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PubMed1998

An outbreak of Brainerd diarrhea among travelers to the Galapagos Islands.

In 1992, an outbreak of chronic diarrhea occurred among passengers on a cruise ship visiting the Galapagos Islands, Ecuador. Passengers (548) were surveyed, and stool and biopsy specimens from a sample who reported chronic diarrhea were examined. On completed questionnaires, returned by 394 passengers (72%), 58 (15%) reported having chronic diarrhea associated with urgency (84%), weight loss (77%), fatigue (71%), and fecal incontinence (62%). Illness began 11 days (median) after boarding the ship and lasted 7 to >42 months. Macroscopic and histologic abnormalities of the colon were common, but extensive laboratory examination revealed no etiologic agent. No one responded to antimicrobial therapy. Patients were more likely than well passengers to have drunk the ship's unbottled water or ice before onset of illness and to have eaten raw sliced fruits and vegetables washed in unbottled water. Water handling and chlorination on the ship were deficient. Outbreaks of a similar illness, Brainerd diarrhea, have been reported in the United States. Although its etiology remains unknown, Brainerd diarrhea may also occur among travelers.

Anti-Bacterial Agents↗

PubMed1989

Hemoglobin as a predictor of response to iron therapy and its use in screening and prevalence estimates.

The use of hemoglobin as a predictor of response to iron therapy, for screening, and for prevalence estimates was studied. An Fe supplementation trial was performed in Quito, Ecuador, in which 412 pregnant women were randomly assigned to treatment and control groups. Women in the treatment group received 390 mg ferrous sulfate/d for 2 mo. The prevalence of Fe deficiency as defined by response to therapy was found to be 60.8%. Sensitivity and specificity were calculated at various cutoff points of hemoglobin. The estimates of sensitivity and specificity allow for the use of hemoglobin in screening for Fe deficiency anemia and in the estimation of the prevalence in populations with characteristics similar to those found in the sample of pregnant women in Quito. Hemoglobin was shown to be a good predictor of response to Fe treatment and a good estimate of prevalence of Fe deficiency when prevalence is high.

Anemia, Hypochromic↗

PubMed1995

Comparison of the heart rate-monitoring and factorial methods: assessment of energy expenditure in highland and coastal Ecuadoreans.

Accurate estimates of total daily energy expenditure (TDEE) are critical to studies of the nutritional adaptation of human populations. This study compared the standard factorial method with the recently developed flex-HR technique in a sample of 32 adults (16 males, 16 females) from rural, agricultural communities of highland and coastal Ecuador. Although energy expenditures obtained from the two methods were highly correlated (r = 0.759, P < 0.0001), the 1985 FAO/WHO/UNU factorial method significantly underestimated TDEE relative to the heart rate-monitoring technique (10.27 +/- 2.54 compared with 11.91 +/- 3.96 MJ/d, P < 0.001). The degree of underestimation was greater in males, who had higher energy expenditures. Similarly, underestimation was greater in the highland farmers, who were studied during a period of heavy agricultural work. The differences in energy expenditure estimates translated into a 10% difference in estimated energy adequacy. Additional research is needed to identify the potential sources of bias in the factorial method and to further develop other techniques for accurately estimating energy expenditure under field conditions.

Adolescent↗

PubMed2002

Effect of zinc on the treatment of Plasmodium falciparum malaria in children: a randomized controlled trial.

