Ochratoxin A concentrations in food and feed from a region with Balkan Endemic Nephropathy.

Balkan Endemic Nephropathy (BEN), a chronic renal disease of unknown aetiology, is found in geographically close areas of Bulgaria, Romania, Serbia, Croatia, Bosnia and Herzegovina, Slovenia, and the former Yugoslav Republic of Macedonia. Ochratoxin A (OTA), a secondary metabolite of Aspergillus and Penicillium species and a natural contaminant of food and feed, is a putative cause of BEN. Some studies have found a geographic covariation between OTA content in food/feed and BEN manifestation; others have not. In May 2000, using a competitive direct ELISA assay for OTA (detection limit 1 microg kg(-1)), we investigated OTA contamination in 165 samples of home-produced food (beans, potatoes, corn, wheat, flour) and feed from households in villages from the BEN region (Vratza district) of north-western Bulgaria. Samples were collected from: (a) BEN villages (n = 8), and therein from BEN households (20), and BEN-free households (16) (within-village controls, WVC households); and (b) BEN-free villages (7) and therein BEN-free households (22) (between-village controls, BVC). BEN households consistently had a higher proportion of OTA-positive samples than WVC households, but similar (for some foods) or lower (for other foods) proportions to BVC households. The proportion of OTA-positive samples was also higher in BVC than in WVC households. Furthermore, BEN households had a similar proportion of OTA-positive samples to the pooled, WVC and BVC, group of households. OTA-exposure estimates, derived from our OTA-concentration findings and the reported average per capita monthly consumption of basic foods in rural Bulgaria, showed the highest OTA intake in BEN households (1.21 microg day(-1)), versus 1.03 microg day(-1) in BVC and 0.71 microg day(-1) in WVC households. These OTA intakes are higher than those in the EU, and are close to the upper limits acceptable to several food-safety organizations. The results indicate that OTA may not alone cause BEN; only synergistically with other environmental toxicants and/or predisposing genotypes may do so.

Geochemistry of Bulgarian soils in villages affected and not affected by Balkan endemic nephropathy: a pilot study.

Balkan endemic nephropathy (BEN) is a chronic tubulointerstitial disease whose mosaic-like distribution throughout the Balkans has not changed significantly since its initial description. In this study, we explored the hypothesis that the occurrence of BEN is linked with the environmental geochemistry of villages. Soil samples were collected from BEN and non-BEN villages in the Vratza region of Bulgaria. Samples were digested in nitric acid and analyzed for 22 elements by hexapole, inductively coupled plasma, and mass spectrometry. Selected results are that: 1) absolute concentrations from both types of villages were not enriched above "background" concentrations; and 2) copper, molybdenum, lead, and cadmium concentrations were higher in BEN than in non-BEN soils, while selenium concentrations were lower. Although geochemical differences between BEN and non-BEN villages were found, not all differences were statistically significant, in part due to a limited number of samples.

Malignant biliary obstruction: management with percutaneous metallic stent placement.

BACKGROUND/AIMS: To report our experience on palliative management of malignant biliary obstruction with percutaneous placement of metallic stents. METHODOLOGY: During a 3-year period 20 patients with malignant biliary obstruction were treated with percutaneous insertion of metallic biliary endoprostheses. RESULTS: Stent placement was successful in 19 patients, with significant improvement of jaundice in 18 patients. 17 patients have died up to date. In this group survival was 4-324 days (mean: 107 days) and mean stent primary and secondary patency 94.3 and 97.4 days, respectively. Three patients are alive with a follow-up from 20-195 days. Mean secondary patency is 65.3 days (20-134 days). We encountered serious complications in 4 patients (20%). Thirty-day mortality was 15%, while procedural mortality was 10%. Four patients presented 13-120 days (mean: 71.5 days) after the procedure with stent reocclusion (reocclusion rate: 20%). CONCLUSIONS: The procedure is relatively easy and safe to perform, yields excellent palliation of the patient's symptomatology and, therefore, contributes substantially to the maintenance of good quality of life of the patient with malignant biliary obstruction.

Is short-term training useful in international environmental and occupational health projects? Experience from the Balkans and Latin America.

Short courses/workshops for international training in environmental and occupational health are an important tool for supplementing longer-term training at the graduate-degree level. Considerable collective and shared experiences in short-term training have been accumulated among these 13 projects sponsored by the Fogarty International Center of the National Institutes of Health (NIH), the International Training and Research in Environmental and Occupational Health (ITREOH) program. This article presents general aspects and considerations of short-term training and highlights guidelines drawn from specific experiences with such training activities in Balkan and Latin American countries.