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Plasma carotenoid and vitamin E concentrations in women living in a rural west African (Gambian) community.

Vitamin E and carotenoid pigments are important nutrients for the maintenance of health and protection of tissues against free radical damage. They also play a potential role in disease-risk-prediction and -protection, but little is known about their physiological and sociodemographic correlates and determinants, especially in a West African context. As part of a study of reproductive health in rural Gambian women, blood samples were obtained from 1286 women aged 15 to 54 years, living in the Farafenni area of The Gambia. Measurement of two forms of vitamin E and six carotenoids in plasma was performed by high performance liquid chromatography. All eight components, but especially the carotenoids: lycopene, alpha- and beta-carotene, exhibited a major seasonal variation, with maximum levels between May and July, corresponding to the end of the "mango" season and the beginning of the "rainy" season. Only the tocopherols varied significantly (increasing) with age. Several unexpected ethnic group differences were observed, and canthaxanthin was present at lower concentrations in women with manual occupations, compared to those with non-manual occupations. There were also significant differences associated with pregnancy and the postpartum period, especially for the tocopherols, but fewer differences associated with marital status. The observed patterns confirm that there are important seasonal, physiological, possibly genetic, and sociodemographic determinants of these nutrients in blood plasma, which may have significance for health and longevity.

Adolescent↗

Infant feeding practices reflect antecedent risk of xerophthalmia in Nepali children.

OBJECTIVE: To determine the relationship between infant feeding history and risk of xerophthalmia due to vitamin A deficiency (VAD) in early childhood. DESIGN: A case-control study of previously xerophthalmic and non-xerophthalmic children. SETTING: Rural lowland region of Nepal. SUBJECTS: One hundred and fifty-six children (aged 1-6 y old), half of whom previously had xerophthalmia due to vitamin A-deficiency, the other half matched by locale, age and the presence and age of a younger sibling (n = 102). METHODS: Xerophthalmia was determined by trained ophthalmic assistants on the basic of current Bitot's spots, corneal xerosis or report of night blindness. Infant feeding history was collected through a diet history method obtained from the mother of the focus child. Exploratory factor analysis was conducted to determine the presence of underlying patterns in infant feeding practices. Conditional logistic regression was used to estimate odds ratios. RESULTS: Mothers of control children tended to have a higher level of education (P < 0.10) and to have fewer children who had died (P < 0.10) than mothers of case children. Feeding of meat (OR = 0.09, CI = 0.01-0.70) or fish (OR = 0.41, CI = 0.17-0.99) with liver, eggs (OR = 0.11, CI = 0.01-0.88) and mango (OR = 0.28, CI = 0.13-0.60) were protective in association with xerophthalmia in early childhood. Factor analysis uncovered several distinct patterns in infant feeding, which varied by age of the infant. Only the 'animal flesh' feeding pattern (factor), practiced in the second year of life, proved significantly protective from xerophthalmia (OR = 0.43, CI = 0.20-0.94). Feeding patterns of younger children closely paralleled those of their older siblings with and without VAD. CONCLUSIONS: The study supports the hypothesis that infant dietary practices can influence subsequent risk for VAD. Our findings emphasize the importance of introducing vitamin A-rich foods during weaning to reduce the risk of VAD-associated xerophthalmia in the later preschool years.

Case-Control Studies↗

Lupeol modulates NF-kappaB and PI3K/Akt pathways and inhibits skin cancer in CD-1 mice.

