A subgroup of lupus patients with nephritis, innate T cell activation and low vitamin D is identified by the enhancement of circulating MHC class I-related chain A.

The major histocompatibility complex (MHC) class I-related chain A (MICA) is induced upon stress, and labels malfunctioning cells for their recognition by cytotoxic lymphocytes. Alterations in this recognition and also abnormal natural killer (NK) functions have been found in systemic lupus erythematosus (SLE). MICA can be shed from cells, subsequently acting as a soluble decoy receptor (sMICA). Our purpose was to study circulating sMICA levels in relationship with the activation of innate pathways in PBMC in a cohort of lupus patients. NK cells were characterized by flow cytometry. Gene expression of Toll-like receptors (TLR), interferon (IFN)-I sensitive genes and MICA were separately analyzed in monocytes, T cells and B cells. Serum sMICA was measured with enzyme-linked immunosorbent assay (ELISA). In our cohort, NK cell counts dropped in relationship with disease activity. sMICA showed an inverse trend with NK cell counts, as well as a significant association with activity indices, but not with complement decrease. Levels of sMICA associated to proteinuria and active nephritis. A multivariate regression model revealed anti-nuclear antibody (ANA) titres, the up-regulation of TLR-4 in T cells and lower vitamin D as predictors of sMICA enhancement. Interestingly, vitamin D showed an inverse association with proteinuria and a strong correlation with T cell MICA mRNA levels. According to our data, circulating sMICA identifies a subgroup of lupus patients with low vitamin D, innate activation of T cells and nephritis. We propose that lymphocyte shedding could account for the enhancement of sMICA and reflect an immune evasion mechanism driving disease activation in lupus.

Spirulina supplementation during the transition period by grazing dairy cattle at tropical highland conditions.

The objective of this experiment was to evaluate the effects of spirulina supplementation on oxidative stress, immunity, and productive performance during the transition period by grazing dairy cattle. Thirty multiparous gestating cows with an initial body weight (BW = 544 ± 57 kg) were enrolled in this experiment and were stratified by expected calving date. Cows were randomly assigned to one of the three experimental groups: (1) control, no supplementation of spirulina; (2) spirulina-15 (15 g/day of spirulina); and (3) spirulina-30 (30 g/day of spirulina). Body weight and body condition score (BCS) were recorded and blood samples were collected at - 21, 1, and 14 days, relative to calving. The day of parturition, colostrum and blood samples from calves were collected to measure IgG concentrations. After parturition milk yield, milk components and somatic cell count were monitored. Body weight, BW loss, BCS, and total antioxidant capacity were not affected by spirulina supplementation (P > 0.23) at any time point measured. Milk yield, milk components, and somatic cell count were not altered by treatment (P > 0.13). Results from this experiment suggest neither positive nor negative effects of spirulina supplementation on oxidative stress and productive performance during the transition period.

Risk factors associated with house infestation by the Chagas disease vector Triatoma pallidipennis in Cuernavaca metropolitan area, Mexico.

