Preliminary nutritional assessment of the Ecuadorian diet based on a 24-h food recall survey in Ecuador.

INTRODUCTION: Ecuador is a country with limited nutritional information, with exception of some general studies supported by Food Agriculture Organization (FAO). AIMS: To carry out a nutritional assessment of the Ecuadorian diet and determine the percentage of contribution to the intake of different nutrients according to the order of the meal (breakfast, morning snack, lunch, afternoon snack, and dinner snack) and Dietary Reference Intake (DRI). METHODS: For that purpose a pilot survey based on 24-h food recall method was carried out in three specific regions in Ecuador and collected information was processed, analyzed statistically and compared with DRIs established for Latin-American population. RESULTS: The study found significant differences for energy and certain vitamins in men and women in addition to determining that the highest energy contribution was obtained in lunch, followed by the afternoon snack and breakfast. Intermediate meals (morning snack, afternoon snack and dinner snack) contributed significantly less in the daily diet in comparison with other types of meal. Furthermore, it was observed that analyzed intakes did not meet the DRI for Carbohydrates, some vitamins (Thiamin, Pantothenic, Biotin, Folate Vitamin D and Vitamin E) and minerals (Ca, K, Cu, Mn, I and Fe). The Na intakes were quite above the DRI and Tolerable Upper Limit given by USDA, indicating a Public Health problem in relation with this electrolyte. CONCLUSIONS: The present pilot survey can be considered as a starting point to get insight into the Ecuadorian diet. This will allow to determine consumption patterns affecting population welfare and to evidence attendant positive and adverse effects.

Objetivos: Realizar una evaluación nutricional de la dieta ecuatoriana y determinar el porcentaje de contribución de la ingesta de diferentes nutrientes en función del tipo de comida (desayuno, almuerzo, comida, merienda, y cena) y de la Referencia de Ingesta Dietética (RID). Métodos: Se realizó una encuesta piloto basada en el método del recordatorio de alimentación de 24 h en tres regiones concretas de Ecuador y se procesó la información recogida, se analizó y se comparó con las RID establecidas para la población latinoamericana. Resultados: El estudio encontró diferencias significativas para energía y ciertas vitaminas en hombres y en mujeres, además de determinar que la mayor contribución energética se obtenía en la comida, seguida de la merienda y el desayuno. Las comidas intermedias (almuerzo, merienda y cena) contribuían de una manera significativamente menor en la dieta diaria en comparación con otros tipos de comidas. Además, se observó que las ingestas analizadas no alcanzaban las RID para hidratos de carbono, algunas vitaminas (tiamina, ácido pantoténico, biotina, folato, vitamina D y vitamina E) y minerales (Ca, K, Cu, Mn, I y Fe). La ingesta de NA estaba bastante por encima de las RID y el Límite Superior Tolerable proporcionado por la USDA, lo que indica un problema de salud pública en relación con este electrolito. Conclusiones: Esta encuesta piloto puede considerarse como un punto de partida para obtener una visión más profunda de la dieta ecuatoriana. Esto permitirá determinar los patrones de consumo que afectan al bienestar de la población y establecer efectos positivos y efectos adversos del patrón de consumo en Ecuador.

Fenómeno de Raynaud y claudicación como manifestación inicial de un caso con arteritis de temporal / Raynaud's phenomenon and claudication as the initial manifestations of temporal arteritis

Describimos un caso de arteritis de temporal (AT) que se inició con síntomas de fenómeno de Raynaud (FR) en una mano, que al poco tiempo de su presentación desarrolló claudicación parcia del mismo miembro. Durante su evolución no presentó síntomas de polimialgia reumática ni de AT. Se descartaron las causas más comunes del FR y se utilizaron técnicas de imagen para detectar lesiones vasculares a ese nivel (angiografía selectiva y eco-Doppler de troncos supraaórticos y sus ramas). La eco-Doppler mostró alteración morfológica de la pared de la arteria axilar del lado afectado. Se realizó también una eco-Doppler de la arteria temporal del mismo lado y biopsia con hallazgos concluyentes de AT. Estos hallazgos indican que las manifestaciones vasculares en forma de FR o claudicación en un miembro en pacientes sin síntomas craneales de AT pueden ser una forma de presentación de la enfermedad y que el uso adecuado de técnicas inocuas y no invasivas, como la eco-Doppler, ayudan considerablemente al diagnóstico precoz de la enfermedad. La instauración de tratamiento esteroideo no cambió el curso de la enfermedad (AU)

