Measurement of socio-economic status in families of children with cancer in Guatemala.

The prospects for survival of children in low and middle income countries are linked to their families socio-economic status (SES), of which income is only one component. Developing a comprehensive measure of SES is required. Informed by clinical experience, a 15-item instrument was designed in Guatemala to categorize SES by five levels in each item. Almost 75% of families attending the Unidad Nacional de Oncología Pediátrica were in the lowest three of six categories, providing a framework for stratified financial and nutritional support. The measure of SES offers an opportunity for examining associations with health outcomes throughout Latin America.

Growth and survival of Escherichia coli O157: H7 in meat, poultry and vegetables mixed with different concentrations of mayonnaise.

In the last 20 years Escherichia coli O157: H7 has emerged as a new pathogen, causing worldwide disease, death and economic loss. Different studies have revealed important survival characteristics of this pathogen, although there are divergent criteria about its ability to survive in various mayonnaise formulations. We studied the effect of different mayonnaise concentrations (0%, 18%, 37% and 56%) (weight/weight) over the survival of the bacterium in common foods from a neotropical environment (Costa Rica). High [10(7)-10(8) Colony Forming Units (CFU)/ml] and low E. coli populations (10(4)-10(6) CFU/ml) were inoculated, (three replicates) in meat, chopped cabbage and poultry, and mixed with commercial mayonnaise to obtain the concentrations specified. They were incubated at 12 degrees C for 24, 48 and 72 hr. The E. coli O157: H7 enumeration was done according to a standard methodology. Populations of E. coli O157: H7 showed an increasing trend during the first incubation period (48 hr), in all the preparations, regardless of the fat concentration used. Our data indicate that E. coli O157: H7 is capable of surviving and growing in meat, cabbage and poultry mixed with mayonnaise, independently of its concentration.

Effect of storage temperatures on growth and survival of Escherichia coli O157: H7 inoculated in foods from a neotropical environment.

Escherichia coli O157: H7 has emerged as a new pathogen and is found worldwide. We studied the effect of several storage temperatures on the survival of this bacterium in common foods from a neotropical environment (Costa Rica) because at least seven clinical cases have been reported from the country, and no epidemiological link or probable food association has been described. High (10(6)-10(8) CFU/ml) and low (10(4)-10(6) CFU/ml) populations of E. coli were inoculated (three replications) in ground meat, chopped cabbage, chicken giblets and pasteurized milk and incubated at 0, 6 and 12 degrees C for 24, 48 and 72 h. Vegetables and milk were also stored at 22 degrees C for the same periods. The E. coli O157: H7 enumeration was done according to the methodology described in the Bacteriological Analytical Manual. Populations of E. coli O157: H7 showed either an increasing or decreasing trend, according to temperature, time or food base. Our data indicate that E. coli O157: H7 is capable of surviving and growing in meat, cabbage, milk and chicken giblets; food items commonly consumed by Costa Ricans.

Acute lymphoblastic leukemia in a developing country: preliminary results of a nonrandomized clinical trial in El Salvador.

