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PubMed2005

Neurolathyrism risk depends on type of grass pea preparation and on mixing with cereals and antioxidants.

OBJECTIVE: To study an array of household individual and dietary risk factors for neurolathyrism. METHOD: Case-control study using recent cases in a district highly affected by the recent neurolathyrism epidemic in Ethiopia: 108 households with cases and 104 households with no cases; 170 neurolathyrism cases, 370 intra-family controls and 170 community controls frequency matched for age and sex. RESULTS: A history of acute illness was associated with a two- and threefold increased risk of paralysis in community and intra-family controls, respectively. Soaking grass pea in water before cooking roughly halved the risk of neurolathyrism but cooking in clay utensils more than quadrupled it. Consumption of grass pea in the green unripe and boiled forms increased the risk 10 times or more. Mixing the food with gravy that contains condiments with antioxidant activity reduced it by a factor of 4. The consumption of grass pea mixed with cereals rich in sulphur amino acids was also highly protective, but the magnitude of the effect depended on the grass pea preparation consumed. CONCLUSION: Consumption of pure grass pea, especially in the green unripe and boiled forms, should be avoided. Communities at risk of neurolathyrism during famine crises should be encouraged to combine and use grass pea with cereals before the household cereal stock is fully depleted. Breeding programmes, alongside traditional attempts to reduce the toxin content, should enhance the content of sulphur amino acids and antioxidants in grass pea.

Adolescent↗
PubMed1994

Northern Sudan in 1991: food crisis and the international relief response.

By the end of 1991, less than half the amount of relief food requested for North Sudan at the beginning of the year had been delivered. Despite ample evidence of social and economic stress and high rates of child malnutrition, many donors felt that relief needs had been exaggerated, and were unwilling to accept that relief assistance was urgently needed. The feeble response of the main food aid donors is explained initially by the politics of relief in 1990/91, which seriously delayed the launch of the relief operation. These problems were compounded by an oversimplified understanding of famine among some sections of the relief community, and by the orientation of the international relief system to crisis indicators. Toward the end of 1991, donors argued that despite the shortfall in relief assistance there had been no deaths from starvation, and therefore local people had 'coped' better than expected. This paper challenges that view by arguing that excess deaths did occur, but went unnoticed and unremarked. Local people's 'coping strategies', which supposedly 'saved the day', actually had very negative and sometimes fatal consequences.

Child, Preschool↗
PubMed1994

Saving enemy children: Save the Children's Russian relief operation, 1921-23.

When the Russian harvest failed in 1921, the economy had been devastated by years of disasters. Appeals were made to the outside world, and Save the Children was one of the main agencies to respond. Despite reservations about supporting the Soviets, a major advertising campaign was launched, raising large sums of money which were used to open feeding centres in the face of adverse climate and a devastated infrastructure. Facing some critical press coverage, the Fund used advanced media techniques to get its message across. By summer 1923, the famine was over and the Fund had succeeded in feeding up to 675,000 people.

Child↗
PubMed1995

Desert locusts in Africa: a disaster?

Migrating locusts, especially the desert locust (Schistocerca gregaria), have been feared in Africa for thousands of years as famine-inducing pests. Instead of simply waiting for outbreaks to occur, attempts are being made to take preventive action against these pests. Since the breeding areas of the desert locust are distributed across the entire Sahel region, the Arabian peninsula, Pakistan and India, a gigantic logistical and organizational effort is required. Every year, millions of dollars are spent on these preventive control measures, which are still unable to prevent locust plagues completely. The outbreaks in 1987/88 and 1993/94 are the most recent examples. Exactly how large potential disasters caused by gigantic locust swarms may be and whether the effort and expense involved in preventing them pays off economically has never been systematically investigated. The Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ) project, 'Integrated Biological Control of Grasshoppers and Locusts', has attempted to assess, on the basis of the available data, what the costs and potential benefits are and to identify the difficulties involved in developing an effective strategy.

Africa↗
PubMed1995

The role of food aid in drought and recovery: Oxfam's North Turkana (Kenya) drought relief programme, 1992-94.

