Difficulties in organizing first indoor spray programme against malaria in Angola under the President's Malaria Initiative

PROBLEM: Successful attempts to control malaria require understanding of its complex transmission patterns. Unfortunately malaria transmission in Africa is often assessed using routine administrative reports from local health units, which are plagued by sporadic reporting failures. In addition, the lack of microscopic analyses of blood slides in these units introduces the effects of many confounding diseases. APPROACH: The danger of using administrative reports was illustrated in Angola, the first country in which malaria control was attempted under the President's Malaria Initiative, a development programme of the Government of the United States of America. LOCAL SETTING: Each local health unit submitted monthly reports indicating the number of suspected malaria cases to their municipality. The identification of the disease was based on clinical diagnoses, without microscopic examination of blood slides. The municipal and provincial reports were then passed on to the national headquarters, with sporadic reporting lapses at all levels. RELEVANT CHANGES: After the control effort was completed, the defective municipal reports were corrected by summarizing only the data from those health units which had submitted reports for every month during the evaluation period. LESSONS LEARNED: The corrected data, supplemented by additional observations on rainfall and mosquito habitats, indicated that there had probably been no malaria transmission before starting the control operations. Thus the expensive malaria control effort had been wasted. It is unfortunate that WHO is also trying to plan and evaluate its malaria control efforts based on these same kinds of inadequate administrative reports

Non-symmetrical double-logistic analysis of 24 hour arterial stiffness profile in normotensive and hypertensive subjects

Objectives: Mechanisms underlying the circadian profile of cardiovascular events (CE) are not totally understood. Whether circadian changes in arterial stiffness (AS) could be related to the circadian profile of CE remains to be investigated. As yet, there is no accepted way to measure circadian profiles or nocturnal-related and/or morning-related changes in cardiovascular variables. The aim of this study was to characterize the circadian pattern and day-night and night-day changes of AS in untreated hypertensive (HG) and healthy subjects (NG), using a recently developed non-symmetrical six-parameter double-logistic model. Methods: Seven hypertensive and seven normotensive subjects underwent 24 hour ambulatory recordings of blood pressure (BP), heart rate (HR) and aorto-brachial pulse transit time (PTTAB) and pulse transit velocity index (PTVAB). PTTAB and PTVAB are inversely and directly related to AS, respectively. The circadian profile and transitional periods (day-night and night-day) were analyzed using a model described by a six-parameter double logistic equation. Conclusions: The model was adequate to characterize the circadian pattern of AS. We provide the first evidence that AS in humans follows an asymmetric circadian pattern and that this differs between NG and HG. In both NG and HG, AS had a circadian profile, with the highest levels in the night. HG showed larger levels of AS, larger BP variations and rate of change and minor changes in AS during transitional periods.4 page(s

Assessing the cardiology community position on transradial intervention and the use of bivalirudin in patients with acute coronary syndrome undergoing invasive management: results of an EAPCI survey.

AIMS: Our aim was to report on a survey initiated by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) collecting the opinion of the cardiology community on the invasive management of acute coronary syndrome (ACS), before and after the MATRIX trial presentation at the American College of Cardiology (ACC) 2015 Scientific Sessions. METHODS AND RESULTS: A web-based survey was distributed to all individuals registered on the EuroIntervention mailing list (n=15,200). A total of 572 and 763 physicians responded to the pre- and post-ACC survey, respectively. The radial approach emerged as the preferable access site for ACS patients undergoing invasive management with roughly every other responder interpreting the evidence for mortality benefit as definitive and calling for a guidelines upgrade to class I. The most frequently preferred anticoagulant in ACS patients remains unfractionated heparin (UFH), due to higher costs and greater perceived thrombotic risks associated with bivalirudin. However, more than a quarter of participants declared the use of bivalirudin would increase after MATRIX. CONCLUSIONS: The MATRIX trial reinforced the evidence for a causal association between bleeding and mortality and triggered consensus on the superiority of the radial versus femoral approach. The belief that bivalirudin mitigates bleeding risk is common, but UFH still remains the preferred anticoagulant based on lower costs and thrombotic risks