Presentación simultánea de un caso de lupus eritematoso sistémico y enfermedad de Kikuchi. Su relación con el síndrome hematofagocítico y revisión de la bibliografía / Simultaneous presentation of a case of systemic lupus erythematosus and Kikuchi´s disease. Relationship with hematophagocytic syndrome and literature review

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Streptococcal erythrogenic toxin B induces apoptosis and proliferation in human leukocytes.

BACKGROUND: Previous reports have shown the presence of erythrogenic toxin type B (ETB), apoptosis, proliferation, and leukocyte infiltration in biopsies from patients with acute poststreptococcal glomerulonephritis (APSGN). METHODS: Attempting to correlate the apoptotic and proliferative events with the interaction of ETB or its precursor (ETBP) with leukocytes, mononuclear leukocytes from 12 healthy subjects were cultured with ETB or ETBP to analyze the levels of apoptosis, proliferation, expression of modulatory apoptosis gene products, and oxidative metabolism. After four days of incubation, cells were assessed for apoptosis by morphological criteria, annexin V assay, and terminal deoxy transferase uridine triphosphate nick end-labeling (TUNEL) assay. The expression of regulatory apoptosis genes was assessed by relevant monoclonal antibodies; proliferation was by incorporation of radioactive thymidine; and oxidative metabolism was by oxidation of 2',7'-dichlorofuorescein diacetate to 2',7'-dichlorofuorescein. Neutralization of Fas-L and cysteine protease activity of ETB were performed by incubation of ETB-treated leukocyte cultures with anti-human Fas-L mAb or with E64, respectively. RESULTS: Elevated levels of apoptosis in ETBP/ETB-treated leukocytes were found when compared with controls: morphological criteria (P < 0.01), Annexin V (control, 5.01 +/- 0.61; ETBP, 10.60 +/- 1.98%, P = 0.0005), and TUNEL (control, 12.5 +/- 2.6; ETBP, 20.56 +/- 3.06%, P = 0.001; ETB, 30.69 +/- 5.05%, P = 0.001). Increased expression of apoptosis was accompanied by increased expression of Fas (control, 20.15 +/- 5.28; ETBP, 43.51 +/- 5.6%, P = 0.03; ETB, 47.16 +/- 5.54%, P = 0.01), Fas ligand (control, 5.64 +/- 2.38; ETBP, 11.66 +/- 3.65%, P = 0.04; ETB, 16.39 +/- 5.05%, P = 0.02) and p53 products (control, 9.22 +/- 3.44; ETBP, 22.82 +/- 5.72%, P = 0.01; ETB, 24.60 +/- 5.20%, P = 0.01). Treatment of ETB-leukocyte cultures with anti-human Fas-L exhibited 2.2-fold lower apoptosis expression. Treatment with E64 significantly abrogated the apoptotic effect of ETB. There was no increment on leukocyte oxidative metabolism. Mononuclear leukocytes also showed elevated levels of proliferation when treated with different concentrations (from 50 to 6.2 microg/mL) of streptococcal proteins (Stimulation index ranging: ETBP, 5.6 +/- 1.9 to 6.4 +/- 1.9; ETB, 9.9 +/- 2.8 to 13.9 +/- 3.8). CONCLUSIONS: These results delineate an additional pathway for the pathogenesis of APSGN related to the role of cationic streptococcal ETB or ETBP on the induction of apoptosis and proliferation during the course of the disease.

Ameboflagellates in bronchial asthma.