BACKGROUND: Zinc supplementation in young children has been associated with reductions in the incidence and severity of diarrheal diseases, acute respiratory infections, and malaria. OBJECTIVE: The objective was to evaluate the potential role of zinc as an adjunct in the treatment of acute, uncomplicated falciparum malaria; a multicenter, double-blind, randomized placebo-controlled clinical trial was undertaken. DESIGN: Children (n = 1087) aged 6 mo to 5 y were enrolled at sites in Ecuador, Ghana, Tanzania, Uganda, and Zambia. Children with fever and >or=2000 asexual forms of Plasmodium falciparum/ micro L in a thick blood smear received chloroquine and were randomly assigned to receive zinc (20 mg/d for infants, 40 mg/d for older children) or placebo for 4 d. RESULTS: There was no effect of zinc on the median time to reduction of fever (zinc group: 24.2 h; placebo group: 24.0 h; P = 0.37), a >or=75% reduction in parasitemia from baseline in the first 72 h in 73.4% of the zinc group and in 77.6% of the placebo group (P = 0.11), and no significant change in hemoglobin concentration during the 3-d period of hospitalization and the 4 wk of follow-up. Mean plasma zinc concentrations were low in all children at baseline (zinc group: 8.54 +/- 3.93 micro mol/L; placebo group: 8.34 +/- 3.25 micro mol/L), but children who received zinc supplementation had higher plasma zinc concentrations at 72 h than did those who received placebo (10.95 +/- 3.63 compared with 10.16 +/- 3.25 micro mol/L, P < 0.001). CONCLUSION: Zinc does not appear to provide a beneficial effect in the treatment of acute, uncomplicated falciparum malaria in preschool children.

Animals↗

PubMed2005

Effects of moderate doses of vitamin A as an adjunct to the treatment of pneumonia in underweight and normal-weight children: a randomized, double-blind, placebo-controlled trial.

BACKGROUND: Randomized controlled trials have shown inconsistent responses of childhood pneumonia to the use of vitamin A as an adjunct to the standard treatment of pneumonia. OBJECTIVE: We evaluated the effect of a moderate dose of vitamin A as an adjunct to standard antimicrobial treatment on the duration of respiratory signs in children with pneumonia. DESIGN: Children, aged 2-59 mo, with pneumonia and weight-for-age <50th percentile who had been admitted to the Baca Ortíz Children's Hospital in Quito, Ecuador, were randomly assigned to receive 50,000 IU (aged 2-12 mo) or 100,000 IU (aged >12-59 mo) vitamin A or a placebo. RESULTS: Of the 287 children enrolled, 145 received vitamin A and 142 received placebo. No overall differences were observed between the 2 groups in the duration of signs of pneumonia. Multiple linear regression showed a significant interaction between basal serum retinol concentration and vitamin A group for the time (in h) to remission of respiratory signs (beta = -3.57, SE = 1.09, P = 0.001). Duration of clinical signs was less in children with basal serum retinol concentrations >200 microg/L who received vitamin A supplements than in children with similar concentrations who received placebo (69.9 +/- 49.9 h compared with 131.3 +/- 143.9 h; P = 0.049). CONCLUSIONS: Overall, we found no effect of a moderate dose of vitamin A supplementation on the duration of uncomplicated pneumonia in underweight or normal-weight children aged <5 y. However, a beneficial effect was seen in children with high basal serum retinol concentrations.

Administration, Oral↗

PubMed2006

Nectar sugar composition and volumes of 47 species of Gentianales from a southern Ecuadorian montane forest.

BACKGROUND AND AIMS: This study investigates 47 taxonomically related species (Gentianales), all native to a tropical montane forest in southern Ecuador, in terms of nectar chemistry and nectar volumes in relation to pollination biology. METHODS: Nectar volumes of covered (24-h production) and uncovered (standing crop) flowers were measured in the natural habitat. Sucrose, fructose and glucose were quantified in the nectar using high performance liquid chromatography. Flower visitors were observed. KEY RESULTS: Nectar sugar concentration did not differ significantly among the pollination syndromes. Regarding sugar composition, the only significant differences were found in chiropterophilous and myiophilous flowers, which had a significantly lower sugar ratio than sphingophilous flowers. A separation of chiropterophilous and myiophilous flowers from the other pollination syndromes is further substantiated by non-linear multidimensional scaling using the chord-normalized expected species shared index of dissimilarity based on nectar sugar compositions. The matrix test revealed no correlation of observed floral visitors to nectar concentrations; however, a weak significant correlation was found between floral visitors and nectar sugar compositions. The nectar volumes of covered and uncovered flowers are related to, and differ significantly among, pollination syndromes. Matrix tests revealed correlation between floral visitors and nectar volume of covered flowers and, to a lesser extent, of uncovered flowers. CONCLUSIONS: Sucrose is the predominant floral nectar sugar in the order Gentianales, suggesting that nectar sugar composition is a conservative characteristic. However, some degree of an adaptive convergence of floral nectar compositions to principal pollinator type within the constraints set by phylogenetic history is likely. The driving force to visitation appears to be the volume of nectar the visitor can expect to consume.