Regional droughts carry the seeds of catastrophe: the immediate risk is famine; the long-term risk is destitution. Preventing both situations is an appropriate, if not essential, goal for relief agencies. In the past, responses to hunger in Turkana District (north-west Kenya) have taken the form of traditional feeding programmes. A better understanding of the boom/bust cycles in pastoralist systems has, however, produced new relief strategies. A central tenet of these strategies is the acceptance that relief aid should assume two roles: humanitarian--to overcome food deficits--and economic--to overcome 'income' deficits. Arguments in favour of a broader role for food aid are tested with a case study of a drought relief programme in north Turkana between 1992-1994. Field studies confirmed that when food aid is integrated as an asset into household resources, it can strengthen economic recovery. Ultimately, the extent to which relief operations are able to protect both people's lives and their livelihoods is the key to more sustainable development in drought-prone areas.

Adult↗
PubMed1996

Food aid and nutritional programmes during the Rwandan emergency.

In contrast to several other recent emergencies, the response of the international relief community to the Rwandan emergency appears largely to have prevented widespread malnutrition and related mortality. While it is true that aspects of the response in the food and nutrition sector were in various ways open to criticism and may have contributed to unnecessarily high levels of wasting in some camps at various points in time, the appalling excesses of famine witnessed in other recent African crises was not revisited during this emergency. Indeed, the main factors contributing to mortality and morbidity during the Rwandan emergency were violence and epidemics rather than lack of food and nutritional support.

Emergencies↗
PubMed1999

Teasing out the truth about collagen.

Of all of the non-mineral constituents of the mammalian body there is more collagen than anything else except water and possibly fat. Nevertheless our understanding of the physiology of collagen is rudimentary. All cells and tissues are supported by a network of collagen fibres, the arrangement of which appears to be specifically site adaptive. We know a lot about the biochemistry of collagen, and its many subtypes: for example, all collagen molecules are made within fibroblasts (or modifications of them such as osteocytes), then the oversized collagen molecule is secreted in a soluble form, with hydrophilic ends which are enzymatically cleaved to leave the insoluble core collagen (tropocollagen) beached in the extracellular space. We know that collagen is made relatively immortal by being cross-linked and rather impervious to proteolysis. However, we do not know much about what governs collagen synthesis or its breakdown in the human body. It is important to know, not simply because like Everest, collagen presents a large unignorable mass. We need to understand collagen metabolism in order to understand how we grow, adapt to the environment, maintain our adult shapes and then wrinkle and crumble as we age. Collagen diseases are relatively common and almost certainly if we knew more about how, for example, the collagen framework of bone is laid down and turned over we would understand much more about osteopenia of old age. The problem in finding out has been that collagen is so difficult to study. It turns over relatively slowly, and that part of it that is cross-linked and forms mature collagen is, it seems, with us for life come hell, high-water or famine. The body reduces to mainly skin and bone-collagen in extremis. Because the system as a whole is so sluggish, it is difficult to see changes in indices of collagen metabolism. However, not all the body collagen seems to be as fixed, and indeed collagen in some tissues must turn over, enabling remodelling and adaptation, rather quickly. Think about the stiffness and discomfort that accompanies un-accustomed exercise, which not only abates with time but ceases to occur once the exercise has become customary. What is happening to collagen protein turnover in these circumstances? One obvious way to study protein turnover, even of collagen, is to follow the incorporation of stable isotope markers such as proline into the tissue (although the breakdown is harder to quantify), but this is technically difficult and requires biopsy of the tissue in question. Another way is to follow the appearance in biological fluids of markers of collagen turnover. Since the propeptides which make collagen soluble are cleaved as collagen is deposited extracellularly, their concentration is an index of the rate of collagen synthesis; similarly when tropocollagen is degraded by extracellular proteases, specific N- and C-terminal fragments are released, the amount of which scales with the rate of collagen breakdown. These bits of collagen find their way into the blood. However, assaying them there introduces non-specificity and dilution, rendering interpretation difficult. The ideal would be to measure them in the extracellular fluid at the site of production. This of course is not easy in vivo. One of the delights of the paper by Langberg and colleagues in this issue of The Journal of Physiology (Langberg et al. 1999) is the sheer cheek with which the authors decided to use the microdialysis technique to do this. Microdialysis is a technique whereby a slowly perfused, thin-walled membranous tube is introduced into the extracellular space and the collected fluid assayed for molecules which have diffused into it. Until now the idea of using microdialysis to measure concentrations of molecules much bigger than 300 Da would be regarded as ludicrous. (ABSTRACT TRUNCATED)

