RESUMEN
An outbreak of acute liver failure occurred at a dialysis center in Caruaru, Brazil (8 degrees 17' S, 35 degrees 58' W), 134 km from Recife, the state capital of Pernambuco. At the clinic, 116 (89%) of 131 patients experienced visual disturbances, nausea, and vomiting after routine hemodialysis treatment on 13-20 February 1996. Subsequently, 100 patients developed acute liver failure, and of these 76 died. As of December 1996, 52 of the deaths could be attributed to a common syndrome now called Caruaru syndrome. Examination of phytoplankton from the dialysis clinic's water source, analyses of the clinic's water treatment system, plus serum and liver tissue of clinic patients led to the identification of two groups of cyanobacterial toxins, the hepatotoxic cyclic peptide microcystins and the hepatotoxic alkaloid cylindrospermopsin. Comparison of victims' symptoms and pathology using animal studies of these two cyanotoxins leads us to conclude that the major contributing factor to death of the dialyses patients was intravenous exposure to microcystins, specifically microcystin-YR, -LR, and -AR. From liver concentrations and exposure volumes, it was estimated that 19.5 microg/L microcystin was in the water used for dialysis treatments. This is 19.5 times the level set as a guideline for safe drinking water supplies by the World Health Organization.
Asunto(s)
Carcinógenos/efectos adversos , Cianobacterias/aislamiento & purificación , Brotes de Enfermedades , Fallo Hepático Agudo/microbiología , Péptidos Cíclicos/efectos adversos , Instituciones de Atención Ambulatoria , Brasil/epidemiología , Carcinógenos/análisis , Cianobacterias/química , Diálisis , Ensayo de Inmunoadsorción Enzimática , Humanos , Hígado/química , Hígado/patología , Fallo Hepático Agudo/etiología , Microcistinas , Péptidos Cíclicos/análisis , Abastecimiento de AguaRESUMEN
Among the major circulating HIV-1 subtypes, subtype C is the most prevalent. To generate full-length subtype C clones and sequences, we selected 13 primary (PBMC-derived) isolates from Zambia, India, Tanzania, South Africa, Brazil, and China, which were identified as subtype C by partial sequence analysis. Near full-length viral genomes were amplified by using a long PCR technique, sequenced in their entirety, and phylogenetically analyzed. Amino acid sequence analysis revealed 10.2, 6.3, and 17.3% diversity in predicted Gag, Pol, and Env protein sequences. Ten of 13 viruses were nonmosaic subtype C genomes, while all three isolates from China represented B/C recombinants. One of them was composed primarily of subtype C sequences with three small subtype B portions in gag, pol, and nef genes. Two others exhibited these same mosaic regions, but contained two additional subtype B portions at the gag/pol overlap and in the accessory gene region, suggesting ongoing B/C recombination in China. All subtype C genomes contained a prematurely truncated second exon of rev, but other previously proposed subtype C signatures, including three potential NF-kappa B-binding sites in the viral promoter-enhancer regions, were found in only a subset of these genomes.
Asunto(s)
Genoma Viral , Infecciones por VIH/virología , VIH-1/genética , Adulto , Secuencia de Bases , Brasil , China , Femenino , Productos del Gen env , Productos del Gen gag/genética , Productos del Gen pol/genética , Productos del Gen rev , Duplicado del Terminal Largo de VIH/genética , VIH-1/clasificación , Humanos , India , Masculino , Persona de Mediana Edad , Datos de Secuencia Molecular , Filogenia , Alineación de Secuencia , Sudáfrica , Tanzanía , Productos del Gen rev del Virus de la Inmunodeficiencia HumanaRESUMEN
OBJECTIVE: To investigate whether periconceptional maternal alcohol consumption increased the risk of delivering infants with orofacial cleft phenotypes. DESIGN: Data were derived from a large population-based case control study of fetuses and infants among a cohort of California births from 1987 to 1989 (n = 548,844). Information concerning alcohol consumption was obtained by telephone interviews with mothers of 731 infants (84.7% of eligible) with orofacial clefts and of 734 (78.2%) infants in a nonmalformed control group. RESULTS: Thirty-nine percent of mothers in the case group and 42% of mothers in the control group reported that they consumed alcohol during the period 1 month before through 3 months after conception. Relative to nonconsumers, women who reported alcohol consumption (
Asunto(s)
Consumo de Bebidas Alcohólicas/efectos adversos , Labio Leporino/epidemiología , Fisura del Paladar/epidemiología , Fertilización/efectos de los fármacos , Trastornos del Espectro Alcohólico Fetal/epidemiología , Efectos Tardíos de la Exposición Prenatal , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , California/epidemiología , Estudios de Casos y Controles , Labio Leporino/etiología , Fisura del Paladar/etiología , Intervalos de Confianza , Femenino , Trastornos del Espectro Alcohólico Fetal/etiología , Humanos , Recién Nacido , Entrevistas como Asunto/métodos , Oportunidad Relativa , Fenotipo , Embarazo , Distribución Aleatoria , Factores de RiesgoRESUMEN