Animals↗

PubMed1992

Validation of a screening questionnaire for the detection of epileptic seizures in epidemiological studies.

A large-scale clinico-epidemiological study of epileptic seizures has been carried out in a highland area in northern Ecuador, South America. This paper describes the design and the two-staged validation procedures undertaken to authenticate the screening questionnaire, which was used to detect epileptic seizures in the community during this project. An initial questionnaire consisting of 20 questions was devised and then validated in a group of healthy subjects and a group of patients with known epileptic seizures. This questionnaire was found to have a sensitivity of 100% and a specificity of 50.8%. A cluster analysis of the responses rates was undertaken and a set of nine questions which presented a specificity of 92% and sensitivity of 98% were chosen to be used during the survey. The validation of this nine-question instrument was then undertaken by direct application to a general population of 72,121 persons. Positive, negative, false positive and false negative rates were derived. The screening instrument was found to have a sensitivity of 79.3%, a specificity of 92.9%, a positive predictive value of 18.3%, a negative predictive value of 99.6% and a Youden's index of 0.79. The methodology of the study and the instruments developed are recommended for future neuro-epidemiological work in epilepsy. The problems of validation are discussed, and previous epidemiological studies of epilepsy reviewed with special emphasis on the handling of questions of validation.

Adolescent↗

PubMed1992

Imported malaria in the Bronx: review of 51 cases recorded from 1986 to 1991.

The cases of 51 patients with malaria seen at the Albert Einstein College of Medicine hospitals from January 1986 to June 1991 are reviewed. Thirty-five patients acquired infection on journeys to their country of origin. Of these 35 patients, 83% of whom had lived in the United States for > or = 2 years, only 17% received antimalarial prophylaxis. Ten of the 51 patients were born and raised in the United States, and 70% received prophylaxis (P < .01). Six of the 51 patients were visitors to the United States from areas endemic for malaria. Overall, 64% of patients acquired malaria in West Africa, south of the Sahara; 20% in Asia; 8% in Ecuador; 6% in Haiti; and 4% in the Middle East. The majority of infections were due to Plasmodium falciparum. Six patients traveled to a zone endemic for malaria while pregnant, and none received prophylaxis. In nine of 13 patients who received prophylaxis, there was inadequate dosing or poor compliance. Individuals born in regions endemic for malaria are at high risk of acquiring malaria on return to their countries of origin and are less aware of the need for malaria prophylaxis than are other travelers.

Adolescent↗

PubMedDate not supplied

Domestic animal rabies control: an overview.

Models for rabies control, particularly in dogs and cats in urban centers in Western nations, have been based on mandatory regular vaccination and restriction of movement of animals, with removal of unrestricted animals. When this three-component approach has been unsuccessful or only temporarily maintained, especially in developing countries, constraints on implementation and maintenance, rather than the model itself, have been blamed. The ecology of the reservoir animals, the relations of dogs and cats to people, and the development of culturally adaptable approaches to rabies control have received little serious attention. As a part of a rabies control pilot program assisted by the World Health Organization, the city of Guayaquil, Ecuador, was chosen as an urban center of high rabies prevalence in animals and high rabies risk in people. The ecology of dogs and cats was investigated, and the findings were applied in developing a model based on community education, annual house-to-house vaccination campaigns, stabilization of the dog and cat populations, limitation of restriction and removal of animals to focal-outbreak control, and environmental measures to promote population control. Initial implementation has been successful, and longitudinal studies are in place to monitor maintenance of control.