Achilles Tendon↗
PubMed2006

Ethical considerations for clinical photography in the global South.

Clinical photography is an important tool for teaching practitioners and field workers about the clinical manifestations of famine and undernutrition, particularly with respect to the Global South. Current international guidelines for clinical photography are not consistently applied or enforced, which has led to violations of privacy and rights, particularly for patients and victims of disaster in the Global South. Combining existing clinical photography guidelines from the North with ongoing clinical ethics debates in the South, this paper explores approaches to establishing photography guidelines throughout the world that will be sensitive to the privacy and dignities of all patients and victims of emergencies.

Clinical Trials as Topic↗
PubMed2004

The obesity syndrome and acanthosis nigricans. Acanthosis nigricans is a common cosmetic problem providing epidemiological clues to the obesity syndrome, the insulin-resistance syndrome, the thrifty metabolism, dyslipidaemia, hypertension and diabetes mellitus type II.

Obesity and its consequences are arguably the chief public health problems facing the developed world. Obesity causes many fatal diseases, in particular cerebrovascular and cardiovascular disease. Acanthosis nigricans (AN) is a common cosmetic disability in pigmented ethnic groups. It may present with periorbital darkening or darkening of the neck or knuckles as well as acrochordons (skin tags) around eyelids, neck or axillae. The more classical AN of axillae and groins is less often a cosmetic disability, although it is an important physical sign. AN is very common in pigmented populations throughout the world, irrespective of domicile. It is rare in whites. AN is closely associated with all the features of the insulin-resistance syndrome (IRS), especially obesity. AN and IRS share a similar prevalence and epidemiology. IRS (also known as syndrome X or the deadly quartet) is characterized by insulin resistance (IR) and its associated conditions, including obesity, dyslipidaemia, hypertension and diabetes mellitus (DM) type II. The sequelae of IRS are cardiovascular and cerebrovascular disease. The origins of insulin resistance and its sequel, IRS, are debated. Insulin resistance can result from obesity. Also obesity usually presents before AN, hypertension or DM II. For these reasons it may be more helpful to recognize instead an obesity syndrome. The obesity syndrome is characterized by a genetically determined thrifty metabolism that protects subjects in famine conditions but which, in conditions of plenty, leads to weight gain with all its consequences, including hyperlipidaemia, hypertension, IR with DM II, and, in due course, cerebrovascular and cardiovascular disease. In pigmented races, AN is an important early manifestation of the obesity syndrome. AN helps identify persons at particular risk of developing the obesity syndrome, dyslipidaemia, hypertension and IR with DM II. Recognition of AN, therefore, offers important opportunities for health screening and preventative medicine.

Journal Article↗
PubMed1996

Adaptation to life at micromolar nutrient levels: the regulation of Escherichia coli glucose transport by endoinduction and cAMP.