Chemoprevention has become an effective cancer control modality; however, the search for novel agent(s) for the armamentarium of cancer chemoprevention continues. We argue that agents capable for inhibition of promotion stage of tumorigenesis with the ability to intervene at several critical pathways in the tumorigenesis process will have greater advantage over other single-target agents. Lupeol, a triterpene, is the principal constituent of common fruit plants such as olive, mango, fig and medicinal herbs that have been used to treat skin aliments. Lupeol has been reported to possess a wide range of medicinal properties that include strong antioxidant, antimutagenic, anti-inflammatory and antiarthritic effects. In the present study, we show that Lupeol possesses antitumor-promoting effects in a mouse skin tumorigenesis model. We first determined the effect of topical application of Lupeol to CD-1 mouse against 12-O-tetradecanoyl-phorbol-13-acetate (TPA)-induced conventional markers and other novel markers of skin tumor promotion. We found that topical application of Lupeol (1-2 mg/mouse) 30 min prior to TPA (3.2 nmol/mouse) application onto the skin of CD-1 mice afforded significant inhibition, in a time- and dose-dependent manner, against TPA-mediated increase in (i) skin edema and hyperplasia, (ii) epidermal ornithine decarboxylase (ODC) activity, and (iii) protein expression of ODC, cyclo-oxygenase-2 and nitric oxide synthase. As of the role of nuclear factor kappa B (NF-kappaB) and phosphatidyl inositol 3-kinase (PI3K)/Akt signaling in tumor promotion, we next determined the effect of topical application of Lupeol to mouse skin against these signaling pathways. We found that Lupeol treatment to mouse skin resulted in the inhibition of TPA-induced (i) activation of PI3K, (ii) phosphorylation of Akt at Thr(308), (iii) activation of NF-kappaB and IKKalpha, and (iv) degradation and phosphorylation of IkappaBalpha. The animals pretreated with Lupeol showed significantly reduced tumor incidence, lower tumor body burden and a significant delay in the latency period for tumor appearance. At the termination of the experiment at 28 weeks, 100% of the animals in TPA-treated group exhibited seven to eight tumors/mouse, whereas only 53% of the mice receiving Lupeol prior to TPA treatment exhibited one to three tumors/mouse. These results for the first time provide evidence that Lupeol possesses antiskin tumor-promoting effects in CD-1 mouse and inhibits conventional as well as novel biomarkers of tumor promotion. We suggest that Lupeol is an attractive antitumor-promoting agent that must be evaluated in tumor models other than skin carcinogenesis.

Administration, Topical↗

The effects of fruit juices and fruits on the absorption of iron from a rice meal.

The effects of the chemical composition of fruit juices and fruit on the absorption of iron from a rice (Oryza sativa) meal were measured in 234 parous Indian women, using the erythrocyte utilization of radioactive Fe method. The corrected geometric mean Fe absorptions with different juices varied between 0.040 and 0.129, with the variation correlating closely with the ascorbic acid contents of the juices (rs 0.838, P less than 0.01). Ascorbic acid was not the only organic acid responsible for the promoting effects of citrus fruit juices on Fe absorption. Fe absorption from laboratory 'orange juice' (100 ml water, 33 mg ascorbic acid and 750 mg citric acid) was significantly better than that from 100 ml water and 33 mg ascorbic acid alone (0.097 and 0.059 respectively), while Fe absorption from 100 ml orange juice (28 mg ascorbic acid) was better than that from 100 ml water containing the same amount of ascorbic acid (0.139 and 0.098 respectively). Finally, Fe absorption from laboratory 'lemon juice' (100 ml orange juice and 4 g citric acid) was significantly better than that from 100 ml orange juice (0.226 and 0.166 respectively). The corrected geometric mean Fe absorption from the rice meal was 0.025. Several fruits had little or no effect on Fe absorption from the meal (0.013-0.024). These included grape (Vitis vinifera), peach (Prunus persica), apple (Malus sylvestris) and avocado pear (Persea americana). Fruit with a mild to moderate enhancing effect on Fe absorption (0.031-0.088) included strawberry (Fragaria sp.) (uncorrected values), plum (Prunus domestica), rhubarb (Rheum rhaponticum), banana (Musa cavendishii), mango (Mangifera indica), pear (Pyrus communis), cantaloup (Cucumis melo) and pineapple (Ananas comosus) (uncorrected values). Guava (Psidium guajava) and pawpaw (Carica papaya) markedly increased Fe absorption (0.126-0.293). There was a close correlation between Fe absorption and the ascorbic acid content of the fruits tested (rs 0.738, P less than 0.0001). There was also a weaker but significant correlation with the citric acid content (rs 0.55, P less than 0.03). Although this may have reflected a direct effect of citric acid on Fe absorption, it should be noted that fruits containing citric acid also contained ascorbic acid (rs 0.70, P less than 0.002).(ABSTRACT TRUNCATED AT 400 WORDS)

Absorption↗

Variability of organophosphorus insecticide residues in large size crops grown in commercial farms in Brazil.