Chagas disease caused by infection with Trypanosoma cruzi Chagas (Kinetoplastida: Trypanosomatidae) is widespread in Mexico, transmitted by various triatomine bugs (Hemiptera: Reduviidae). The only domestic vector in Cuernavaca (population 650 000) is Triatoma pallidipennis (Ståhl) with T. cruzi seroprevalence ranging from 1% to 9% in the resident human population. We surveyed possible risk factors for T. pallidipennis infestation at Cuernavaca (altitude 1200-2200 m) on south-western slopes of the Sierra Madre Occidental. This metropolitan area (with five administrative counties) has rapid urbanization, forested environs and proliferation of 'weekend housing' for visitors from Mexico City, 60 km to the north. To assess factors associated with T. pallidipennis infestation, we first stratified Cuernavaca by altitude and by socio-economic status of population catchment units (PCUs). Within each PCU, one to three blocks were chosen for cluster sampling (three houses/block) and information about Chagas disease was distributed. After obtaining signed consent from householders, representative houses were routinely and opportunistically inspected for T. pallidipennis and surveyed for demographic, economic, physical and other potential risk factors. Of the 1129 houses assessed, T. pallidipennis was found in 4.1% (range 3.0-6.8% per county) and the T. cruzi infection rate was approximately 50% in bugs. Rates of house infestation in poor PCUs were double those in higher socio-economic strata (odds ratio 2.12, confidence interval 1.03-4.3), with >4-fold greater crowding index of T. pallidipennis. The bug density index was inversely correlated with PCU altitude and socio-economic category (altitude of homes being associated with prosperity), while the bug colonization index (presence of nymphs indicating breeding) did not vary significantly across the PCU categories, but did vary according to altitude. Multivariate regression analysis showed that the most significant risk factors associated with T. pallidipennis infestation were lower altitude (linked with lower socio-economic status), garden area >80 m(2), dogs at liberty to enter the house, occurrence of squirrels and opossums around the house, presence of pigs in the surrounding area and having at least one of the adjacent lots empty (unconstructed). Householders who had received information about Chagas disease comprised 33% from infested houses (14/42) but only 15% from non-infested houses (148/984). Hence, the awareness of Chagas disease was significantly associated with having a bug-free house (P < 0.01). When shown specimens of T. pallidipennis, the proportions of householders who recognized them were 78% from infested houses but only 29% of those with uninfested houses. Given the low infestation rates and the high capacity of the population to act appropriately once they have received information regarding this disease and its vector, relevant health education is expected to have a significant impact on triatomine control in this metropolitan area.

Domestic scorpion control with pyrethroid insecticides in Mexico.

Scorpion stings cause more morbidity in Mexico than any other country, leading to about 100 deaths annually. In 1999, the State of Morelos reported nine deaths among 30663 cases of scorpion sting. To replace lindane used for scorpion control, field trials of pyrethroid pesticides were undertaken in Morelos during 1998-2000 at the village of Chalcatzingo (population initially with 2760 inhabitants and 530 houses). Pre-intervention surveys detected scorpions (Scorpiones: Buthidae) of two species in the majority of houses: Centruroides limpidus limpidus Karsch outnumbering Vaejovis mexicanus smithi Koch. Scorpion prevalence was assessed, pre- and post-spray, directly by searching (40 min/house) and by householder reports of sightings inside houses. Pre-intervention perceptions of scorpion abundance were similar for all areas, with sightings in 12-18% of houses, whereas daytime searches detected more infestations in eastern parts of the village (prevalence 17% indoors, 22% outdoors) than in other sectors (9% indoors, 14% outdoors). Pyrethroids were evaluated as residual treatments in separate sectors of Chalcatzingo, with almost complete coverage indoors and peridomestically, using the following four formulations: bifenthrin 10% wettable powder (WP) applied at 50mg a.i./m2, cyfluthrin 10% WP (Solfac 10 WP) at 44-55 mg a.i./m2, deltamethrin 2.5% suspension concentrate (Biothrin 25 SC) at 11 mg a.i./m2 and 5% WP (K-Othrine 50 WP) at 35 mg a.i./m2. Phase 1 compared bifenthrin 10 WP, Solfac 10 WP and Biothrin 25 SC sprayed in December 1998; phase 2 compared Solfac 10 WP and K-Othrine 50 WP sprayed in June and again in December 2000, with follow-up surveys of scorpions one month post-spray and subsequently. Scorpion prevalence was reduced by 64-77% peridomestically one month post-spray and by 83, 46 and 15% in houses sprayed with cyfluthrin WP, bifenthrin WP or deltamethrin SC, respectively. Householder reports of sighting scorpions indoors were 33-85% below pre-intervention levels. Cumulative effects of the three spray-rounds over 3 years reduced scorpion prevalence by approximately 60% in the deltamethrin WP re-sprayed area and by approximately 90% in the cyfluthrin WP re-sprayed area. Householder sightings also fell by 67 and 28% in the cyfluthrin and delta-methrin re-sprayed areas, respectively. Operational efficacy of these products against scorpions at the dosages applied was ranked as cyfluthrin WP > bifenthrin WP > deltamethrin SC > WP. Reported cases of scorpion sting intoxication fell by 17% during this study after having risen by approximately 40% over four previous years.