Free-living bacteria are expert in adapting to variations in nutrient availability, often using an array of transport systems of different affinities to scavenge for particular substrates (multiport). This review concentrates on the regulation of expression of different transporters contributing to multiport in response to varying nutrient levels. A novel mechanism of controlling bacterial transport affinity under sugar limitation is described. In particular, switching from glucose-rich to glucose-limited conditions results in Escherichia coli orchestrating outer membrane changes as well as the induction of a periplasmic binding protein-dependent (ABC-type) transport system. The changes leading to the high affinity transport pathway are directed towards uptake of rapidly utilisable concentrations and are optimal close to 10-6 M medium glucose. High affinity transport is absent under both glucose-rich 'feast' and glucose-starved 'famine' conditions hence high affinity transporters are not simply repressed by excess nutrient. Rather, the improvement in glucose scavenging involves induction of genes in 2 distinct regulons (mgl/gal and mal/lamB) through synthesis of 2 different endogenous inducer molecules (galactose, maltotriose). Endoinducer levels are tightly controlled by extracellular glucose concentration at different glucose-limited growth rates. Aside from endoinducers, the elevated intracellular level of cAMP plays a role in induction of the high-affinity pathway but cAMP-mediated relief from catabolite repression is not itself sufficient for high affinity transport. In contrast to the repressive role of glucose when present at millimolar concentrations, micromolar glucose also leads to the induction of transport systems for other sugars, further broadening the scavenging potential of nutrient-limited bacteria for other substrates.

Adaptation, Physiological↗
PubMed1995

Computer Program for Diagnosing and Teaching Geographic Medicine.

One of the unique aspects of infectious disease is its wide variety, both in time and place. The specialist practicing in India may have little or no expertise in Peruvian disease. A colleague in New York may be called upon to diagnose and treat conditions originating in Africa, Asia, South America, Fiji and Papua, New Guinea. At the same time, this colleague must be familiar with the pathogens that originate in Texas, Hawaii, and Canada. Indeed, even the full-time infectious diseases specialist may not be conversant in diseases such as lagochilascariasis, louping ill, and lobomycosis. War, famine, education, immigration, and business travel have contributed to the advent of specialists in Geographic Medicine and Emporiatrics, otherwise known as Travel medicine. The "art" of diagnosis is largely an ability (albeit subconscious) to rank probabilities based on the incidences of likely diseases and the chance of encountering given clinical features within each disease. In theory, Bayesian analysis could be employed to diagnose disease accurately when given proper input. A multicenter study was undertaken to test a comprehensive computer driven-software program that incorporates worldwide epidemiologic and clinical parameters.

Journal Article↗
PubMed1999

Do parents prefer sons in North Korea?

Son preference in South Korea is stronger than anywhere else in the world, yet little is known about such preference in North Korea. Simple indicators of son preference in North Korea are constructed from its 1993 population census and a 1998 survey of child nutrition (conducted in the wake of the recent famine). These indicators include sex ratio at birth, sex ratios of infant and child mortality, and sex ratios of child malnutrition. North Koreans do not evince prenatal discrimination against daughters, a finding that may indicate a lack of prenatal sex-testing technologies. Neither is evidence found of excess female mortality or malnutrition in the postnatal period, during which discrimination requires no special technology. The discrepancy in son preference across the Korean peninsula seems due largely to the socialist agenda pursued in the north following political partition after World War II. An important aspect of that agenda challenged the ancient Confucian ideology presumed to underlie son preference. Apparently, this challenge was more successful in North Korea than in other Asian societies instituting similar political changes, because son preference was not eliminated in China or in Vietnam.

Child↗
PubMed1992

Did Columbus also open the exploration of the modern diet?

On the 500th anniversary of Columbus's voyage of discovery, one aspect that merits particular attention is its influence on food and nutrition worldwide. Columbus found an unexpected wealth in food resources rather than the gold he sought. The sailors came from a continent where famine was well known and had subsisted for two months on a typical seamen's diet of preserved foods, primarily hardtack and salt pork. They made landfall in green and fertile islands. The foods that constituted the core of the diet of the Americas before 1492--from maize to potatoes, beans to tomatoes, to numerous other fruits and vegetables--became the true patrimony that the inhabitants of the New World bequeathed to humanity. These foods, new to the Old World, provided the basis for the exchange and evolution of networks of food production and consumption which, with many trials and errors and with no preestablished plan, characterize modern nutrition. The diet of Mediterranean countries, now universally recommended for nutritional health, is high in several foods, tomatoes and beans in particular, that originated in the New World.

Diet↗
PubMed1993

Malnutrition in Iraqi children following the Gulf War: results of a national survey.

