Asthma programmes in diverse regions of the world: challenges, successes and lessons learnt.

International surveys have demonstrated that asthma is still underdiagnosed and undertreated in many parts of the world. Despite improvements in the standard of asthma care delivered in many areas, as evidenced by improved global asthma mortality data, much information on projects and programmes undertaken in resource-limited regions of the world is not in the public domain. The aim of this report is to review projects and programmes in diverse regions around the world so that health care providers, planners and consumers may draw on the successes, failures and lessons learnt. Such real world experiences may contribute to achieving Global Initiative for Asthma goals of asthma control. Asthma projects and programmes in Argentina, Australia, Brazil, China, Japan, Mexico, Philippines, Russia, South Africa and Turkey were discussed by a group of experts in asthma care, the Advancing Asthma Care Network, from their respective countries, over a course of three satellite meetings in 2010. Collective analyses consistently identified low rates of dissemination and implementation of national and international treatment guidelines, low levels of continuing medical education and training of primary health care professionals and access and distribution of inhaled corticosteroids to be major barriers that are critical to the overall success of a national asthma management programme. In the less developed asthma programmes, under-recognition and undertreatment further limited the success of the programmes. Evidence from well-established national asthma management programmes suggests that establishment of a successful programme entails a logical progression through specific developmental stages, starting with political/stakeholder endorsement and commitment, followed by epidemiological evaluation, evaluation of disease burden, evaluation of access to care and best therapy, and finally optimisation and maintenance therapy for individual patients.

Preferential transport and metabolism of glucose in Bergmann glia over Purkinje cells: a multiphoton study of cerebellar slices.

Knowing how different cell types handle glucose should help to decipher how energy supply is adjusted to energy demand in the brain. Previously, the uptake of glucose by cultured brain cells was studied in real-time using fluorescent tracers and confocal microscopy. Here, we have adapted this technique to acute slices prepared from the rat cerebellum by means of multiphoton microscopy. The transport of the fluorescent glucose analogs 2NBDG and 6NBDG was several-fold faster in the molecular layer of the cerebellar cortex than in Purkinje cell somata and granule cells. After washout of free tracer, it became apparent that most phosphorylated tracer was located in Bergmann glia, which was confirmed by counterstaining with the glial marker sulforhodamine 101. The effective recovery of fluorescence after photobleaching showed that 2NBDG-P can diffuse horizontally across the molecular layer, presumably through gap junctions between Bergmann glial cells. Our main conclusion is that in acute cerebellar slices, the glucose transport capacity and glycolytic rate of Bergmann glia are several-fold higher than those of Purkinje cells. Given that the cerebellum is largely fueled by glucose and Purkinje neurons are estimated to spend more energy than Bergmann glial cells, these results suggest substantial shuttling of an energy-rich metabolite like lactate between glial cells and neurons.

Hexachlorobenzene-induced alterations of rat hepatic microsomal membrane function.

The time and dose-dependent effects of the in vivo administration of hexachlorobenzene (HCB), on hepatic microsomal membrane functions, were studied in female Wistar rats. Administration of HCB (100 mg/100 g b.w.) resulted in time-dependent decreases in the activity of two membrane-bound enzymes: 5'nucleotidase and Na+/K+ ATPase. HCB was found to cause a significant rise in protein tyrosine kinase (PTK) activity during the early stages of intoxication (day 2), followed by a significant decrease at 10 days, returning to control levels after 20 days of treatment. A stimulatory effect of HCB on in vitro endogenous microsomal protein phosphorylation was observed from 2 days of intoxication up to 30 days of treatment, with an important stimulation of phosphorylation at 5 days. Administration of HCB (100 mg/100 g b.w.) for 10 days caused a 50% reduction in epidermal growth factor receptor (EGF-R) ligand binding. The effects of known specific inhibitors of protein phosphatases on endogenous protein phosphorylation were studied. HCB affected the labelling of several bands, as well as the 5'nucleotidase and PTK activities, in a dose-dependent manner. In conclusion, this study indicated that the in vivo administration of HCB results in a significant alteration of membrane function.