Field trials were conducted in commercial agricultural areas in Brazil to determine the variability of residues of parathion methyl, diazinon and methidathion in individual units of large crops treated twice with a mixture of the three pesticides. Over 120 random samples were collected, extracted with ethyl acetate and residues determined by GC/FPD. The recoveries and their coefficient of variation were, in general, within the acceptable levels during sample analyses. Residues in papaya and mango were not affected by the position of the fruits in the plant, apparently more or less exposed to the pesticides. Variability factor ?, defined as the 97.5th percentile divided by the mean of residues in all samples taken from a field ranged from 2.0-2.6. The variability of residues within the plant contributed to about 34-61% of the field variability. The results found in this study support the variability factor of 3 adopted by the FAO/WHO for the deterministic estimation of dietary acute intake of pesticides.

Agriculture↗

Automated headspace GC-MS analysis of ethylene dibromide fumigant residues in fresh fruits.

An automated headspace capillary column GC-MS method using selected ion monitoring was developed for the analysis of ethylene dibromide (EDB) residues in fresh fruits. The method was shown to be rapid, to give good agreement with more conventional methods involving distillative extraction, to be free from interferences and to have a limit of detection of 1 microgram/kg. A small survey of a range of fresh fruits including oranges, grapefruit, lemons and mangoes showed no detectable EDB residues in a total of 45 samples obtained from various retail outlets.

Citrus↗

A basis for estimation of consumption: literature values for selected food volatiles. Part III.

Quantitative data on volatile compounds have been reported in 16 food items. No publications reporting quantitative data were found for two of these 16 food products, i.e. avocado and jackfruit. About 550 volatile compounds have been assayed globally in the other 14 food products. Mango and raspberry were the products with the greatest number of volatile compounds; the most representative substances were benzaldehyde, ethyl acetate, limonene, and 2-phenylethanol.

Flavoring Agents↗

Beliefs and practices of urban mothers regarding "hot" and "cold" foods in childhood illnesses.

Beliefs and practices of 100 urban mothers regarding "hot" and "cold" foods during four common childhood illnesses were determined by using a pretested, partly structured interview schedule. Egg, by 60% of mothers, mango by 52%, lentils by 49%, jaggery by 46% were considered "hot" properties. "Hot" foods were preferred and "cold" foods restricted in the treatment of cough and cold and illnesses with rash. In diarrhoea, "cold" foods were preferred and "hot" foods restricted. The knowledge that many food combinations and certain procedures are believed to change the properties of common food may be utilized in promoting the consumption of nutritionally balanced diets. Introduction of culturally acceptable education in nutrition which incorporates the above knowledge is likely to help in the prevention of protein-energy malnutrition and to increase parental co-operation during therapy.

Abdomen↗

A prospective survey of gingivitis in Keneba, a rural West African community.

The prevalence and severity of gingivitis was studied in 204 children living in a rural West African community. Seasonal prevalence varied from 38.6% to 9.5%. The lowest prevalence coincided with the seasonal consumption of citrus fruits and mangoes. Prevalence increased with age. Of the children, 13.7% required treatment with a standard antibiotic regime for severe gingivitis. Severe gingivitis occurred frequently in children under three years of age and in females. There was no clear relationship between the prevalence of gingivitis and malnutrition as assessed by anthropometric indices obtained from the children. Findings in this study suggest that measures to improve oral hygiene is the intervention most likely to reduce the prevalence of gingivitis.

Age Factors↗

Conservation of the ruptured spleen in children: an African series.

In the Zaria region of northern Nigeria, which is endemic for malaria and schistosomiasis, laparotomy was performed for traumatic rupture of the spleen in 27 children, 10 of whom had splenomegaly. Eleven of the children were pedestrians knocked down by motor vehicles while crossing the road and six were boys who fell off mango or guava trees. Using suture techniques, 17 ruptured spleens were repaired and one was partially resected: eight of them were enlarged. Total splenectomy was performed in nine cases. Five of the children in the splenic conservation group died within 4 days of surgery owing to severe associated injuries. It is concluded that splenorrhaphy is quite feasible in both normal-sized and enlarged spleens and should be encouraged in similar tropical countries where splenomegaly is a common response to endemic malaria and schistosoma.