The community-based Iraq Infant and Child Mortality and Nutrition Survey was designed to estimate mortality and nutritional status of Iraqi infants and children under five years of age after the Gulf conflict of 1991. This article presents results from a nationwide nutritional survey conducted between August 25 and September 5, 1991. A random multistage cluster sample was selected, including a subsample of 2676 children in the anthropometric analysis. The percentage below -2 standard deviations was 21.8% for height-for-age, 11.9% for weight-for-age, and 3.4% for weight-for-height. It is possible that the observed prevalence of wasting was an underestimate, resulting from a survivor bias. This observation suggests that cross-sectional nutritional surveys may not be the most appropriate method for assessing the effect of the Gulf conflict on the nutritional status of children in Iraq. Longitudinal information on child mortality and nutritional status would be more useful in predicting the likelihood of famine.

Body Height↗
PubMed2003

Effects of triclosan-containing rinse on the dynamics and antimicrobial susceptibility of in vitro plaque ecosystems.

Dental plaque microcosms were established under a feast-famine regimen within constant-depth film fermentors and exposed four times daily postfeeding to a triclosan (TR)-containing rinse (dentifrice) (TRD). This was diluted so that the antimicrobial content was 0.6 mg/ml. Microcosms were characterized by heterotrophic plate counts and PCR-denaturing gradient gel electrophoresis (DGGE) with primers specific for the V2-V3 region of the eubacterial 16S rRNA gene (rDNA). Dominant isolates and PCR amplicons were identified by partial sequencing of 16S rDNA. TRD caused considerable decreases in the counts of both gram-negative organisms and total anaerobic cells, transiently lowered the numbers of streptococci and actinomycetes, and markedly increased the proportion of lactobacilli. DGGE indicated the presence of putatively unculturable bacteria and showed that a Porphyromonas sp. and Selenomonas infelix had been inhibited by TRD. Pure culture studies of 10 oral bacteria (eight genera) showed that Neisseria subflava, Prevotella nigrescens, and Porphyromonas gingivalis were highly susceptible to TR, while the lactobacilli and streptococci were the least susceptible. Clonal expansion of the lactobacilli in the pulsed microcosm could be explained on the basis of TR activity. The mean MICs of TR, chlorhexidine, erythromycin, penicillin V, and vancomycin for the population before and after 5 days of exposure to TRD showed few significant changes. In conclusion, changes in plaque microcosm populations following repeated exposure to TRD showed inhibition of the most susceptible flora and clonal expansion of less susceptible species.

Anti-Bacterial Agents↗
PubMed2000

Succession of pelagic marine bacteria during enrichment: a close look at cultivation-induced shifts.

Enrichment experiments with North Sea bacterioplankton were performed to test if rapid incubation-induced changes in community structure explain the frequent isolation of members of a few particular bacterial lineages or if readily culturable bacteria are common in the plankton but in a state of dormancy. A metabolic inhibitor of cell division (nalidixic acid [NA]) was added to substrate-amended (S+) and unamended (S-) grazer-free seawater samples, and shifts in community composition and per cell DNA and protein content were compared with untreated controls. In addition, starvation survival experiments were performed on selected isolates. Incubations resulted in rapid community shifts towards typical culturable genera rather than in the activation of either dormant cells or the original DNA-rich bacterial fraction. Vibrio spp. and members of the Alteromonas/Colwellia cluster (A/C) were selectively enriched in S+ and S-, respectively, and this trend was even magnified by the addition of NA. These increases corresponded with the rise of cell populations with distinctively different but generally higher protein and DNA content in the various treatments. Uncultured dominant gamma-proteobacteria affiliating with the SAR86 cluster and members of the culturable genus Oceanospirillum were not enriched or activated, but there was no indication of substrate-induced cell death, either. Strains of Vibrio and A/C maintained high ribosome levels in pure cultures during extended periods of starvation, whereas Oceanospirillum spp. did not. The life strategy of rapidly enriched culturable gamma-proteobacteria could thus be described as a "feast and famine" existence involving different activation levels of substrate concentration.