Animals↗

PubMed2000

Recessive mutation in desmoplakin disrupts desmoplakin-intermediate filament interactions and causes dilated cardiomyopathy, woolly hair and keratoderma.

Desmosomes are major cell adhesion junctions, particularly prominent in the epidermis and cardiac tissue and are important for the rigidity and strength of the cells. The desmosome consists of several proteins, of which desmoplakin is the most abundant. Here, we describe the first recessive human mutation, 7901delG, in the desmoplakin gene which causes a generalized striate keratoderma particularly affecting the palmoplantar epidermis, woolly hair and a dilated left ventricular cardiomyopathy. A number of the patients with this syndromic disorder suffer heart failure in their teenage years, resulting in early morbidity. All tested affected members of three families from Ecuador were homozygous for this mutation which produces a premature stop codon leading to a truncated desmoplakin protein missing the C domain of the tail region. Histology of the skin revealed large intercellular spaces and clustering of desmosomes at the infrequent sites of keratinocyte adhesion. Immunohistochemistry of skin from the patients showed a perinuclear localization of keratin in suprabasal keratinocytes, suggesting a collapsed intermediate filament network. This study demonstrates the importance of desmoplakin in the attachment of intermediate filaments to the desmosome. In contrast to null DESMOPLAKIN: mice which die in early development, the truncated protein due to the homozygous 7901delG mutation in humans is not embryonic lethal. This suggests that the tail domain of desmoplakin is not required for establishing tissue architecture during development.

Amino Acid Sequence↗

PubMed1986

Prevalence rates of microtia in South America.

A high frequency of microtia in Quito (Ecuador) was detected by the Latin American Collaborative Study of Congenital Malformations (ECLAMC), and the data available on file were used to define the cluster and to test some potential risk factors. The Quito material consisted of 46 041 livebirths from two hospitals. The rest of the sample consisted of 553 068 livebirths from 58 hospitals located in 24 cities of six other South American countries. The observed prevalence rate for microtia was over five times higher in Quito (17.4/10 000) than in the other cities (3.2/10 000). The microtias from Quito were mostly represented by isolated forms (without other anomalies except for preauricular tags and/or sinuses), and the proportion of severe microtia was higher than in the rest of the sample. Neither seasonal, nor secular variations were observed in Quito or the rest of the sample; data suggesting the geographical cluster did not arise in recent years. Case-control analysis of familial, prenatal and perinatal history data in 184 cases with isolated microtia (68 from Quito and 116 from the rest) and in 184 matched non-malformed control newborn babies, identified prenatal drug exposure, high birth order, and elevated paternal age as risk factors for the microtias born in Quito.

Age Factors↗

PubMed1990

Age-specific prevalence of antibody to enterotoxigenic Escherichia coli in Ecuadorian and German children.

Serum samples from 1397 Ecuadorian children 0-5 years of age were tested by ELISA for antibodies to enterotoxigenic Escherichia coli (ETEC). A gradual prevalence and titer increase was seen for IgG antibodies to heat-labile enterotoxin in children 6-18 months old; 90% prevalences were reached in the second year of life. At this age less than 10% of West German children showed IgG antibodies to heat-labile enterotoxin. In Ecuador age-related ETEC-specific antibody titer increases correlated with age-related prevalence of diarrheal disease. On the other hand, pooled lipopolysaccharide from different ETEC-associated O serogroups could not be used as a seroepidemiologic marker of ETEC infections.

Age Factors↗

PubMed1992

Outbreak of cholera associated with crab brought from an area with epidemic disease.