Further refinement of the MYP2 locus for autosomal dominant high myopia by linkage disequilibrium analysis.

INTRODUCTION: High myopia (>-6.00 diopters) is a complex common disorder that predisposes individuals to retinal detachment, glaucoma, macular degeneration, and premature cataracts. A recent linkage analysis of seven families with autosomal dominant high myopia has identified one locus (MYP2) for high myopia on chromosome 18p11.31 (Young et al.: Am J Hum Genet 1998;63:109-119). Haplotype analysis revealed an initial interval of 7.6 centimorgans (cM). METHODS: Transmission disequilibrium tests (TDT) with both the Statistical Analysis for Genetic Epidemiology (SAGE) 3.1 TDTEX and GENEHUNTER 2 (GH2) programs were performed using chromosome 18p marker alleles for this interval. RESULTS: Using SAGE analysis, the following p values were obtained for markers in marker order in this region: D18S1146 (p = 0.227), D18S481 (p = 0.001), D18S63 (p = 0.062), D18S1138 (p = 0.0004), D18S52 (p = 1.79 x 10(-6)), and D18S62 (p = 0.141). GH2 TDT analysis revealed the following p values for the best allele for the markers: D18S1146 (p = 0.083), D18S481 (p = 0.108), D18S63 (p = 0.034), D18S1138 (p = 0.011), D18S52 (p = 0.007), and D18S62 (p = 0.479). CONCLUSION: These data suggest that the gene for 18p11.31-linked high myopia is most proximal to marker D18S52, with a likely interval of 0.8 cM between markers D18S63 and D18S52. Due to the contraction of the interval size by TDT, these results provide a basis for focused positional cloning and candidate gene analysis at the MYP2 locus.

Lactancia materna: mucho más que solo nutrientes / Breastfeeding: much more than nutrients

La alimentación al pecho ha sido la responsable de la sobrevida de la especie humana desde su creación. sin embargo la incorporación de la mujer al campo laboral y la consecuente desvalorización del proceso de crianza, ha obligado a redescubrir las bondades de la leche materna. Esta revisión actualiza los efectos a corto y largo plazo de la leche materna, con el objeto de entregar al equipo de salud argumentos convicentes en favor de la lactancia natural y continuar promoviendo su uso en beneficio de los niños, y sociedad en general

Distribution of domestic triatominae and stratification of Chagas Disease transmission in Oaxaca, Mexico.

Mexico has 18 species of Triatomine bugs (Hemiptera: Reduviidae) reported to be vectors of Trypanosoma cruzi. Chagas Disease is widespread in Mexico, with up to 3.5% seropositivity of human transfusion blood. The State of Oaxaca has the longest history of endemic Chagas Disease, based on acute and chronic case reports, and of entomological surveys in the country. However, the State health care services need more information on current risks of vector transmission. In order to identify and characterize areas of transmission in Oaxaca and to stratify the vector potential, the distribution of domestic Triatominae was surveyed during 1996-98 in collaboration with the primary health care services and local communities. Villages were studied in 11% of 570 municipalities in Oaxaca. Eight triatomine species were found in domestic and peri-domestic habitats: Triatoma barberi Usinger, T. bolivari Carcavallo et al., T. dimidiata (Latreille), T. mazzottii Usinger, T. nitida Usinger, T. pallidipennis (Stal), T. phyllosoma (Burmeister) and Rhodnius prolixus Stal. For each triatomine species in Oaxaca, the range of distribution and habitat characteristics are described. Habitat partitioning, principally based on altitude and mean annual precipitation, limited the overlap of distribution between species. Relatively consistent altitude of human settlements facilitates the dispersion of individual species within microregions. Entomological indices of house infestation were used to estimate that approximately 50% of the human population (1,874,320 inhabitants) would be at risk of vector transmission, with a minimum of 134,320 infected people and 40,280 chronic cases of Chagas Disease currently in Oaxaca.