OBJECTIVES: This study investigated a previously reported 50% or more increased risk for neural tube defect-affected pregnancies among Latina women compared with White women. METHODS: Data were derived from a population-based case-control study of fetuses and live-born infants with neural tube defects in a 1989-through-1991 California birth cohort. Interviews were conducted with mothers of 538 (88% of eligible) infants/fetuses with neural tube defects and mothers of 539 (88%) nonmalformed control infants. RESULTS: The risk for a neural tube defect-affected pregnancy was approximately twice as high among women of Mexican descent than among White women (odds ratio = 1.9, 95% confidence interval [CI] = 1.5, 2.8). The odds ratio for Mexico-born Mexican women compared with White women was 2.4 (95% CI = 1.7, 3.2), whereas the risk for US-born women of Mexican and other racial/ethnic descent was not substantially higher than that for Whites. The higher risk among Mexico-born Mexican women was not attributable to differences in numerous studied parental characteristics and exposures. CONCLUSIONS: Given that nearly 20% of all California births are to Mexico-born Mexican women, the increased risks observed are relevant to the population burden of neural tube defects.
Asunto(s)
Americanos Mexicanos , Defectos del Tubo Neural/etnología , Población Blanca , Adulto , California/epidemiología , Estudios de Casos y Controles , Femenino , Humanos , Recién Nacido , Masculino , Edad Materna , Embarazo , Factores de Riesgo , Apoyo Social , Factores SocioeconómicosRESUMEN
Isolated neural tube defects (NTDs) appear to have different risk factors compared to nonisolated NTDs. To extend those observations, we explored routinely collected child and parental characteristics as possible risk factors among isolated versus nonisolated NTD cases, among high versus low spina bifida cases, and among open versus skin-covered spina bifida case. Fetuses and liveborn infants with anencephaly or spina bifida among the 1983-87 cohort of births and fetal deaths (n = 712,863) were ascertained by the California Birth Defects Monitoring Program. One hundred and ninety-three anencephalic cases and 272 spina bifida cases were compared to a random sample of 5,000 liveborn infants. Among anencephalic cases, 55% were livebirths and 85% were isolated. The proportion of males was similar to females across all subgroups. Increased risks were found for Hispanic whites, with risk estimates highest for nonisolated cases (odds ratio = 4.0, 95% confidence interval [1.5, 10.5]). Among spina bifida cases, 92% were livebirths, 81% isolated, 82% open, and 86% were low. More males were found among the group with isolated high open defects, and fewer males were found among the group of all closed defects. The proportion of males was similar to females in all other subgroups. Cases were more likely to be Hispanic with risks largest for high open defects (odds ratio = 2.9, [1.2,6.6]), particularly for nonisolated cases. This study provides some evidence that further classifications of NTDs may reveal subgroupings of cases with different etiologies.
Asunto(s)
Defectos del Tubo Neural/epidemiología , Anomalías Múltiples/epidemiología , Anomalías Múltiples/etnología , Anencefalia/epidemiología , Anencefalia/etnología , California/epidemiología , Estudios de Cohortes , Enfermedades en Gemelos/epidemiología , Etnicidad , Femenino , Muerte Fetal/epidemiología , Muerte Fetal/etnología , Hispánicos o Latinos , Humanos , Recién Nacido , Masculino , Edad Materna , México/etnología , Madres , Defectos del Tubo Neural/clasificación , Defectos del Tubo Neural/etnología , Oportunidad Relativa , Paridad , Edad Paterna , Fenotipo , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Muestreo , Disrafia Espinal/clasificación , Disrafia Espinal/epidemiología , Disrafia Espinal/etnologíaRESUMEN
Evidence for human T cell lymphotropic viruses (HTLV) was sought in sera and cells collected from adults in 13 isolated South and Central American Indian tribes. Serologic tests identified frequent HTLV-II-like reactivity among the Cayapo and Kraho tribes, who live 330 km apart in Central Brazil. Polymerase chain reaction analyses of viral DNA in cell pellet and plasma fractions confirmed the virus as HTLV-II. Both tribes speak Gé and, at the time of blood collection (1974), subsisted as hunter/gatherers and slash and burn agriculturalists. Further testing of plasma from Cayapo and Kraho of all ages revealed overall HTLV-II prevalence rates of 33.3% and 12.2%, respectively, with increasing prevalence associated with age and female gender. These data reveal for the first time a high prevalence of HTLV-II infection in remote South American Indians with little contact with non-Indians. Thus, HTLV-II is postulated to be an ancient human virus in the New World.