PURPOSE: To improve outcome and study biology of childhood acute lymphoblastic leukemia (ALL) in El Salvador. PATIENTS AND METHODS: Between January 1994 and December 1996, 153 children of El Salvador had newly diagnosed ALL treated in a collaborative program between Hospital Benjamin Bloom and St. Jude Children's Research Hospital (SJCRH). Therapy was based on a modified SJCRH protocol, with uniform remission induction (prednisone, vincristine, L-asparaginase) followed-up by consolidation with teniposide/cytarabine and/or high-dose methotrexate. Continuation treatment was risk-stratified: 123 patients assigned to the high-risk group received weekly rotational drug pairs, and 16 assigned to the standard-risk group received daily 6-mercaptopurine, weekly methotrexate, and monthly pulses of vincristine plus dexamethasone. High risk was defined as: DNA index < 1.16, age 12 months or younger, white blood cell count > or = 50 x 10(9)/L, T-cell immunophenotype, anterior mediastinal mass, central nervous system leukemia at diagnosis, or t(4;11), t(1;19), or t(9;22). Duration of the continuation treatment was 2.5 years in both groups. The median age at diagnosis of all patients was 4.8 (range I d-17 yrs), median leukocyte count was 15 (range 1-766) x 10(9)/L, and sex distribution was equal. RESULTS: Immunophenotypes were early beta-progenitor in 79%, T-cell in 3.9%, and inconclusive in 17% of cases. DNA index was <1.16 in 80.5% and was > or = 1.16 in 19.5% of the 123 known cases. For the analyzes, patients who refused therapy (abandoned treatment) were considered to have treatment failure as of their last follow-up dates. Complete remission was achieved in 126 of 151 (82.4%) patients (11 abandoned therapy during induction). The overall 4-year event-free survival (EFS) rate +/- 1 standard error was 48 +/- 6%. The 4-year EFS rates in patients at high-risk and standard-risk were 46 +/- 7% (n = 121) and 69 +/- 15% (n = 16), respectively (P = 0.20). When patients who refused further treatment are censored, the corresponding 4-year estimates of EFS are 51 +/- 8% and 75 +/- 14%, respectively. CONCLUSIONS: These results suggest that the biology of childhood ALL in El Salvador appears to be similar to that seen in the United States. Risk-directed chemotherapy can successfully be used in developing countries, but risk factors must be carefully determined and applied.

Microbiological contamination of enteral feeding solutions used in Costa Rican hospitals.

Enteral feeding is the most common and preferred modality for providing nutritional support to hospital patients with a functional gastrointestinal tract that can not satisfy their nutritional requirements. Nevertheless, enteral feeding may be an important cause of bacterial infection. The aim of this study was to evaluate the microbial contamination level of enteral feedings distributed in Costa Rican hospitals. A total of 124 samples of enteral feeding, coming from five different hospitals from San José, Costa Rica, were evaluated during the second semester of 1997 and first of 1998 for the presence and identification of total and fecal coliforms, Pseudomonas sp. and Listeria sp. A subpopulation of the Pseudomonas isolated was analyzed for their antibiotic susceptibility patterns. The concentration of Gram negative rods in the samples of enteral feeding solutions ranged from 10(3) to 10(7) CFU/mL, markedly exceeding the permissible level (10(2) CFU/mL or less). The coliforms most frequently isolated included Enterobacter cloacae, Escherichia coil, Serratia sp. and Klebsiella pnuemoniae, Pseudomonas sp. was isolated in more than 70% of the samples made from commercial based solutions, fruits and vegetables. P. aeruginosa and P. fluorescens were the species most frequently isolated. Listeria sp. was not isolated from enteral solutions samples. The results obtained demonstrate that it is urgent to assure strict hygiene during the preparation and handling of all enteral feed in order to avoid bacterial growth. The implementation of HACCP (Hazard Analysis and Critical Control Points) system will be required in a near future for better quality control of enteral nutrition mixtures.

Pediatric primary diffuse large cell lymphoma of bone with t(3;22)(q27;q11).

PURPOSE: A child with a primary lymphoma of bone (PLB) with a t(3;22)(q27;q11) is described. METHODS: An 11-year-old boy had a 5-week history of back pain and a destructive lesion of S1 that contained an epidural component. Histologic evaluation of a biopsy confirmed the diagnosis of diffuse large B-cell non-Hodgkin lymphoma. Karyotypic analysis disclosed a t(3;22)(q27;q11), but the amount of tumor tissue was insufficient for molecular studies of the BCL-6 gene. RESULTS: The patient remains free of disease 4 years after completion of intensive systemic chemotherapy and intrathecal chemotherapy. CONCLUSIONS: The lymphoma in the patient described in this report is highly unusual because of the coexistence of pediatric PLB and a t(3;22)(q27q11).

[Microwave effect on survival of sporulated bacteria inoculated in minced meat]. / Efecto de las microondas sobre la sobrevivencia de bacterias esporuladas inoculadas en carne molida.