Leche materna y sus efectos a largo plazo / Long term effects of maternal milk feeding

La alimentación al pecho ha sido la responsable de la sobrevida de la especie humana desde su creación, sin embargo la incorporación de la mujer al campo laboral y la consecuente desvalorización del proceso de crianza, ha obligado a redescubrir las bondades de la leche materna. En esta revisión se resume en forma actualizada, los efectos a corto y largo plazo de la leche materna, de modo de entregar al equipo de salud argumentos convicentes a favor de la lactancia natural

A second locus for familial high myopia maps to chromosome 12q.

Myopia, or nearsightedness, is the most common eye disorder worldwide. "Pathologic" high myopia, or myopia of <=-6.00 diopters, predisposes individuals to retinal detachment, macular degeneration, cataract, or glaucoma. A locus for autosomal dominant pathologic high myopia has been mapped to 18p11.31. We now report significant linkage of high myopia to a second locus at the 12q21-23 region in a large German/Italian family. The family had no clinical evidence of connective-tissue abnormalities or glaucoma. The average age at diagnosis of myopia was 5.9 years. The average spherical-component refractive error for the affected individuals was -9.47 diopters. Markers flanking or intragenic to the genes for the 18p locus, Stickler syndromes type I and II (12q13.1-q13.3 and 6p21.3), Marfan syndrome (15q21.1), and juvenile glaucoma (chromosome 1q21-q31) showed no linkage to the myopia in this family. The maximum LOD score with two-point linkage analysis in this pedigree was 3.85 at a recombination fraction of .0010, for markers D12S1706 and D12S327. Recombination events identified markers D12S1684 and D12S1605 as flanking markers that define a 30.1-cM interval on chromosome 12q21-23, for the second myopia gene. These results confirm genetic heterogeneity of myopia. The identification of this gene may provide insight into the pathophysiology of myopia and eye development.

Evidence that a locus for familial high myopia maps to chromosome 18p.

Myopia, or nearsightedness, is the most common human eye disorder. A genomewide screen was conducted to map the gene(s) associated with high, early-onset, autosomal dominant myopia. Eight families that each included two or more individuals with >=-6.00 diopters (D) myopia, in two or more successive generations, were identified. Myopic individuals had no clinical evidence of connective-tissue abnormalities, and the average age at diagnosis of myopia was 6.8 years. The average spherical component refractive error for the affected individuals was -9.48 D. The families contained 82 individuals; of these, DNA was available for 71 (37 affected). Markers flanking or intragenic to the genes for Stickler syndrome types 1 and 2 (chromosomes 12q13.1-q13.3 and 6p21.3, respectively), Marfan syndrome (chromosome 15q21.1), and juvenile glaucoma (chromosome 1q21-q31) were also analyzed. No evidence of linkage was found for markers for the Stickler syndrome types 1 and 2, the Marfan syndrome, or the juvenile glaucoma loci. After a genomewide search, evidence of significant linkage was found on chromosome 18p. The maximum LOD score was 9.59, with marker D18S481, at a recombination fraction of .0010. Haplotype analysis further refined this myopia locus to a 7.6-cM interval between markers D18S59 and D18S1138 on 18p11.31.