Adolescent↗

Acute plant poisoning and antitoxin antibodies.

Plant poisoning is normally a problem of young children who unintentionally ingest small quantities of toxic plants with little resulting morbidity and few deaths. In some regions of the world, however, plant poisonings are important clinical problems causing much morbidity and mortality. While deaths do occur after unintentional poisoning with plants such as Atractylis gummifera (bird-lime or blue thistle) and Blighia sapida (ackee tree), the majority of deaths globally occur following intentional self-poisoning with plants such as Thevetia peruviana (yellow oleander) and Cerbera manghas (pink-eyed cerbera or sea mango). Antitoxins developed against colchicine and cardiac glycosides would be useful for plant poisonings--anti-digoxin Fab fragments have been shown to be highly effective in T. peruviana poisoning. Unfortunately, their great cost limits their use in the developing world where they would make a major difference in patient management. Therapy for some other plant poisonings might also benefit from the development of antitoxins. However, until issues of cost and supply are worked out, plant antitoxins are going to remain a dream in many of the areas where they are now urgently required.

Acute Disease↗

A new synthesis of 9-(2-deoxy-2-fluoro-beta-D-arabinofuranosyl)guanine (AraF-G).

Interesting and very promising antisense properties of 2'-deoxy-2'-fluoroarabinonucleic acids ((a) Wilds, C.J.; Damha, M.J. 2'-Deoxy-2'-fluoroarabinonucleosides and oligonucleotides (2'F-ANA): synthesis and physicochemical studies. Nucl. Acids Res. 2000, 28, 3625-3635; (b) Viazovkina, E.; Mangos, M.; Elzagheid, M.I.; Damha, M.J. Current Protocols in Nucleic Acid Chemistry 2002, 4.15.1-4.15.21) (2'F-ANA) has encouraged our research group to optimize the synthetic procedures for 2'-deoxy-2'-fluoro-beta-D-arabinonucleosides (araF-N). The synthesis of araF-U, araF-T, araF-A and araF-C is straightforward, (Tann, C.H.; Brodfuehrer, P.R.; Brundidge, S.P.; Sapino, C., Jr. Howell H.G. Fluorocarbohydrates in synthesis. An efficient synthesis of 1-(2-deoxy-2-fluoro-beta-D-arabinofuranosyl)-5-iodouracil (beta-FIAU) and 1-(2-deoxy-2-fluoro-beta-D-arabinofuranosyl)thymine (beta-FMAU). J. Org. Chem. 1985, 50, 3644-3647; Howell, H.G.; Brodfuehrer, P.R.; Brundidge, S.P.; Benigni, D.A.; Sapino, C., Jr. Antiviral nucleosides. A stereospecific, total synthesis of 2'-fluoro-2'-deoxy-beta-D-arabinofuranosyl nucleosides. J. Org. Chem. 1988, 53, 85-88; Maruyama, T.; Takamatsu, S.; Kozai, S.; Satoh, Y.; Izana, K. Synthesis of 9-(2-deoxy-2-fluoro-beta-D-arabinofuranosyl)adenine bearing a selectively removable protecting group. Chem. Pharm. Bull. 1999, 47, 966-970) however, the synthesis of the guanine analogue is more complicated and affords poor to moderate yields of araF-G (4) ((a) Elzagheid, M.I.; Viazovkina, E.; Masad, M.J. Synthesis of protected 2'-deoxy-2'-fluoro-beta-D-arabinonucleosides. Synthesis of 2'-fluoroarabino nucleoside phosphoramidites and their use in the synthesis of 2'F-ANA. Current Protocols in Nucleic Acid Chemistry 2002, 1.7.1-1.7.19; (b) Tennila, T.; Azhayeva, E.; Vepsalainen, J.; Laatikainen, R.; Azhayev, A.; Mikhailopulo, I. Oligonucleotides containing 9-(2-deoxy-2-fluoro-beta-D-arabinofuranosyl)-adenine and -guanine: synthesis, hybridization and antisense properties. Nucleosides, Nucleotides and Nucl. Acids 2000, 19, 1861-1884). Here we describe an efficient synthesis of araF-G (4) that involves coupling of 2-deoxy-2-fluoro-3,5-di-O-benzoyl-alpha-D-arabinofuranosyl bromide (1) with 2-chlorohypoxanthine (2) to afford 2-chloro-beta-araF-I (3) in 52% yield. Nucleoside (3) was transformed into araF-G (4) by treatment with methanolic ammonia (150 degrees C, 6 h) in 67% yield.

