The free healthcare initiative in Sierra Leone: Evaluating a health system reform, 2010-2015.

This article presents the findings of a theory-based evaluation of the Sierra Leone Free Health Care Initiative (FHCI), using mixed methods. Analytical approaches included time-series analysis of national survey data to examine mortality and morbidity trends, as well as modelling of impact using the Lives Saved Tool and expenditure trend analysis. We find that the FHCI responded to a clear need in Sierra Leone, was well designed to bring about needed changes in the health system to deliver services to the target beneficiaries, and did indeed bring funds and momentum to produce important systemic reforms. However, its ambition was also a risk, and weaknesses in implementation have been evident in a number of core areas, such as drugs supply. We conclude that the FHCI was one important factor contributing to improvements in coverage and equity of coverage of essential services for mothers and children. Modelled cost-effectiveness is high-in the region of US$ 420 to US$ 444 per life year saved. The findings suggest that even-or perhaps especially-in a weak health system, a reform-like fee removal, if tackled in a systematic way, can bring about important health system gains that benefit vulnerable groups in particular.

The L-Arginine-Nitric Oxide-Peroxynitrite pathway (LANOP pathway): does it protect or worsen the course of Chagas disease? / Vía L-Arginina-Óxido Nítrico-Peroxinitrito (Vía-LAONP): ¿protege o empeora el curso de la enfermedad de Chagas?

Many different immunological processes have been described in the Chagas infection, some of them associated with the Chagas disease. In this scenario, the L-Arginine-Nitric oxide (NO) – Peroxynitrite (NOOO-) pathway (LANOP pathway) appears as an essential component of that process. The relationship is well known between cytokines that can induce Oxide Nitric Synthase (iNOS) genes, such as TNF-a and IFN-g, and other molecules that can inhibit their expression (TGF-b, IL-10 and others), which are involved in both acute and chronic stages of the disease pathogenesis. However the participation of the LANOP pathway seems complex, given that evidence shows different roles for it during the course of the infection. In this article, the authors review the immunological and inflammatory response leading to the activation of the LANOP pathway during the Chagas infection, and the role this via plays, including different effects, protector or deleterious, observed in parallel during the development of the infection.

En la infección chagásica se han descrito diversos procesos inmunológicos, algunos de los cuales se han asociado con la enfermedad. En este escenario, aparece la vía L-Arginina-Óxido Nítrico (NO) - Peroxinitrito (ONOO-) (Vía-LAONP) como un componente esencial de estos procesos. Se conoce la asociación entre citocinas inductoras de los genes de la Sintasa del Óxido Nítrico (iNOS) tales como TNF-a e IFN-g, así como moléculas que inhiben su expresión (TGF-b e IL-10 entre otras), involucradas en la patogénesis tanto de la fase aguda como crónica de la enfermedad. No obstante, la participación de la vía-LAONP parece ser compleja, una vez que las evidencias señalan papeles diferentes de ésta durante el curso de la infección. Por tanto, los autores revisan la respuesta inmunológica e inflamatoria que da lugar a la activación de la vía-LAONP durante la infección chagásica, y el papel que ésta desempeña, incluyendo efectos diversos, tanto protectores como deletéreos, que han sido observados en paralelo durante el curso de la misma.