Asunto(s)
ADN Viral/sangre , Anticuerpos Anti-HTLV-II/sangre , Infecciones por HTLV-II/epidemiología , Virus Linfotrópico T Tipo 2 Humano/genética , Indígenas Sudamericanos , Adulto , Factores de Edad , Secuencia de Bases , Brasil/epidemiología , Femenino , Virus Linfotrópico T Tipo 2 Humano/inmunología , Humanos , Immunoblotting , Masculino , Persona de Mediana Edad , Datos de Secuencia Molecular , Sondas de Oligonucleótidos/química , Reacción en Cadena de la Polimerasa , Prevalencia , Factores SexualesRESUMEN
A recombinant protein of the human T cell lymphotropic virus type I (HTLV-I) gp46 outer membrane envelope, MTA-4 (residues 129-203), reacted by Western blot with sera from HTLV-I-infected individuals from the United States and Jamaica but not with 24 (10%) of 242 Japanese sera. A related gp46 recombinant protein, MTA-1 (residues 162-209), reacted with all 58 sera from HTLV-I-infected US and Jamaican individuals and 238 of 242 sera from infected Japanese (combined sensitivity of 99%). Neither recombinant showed reactivity to sera from HTLV-II-infected individuals or uninfected controls. The reactivity of recombinant proteins containing the region of HTLV-II gp46 analogous to MTA-1 was also evaluated by Western blot: GH2-K15 (residues 157-205) and GH2-K55 (residues 162-205) reacted with 88 (98%) and 89 (99%), respectively, of 90 sera from HTLV-II-infected individuals but not with sera from HTLV-I-infected individuals or uninfected controls. These recombinant proteins should permit the development of assays to unambiguously confirm and differentiate HTLV-I and HTLV-II infections.
Asunto(s)
Anticuerpos Antideltaretrovirus/biosíntesis , Antígenos HTLV-I/inmunología , Infecciones por HTLV-I/diagnóstico , Antígenos HTLV-II/inmunología , Infecciones por HTLV-II/diagnóstico , Secuencia de Aminoácidos , Anticuerpos Monoclonales , Western Blotting , Diagnóstico Diferencial , Epítopos/química , Epítopos/inmunología , Antígenos HTLV-I/química , Antígenos HTLV-II/química , Humanos , Jamaica , Japón , Datos de Secuencia Molecular , Reacción en Cadena de la Polimerasa , Proteínas Recombinantes/química , Proteínas Recombinantes/inmunología , Estados UnidosAsunto(s)
Síndrome de Inmunodeficiencia Adquirida/microbiología , Anticuerpos Antivirales/análisis , Encefalopatías/microbiología , Encéfalo/inmunología , ADN Viral/análisis , VIH/aislamiento & purificación , Síndrome de Inmunodeficiencia Adquirida/inmunología , Síndrome de Inmunodeficiencia Adquirida/patología , Encéfalo/patología , Encefalopatías/inmunología , Encefalopatías/patología , Ensayo de Inmunoadsorción Enzimática , VIH/inmunología , Humanos , Lactante , Masculino , Factores de TiempoRESUMEN
The number of deaths caused by gastroenteritis rather than the notification of the illness is a more readily available index of the incidence of this disease in Jamaica. In order to examine the pattern of gastroenteritis with respect to its seasonal incidence data on a monthly or other cyclic basis. However, in the absence of such incidence figures for Jamaica, in this paper we have used the figures for deaths from gastroenteritis to determine the monthly incidence of disease in Jamaican children up to five years of age during the period 1963-1967(AU)
Asunto(s)
Gastroenteritis/mortalidadRESUMEN
The latest period for which detailed and final figures on causes of mortality are available is the year 1956. At this time among the 10 principal causes of death there were still 5 communicable diseases - pneumonia, gastro-enteritis, respiratory tuberculosis, malaria and syphilis. Infective and parasitic diseases accounted for 12.7 percent of total deaths but this represented a reduction of more than 50 percent over the 10 year period prior to 1956 and the specific death rates for these diseases, excepting gastro-enteritis, are declining steadily. The majority of deaths from pneumonia, gastro-enteritis, malaria and syphilis occurs in the 0-4 years age groups and the respiratory tuberculosis death rates are now highest in the older age groups. Of the other reportable diseases large increases have been noted in the number of cases of infectious hepatitis reported (AU)