Arabinonucleosides↗

Innate immunity, gut integrity, and vitamin A in Gambian and Indian infants.

Gut integrity, which can be measured by the urinary lactulose:mannitol excretion test, deteriorates with the introduction of weaning foods. In The Gambia, gut integrity measured monthly over 15 months in 119 infants (aged 2-15 months) was least impaired from April to June. This coincides with the time of year of maximum vitamin A (VA) intake-the mango season. Subsequently, two VA intervention studies were done in infants in India. Eighty infants attending a community health center received 16,700 IU weekly or placebo. In another study, 94 hospitalized infants were given 200, 000 IU VA or placebo: 31 received VA on admission, while the rest (32 VA, 31 placebo) received treatment on discharge. All VA-treated groups had more rapid improvement in gut integrity than the placebo groups, but no group had gut integrity normalized by Western standards. The data suggest that VA status may influence gut integrity.

Child, Hospitalized↗

Dietary practices and xerophthalmia among Indonesian children.

The stated frequency with which 30 Indonesian children with corneal xerophthalmia and age/sex/neighborhood matched controls ordinarily consumed vitamin- and provitamin A-rich foods was compared. Controls were more frequent consumers of eggs (p less than 0.05), fish (p less than 0.05), dark green leafy vegetables (p less than 0.05), carrots (p less than 0.01), and carotene-containing fruits (p less than 0.1). Similar data were collected on 358 children with Bitot's spots and on normal preschool age children in a countrywide survey. Breast-feeding was more common among normals than among cases (p less than 0.001). Normals were also more frequent consumers of mango and papaya during the 2nd and 3rd yr of life (p less than 0.05); and of dark green leafy vegetables and eggs during the 3rd through 6th yr of life (p less than 0.01). In two separate studies, differences in carotene consumption by normals and abnormals were confirmed by differences in their serum carotene levels. Approximately 80% of Indonesian families, with an without xerophthalmic children, consumed dark-green leafy vegetables at least once a day, and 99% at least once a week. Diet therefore appears to be an important factor in the genesis of xerophthalmia in Indonesia despite the availability of suitable provitamin A-rich foods.

Age Factors↗

Nutritional and household risk factors for xerophthalmia in Aceh, Indonesia: a case-control study. The Aceh Study Group.

Risk factors for xerophthalmia were assessed in 466 subjects [38% with night blindness (XN), 60% with Bitot's spots (X1B), 2% with corneal xerophthalmia (X2 or X3)] under age 6 y and their village-age-sex-matched control subjects during a community trial. Socioeconomic status and hygiene standards were lowest for households of xerophthalmic children and highest for nonstudy households in the trial population, with values for control households lying in between (P less than 0.001 by linear trend). Risk of xerophthalmia increased with less frequent consumption of dark green leaves, yellow fruits, or egg during weaning, adjusted for current intake and present age [odds ratio (OR) = approximately 3.5]. Exclusion of these same foods from the current diet (except for mango and papaya in older children) was associated with a two- to ninefold excess risk of xerophthalmia, adjusted for weaning influences. Xerophthalmic children aged less than 3 y were generally at higher risk of dietary imbalance than were older children. Xerophthalmia is associated with a chronic, infrequent consumption of key vitamin A foods from weaning through early childhood.

Age Factors↗

Mothers' and children's intakes of vitamin A in rural Bangladesh.

The vitamin A intake of 370 mothers and 183 children 3-27 mo of age in rural Bangladesh was ascertained monthly from January to July in 1986. For mothers, dark green leafy vegetables and fruits were the main sources of vitamin A. Vitamin A from vegetables, the single most important source, did not show consistent associations with wealth or with the other socioeconomic indicators. In May and June, fruits provided wealthier (and more educated) mothers with significantly higher vitamin A intakes than poor mothers, whereas in January the poorer mothers had higher intakes. When breast milk was included, average intakes for children came close to 100% of the recommended dietary allowance; the only other significant source of vitamin A for children was seasonally available mangoes. Fourteen children who had stopped breast-feeding by the end of the study were at very high risk of vitamin A deficiency when fruits were not plentiful.

