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BACKGROUND Hypertension is the leading risk factor for cardiovascular diseases (CVDs) and a major public health issue worldwide. In Brazil, it affects approximately 52.5% of the adult population. We describe the solutions package and the impact of a population health initiative in São Paulo city, following the CARDIO4Cities approach for the management of cardiovascular risk. METHODS Using a design thinking approach, interventions were developed with a coalition of local and international stakeholders to address needs of patients, healthcare professionals, and the health system. The resulting solution package was checked to comply with guidelines for non-communicable disease and hypertension management. Clinical impact was measured by extracting the hypertension cascade of care—monitored, diagnosis, treatment, and control—from medical records. RESULTS Under the leadership of the municipal health authorities, nine solutions were piloted and scaled across the city. Solutions conform with local and international best-practices. Between October 2017 and December 2021, 11,406 patient records were analyzed. Results showed a 40% increase in monitored patients (patients with at least one blood pressure, BP, measurement); reduced proportions of patients diagnosed among those with available BP measurements (72%–53%) and treated among diagnosed (93%–85%); and an improvement in controlled patients among those receiving treatment (16%–27%). CONCLUSIONS The solution package described in this study was correlated with increased BP control. The implementation methodology and results add to the body of real-world evidence supporting population health implementation science in Brazil and beyond. [ABSTRACT FROM AUTHOR]

Over the past decade, considerable progress has been made by higher education institutions (HEIs) to align with sustainable development goals. Specifically, aspects of sustainable development have been integrated into the existing mandates of HEIs – education, research and operations. The main objective of the current study was to assess a sub‐group of African HEIs that have an explicit mandate for implementation science and pursue development assistance‐type services and to describe their added value to advance sustainable development. We conducted a qualitative situational assessment, including 22 institutions from 13 countries. Interviews and surveys were done with 42 participants composed of director‐level representatives and staff members engaged both in research and implementation. The data were subjected to qualitative content analysis. The main strengths of the participating organisations vis‐à‐vis implementation projects and wider sustainable development were the quality of implementation, local relevance of the research and uptake of research evidence into policy and practice. A major weakness was the challenge of operating such a bi‐sectoral model, while maintaining high‐level performance in both areas. Yet, the examined research−implementation institutions draw from and combine the competences of research, education and implementation and have a distinctive role to play in the attainment of sustainable development, especially when operating by an optimised support system and within strong research ecosystems. Based on our study, we provide a definition of research−implementation organisations that may serve institutions to enhance their standing, their operations and their significance for sustainable development. [ABSTRACT FROM AUTHOR]

Background: Knowing the species composition and insecticide resistance status of the target vector population is important to guide malaria vector control. The aim of this study was to characterize the malaria vector population in terms of species composition, insecticide susceptibility status and potential underlying resistance mechanisms in Ellibou, southern Côte d'Ivoire. Methods: A 1-year longitudinal entomological survey was conducted using light traps and pyrethroid spray catches to sample adult mosquitoes in combination with larval sampling. The susceptibility status of Anopheles gambiae sensu lato (s.l.) to bendiocarb, deltamethrin, DDT and malathion was assessed using the World Health Organization insecticide susceptibility test. Additionally, An. gambiae specimens were screened for knockdown (kdr) and acetylcholineesterase (ace1) target site resistance alleles, and the expression levels of eight metabolic resistance genes, including seven cytochrome P450 monooxygenases (P450s) and one glutathione S-transferase (GST), measured with reverse transcription quantitative real-time polymerase chain reaction (qPCR). Results: Overall, 2383 adult mosquitoes from 12 different taxa were collected with Culex quinquefasciatus and An. gambiae being the predominant taxa. Molecular identification of An. gambiae s.l. revealed the presence of Anopheles arabiensis, Anopheles coluzzii, An. gambiae sensu stricto (s.s.) and Anopheles coluzzii/An. gambiae s.s. hybrids. Anopheles gambiae mosquitoes were resistant to all insecticides except malathion. PCR diagnostics revealed the presence of ace1-G280S and the kdr L995F, L995S and N1570Y target-site mutations. Additionally, several genes were upregulated, including five P450s (i.e., CYP6P3, CYP6M2, CYP9K1, CYP6Z1, CYP6P1) and GSTE2. Conclusion: This is the first documented presence of An. arabiensis in Côte d'Ivoire. Its detection – together with a recent finding further north of the country – confirms its existence in the country, which is an early warning sign, as An. arabiensis shows a different biology than the currently documented malaria vectors. Because the local An. gambiae population was still susceptible to malathion, upregulation of P450s, conferring insecticide resistance to pyrethroids, together with the presence of ace1, suggest negative cross-resistance. Therefore, organophosphates could be an alternative insecticide class for indoor residual spraying in the Ellibou area, while additional tools against the outdoor biting An. arabiensis will have to be considered. [ABSTRACT FROM AUTHOR]