Due to the current tendency of cooking and heating meat prepared foods in microwave ovens and the possibility that they transmit bacterial diseases, the survival rate of spore-forming bacteria was evaluated in minced meat samples. Meat was innoculated with a known number of Bacillus cereus and Clostridium perfringens spores, and laterly thawed and cooked in an Amana microwave oven (2450 Hz). Survival rate was determined according to the methodology described by Vanderzant & Splittstoesser, and the activity of the enzyme acid phosphatase was determined as cooking parameter. B. cereus spore showed a decrease in its number as the time of exposition increased, but without fully disappearing. C. perfringens spores also decreased in number, but showed a later increase, associated with the germination of survival spores.

5q- in a child with refractory anemia with excess blasts: similarities to 5q- syndrome in adults.

A 19-month-old boy was referred to our institution because of chronic macrocytic anemia and severe thrombocytopenia. At age 17 months, he had developed petechiae. He had a leukocyte count of 4.4 x 10(9)/L, hemoglobin concentration of 7.9 g/dL, packed cell volume of 21%, mean corpuscular volume of 101 fL, and platelet count of 19 x 10(9)/L. At the time of referral, a bone marrow aspirate and biopsy revealed myelodysplastic changes that included megakaryocytic hyperplasia with hypolobated megakaryocytes, megaloblastoid erythropoiesis, 12% blast cells, and bone marrow fibrosis; the diagnosis was refractory anemia with excess blasts (RAEB). Cytogenetic analysis showed the following abnormalities: 47, XY, inv(3)(p21q25), del(5)(q22q31), +21/46, XY. By dinucleotide polymorphism analysis, the 5q22-q31 loci were normal in peripheral blood granulocytes. Because of severe thrombocytopenia that became refractory to platelet transfusions and because of possible progression to leukemia, the patient received an unrelated-donor bone marrow transplant. Recovery was complicated by a visceral fungal infection, but the patient now has normal, fully reconstituted bone marrow function. This patient is the youngest to be reported with RAEB and a 5q- anomaly accompanied by thrombocytopenia, megakaryocytic hyperplasia with hypolobated megakaryocytes, and macrocytic anemia with megaloblastoid erythropoiesis, similar to "5q- syndrome" in adults.

Primitive neuroectodermal tumor of bone as a second malignant neoplasm in a child previously treated for acute lymphoblastic leukemia.

PURPOSE: Although rare, second malignant neoplasms (SMNs) are a devastating consequence of successful treatment of childhood cancer. The 15-year estimated risk of developing a second malignant neoplasm after treatment of childhood acute lymphoblastic leukemia (ALL) is 2.5%. Most of these neoplasms are central nervous system tumors. The risk of secondary acute myeloid leukemia has been negligible in most treatment regimens. Here, we report the first case of a primitive neuroectodermal tumor (PNET) in a patient treated for ALL. PATIENTS AND METHODS: A 15.7-year-old girl developed pain in her left leg 7 years after diagnosis of low-risk ALL. Imaging studies revealed lytic lesions in her left proximal tibia and several vertebra as well as metastatic nodules in both lungs. RESULTS: Immunocytochemical and molecular analyses led to the diagnosis of PNET. The treatment of this SMN was composed of combination chemotherapy with hematopoietic growth factor support and radiotherapy to the primary lesion and affected spine. The tumor recurred 5 months after the completion of treatment, and the patient is now undergoing salvage therapy composed of chemotherapy and radiotherapy. CONCLUSIONS: To our knowledge, this is the first report of PNET as an SMN after successful treatment of ALL.

[Effect of microwaves over Staphylococcus aureus and Salmonella spp. inoculated into frozen minced meat]. / Efecto de microondas sobre Staphylococcus aureus y Salmonella spp. inoculados en carne molida congelada.

The efficacy of the microwave oven in the destruction of some pathogenic microorganisms inoculated into minced meat was studied. These were inoculated with Salmonella spp. or Staphylococcus aureus, freezed for 2-3 days at -4 degrees C and thawed, according to their weight, in an Amana microwave (24450 Hz). They were radiated at levels of 60%, 70%, 80% and 90% for periods of 15, 45, 60, 90 and 105 seconds. The rate of survival of each bacteria was determined according to the methodology described by Vanderzant and Splittstoesser, as well as the activity of the acid phosphate enzyme as cooking parameter. The microbiological analysis shows that, despite the cooking level used, the time required for the elimination of both bacteria is greater than the one in which the meat is considered enzymatically and organoleptically cooked.

