[Monoclonal component in visceral leishmaniasis: a rare association that can lead to misdiagnosis]. / Componente monoclonal en leishmaniasis visceral: rara asociación que puede conducir a un falso diagnóstico.

The detection of monoclonal components is exceptional in patients with visceral leishmaniasis (VL). The cases are here reported of two patients with VL in a non-endemic area and monoclonal components which posed problems for the differential diagnosis with other entities associated with the presence of paraproteins. The predominant clinical manifestations in both cases were general symptoms, fever and severe spleen enlargement. One patient had a monoclonal triple band in urine and the other several oligoclonal bands in serum. In the initial bone marrow aspiration smear no parasites were observed in any of the two cases but a remarkable plasmacytosis in one of them. The presence of increased serum titers of anti-Leishmania antibodies was the first demonstrative finding of VL. The diagnosis was confirmed with positive culture of Leishmania and therapy with pentavalent antimonials was successful in both cases. The different diagnostic possibilities are discussed and the possibility of VL is emphasized even in non-endemic areas when monoclonal components in serum or urine specimens are found and consistent clinical findings are present.

[Demographic dynamics in the food-nutrition problem: the search for effective strategies in Latin America]. / La dinámica demográfica en la problemática alimentaria-nutricional: la búsqueda de estrategias effectiv as en América Latina.

This paper addresses the interrelationship between the food and nutrition problem and population problems in Latin America within a global focus. A basic framework is presented which defines four demographic problems highly related with the food and nutrition situation: The underutilization of the labor force; the accelerated growth of the marginal population; the poor geographic distribution and rapid urbanization; and the high rates of infant and child mortality. Findings from the recent experience of demography in food and nutrition planning in the last four years in Central America and Panama are outlined, and strategies are recommended for the development of different types of programs and projects in population-nutrition. Finally, a list of applied research, basic information and direct action projects in population-nutrition that have been detected as needed by most of the Central American countries, is presented.

PIP: This paper explores various strategies for development of more effective integrated programs of nutrition and population, based on the study of the interrelationship between the 2 problems and the experience acquired in the application of population studies to the process of food and nutrition planning in Central America and Panama. An implicit consensus has been reached that the major problems which confront Latin American governments as a result of present demographic and social trends are urban concentration and metropolization, underutilization of the labor force, extreme poverty, and insufficient basic services. Many existing studies of the links between population, nutrition, and socioeconomic development have had perspectives that have been too global or too partial to support policymaking and planning. Some new lines of study of women, the family, basic needs and extreme poverty, on 1 side, and the elaboration of diagnostic tools, target groups, goals, primary health interventions, integral rural development, and their evaluation, on the other, represent advances in the integration of population and nutrition problems into development planning. A model of interrelationships between demographic policies, malnutrition, and socioeconomic development gives highest priority to 4 demographic problems affecting nutrition: underutilization of the labor force, which affects purchasing power and consumption; growth of the marginal sector, poor population distribution and rapid urbanization; and high mortality among children under 5. A project developed in Central America and Panama from 1977-79 on the sociodemographic dimensions of food and nutrition planning was largely intended to improve institutional planning capacity. An illustrative table identifies 4 conditioning factors of malnutrition, including lack of adequate planning, insufficient food production and poor distribution and underutilization of available food by the body; provides examples of nutritional programs directed toward the problems, and lists expected effects of the programs on demographic variables. Another table outlines conditioning factors of malnutrition and related demographic variables. 5 areas requiring research in Central America are seasonal migration and malnutrition; malnutrition and infant mortality; composition and stability of the family and intrafamily food distribution; urban women's role and lactation; and agricultural density, rural displacement, and home production.

[Nutritional consequences of demographic change in Central America and Panama]. / Las consecuencias nutricionales del cambio demografico en Centroamerica y Panama

PIP: The relationship between malnutrition and demographic change in Central America and Panama between 1965 and 1975 is analyzed, with a focus on the growing social and demographic gaps between rural and urban areas and the consequences for food supply and nutrition. Models are presented that allow the identification of economic and demographic factors involved in the determination of nutritional status.^ieng

Population and nutrition; implications of sociodemographic trends and differentials for food and nutrition policy in Central America and Panama.

PIP: This paper looks into some of the sociodemographic trends and differentials that may be influencing the lack of improvement in the food and nutrition situation in rural Central America. Evidence is presented that indicates that it is more difficult to reduce malnutrition and fertility than it was to reduce infant and child mortality initially. When sociostructural changes are not forthcoming after the initiation of the mortality decline, then resultant population growth, distribution and composition dynamics can hinder improvement in nutrition. In particular, changes in the social composition differentials as a result of selectivity in mortality, fertility and migration have apparently contributed to the increasing nutrition gap between the well-fed and the poorly-fed classes.^ieng

Population and nutrition planning: the usefulness of demographic discipline for nutrition policy in Latin America.

PIP: Demography can play an important part in the diagnosis and improvement of the nutrition situation in Latin America. Applied population studies can provide diagnostic and evaluative frameworks, analytical indicators and indices, and a definition of the nature, size, and distribution of the target groups. Several models of relationships between population dynamics and economic development have recently been worked out, and the paper diagrams a conceptual framework that can be used to identify demographic data that are important in diagnosing nutritional situations. Another table lists selected sociodemographic indicators related to malnutrition in the areas of mortality, maternal and child health and nutrition, food consumption and child care, environmental sanitation and services, potential demand for food and services, and employment. Besides the advantages of being generally available through collection for other purposes, demographic information has the further advantages of focusing on family units, utilizing concepts that are basic and easily understood, allowing geographic breakdowns, and permitting expression in terms of trends and projections. 3 activities of the Institute of Nutrition of Central America and Panama (INCAP) demonstrate the usefulness of demographic information. A "demographic sourcebook for food and nutrition planning" for each of the countries provides for constant updating of locally available demographic information which is used in planning; a nutritional surveillance system under study or development in 5 countries aims to detect change and predict deterioration so that corrective measures can be taken; and a functional classification of malnutrition seeks to identify specific population subgroups in regions that are administratively, economically, and ecologically uniform for purposes of program planning.^ieng