From 31 March through 3 April 1991, 8 New Jersey residents developed severe, watery diarrhea after eating crabmeat brought back in the suitcase of a traveler to Ecuador. Stool cultures yielded toxigenic Vibrio cholerae O1, serotype Inaba, biotype El Tor from 4 persons, and vibriocidal antibody titers were > or = 1:640 in 7 persons, indicating recent infection with Vibrio cholerae O1. Eating crab was statistically associated with illness (P = .006); however, no leftover crabmeat was available for testing. All 8 patients fully recovered and no cases of secondary transmission were reported. This was the first reported incident of cholera in the continental United States associated with food transported from an area with epidemic disease. Discouraging the transport of perishable souvenir seafood may prevent further outbreaks.

Adult↗

PubMed1993

Tetanus and diphtheria immunization coverage in Ecuadorian children after a national vaccination campaign.

Between October 1985 and June 1986, a national vaccination campaign was launched in Ecuador. Between March and November 1986, 7798 Ecuadorian children < 5 years old were enrolled in a representative health survey. According to their vaccination cards, 65% of children had a complete series of three doses of diphtheria-tetanus-pertussis (DTP) vaccination. Serum samples were obtained from a subset of 1400 children; by ELISA, 80% had serologic evidence of recent DTP vaccination and > 80% of the newborns had tetanus antitoxin titers, indicating recent tetanus vaccination of their mothers. For all 1400 children, median tetanus and diphtheria antitoxin titers were 1.0 and 0.6 IU/mL, respectively. These data indicate the possibility of success of such vaccination campaigns if supported by the government.

Aging↗

PubMed1995

Resistance to Onchocerca volvulus: differential cellular and humoral responses to a recombinant antigen, OvMBP20/11.

Persons putatively immune (PI) to Onchocerca volvulus (Ov) infection were identified in Ecuador on the basis of epidemiologic, clinical, and parasitologic findings. Immune responses of PI subjects to a recombinant onchocercal protein, OvMBP20/11, were determined and compared with those of a comparable infected (INF) group from the same Ov-endemic area. PI subjects had significantly less antibody reactivity to this molecule; however, not all INF subjects had an antibody response. IgG1 and IgG4 were the predominant IgG subclasses induced to this molecule, and the amount of IgG1 produced was the only significant difference between the PI and INF groups. In contrast to the antibody responses, proliferative responses to OvMBP20/11 were significantly higher in PI than in INF subjects. Cytokine analysis of peripheral blood mononuclear cell culture supernatants revealed that INF subjects produced significantly more interleukin-10 in response to OvMBP20/11 than did PI subjects. This antigen induced few other cytokines, and there were no differences between study groups.

Animals↗

PubMed2005

Stomatal conductance, transpiration and sap flow of tropical montane rain forest trees in the southern Ecuadorian Andes.

We investigated tree water relations in a lower tropical montane rain forest at 1950-1975 m a.s.l. in southern Ecuador. During two field campaigns, sap flow measurements (Granier-type) were carried out on 16 trees (14 species) differing in size and position within the forest stand. Stomatal conductance (g(s)) and leaf transpiration (E(l)) were measured on five canopy trees and 10 understory plants. Atmospheric coupling of stomatal transpiration was good (decoupling coefficient Omega = 0.25-0.43), but the response of g(s) and E(l) to the atmospheric environment appeared to be weak as a result of the offsetting effects of vapor pressure deficit (VPD) and photosynthetic photon flux (PPF) on g(s). In contrast, sap flow (F) followed these atmospheric parameters more precisely. Daily F depended chiefly on PPF sums, whereas on short time scales, VPD impeded transpiration when it exceeded a value of 1-1.2 kPa. This indicates an upper limit to transpiration in the investigated trees, even when soil water supply was not limiting. Mean g(s) was 165 mmol m(-2) s(-1) for the canopy trees and about 90 mmol m(-2) s(-1) for the understory species, but leaf-to-leaf as well as tree-to-tree variation was large. Considering whole-plant water use, variation in the daily course of F was more pronounced among trees differing in size and crown status than among species. Daily F increased sharply with stem diameter and tree height, and ranged between 80 and 120 kg day(-1) for dominant canopy trees, but was typically well below 10 kg day(-1) for intermediate and suppressed trees of the forest interior.