Sindrome de alcoholismo fetal y efectos del alcohol sobre el feto: importancia del diagnóstico precoz y del manejo nutricional / Fetal alcohol syndrome and fetal alcohol effects among children in a secondary nutritional recovery centre

Background: Fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE) encompass a pattern of birth defects in persons whose mothers ingested alcohol during pregnancy. People with FAE display fewer of the FAS traits. Aim: To assess the prevalence and features of these affections in a secondary nutritional recovery centre. Patients and methods: All charts of children admitted between 1985 and 1995 were reviewed, and those children diagnosed as having a FAS or FAE by a geneticist were considered for this study. Birth, maternal, social and economic characteristics, psychomotor abilities (using Denver test) and response to nutritional treatment were assessed. Results: During the study period, 1572 infants were admitted to the centre, and 1.97 percent (70 percent female) were diagnosed as having a FAS or FAE. These infants were admitted at 11.1 ñ 4.5 months of age and discharged after 96.7 ñ 58.1 months of hospitalisation. Mean mother's age was 33 ñ 7 years, and all belonged to low socioeconomic levels. Mean birth weight was 2048 ñ 431 g and 2469 ñ 619 g in children with FAS and FAE respectively (p< 0.03). Children with FAE performed better for gross and fine motor abilities than those with FAS. No differences were observed for language performance. Sixty five percent of children with FAS and 71 percent of children with FAE had an adequate weight and height increment during nutritional therapy. A multiple regression analysis showed that age at admission and gestational age were significant predictors of weight gain during therapy. Conclusions: Alcohol has teratogenic effects on the foetus that affect craneal size and psychomotor development. Alcohol also affects pre and post natal growth

Síndrome de Nauhäusser: megalocórnea y retraso mental / Neuhäusser's syndrome: megalocornea and mental retardation

Se describe una niña de 12 meses de edad, con megalocórnea, retraso severo del desarrollo psicomotor, desnutrición calórico proteica de tercer grado, síndrome hipotónico, retraso de crecimiento, macrocefalia relativa y convulsiones, síntomas y signos que corresponden a los del síndrome de Neuhäusser tipo 3 de Verloes. Este síndrome tiene como características más importantes megalocórnea, retraso mental, trastornos neurológicos y retraso del crecimiento, las que con frecuencia se asocian con otras anomalías menores, y en lo que respecta a la herencia, ésta es preferentemente autosómica recesiva, pero puede haber casos esporádicos

Función muscular esquelética en pacientes que han sufrido desnutrición / Skeletal muscle function in patients who had been malnutrished

La función muscular se relaciona con estado nutricional. Se estudió función muscular esquelética en 40 niños con antecedentes de haber sufrido una desnutrición grave precoz (GE) en comparación con igual número de niños pareados por sexo y edad a los 12 a 4 m, sin antecedentes de desnutrición (GC). La función muscular se midió, según protocolo de Shizgal, de la fuerza de contracción isométrica del músculo abductor del pulgar obtenida por estimulación eléctrica del nervio cubital (en la muñeca) y registrada mediante un transductor de fuerza (Grass Mod FT-10). La fuerza muscular se relacionó con la composición corporal determinada por antropometría convencional y las fórmulas de Durnin y Frisancho. La recuperación a la fatiga muscular fue más rápida (p< 0,05) y la fuerza generada mayor (p < 0,05) en los niños controles, sin antecedente de desnutrición. La desnutrición grave precoz altera la función muscular, incluso pasados varios años después de su tratamiento y recuperación

Desarrollo puberal y edad ósea en niños con antecedentes de desnutrición calórico-proteica grave precoz / Puberal development and bone age in children with early severe protein-energy malnutrition

La desnutrición grave y prolongada retrasa el crecimiento y desarrollo en el niño. Esto se ve objetivado en el menor tamaño corporal y el enlentecimiento dela maduración de diferentes tejidos, incluyendo el hueso. El retraso de la edad ósea alargaría el período de crecimiento recuperacional, si la situación nutricional mejorara. Se comparó, a una edad promedio de 12 años y 5 meses, el crecimiento estatural, la maduración ósea y el desarrollo puberal en 20 niños (10 niñas) que sufrieron desnutrición calórico-proteica grave precoz que requirió tratamiento hospitalario, con las de otros 20 niños de igual condición socioeconómica, edad y sexo, sin antecedentes de desnutrición. Se registraron diferencias significativas en el tamaño corporal en favor del grupo control (p<0,001) tanto entre los hombres como en las mujeres. Las edades óseas medidas en 18 niños de grupo de estudio (9 mujeres) y 17 controles (9 mujeres) mostraron un retraso leve, que no alcanzó significación, en todos los grupos. Las etapas puberales alcanzadas fueron semejantes en casos y controles para los dos sexos, independientemente del antecedente nutricional. Estos hallazgos sugieren que la desnutrición grave precoz, tratada, produce retraso en el crecimiento estatural pero no afectaría la maduración ósea y la maduración sexual