Role of orthotopic heart transplantation in the management of patients with recurrent ventricular tachyarrhythmias following myocardial infarction.

OBJECTIVE: To report the outcome of an intention to treat by heart transplantation strategy in two groups of patients after infarction, one with both left ventricular failure (LVF) and ventricular tachyarrhythmias (VTA) (group A) and the other with progressive LVF following antiarrhythmic surgery for VTA (group B). PATIENTS AND METHODS: Group A comprised 17 consecutive patients for whom transplantation was considered the best primary non-pharmacological treatment; group B comprised five consecutive patients assessed and planned for transplantation after antiarrhythmic surgery. RESULTS: In group A, eight patients underwent transplantation and all survived the first 30 day period. At median follow up of 55 months (range 11 to 109) seven of this subgroup were still alive. Five patients died of recurrent VTA before transplantation, despite circulatory support. In the face of uncontrollable VTA, four of these underwent "high risk" antiarrhythmic surgery while awaiting transplantation: three died of LVF within 30 days and one was saved by heart transplantation two days after arrhythmia surgery. Mortality for the transplantation strategy in group A patients was 47% by intention to treat analysis. Quality of life in the eight actually transplanted, however, was good and only one died during median follow up of 56 months. The five patients in group B were accepted for transplantation for progressive LVF at a median of 21 months (range 12 to 28) after antiarrhythmic surgery. One died of LVF before transplantation, 22 months after initial surgery; another died of high output LVF three days after transplantation. Thus mortality of the intended strategy was 40%. The three transplanted patients are alive and well at 8-86 months. CONCLUSIONS: Although the short and medium term outcome in category A or B patients who undergo transplantation is good, the overall success of the transplantation strategy in category A patients is limited by lack of donors in the short time frame in which they are required.

Electrocardiographic features of septal location of right ventricular outflow tract tachycardia.

A consistent 12-lead electrocardiogram (ECG) morphology and characteristic frontal plane axis shift from sinus rhythm to ventricular tachycardia (VT) was demonstrated in 10 consecutive patients with idiopathic right ventricular outflow tract (RVOT) VT. All arrhythmias were successfully ablated on the septal side of the RVOT.

Sugars in the alimentary canal of Lutzomyia youngi (Diptera: phlebotominae).

Gas chromatography (GC) analysis of 159 specimens (144 females and 15 males) of Lutzomyia youngi collected in Shannon traps in a coffee plantation in the Andean region of western Venezuela, where leishmaniasis is endemic, revealed the presence of fructose, sucrose, glucose and maltose in the gut and crop of the wild sandflies. The identification of the sugars was confirmed by comparing retention times with those observed for standard sugars and those obtained from sandflies experimentally fed on known sugar solutions. Although the sandflies in nature may ingest each of the four sugars, the results suggest that it is more probable there is an invertase enzyme (glycosidase?) in the gut or crop of the sandfly which hydrolyses ingested disaccharides (e.g. sucrose) to the constituent monosaccharides (i.e. fructose and glucose). Ecological and altitudinal distributions of sandfly species may be related to the availability of specific sugar sources, with epidemiological implications. Identification of the preferred sugar could make breeding easier and would facilitate further research on Leishmania-vector relationships.

Prevalencia de anticuerpos para Toxoplasma gondii en bovinos y porcinos. / Prevalence of Toxoplasma gondii antibodies in cattle and swine

Mediante la tecnica de hemaglutinacion indirecta (HAI) se determinaron los niveles de anticuerpos contra Toxoplasma gondii en los sueros de 371 bovinos y 368 porcinos sacrificados en el matadero municipal de Medellin, Colombia. Fueron positivos el 24% de los sueros bovinos (90 animales) y el 30% de los sueros porcinos (111 animales). La intensidad de la respuesta inmunologica fue baja en los bovinos, con un titulo maximo de 1:128. En cambio, en los porcinos se obtuvieron titulos elevados de 1:1,024. Se insiste en la importancia de estas dos especies como posible fuente de infeccion para humanos en Colombia y de modo muy especial, en porcinos