Adult↗

What many of us are doing or should be doing in clinical pathology: a list of the activities of the pathologist in the clinical laboratory.

Mr. Paul Mango, Chief Operating Officer of a hospital-based clinical laboratory network in Pittsburgh, recently performed a survey of patients presenting for phlebotomy. The survey included the question, "What does a pathologist do?" The results were that 50% of the patients had no idea what a pathologist did, and 30% of the patients stated that pathologists examined dead bodies. It is not surprising that there is a limited understanding by patients of the activities of pathologists because patients do not usually see pathologists. However, beyond autopsy and surgical pathology, the activities of pathologists are also not well known to nonpathologist physicians and hospital administrators. A poor understanding of activities in clinical pathology have placed these clinical responsibilities of the pathologist under particular scrutiny for cost reduction. The quantitation of output from anatomic pathology, in number of slides reviewed or number of autopsies performed, is objective and easily understood. As noted in the list of clinical pathology activities that follows, the responsibilities within the clinical laboratory are highly diverse and, if the pathologist handles them successfully, highly contributory to patient care. Thus, it is timely that a compilation of activities in clinical pathology be issued for review by the pathologist community. I would hope that this list will serve as a starting point for a universally accepted group of activities that describes clinical pathology today and that it will be useful for pathologists to make their significant contributions in the clinical laboratory apparent to administrators, fellow physicians, and patients. The clinical laboratory responsibilities should also be valuable to directors of residency training programs to focus training in clinical pathology toward the development of currently desirable expertise.

Clinical Laboratory Techniques↗

Night blindness of pregnancy in rural Nepal--nutritional and health risks.

BACKGROUND: Night blindness (XN) is the most common clinical symptom of vitamin A deficiency among children in developing countries. Yet little is known about the aetiology or associated risks of maternal XN. Emerging evidence from South East Asia suggests that it may be more frequent than previously thought in women of reproductive age, especially during pregnancy. METHODS: A population-based, case-control study was conducted to reveal the epidemiology of XN among pregnant Nepali women. Night blind cases were identified by history through a weekly community surveillance system. Controls were randomly selected from a pool of pregnant women without XN and pair-matched for gestational age of the cases. A home-based assessment was done within a week of selection, at which 7-day food frequency and morbidity histories were collected, anthropometry measured, and capillary blood drawn for serum retinol, beta-carotene and haemoglobin (Hb) estimation. RESULTS: Cases and controls did not differ by age or number of previous pregnancies. However, cases were more likely to be from the lower castes, be illiterate, live in poorer quality homes, and own no land. The mean serum retinol level of cases was approximately 0.30 mumol/l lower than controls (P < 0.001), indicating a low vitamin A status of night blind pregnant women. Mean Hb level was significantly lower (by 0.7 g/dl, P < 0.004), and the risk of severe anaemia (Hb < 7.0 g/dl) higher among cases than controls (odds ratio = 3.0, 95% CI: 1.25-7.23). Cases were more under-nourished than controls reflected by lower mean weight (-2.6 kg), body mass index (-0.8), arm circumference (-0.9 cm) and triceps skinfold (-0.8 mm). Night blindness was associated with less frequent consumption of preformed vitamin A (milk products, fish and meat) and provitamin A (dark green leafy vegetables and mangoes) foods, especially in summer. Night blind women were 2-3 times more likely to report symptoms of urinary/reproductive tract infections such as lower abdominal pain, painful and burning urination, or vaginal discharge, symptoms of diarrhoea/dysentery, of pre-eclampsia or eclampsia, and of nausea, vomiting or poor appetite throughout pregnancy than controls. CONCLUSION: Women who experience XN during pregnancy have a low vitamin A status, although several other risk factors appear to cluster among these women as well. Night blind women are also more likely to be anaemic, ill, and acutely under-nourished, and to be consuming a nutritionally poorer diet in pregnancy than non-night blind pregnant women. A simple history of XN can identify women at high risk during pregnancy who may require special nutritional support, antenatal care and counselling.

Adult↗