Alteromonas↗
PubMed2003

Effects of a chlorhexidine gluconate-containing mouthwash on the vitality and antimicrobial susceptibility of in vitro oral bacterial ecosystems.

Oral bacterial microcosms, established using saliva inocula from three individuals, were maintained under a feast-famine regime within constant-depth film fermenters. Steady-state communities were exposed four times daily, postfeeding, to a chlorhexidine (CHX) gluconate-containing mouthwash (CHXM) diluted to 0.06% (wt/vol) antimicrobial content. The microcosms were characterized by heterotrophic plate counts and PCR-denaturing gradient gel electrophoresis (DGGE). CHXM caused significant decreases in both total anaerobe and total aerobe/facultative anaerobe counts (P < 0.05), together with lesser decreases in gram-negative anaerobes. The degree of streptococcal and actinomycete inhibition varied considerably among individuals. DGGE showed that CHXM exposure caused considerable decreases in microbial diversity, including marked reductions in Prevotella sp. and Selenomonas infelix. Pure-culture studies of 10 oral bacteria (eight genera) showed that Actinomyces naeslundii, Veillonella dispar, Prevotella nigrescens, and the streptococci were highly susceptible to CHX, while Lactobacillus rhamnosus, Fusobacterium nucleatum, and Neisseria subflava were the least susceptible. Determination of the MICs of triclosan, CHX, erythromycin, penicillin V, vancomycin, and metronidazole for microcosm isolates, before and after 5 days of CHXM exposure, showed that CHXM exposure altered the distribution of isolates toward those that were less susceptible to CHX (P < 0.05). Changes in susceptibility distributions for the other test agents were not statistically significant. In conclusion, population changes in plaque microcosms following repeated exposure to CHXM represented an inhibition of the most susceptible flora with a clonal expansion of less susceptible species.

Bacteria↗
PubMed2025

SloR-SRE binding to the S. mutans mntH promoter is cooperative.

UNLABELLED: Streptococcus mutans is a commensal member of the plaque microbiome. It is especially prevalent when dietary sugars are available for S. mutans fermentation, generating acid byproducts that lower plaque pH and foster tooth decay. S. mutans can survive in the transient conditions of the mouth, in part because it can regulate the uptake of manganese and iron during periods of feast when metal ions are available, and famine when they are limited. S. mutans depends on a 25kDa metalloregulatory protein, called SloR, to modulate the uptake of these cations across the bacterial cell surface. When bound to manganese, SloR binds to palindromic recognition elements in the promoter of the sloABC genes that encode the major manganese transporter in S. mutans. Reports in the literature describe MntH, an ancillary manganese transporter in S. mutans, that is also subject to SloR control. In the present study, we performed expression profiling experiments that reveal coordinate regulation of the sloABC and mntH genes at the level of transcription. In addition, we describe a role for the mntH gene product that is redundant with that of the sloABC-encoded metal ion uptake machinery. The results of DNA-binding studies support direct SloR binding to the mntH promoter region which, like that at the sloABC promoter, harbors three palindromic recognition elements to which SloR binds cooperatively to repress downstream transcription. These findings expand our understanding of the SloR metalloregulome and elucidate SloR-DNA binding that is essential for S. mutans metal ion homeostasis and fitness in the oral cavity. IMPORTANCE: Dental caries disproportionately impacts low-income socioeconomic groups in the United States and abroad. Research that is focused on S. mutans, the primary causative agent of dental caries in humans, is significant to mitigation efforts aimed at alleviating or preventing dental caries. The SloR protein is a major regulator of the S. mutans metal ion uptake machinery encoded by the sloABC- and mntH genes. This SloR-mediated gene control is essential for maintaining intracellular metal ion homeostasis, and hence S. mutans fitness in the plaque microbiome. An improved understanding of the sloABC and mntH metal ion transporters and their regulation by SloR can guide rational drug design that, by targeting the SloR-DNA-binding interface, can alleviate or prevent S. mutans-induced disease.

Streptococcus mutans↗