Ecuador↗

PubMed1995

Nutritional status and cutaneous leishmaniasis in rural Ecuadorian children.

The relationship between nutritional status and cutaneous leishmaniasis (CL) was evaluated in 230 children living in a rural subtropical rainforest in Northwest Ecuador. One-third of the subjects had evidence of either current (13 per cent) or past CL infection (21 per cent). Subjects with current (4.71 +/- 0.44 mg) or previous disease (4.29 +/- 0.35 mg) had lower mean daily dietary iron intakes than non-infected children (5.45 +/- 0.2 mg; chi 2 = 0.048), but not energy, protein, or other micronutrients. The low dietary iron intake data was corroborated by the reduced mean haemoglobin values observed in children with current (11.7 +/- 0.3 mg/dL) or past infection (11.3 +/- 0.2 mg/dL) compared to non-infected subjects (12.7 +/- 0.15 mg/dL; F-ratio = 17.0, P < 0.0001). Mean hematocrit values were also lower in the two infected groups (37.4 +/- 0.9 per cent and 37.4 +/- 0.6 per cent v. 39.5 +/- 0.5 per cent; F-ratio = 4.23, P = 0.0175). Furthermore, they were more likely to suffer from iron-deficiency anaemia than their non-infected counterparts (chi 2 = 4.64, P = 0.03). However, the children with active disease accounted for most of the excess risk for anemia (Fisher's exact test P = 0.009; OR = 10.0, exact 95 per cent CI = 1.37-111.8). Finally, growth stunting (< -2SD height-for-age) was more common in subjects with current (54 per cent) or past infection (51 per cent) compared to those without CL history (31 per cent; chi 2 = 8.03, P = 0.004).(ABSTRACT TRUNCATED AT 250 WORDS)

Anemia, Iron-Deficiency↗

PubMed2001

Real-time Internet connections: implications for surgical decision making in laparoscopy.

OBJECTIVE: To determine whether a low-bandwidth Internet connection can provide adequate image quality to support remote real-time surgical consultation. SUMMARY BACKGROUND DATA: Telemedicine has been used to support care at a distance through the use of expensive equipment and broadband communication links. In the past, the operating room has been an isolated environment that has been relatively inaccessible for real-time consultation. Recent technological advances have permitted videoconferencing over low-bandwidth, inexpensive Internet connections. If these connections are shown to provide adequate video quality for surgical applications, low-bandwidth telemedicine will open the operating room environment to remote real-time surgical consultation. METHODS: Surgeons performing a laparoscopic cholecystectomy in Ecuador or the Dominican Republic shared real-time laparoscopic images with a panel of surgeons at the parent university through a dial-up Internet account. The connection permitted video and audio teleconferencing to support real-time consultation as well as the transmission of real-time images and store-and-forward images for observation by the consultant panel. A total of six live consultations were analyzed. In addition, paired local and remote images were "grabbed" from the video feed during these laparoscopic cholecystectomies. Nine of these paired images were then placed into a Web-based tool designed to evaluate the effect of transmission on image quality. RESULTS: The authors showed for the first time the ability to identify critical anatomic structures in laparoscopy over a low-bandwidth connection via the Internet. The consultant panel of surgeons correctly remotely identified biliary and arterial anatomy during six laparoscopic cholecystectomies. Within the Web-based questionnaire, 15 surgeons could not blindly distinguish the quality of local and remote laparoscopic images. CONCLUSIONS: Low-bandwidth, Internet-based telemedicine is inexpensive, effective, and almost ubiquitous. Use of these inexpensive, portable technologies will allow sharing of surgical procedures and decisions regardless of location. Internet telemedicine consistently supported real-time intraoperative consultation in laparoscopic surgery. The implications are broad with respect to quality improvement and diffusion of knowledge as well as for basic consultation.

Cholecystectomy, Laparoscopic↗