interactions and dose-related toxicity. TurboFlow(TM) technology offers online, automated sample preparation. An Aria Transcend(TM) TLX-II coupled with a TSQ Vantage(TM) MS was used. Centrifuged samples (25 µL) were mixed with internal standard solution (975 µL) and 30 µL injected directly onto a C18-P-XL TurboFlow column. Analytes were focussed onto a Phenomenex Gemini Phenyl analytical column and eluted using a methanol/water gradient (flow-rate, 0.8 mL/min). Analytes were monitored in selected reaction monitoring mode (two transitions per analyte, positive mode APCI). Calibration ranges were as follows: itraconazole, hydroxyitraconazole, and posaconazole 0.05-5.0 mg/L; voriconazole and fluconazole 0.1-10 mg/L. Total analysis time was 12 min. TurboFlow column recovery was >77% for all analytes. Calibration was linear (R (2) > 0.99) for all analytes. Inter- and intra-assay imprecision (% RSD) was <8% and accuracy (nominal internal quality control values) 90-105% for all analytes. The limit of detection was 0.01 mg/L for all analytes. No matrix effects were observed. This method is simple, robust and suitable for measuring these compounds at concentrations attained during therapy.

Prevalence of diabetes in rural and urban populations in southern Sierra Leone: a preliminary survey.

We conducted a preliminary community survey for diabetes in the Bo district of southern Sierra Leone. Five hundred and one subjects comprising 256 rural adults in two villages and 245 urban adults in Bo town were randomly selected and screened for diabetes using random capillary blood glucose according to WHO criteria. There were 6 diabetics, all in the urban area, giving a prevalence of 2.4% in the urban population, and 0% in the rural villages. The mean (s.d.) capillary random blood glucose (RBG) concentration was 5.7 +/- 1.7 mmol/l for the entire study population, while concentrations for the urban and rural populations were 5.8 +/- 2 and 5.5 +/- 1.4 mmol/l respectively (P > 0.05). RBG increased significantly with age. The mean (s.d.) body mass index (BMI) was 22.3 +/- 4.9 kg/m2 for the total population while those for the urban and rural populations were 23.0 +/- 5.8 and 21.6 +/- 3.6 respectively (P < 0.01). Only 5% of the population were obese, i.e. BMI > or = 30 kg/m2. Dietary habits were similar in both town and country. According to this survey, the prevalence of diabetes is very low in rural Sierra Leone, but urban areas may be experiencing increasing prevalence. Mechanisms for effective screening and promotion of proper diet and exercise must be incorporated into existing health services to prevent an escalation of diabetes in urban Sierra Leone.