OBJECTIVE: To distinguish between the existence of detached ciliary tufts (DCTs) and the possibility of protozoa in the sputum of asthma patients. STUDY DESIGN: One hundred six samples of sputum obtained from 97 patients hospitalized with either asthma or other respiratory diseases were examined blindly. The combination of such criteria as movement, absence of basal plate, existence of red granules, positivity for ultraviolet light and Heidenhain's iron hematoxylin stain (for protozoa) was employed to distinguish between DCTs and true protozoa. RESULTS: The presence of ameboflagellates in sputum has a diagnostic accuracy of 86% in predicting or ruling. out the possibility of acute asthma. CONCLUSION: The presence of ameboflagellate forms is closely related to the existence of bronchial asthma, and these result reflect some etiopathogenic significance in asthma.

Variation in plasma lipid and lipoprotein concentrations in community-acquired pneumonia a six-month prospective study.

The nature of changes in the lipid profile caused by an acute infection is controversial. The aims of the present study were to study the changes in plasma lipids and lipoproteins in community-acquired pneumonia, to determine whether these changes differ according to the aetiologica/agents, and finally to observe the behaviour of these lipoproteins six months later. Sixty patients, aged between 18 and 87 years, admitted during the period September 1992 and April 1993 with suspected community-acquired pneumonia, were included in the study. Fifty-three of the patients completed the 15-day follow-up investigation, and 37 remained available for study for up to 6 months. On admission and at 15 and 180 days, analyses were carried out for total cholesterol, HDL cholesterol, apolipoproteins A1 and B, triacylglycerols and transaminases. Student's t test for parametric variables was used for statistical analysis, and the Mann-Whitney test for non-parametric variables. The concentrations of total cholesterol (4.2 +/- 1.0 vs 5.5 +/- 1.3 mmol/1), HDL cholesterol (0.9 +/- 0.4 vs 1.2 +/- 0.3 mmol/l), apolipoprotein A1 (0.80 +/- 0.25 vs 1.15 +/- 0.28 g/l) and apolipoprotein B (0.77 +/- 0.28 vs 0.95 +/- 0.28 g/l) showed significantly lower values during the acute infectious process. These analyte concentrations became stable after 15 days with the exception of HDL cholesterol which continued to increase until 6 months (1.2 +/- 0.3 vs 1.3 +/- 0.3 mmol/l, p < 0.01). Patients with non-viral atypical pneumonia showed, on admission, higher triacylglycerol values (1.8 +/- 0.8 vs 1.3 +/- 0.9 mmol/l, p < 0.01) and lower HDL cholesterol values (0.6 +/- 0.3 vs 1.0 +/- 0.4 mmol/l, p < 0.03). Values of aspartate aminotransferase (112 +/- 117 vs 23 +/- 11 U/l, p < 0.001), alanine aminotransferase (127 +/- 141 vs 24 +/- 16 U/l, p < 0.02) and gamma-glutamyl transferase (113 +/- 158 vs 33 +/- 25 U/l, p < 0.03) were higher in the subgroup of non-viral atypical pneumonia. In conclusion, patients with community-acquired pneumonia present a significant decline in total cholesterol, HDL cholesterol and apolipoprotein A1 and B concentrations. Lower concentrations of HDL cholesterol are maintained up 15 days. Patients with non-viral atypical pneumonia present on admission significantly higher triacylglycerol and lower HDL cholesterol values. Those with non-viral atypical pneumonia also present higher transaminase values.

The evolution of pulmonary tuberculosis in coal miners in Asturias, northern Spain. An attempt to reduce the rate over a 15-year period, 1971-1985.

A prospective study of 53,753 coal miners was undertaken at the Instituto Nacional de Silicosis (INS) in Asturias, Spain, during the period 1971 to 1985. This included a complete medical history, physical examination, pulmonary function tests, and intensive search for pulmonary tuberculosis. A total of 1,136 new cases of active pulmonary tuberculosis were found, all of which were confirmed by bacteriology. The average incidence was 150 +/- 31 cases per 100,000 miners year-1. Annual analysis revealed that this figure remained fairly stable during the period of study. Only a reduction of the prevalence in the subgroup of miners with massive pulmonary fibrosis was seen in later years. The risk of tuberculosis among miners was three times greater than that for the general population of the same area. Our inability to reduce the incidence of pulmonary tuberculosis in a large group of coal miners, in spite of the fact that the treatments given were effective and that in the last eight years chemoprophylaxis was given to close contacts, should be emphasized.