[Microbiologic depuration of Anadara tuberculosa (Mollusca: Arcidae)]. / Depuración microbiológica artesanal de la piangua, Anadara tuberculosa (Mollusca: Arcidae).

In Costa Rica the mollusk Anadara tuberculosa represents a risk for human health due to the contamination of the growing waters and the fact that its is consumed raw. The families depending on the income obtained through commercialization of these animals have a low education and economic status. Therefore, it is of great importance to develop and evaluate simple methods of depuration that could be easily used by these families to make these mollusks safe for consumption. Bottles containing 11 of saline solution (25g/l) were prepared in duplicates to test the bactericidal effect of acetic acid. The solution in each bottle was adjusted to ph 4.5, 5.0 or 5.5 or held at ph of 7.0 or 8.0 for the controls. The solution in each bottle was then inoculated with approximately 1 X 104 cfu/ml of coliforms. Counts of coliforms were determined for each bottle 0, 1, 2, 4 and 8 hours after inoculation. For the depuration studies, specimens with diameters ranging from 4.0 to 4.5 cm were collected from a harvester at the estuary of Puntarenas, Gulf of Nicoya. Fifty specimens each were depurated in separate tanks containing 25 1 of oxygenated saline solution adjusted with acetic acid to an initial ph of 4.5 (treatment) or non adjusted ph of 8.0 (control). Counts of Enterobacteriaceae were determined, in duplicates, every 12 hr for 48 hr. An additional fifty animals were depurated using the defined method and tested to determine if they met international standards of microbiological quality for aerobic plate count, Enterobacteriaceae count, Escherichia coli count and presence of Salmonella. A sensory evaluation using a triangle test was performed to compare a typical dish prepared with depurated or non-depurated animals. A significant coliform reduction was determined in a saline solution (25 g/l) at a pH range of 4.5 to 5.5. This reduction, during 8 hr, was higher in the acid treatments compared to the controls. During depuration, the elimination of Enterobacteriaceae bacteria was faster when acetic was used (initial ph = 4.5) than when it was not. This elimination was more important the first 24 hr, time defined as adequate for the application of the method. The method has the advantage of transforming the bivalve in a product that is safe for human consumption, since it guarantees that the international standards of microbiological quality, for raw and depurated mollusks, are reached. On the other hand, the sensory qualities of a typical dish prepared with depurated animals are not affected by the method, which can be easily implemented and applied by the people that work in the extraction of this mollusk.

[Microbiological quality of street sold fruits in San José, Costa Rica]. / Calidad microbiológica de frutas que se venden en Puestos Callejeros de San José, Costa Rica.

The sanitary quality of street sold fruits was analyzed during the period from march 1990 thru march 1993 in San Jose, Costa Rica. It looked for the presence of Salmonella spp. Shigella spp., Escherichia coli as well as fecal coliforms in natural refreshments, fruit salads and the fruits most frecuently expended on streets, either in slices as the pineapple (Ananas comosus), papaya (Carica papaya), non-ripe mangoe (Mangifera indica) and watermelon (Citrullus vulgaris) and those that can be eaten without peeling, like nances (Byrsonima crassifolia) and jocotes (Spondias purpurea). 25 samples of each fruit, 50 natural refreshments and 50 fruit salads were processed according to rinse solution method, and the bacteriological determination was based in the methodology described by Vanderzant & Splittstoesser and the Bacteriological Analytical Manual. In the same way, it was used the Most Probable Number for 5 tubes described in the Standar Methods of Water and Wastewater in orden to analyze 15 samples of ready to use water by the fruit hawker. The nutritional value was studied according to the food composition tables for Costa Rica, Latin America and USA. The results show that more than 30% of fruit samples, 70% of natural refreshments and 96% of fruit salad presented fecal coliforms. Same time, all of them present important contamination indexes with E. coli. Salmonella spp. and Shigella spp. were not isolated. The water analysis revelead that 53% contained fecal coliforms, probably due to the lack of hygiene in the utensils used to collect water. The nutritional evaluation shows that fruit portions (except watermelon) satisfy more than 100% of the diary recommendation of vitamin C (60 mg) and 4-7% of the recommended ingestion of dietetic fiber (30g).

