Background In rural areas in China and India, cardiovascular disease burden is high but economic and healthcare resources are limited. This study aims to develop and evaluate a simplified cardiovascular management program (SimCard) delivered by community health workers (CHWs) with the aid of a smartphone-based electronic decision support system. Methods and Results The SimCard study was a yearlong cluster-randomized controlled trial conducted in 47 villages (27 in China and 20 in India). 2,086 ‘high cardiovascular risk’ individuals (aged 40 years or older with self-reported history of coronary heart disease, stroke, diabetes, and/or measured systolic blood pressure ≥160 mmHg) were recruited. Participants in the intervention villages were managed by CHWs through an Android-powered “app” on a monthly basis focusing on two medication use and two lifestyle modifications. Compared with the control group, the intervention group had a 25.5% (P<0.001) higher net increase in the primary outcome of the proportion of patient-reported anti-hypertensive medication use pre-and-post intervention. There were also significant differences in certain secondary outcomes: aspirin use (net difference 17.1%, P<0.001) and systolic blood pressure (−2.7 mmHg, P=0.04). However, no significant changes were observed in the lifestyle factors. The intervention was culturally tailored and country-specific results revealed important differences between the regions. Conclusions The results indicate that the simplified cardiovascular management program improved quality of primary care and clinical outcomes in resource-poor settings in China and India. Larger trials in more places are needed to ascertain potential impacts on mortality and morbidity outcomes. Clinical Trial Registration Information clinicaltrials.gov. Identifier: NCT01503814.

In visceral leishmaniasis, the draining LN (DLN) is the initial site for colonization and establishment of infection after intradermal transmission by the sand fly vector; however, little is known about the developing immune response within this site. Using an intradermal infection model, which allows for parasite visceralization, we have examined the ongoing immune responses in the DLN of BALB/c mice infected with Leishmania infantum. Although not unexpected, at early times post-infection there is a marked B-cell expansion in the DLN, which persists throughout infection. However, the characteristics of this response were of interest; as early as day 7 post-infection, polyclonal antibodies (TNP, OVA, chromatin) were observed and the levels appeared comparable to the specific anti-leishmania response. Although B-cell-deficient J h D BALB/c mice are relatively resistant to infection, neither B-cell-derived IL-10 nor B-cell antigen presentation appear to be primarily responsible for the elevated parasitemia. However, passive transfer and reconstitution of J h D BALB/c with secretory immunoglobulins, (IgM or IgG; specific or non-specific immune complexes) results in increased susceptibility to L. infantum infection. Further, J h D BALB/c mice transgenetically reconstituted to secrete IgM demonstrated exacerbated disease in comparison to WT BALB/c mice as early as 2 days post-infection. Evidence suggests that complement activation (generation of C5a) and signaling via the C5a receptor (CD88) is related to the disease exacerbation caused by IgM rather than cytokine levels (IL-10 or IFN-c). Overall these studies indicate that polyclonal B-cell activation, which is known to be associated with human visceral leishmaniasis, is an early and intrinsic characteristic of disease and may represent a target for therapeutic intervention.Key words: Antibody . C5a . Parasitic protozoan IntroductionVisceral leishmaniasis (VL) is a potentially fatal human disease caused by the intracellular protozoan parasites Leishmania donovani and L. infantum/L. chagasi. The immune response to VL is complex and has been shown to be organ-specific, differing significantly dependent upon the site of infection examined (liver versus spleen) [1,2]. Although the lymph node is thought to be analogous to the spleen, there are considerable developmental as well as structural and functional differences [3,4]. Reflective of this is the fact that although both spleens and lymph nodes from fatal human cases of VL exhibit destruction of normal architecture, follicular DC (FDC) and GC are lost in spleens, while continuing to be present in lymph nodes [5]. However, few Eur. J. Immunol. 2010. 40: 1355-1368 DOI 10.1002 Immunity to infection 1355 experimental studies to date have examined the lymph node responses that occur as a result of infection and have instead focused on the spleen where, akin to observations in humans, the destruction of FDC and GC is evident [6]. Although these observations in the spleen might appear to preclude a role for B cells in disea...

A case of Mycobacteriurn chelonae keratitis is described. As with any infective keratitis, appropriate treatment depends upon rapid and accurate microbi-ological assessment of corneal scraping. Acid-fast stains such as Ziehl-Nielson should be performed, particularly in chronic corneal ulcers, as only these stains will distinguish mycobacteria from the more common diphtheroid organisms. The rnycobac-teriurn chelonae organism was sensitive only to tetracyclines.' Case Report An 80-year-old man was referred with a two-month history of right focal keratitis which had a slow indolent course despite two-hourly topical chloram-phenicol 0.5% and tobramycin 0.3% and four-hourly steroids. He wore a hard contact lens, having had an intracapsular cataract extraction 20 years earlier. He followed standard PMMA lens cleaning routine with cleaning gel (thiomerosal 0.00470), storage solution (benzylkonium chloride 0.004% and edatate sodium 0.2%) and wetting solution (benzylkonium chloride 0.004% and edatate sodium Ocular examination revealed an area of corneal 0.02%). ulceration inferiorly 1.9 x 2.9 mm with 50% stromal thinning and edges shaggy and oedematous with minimal infiltration. There was a fine speckled deposition on the endothelium. Initial corneal scraping did not show an organism on the Gram stain but after four days' incubation, a Gram-positive rod resembling a diphtheroid was isolated. An acid-fast stain was negative at this stage. At this time an hypopyon had developed and a second corneal scraping was performed with the Gram stain now revealing diphtheroid-type organisms. The patient was treated with hourly gentamicin 1.570, cephalothin 5% and natamycin 5% topically. Over the next week the infected corneal ulcer progressed, with increased thinning of the ulcer base and significant infiltration of the margin to create a ring-like appearance (Figure 1). Fig.-Ring shaped infected corneal ulcer with central thinning, one week after presentation.