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Some features of Balkan endemic nephropathy.

This paper presents a brief review of the initial investigative efforts in three countries--"Yugoslavia", Bulgaria and Romania--on Balkan endemic nephropathy. There is now expert agreement that the disease represents an unusual type of chronic interstitial nephropathy of unknown aetiology. The epidemiological and histopathological data are summarized very briefly. The clinical symptoms and signs and the diagnostic approach to the disease are presented in greater detail. The possibilities of an early diagnosis in the latent, subclinical and early phases of the disease are discussed, together with the importance of the detection of a tubular type of proteinuria and enzymuria as a diagnostic aid.

Balkan Nephropathy↗

Pathomorphology of Balkan endemic nephropathy.

Within the county of Slavonski Brod, Yugoslavia hyperendemic areas of Balkan endemic nephropathy (BEN) have been recognized for a long time. As the Department of Pathology and Forensic Medicine of the Medical Centre in Slavonski Brod is responsible for all diagnostic post-mortem examinations in the county, and at the same time is engaged in surgical pathological diagnosis, a considerable amount of material relating to BEN and concomitant urinary-tract tumours has been collected during a 16-year period. This material has been classified and used for pathological, anatomical and histological investigations. In this paper the most relevant findings are described and briefly discussed, without the intention to speculate on possible aetiology of BEN. As the origin of BEN and of the high frequency of urinary tumours among the people from the endemic areas are still unexplained, and uniform criteria for the pathomorphological diagnosis of BEN are badly needed, the proposal to set up an archive encompassing cases from all the centres investigating BEN is supported.

Age Factors↗

Evaluation of excretory-secretory antigens for the serodiagnosis of swine trichinellosis.

Groups of hog sera from endemic and non-endemic areas for swine trichinellosis in Yugoslavia were tested by ELISA using excretory-secretory (ES) antigens collected from T. spiralis muscle larvae maintained in vitro for 24, 48 or 72 h. The 24-h ES had the highest level of specificity for T. spiralis infection. Antigen preparations recovered after 48 or 72 h yielded an increasing rate of false-positive reactions. Additional antigens occurred in the 48- and 72-h ES preparations as determined by gel electrophoresis and monoclonal antibody binding. The occurrence of false-negative reactions was directly correlated with T. spiralis worm burdens. Hogs with muscle larvae densities greater than 10 larvae per gram were all positive by ELISA. Among 17 hogs with less than 10 larvae per gram, only one hog was negative by ELISA with 24-h ES antigen; the false-negative rate was higher with 48- and 72-h ES. These results show that ES antigen produced during the first 24 h of in vitro cultivation is highly specific for the immunodiagnosis of swine trichinellosis.

Animals↗

Diet and coronary disease: a survey of mortality rates and food consumption statistics of 24 countries.

Direct, linear and reasonably accurate correlation has been found between coronary heart disease (CHD) mortality rates and the consumption of unfermented milk proteins--namely the protein content of all dairy products with the only important exception of cheese--in a study of male mortality rates and food consumption statistics of 24 countries. Thus in Finland, with the highest CHD mortality amongst these countries, the consumption of unfermented mile proteins is also higher than in the other countries, 30.4 g/day, corresponding to the protein content of 0.85 l of whole milk. In Germany, Yugoslavia and Japan male CHD mortality is approximately a half, a quarter and a tenth of that in Finland. So is the consumption of milk proteins, 14.1, 8.1 and 2.5 g respectively. Multivariate analysis on the combined effect of milk proteins and other possible atherogenic agents, like sugar, saturated fats and cigarette smoking, is performed, the results tending to confirm the leading role of milk proteins, attributing only an adjuvant effect to co-factors. Possible theoretical interpretation of the results is briefly discussed.

Aged↗

Results from the European multicenter study on lead neurotoxicity in children: implications for risk assessment.

In order to improve dose-response information on neurobehavioral effects of environmental lead exposure in children, the World Health Organization, Regional Office for Europe (WHO/EURO), in collaboration with the Commission of the European Communities, initiated this international study which was planned, executed and evaluated between 1984 and 1989. Eight groups from eight European countries (Bulgaria, Denmark, Greece, Hungary, Italy, Roumania, W. Germany and Yugoslavia) took part. A common study protocol with inherent quality assurance elements was developed to achieve comparability. Blood-lead concentrations (PbB) were the main markers of exposure. The WISC (4 subtests) for psychometric intelligence, the Bender Gestalt test (GFT version) and the Trail-Making test for visual-motor integration, the Vienna Reaction Device and a delayed RT task for reaction performance, and the Needleman scales for behavior ratings served as behavioral endpoints. All individual studies taken together represent a sample size of 1879 school-age children and cover a PbB range from below 5 to about 60 micrograms/100 ml. Overall statistical evaluation of outcome was done by multiple regression analysis using a uniform confounder model. The strongest and most consistent effects occurred for the Bender Gestalt test (GFT version) and for serial choice reaction performance (Vienna Device). The degree of association with PbB was significant for these variables, although the contribution of PbB to the observed variance never exceeded 0.8%. Psychometric intelligence was also negatively affected, although the consistency of outcome between studies was poor, and the association with PbB only borderline. An effort towards risk assessment was made by calculating the proportion of children at risk, using the observed regression coefficients as well as means and standard deviations.