We present a novel application of the heteronuclear statistical total correlation spectroscopy (HET-STOCSY) approach utilizing statistical correlation between one-dimensional [sup.19]F/[sup.1]H NMR spectroscopic data sets collected in parallel to study drug metabolism. Parallel one-dimensional (1D) 800 MHz [sup.1]H and 753 MHz [sup.19]F{[sup.1]H} spectra (n = 21) were obtained on urine samples collected from volunteers (n = 6) at various intervals up to 24 h after oral dosing with 500 mg of flucloxacillin. A variety of statistical relationships between and within the spectroscopic datasets were explored without significant loss of the typically high 1 D spectral resolution, generating [sup.1]H-[sup.1]H STOCSY plots, and novel [sup.19]F-[sup.1]H HET-STOCSY, [sup.19]F-[sup.19]F STOCSY, and [sup.19]F-edited [sup.1]H-[sup.1]H STOCSY (X-STOCSY) spectroscopic maps, with a resolution of ~0.8 Hz/pt for both nuclei. The efficient statistical editing provided by these methods readily allowed the collection of drug metabolic data and assisted structure elucidation. This approach is of general applicability for studying the metabolism of other fluorine-containing drugs, including important anticancer agents such as 5-fluorouracil and flutamide, and is extendable to any drug metabolism study where there is a spin-active X-nucleus (e.g., [sup.13]C, [sup.15]N, [sup.31]P) label present.

Abstract Background The urinary metabolic fingerprint of a patent Schistosoma mansoni infection in the mouse has been characterized using spectroscopic methods. However, the temporal dynamics of metabolic alterations have not been studied at the systems level. Here, we investigated the systems metabolic changes in the mouse upon S. mansoni infection by modeling the sequence of metabolic events in urine, plasma and faecal water. Methods Ten female NMRI mice, aged 5 weeks, were infected with 80 S. mansoni cercariae each. Ten age- and sex-matched mice remained uninfected and served as a control group. Urine, plasma and faecal samples were collected 1 day before, and on eight time points until day 73 post-infection. Biofluid samples were subjected to 1H nuclear magnetic resonance (NMR) spectroscopy and multivariate statistical analyses. Results Differences between S. mansoni-infected and uninfected control mice were found from day 41 onwards. One of the key metabolic signatures in urine and faecal extracts was an alteration in several gut bacteria-related metabolites, whereas the plasma reflected S. mansoni infection by changes in metabolites related to energy homeostasis, such as relatively higher levels of lipids and decreased levels of glucose. We identified 12 urinary biomarkers of S. mansoni infection, among which hippurate, phenylacetylglycine (PAG) and 2-oxoadipate were particularly robust with regard to disease progression. Thirteen plasma metabolites were found to differentiate infected from control mice, with the lipid components, D-3-hydroxybutyrate and glycerophosphorylcholine showing greatest consistency. Faecal extracts were highly variable in chemical composition and therefore only five metabolites were found discriminatory of infected mice, of which 5-aminovalerate was the most stable and showed a positive correlation with urinary PAG. Conclusions The composite metabolic signature of S. mansoni in the mouse derived from perturbations in urinary, faecal and plasma composition showed a coherent response in altered energy metabolism and in gut microbial activity. Our findings provide new mechanistic insight into host-parasite interactions across different compartments and identified a set of temporally robust biomarkers of S. mansoni infection, which might assist in derivation of diagnostic assays or metrics for monitoring therapeutic response.

Author(s): Bassirou Bonfoh, Jasmina Saric, Jürg UtzingerAuthor Affiliations:Research hotspots in Côte d'Ivoire The top-ranking institutions for research productivity in 2012-16 in Côte d'Ivoire were its two largest national universities: Félix [...]

Buruli ulcer (BU) belongs to the group of neglected tropical diseases and constitutes a public health problem in many rural communities in Côte d'Ivoire. The transmission patterns of this skin infection are poorly defined, hence the current study aimed to contribute to the understanding, perceptions and interpretations of its mode of transmission using a socio-environmental approach. Social and environmental risk factors that may expose people to infection, and the dynamics of local transfer of knowledge and practices related to BU, were assessed in two endemic locations in southern Côte d'Ivoire, i.e. Taabo and Daloa. Data were generated by the administration of a household questionnaire (N=500) between February and June 2012 to assess how the population perceived transmission of BU, focus group discussions with local communities (N=8) to analyse ideologies regarding transmission patterns and semi-structured interviews with patients or their parents, former BU patients and traditional healers (N=30). The interviewees' empirical knowledge of the disease was found to be close to its biomedical description. Their aetiological perception of the disease was linked to natural (e.g. dirty water, insects) and supernatural (e.g. witchcraft, fate) causes. Some informants attributed the spread of the disease to recently immigrated neighbouring communities whose arrival coincided with an increase in reported BU cases. However, the general consensus seemed to be that the main mode of transmission was contact with infested soil or ulcerated wounds. The participants were aware that BU was a socio-environmental problem in these endemic areas, offering a good starting point for educational campaigns for at-risk communities. Buruli ulcer control programmes should therefore include educational campaigns and Water, Sanitation and Hygiene (WASH) interventions for those at risk in affected communities. [ABSTRACT FROM AUTHOR]