Increase production of fibronectin by glomerular cultures from rats with nephrotoxic nephritis. Macrophages induce fibronectin production in cultured mesangial cells.

BACKGROUND: The participation of monocytes-macrophages and their products in the pathogenesis of several types of glomerulonephritis has become increasingly evident. One of the most important aspects is the potential stimulation of monocyte-macrophages of the extracellular matrix. Therefore, production of fibronectin (FN) by glomeruli of rats with nephrotoxic nephritis was studied. In addition, the effect of macrophage-conditioned medium and interleukin-1 on FN production by cultured mesangial cell (MC) was tested. EXPERIMENTAL DESIGN: Nephrotoxic nephritis was induced in rats by injection of nephrotoxic serum and glomeruli obtained at different periods of time from nephritic and normal animals were cultured. FN in glomerular supernatants was determined by enzyme-linked immunosorbent assay and newly synthesized FN by incorporation of [35S]-methionine. Macrophage-conditioned medium was obtained from cultures of peritoneal resident macrophages and elicited macrophages by different stimuli. MC were cultured with or without macrophage supernatant or interleukin-1 and FN content from MC supernatants was determined by enzyme-linked immunosorbent assay. RESULTS: These data show increase amounts of FN in nephritic cultures when compared with saline controls (time of nephritis; day 4: 3.9-, day 8: 4.35-, and day 18: 2.68-fold increase in FN) and experiments of newly synthesized FN by incorporation of [35S]-methionine had similar results. Macrophage-conditioned medium had FN stimulatory effect on cultured MC but interleukin-1 did not. CONCLUSIONS: These data suggest: (a) that there is an increased newly synthesized FN production in glomeruli from rats with nephrotoxic nephritis, (b) that macrophage produce a FN-stimulatory factor(s) for MC, and (c) that this stimulatory factor probably is not interleukin-1.

Interferon-gamma induces class II antigen expression on cultured rat mesangial smooth muscle cells.

In this study, Ia antigen expression was detected on cultured rat mesangial smooth muscle (MSM) cells by anti-Ia monoclonal antibodies and indirect immunofluorescence when the cultures were stimulated with recombinant interferon-gamma. This finding may be relevant to the increased expression of Ia on mesangial cells during immunologically mediated glomerulonephritis, since it is possible that Ia expression may be induced not only on mesangial macrophages but also in MSM cells during immunologic pathogenesis of glomerular injury.

Massive melanoptysis: a serious unrecognized complication of coal worker's pneumoconiosis.

Black sputum is produced when cavitation of progressive massive fibrosis occurs due to mycobacterial and anaerobic bacterial infections (67%) or ischaemic necrosis. The blackish or greyish sputum suggests cavitation of conglomerated masses; the acinar shadows in gravity dependent areas together with cavitary pneumoconiosis, make us suspect an insufficiency of bronchial clearing. Bronchoscopy confirms the diagnosis by showing the airway blocked by dark material. During melanoptysis the patient suffers respiratory failure which can be fatal. Close vigilance of the arterial blood gases is essential. Measures must be taken to maintain clear airways. Melanoptysis should be listed with the other complications of coal worker's pneumoconiosis.

Tuberculous arthritis of peripheral joints in patients with previous inflammatory rheumatic disease.

Four patients with a previous inflammatory rheumatic disease developed a peripheral tuberculous (TB) arthritis in a joint apparently affected by a rheumatic disease. The single most important factor in the diagnosis of TB was the presence of past or present pulmonary TB or a family history on a background of steroid use. Clinical presentation, disease evolution, and routine laboratory tests were unhelpful. The most effective method of diagnosis was synovial biopsy.

Glomerular binding sites for peanut agglutinin in acute poststreptococcal glomerulonephritis.