Child↗

Patterns of childhood cancer incidence and mortality in Europe.

Histograms including age-standardised (0-14 years, world standard) incidence and mortality rates from selected childhood cancers are presented for 21 European cancer registration areas and 24 countries. The overall range of variation in all childhood cancer incidence rates across various cancer registration areas in Europe was around a factor 1.5, with highest rates in Spain, Italy, Sweden and France, and lowest rates in Poland, Hungary, UK, Germany and Yugoslavia. For most single cancer sites, however, the observed pattern is essentially attributable to random variation alone. A clearer pattern, however, emerged with reference to mortality. The overall range of variation, in fact, was around a factor two in both sexes, with highest rates in Bulgaria, Portugal, Hungary, Czechoslovakia and Poland, and the lowest rates in Austria, UK, Germany, The Netherlands and Finland. Trends in mortality from childhood cancers between 1950 and 1989 were also presented. Recent declines were observed for total childhood cancer mortality, leukaemias, kidney cancer (Wilms' tumours), Hodgkin's disease and other lymphomas in most European countries. These declines, however, were generally earlier and larger in northern as compared with southern and, mostly, with eastern European countries. This pattern of trends likely reflects the different adoption and impact of newer efficacious therapies of childhood cancer, and hence, confirms that there is ample scope for further reduction in childhood cancer mortality in several eastern and some southern European countries.

Adolescent↗

Mass miniature X-ray screening for tuberculosis among immigrants entering Switzerland.

Among 50,784 new immigrants entering Vaud Country, Switzerland, between 1988 and 1990, 674 abnormalities were discovered by mass miniature X-ray screening on arrival (424/43,803 foreign workers, 238/4512 refugees and 12/2469 foreign students). 2043 refugees had no radiological examination. After clinical examination, tuberculosis (TB) was considered the likely diagnosis in 256 cases, of which 132 were offered an antituberculous treatment according to the current recommendations of the Swiss Association against TB. 34 of the subjects were smear- or culture-positive (5% of all radiological abnormalities, 0.08% of all immigrants). Only 46 subjects had any clinical complaint. Among foreign workers, 0.18% were carriers of tuberculous lesions needing a treatment; the proportion was 1.22% among refugees. By ethnic origin, the proportion is highest among Africans (1.43%), followed by Turks (1.04%), subjects from the Middle East (0.62%), Yugoslavia (0.55%), Portugal and Spain (0.14%). Mass miniature X-ray screening for TB in immigrants from high prevalence countries entering Switzerland still detects a majority of asymptomatic cases and seems an easy means of preventing the transmission of TB to members of the same community.

Emigration and Immigration↗

The use of forensic botany and geology in war crimes investigations in NE Bosnia.

From 1997 to 2002 the United Nations International Criminal Tribune for the former Yugoslavia (ICTY) undertook the exhumation of mass graves in NE Bosnia as part of the war crimes investigations aimed at providing evidence for the prosecution of war criminals in The Hague. This involved the location and exhumation of seven former mass graves (primary sites) dug following the fall of Srebrenica in July 1995. These primary mass graves were secretly and hurriedly exhumed three months later and most of the bodies or body parts transported and reburied in a large number of secondary sites many of which were subsequently exhumed by ICTY. The aim of the pollen and soil/sediment studies was to provide an 'environmental profile' of the original site of the samples and use this to match the relocated bodies to the original mass graves. This was part of completing the chain of evidence, providing evidence of the scale and organization of the original atrocities and the subsequent attempts to conceal the evidence related to them. All the primary sites were located in areas of contrasting geology, soils and vegetation, and this allowed matching of the sediment transported in intimate contact with the bodies to the original burial sites, which in some cases were also the execution sites. In all, over 24 sites were investigated, over 240 samples collected and analyzed under low power microscopy and 65 pollen sub-samples fully analyzed. The pollen and sediment descriptions were used in conjunction with the mineralogy (using XRD) of primary and secondary sites in order to provide matches. These matches were then compared with matching evidence from ballistic studies and clothing. The evidence has been used in court and is now in the public domain. It is believed this is the first time 'environmental profiling' techniques have been used in a systematic manner in a war crimes investigation.

Bosnia and Herzegovina↗

Determination of depleted uranium in environmental samples by gamma-spectroscopic techniques.

