Congenital and childhood atrioventricular blocks: pathophysiology and contemporary management

Atrioventricular block is classified as congeni- tal if diagnosed in utero, at birth, or within the first month of life. The pathophysiological process is believed to be due to immune-mediated injury of the conduction system, which occurs as a result of transplacental pas- sage of maternal anti-SSA/Ro-SSB/La antibodies. Childhood atrioventricular block is therefore diagnosed between the first month and the 18th year of life. Genetic variants in multiple genes have been described to date in the pathogenesis of inherited progressive car- diac conduction disorders. Indications and techniques of cardiac pacing have also evolved to allow safe perma- nent cardiac pacing in almost all patients, including those with structural heart abnormalities

Personal barriers to antiretroviral therapy adherence: case studies from a rural Uganda prospective clinical cohort.

BACKGROUND: Although good adherence to antiretroviral therapy (ART) is essential for successful treatment outcomes, some patients may have specific personal barriers to ART adherence. OBJECTIVES: To study specific personal barriers to ART adherence. METHODS: Quantitative data on patients' health status, ART adherence, CD4 cell counts and viral loads were collected, and qualitative data on life experiences of five patients with poor ART outcomes and adherence were also collected. RESULTS: Out of 35 patients with poor immunological and virological ART outcomes, 17 (49%) also had poor ART adherence. Patient 1 had no living child and did not disclose her HIV serostatus to her spouse because she wanted to have a child. Patient 2 was an orphan with neither social nor family support. Patient 3 stopped ART when she conceived, returned to the study clinic when pregnant again and was sickly. She was switched to second-line ART with satisfactory outcomes. Patient 4, a 14 year old orphan had missed ART for 2 months when his treatment supporter was away. Patient 5 aged 66 years stopped ART which he blamed for his erectile dysfunction. CONCLUSION: ART adherence counselling should target specific personal barriers to ART adherence like: lack of family support, health and sexual life concerns, desire to have children and family instability

Tissue culture banana (Musa spp.) for smallholder farmers: lessons learnt from East Africa

The use of tissue culture (TC) banana (Musa spp.) planting material is an effective method of providing pest and disease-free plants. Although there are many added benefits to using TC plants, the adoption of TC technology remains relatively low in East Africa. Currently, adoption is increasing under impetus from the private sector. Adopting TC banana technology, however, is more expensive for the farmer than conventional suckers and may not be economically beneficial across all bananaproducing areas in East Africa. One of the greatest potential dangers for sustainable commercial TC plant production is the limited use of certification for plant quality and health, which is especially important in order to avoid the spread of viruses. Additionally, TC plant nurseries are important components, as they provide essential distribution hubs connecting TC producers with farmers. However, TC nurseries in East Africa face an array of challenges. Organizing banana farmers into groups has long been considered advantageous, as they foster increased buying and selling power, reduce economic and social risk, increase economies of scale, and facilitate access to credit and inputs in the case of formally certified groups. Distribution of superior planting material alone, however, does not ensure improved productivity. Smallholder farmers are constrained by factors such as a lack of: land, capital, access to technology and effective marketing infrastructure. As such, efficient distribution systems need to deliver TC plants as part of a package, including training and access to micro-credit. Despite a booming commercial sector, there is only anecdotal evidence that farmers who have adopted TC bananas have benefitted substantially in terms of higher yields and household incomes. Sound socio-economic analyses are crucial to guide policy strategies, to learn from successes already achieved and to identify important constraints for a wider dissemination of TC banana in the region