Crecimiento después de desnutrición grave precoz / Growth after early severe undernutrition

Con el propósito de investigar el crecimiento en niños que han sufrido desnutrición calórica proteica severa precozmente se comparó la evolución antropométrica en 40 de tales niños, previamente tratados y recuperados en un centro de recuperación nutricional, y la estatura de sus madres, con las de 40 controles sanos de las mismas edades, sexos y condición socioeconómica, a lo largo de 9 años y por el mismo observador. Se encontraron diferencias significativas en favor de los controles en la talla de las madres (154,8 ñ 5,2 vs. 150 ñ 3,6 cm) y en el peso de nacimiento de los niños (varones 3453,5 ñ 522,3 vs. 3018,2 ñ 490,3 y mujeres 3328,4 ñ 563,4 vs. 2654,6 ñ 579,6 g, p < 0,001). También había diferencias significativas en las relaciones talla/edad y peso/edad (p < 0,001), pero no en la de peso/talla entre ambos grupos. No se detectaron diferencias en la edad ósea. La velocidad de crecimiento fue semejante en los varones de ambas muestras (10,4 ñ 2,3 vs. 9,81 ñ 1,4 cm y 12,94 ñ 2,53 vs. 12,8 ñ 1,64 cm de 5 a 7 y de 7 a 9 años respectivamente), pero fue significativamente mayor en las niñas controles (11,22 ñ 2,7 vs. 9,3 ñ 1,6 y 15,6 ñ 1,66 vs. 12,8 ñ 2,2 cm de 5 a 7 y 7 a 9 años respectivamente, p < 0,01). Estos hallazgos sugieren que la desnutrición calórica proteica antes de la edad de 2 años puede producir efectos en el largo plazo en niños de baja condición socioeconómica que son devueltos al medioambiente desfavorable después de tratarlos y recuperarlos de la desnutrición

Microambiente de la desnutrición marásmica / Social background in severe undernutrition

La desnutrición se relaciona a malas condiciones socioculturales y hay evidencia que permite establecer clara asociación entre nivel de vida y calidad de la nutrición. En Chile se han formulado programas para mejorar la situación nutricional de la población infantil. Uno de ellos corresponde al de Centros Cerrados de Recuperación Nutricional. La persistencia de la recuperación obtenida en estas instituciones puede depender en forma importante de la calidad de la situación de la familia. En un seguimiento de 9 años, hecho a niños de extrema pobreza que fueron tratados en uno de tales centros, sólo el 13%conservaban el estado nutricional logrado. Entre los factores que se asocian con evoluciones desfavorables después del alta destacan el alcoholismo del padre y otro hermano con desnutrición, pero también influyen la educación deficiente y las madres solas

Detección viral en infecciones respiratorias agudas del lactante / Viral detection in acute respiratory infections in infants

Los virus respiratorios se detectan en un alto porcentaje en la patología respiratoria aguda que afecta al lactante. No nos debe llamar la atención que un alto porcentaje de virus detectados aparecieron en los cuadros de Neumonitis. Es llamativo el alto porcentaje de positividad viral encontrado en las Bronconeumonias. Por último, el aumento de la detección viral observada en los últimos años se debe fundamentalmente a la introducción de nuevas técnicas, específicamente, la detección de antígenos virales por inmunofluorescencia directa y aislamiento viral a partir del aspirado nasofaríngeo y también, a la adecuada toma, envío y procesamiento de las muestras