[Sanitary quality of some food distributed by hospital food services of Costa Rica]. / Calidad sanitaria de algunos alimentos distribuidos en servicios de alimentación hospitalarios de Costa Rica.

The sanitary quality of 100 samples of salad and 100 samples of skinless fruits distributed by the Hospital Food Services were studied. Samples were processed according to rinse solution method, and the bacteriological determination was based in the methodology described by Vanderzant & Splittstoesser. The preparation scheme of each product was realized in order to analyze risks and determine the critical control points according to ICMSF (International Commission on Microbiological Specifications for Foods). Microbiological studies on the critical control points (total and fecal coliforms determinations) were done according to the surface analysis using the swab contact method as described by Vanderzant & Splittstoesser. Our results show that 93% of the salads and 65% of the fruits presented contamination of fecal origin. The hands of the operators and kitchen utensils also presented important fecal contamination indexes.

Study of HLA antigens in patients with osteosarcoma.

HLA typing was carried out in a group of twenty-four Spanish unrelated patients diagnosed with conventional high-grade osteosarcoma. All of them were typed for HLA-A and HLA-B antigens. A significant increase in the HLA-A11 (33.3 vs. 12%, chi 2 = 9.752, corrected p value = 0.016) and HLA-B7 (33.3 vs. 11.3%, chi 2 = 10.919, corrected p value = 0.011) was found in osteosarcoma patients compared with the control group. A trend towards an increased frequency in HLA-A24 and HLA-A28 antigens was also found.

[Isolation of Vibrio cholerae no-01 in the Gulf of Nicoya, Costa Rica]. / Aislamiento de Vibrio cholerae no-01 en el Golfo de Nicoya, Costa Rica.

In a bacteriological study on samples of bivalves, mud and surface waters from the Gulf of Nicoya, Costa Rica, 18 strains of non-01 Vibrio cholerae and 50 of V. mimicus were isolated. The samples were enriched in alkaline peptone water, and streaked on MacConkey and inositol-brilliant green bile agars. Biochemical and serological tests were used for their identification. Both species were isolated from all sampling sites (Lepanto, Jicaral and Puntarenas) with either of the two agar media, even though these were not specific for vibrios.

Production of enterotoxin and cytotoxin in Campylobacter jejuni strains isolated in Costa Rica.

The production of toxins by 79 strains of Campylobacter jejuni isolated in Costa Rica from children with campylobacter-induced diarrhoea (44 strains) and from chickens (35 strains) was studied. An enterotoxic effect giving a rounding of mouse adrenocortical tumour (Y1) cells, which could be neutralised with antitoxin against Escherichia coli heat-labile enterotoxin, was detected in supernates from 16 (62%) of 26 strains from children with watery diarrhoea, in 5 (28%) of 18 strains from children with bloody or inflammatory diarrhoea, and in 12 (34%) of the 35 strains from chickens. Cytotoxic effects in human lung fibroblasts (MRC-5), African Green monkey kidney (Vero) cells and human cervical carcinoma (HeLa) cells were observed in none of the 26 strains from children with watery diarrhoea, in 2 (11%) of the 18 strains from children with bloody or inflammatory diarrhoea, and in 6 (17%) of the 35 strains from chickens. The simultaneous production of enterotoxin and cytotoxin was detected in four strains. The cytotoxic effect, which was most prominent in cells freshly seeded at a low density, appeared as a lethal rounding of the cells. Fibroblasts were more sensitive than epithelial cells. The effects of the supernates were inactivated by heating at 100 degrees C for 10 min and decreased after 1 week at 4 degrees C. The production of toxins was lost after storage of the strains for one year at -70 degrees C.