Streptococcal neuraminidase may be responsible for the development of auto-immune reactivity in acute poststreptococcal glomerulonephritis (APSGN). Neuraminidase may react with immunoglobulins in the circulation and with sialic acid-rich sites in the endothelial and epithelial glomerular capillary, therefore, extrinsic or intrinsic sialic acid-depleted substrate may be localized in the glomeruli. We studied renal biopsies from 17 patients with APSGN, 48 patients with other renal pathologies and 2 normal kidneys for the capacity to bind fluorescein-labelled peanut agglutinin (PNA) lectin. PNA has specificity for galactosyl radicals which are exposed after sialic acid removal. We similarly studied the kidneys of rats at intervals ranging from hours to 32 days after an intravenous injection of 0.02 units of neuraminidase per g of body weight. Five biopsies of APSGN patients and 2 biopsies from patients with renal pathologies different from APSGN showed glomerular PNA binding. Of APSGN patients, 4 corresponded to the 5 patients biopsied within 30 days of the beginning of the disease and only 1 biopsy was positive in the 12 patients who were biopsied later. The PNA binding predominated in the mesangium and the pattern was irregular and speckled. These findings suggest that sialic-acid depleted material is present in the glomeruli, early in the course of APSGN.

Neuraminidase production by streptococci from patients with glomerulonephritis.

Autoantigenic events in acute poststreptococcal glomerulonephritis (APSGN) may result from neuraminidase-induced alterations in immunoglobulin levels. Whether streptococci from patients with APSGN produced neuraminidase and, if so, what substrates could be used for screening purposes and what were of potential clinical relevance were determined. Group A streptococci cultured from 20 patients with APSGN and four patients with acute rheumatic fever and group B, C, D, and G streptococci cultured from other individuals were reacted with the substrates to determine neuraminidase activity by the thiobarbituric acid assay. Neuraminidase production was detected in 16 of 20 streptococci from patients with APSGN. Partial purification by Sephadex G-150 chromatography gave two peaks, and polyacrylamide gel electrophoresis gave two bands with neuraminidase activity. Bovine mucin was the most useful substrate to detect neuraminidase production by nephritogenic streptococci, and with respect to human substrates, IgM was the most sensitive and renal basement membrane the least sensitive to enzyme action.

[Cutters and drillers: 2 different coal pneumoconioses?]. / Foreurs et abatteurs: deux pneumoconioses différentes du charbon?

The radiographs of 393 coal-cutters (or hewers) and 187 drillers were read independently by two pneumoconiosis experts following the complete 12 grade classification (BIT 1980). The two groups were comparable for age, tobacco and alcohol consumption, and respiratory symptoms but the VEMS was lower in he drillers (p = 0.05). There were significant radiological differences between the groups as follows: with the coal-cutters predominantly type "p" opacities and Category 1; in the drillers "q" and "v" opacities and category 3 were most frequent, and there were a large number of pseudo-tumoral masses and signs of hyperinflation. The two groups have a quantitative and qualitative differences in exposure; it is necessary to interpret the results as two different types of pneumoconiosis, although there are intermediate types. The coal cutters have coal-workers pneumoconiosis in the strictest sense, while the drillers have silicosis with mixed dusts, the latter being more aggressive and incapacitating. One should take account of the two types in epidemiological evaluations in coal miners. It helps to explain certain contradictory results.

Anaerobes: a new aetiology in cavitary pneumoconiosis.

The role of mycobacteria in the cavitation of large pneumoconiotic masses is well established. In other cases softness is attributed to an ischaemic or aseptic necrosis. Five cases are described in which cavitation of the pulmonary masses was caused by anaerobic bacteria, confirmed by the growth of such bacterial in cultures after transtracheal or transpleural puncture. Repeated cultures for mycobacteria gave negative results. Two cases were acute, having serious complications such as bronchopleural fistula, empyema, and serious respiratory insufficiency. The role of anaerobes in cavitary pneumoconiosis has not been recognised previously, probably because of the special conditions required to culture these bacteria and the infrequent use of transtracheal puncture in the diagnosis of this entity. The prevalence of anaerobes as agents capable of cavitating pneumoconiotic masses remains to be established.