The military use of depleted uranium initiated the need for an efficient and reliable method to detect and quantify DU contamination in environmental samples. This paper presents such a method, based on the gamma spectroscopic determination of 238U and 235U. The main advantage of this method is that it allows for a direct determination of the U isotope ratio, while requiring little sample preparation and being significantly less labor intensive than methods requiring radiochemical treatment. Furthermore, the fact that the sample preparation is not destructive greatly simplifies control of the quality of measurements. Low energy photons are utilized, using Ge detectors efficient in the low energy region and applying appropriate corrections for self-absorption. Uranium-235 in particular is determined directly from its 185.72 keV photons, after analyzing the 235U-226Ra multiplet. The method presented is applied to soil samples originating from two different target sites, in Southern Yugoslavia and Montenegro. The analysis results are discussed in relation to the natural radioactivity content of the soil at the sampling sites. A mapping algorithm is applied to examine the spatial variability of the DU contamination.

Algorithms↗

Ethnic differences in social participation and social capital in Malmö, Sweden: a population-based study.

The aim of this study was to investigate ethnic differences in different aspects of social participation in Malmö, Sweden. The public health survey in Malmö 1994 is a cross-sectional study. A total of 5600 randomly chosen individuals aged 20-80 years were asked to complete a postal questionnaire. The participation rate was 71%. The population was divided into categories born in Sweden, Denmark/Norway, other Western countries, former Yugoslavia, Poland, Arabic speaking countries and all other countries. The age-adjusted and multivariate analyses were performed using a logistic regression model in order to investigate the importance of possible confounders (age, education, economic stress and unemployment) on the differences by country of origin in different aspects of social participation. Men and women born in Arabic speaking countries and other countries (Iran, Turkey, Vietnam, Chile and subsaharan Africa) participate to a significantly lower extent in a variety of civic and social activities when compared to the reference population born in Sweden. The differences in participation in these groups compared to the group born in Sweden are observed both for social participation items at the core of the definition of social capital and cultural and other activities unrelated to social capital. This pattern is particularly pronounced for women born in Arabic speaking countries. These women even sharply differ from the participation rates of men born in Arabic speaking countries. The ethnic differences in most cases do not seem to be explained satisfactorily by education, economic stress or possibly unemployment.

Adult↗

Disability pension among immigrants in Sweden.

Using large samples, disability pensions among foreign-born and native-born women and men living in Sweden is studied here for the period 1981-1999. The results show foreign-born individuals having higher rates of disability pension. The risk of being on disability pension is very low for newly arrived immigrants, but increases rapidly on a yearly basis after immigration. Higher rates of disability pension are reported for persons born in Greece, Yugoslavia, Turkey and Finland. Results from multivariate analysis indicate that factors such as education, country of residence and marital status cannot fully explain the high rates of disability pension observed among many immigrant groups. Future research needs to address which possible causes are most important for policies to address.

Persons with Disabilities↗

Interaction of some metals between marine-origin humic acids and aqueous solutions.

The interaction of metal ions (carrier-free form) in aquatic medium with humic acids is a complicated process depending on the properties of humic acids (elementary, chemical, and trace element composition), metals studied (valence, charge, chemical form, concentration), and medium used (pH, ionic strength). The use of radionuclides was found to be very suitable for a rapid and precise determination of the distribution coefficient Kd (ratio of the concentration of a certain trace metal association with a gram of humic acid over the concentration of the same trace metal per milliliter of solution) of the investigated system. Isolated humic acids from offshore sediments from the North Adriatic (Lim channel, near Rovinj, Yugoslavia) were characterized according to their elementary composition, the amount of products of hydrolysis, and the trace elements bound. All experiments were carried out between pH 3 and 5. It was found that conditions usually present at the site where humic acid interacts with metal ions (anaerobic conditions, H2S) in brackish (21% S) and standard seawater (38% S) are determined in the pH range 3 to 5. The results of the pick-up (uptake) and replacement (release) experiments are presented as a distribution coefficient (Kd), as a function of contact time. Processes of pick-up and replacement of a number of metals under various physicochemical conditions were investigated and special attention was paid to the influence of salinity. With the increase in NaCl concentration and pH in the system, the fixation of ruthenium, zinc, cobalt, and mercury by humic acids decreased. The liberation and fixation of metal ions along the coastal seawater are important for the marine ecosystem.

Chemical Phenomena↗

Independent effects of lead exposure and iron deficiency anemia on developmental outcome at age 2 years.

For a prospective study of lead exposure, iron status, and infant development, we recruited infants living in a smelter town and a non-lead-exposed town in Kosovo, Yugoslavia. Among 392 infants assessed at age 2 years, the mean Mental Development Index (MDI), Bayley Scales of Infant Development, was 105.2. At age 2 years, geometric mean blood lead concentrations were 35.5 and 8.4 micrograms/dl, respectively, among infants from the exposed and nonexposed towns. After controlling for variables associated with MDI, we found significant independent associations for both blood lead and hemoglobin concentrations. For example, a rise in blood lead concentration at age 2 years from 10 to 30 micrograms/dl was associated with an estimated 2.5 point decrement in MDI (p = 0.03); statistically nonsignificant decrements were associated with blood lead levels measured at birth and at 6, 12, and 18 months of age. A decrease in hemoglobin concentration at 18 months of age from 12 to 10 gm/dl was associated with an estimated 3.4 point decrement in MDI (p = 0.02); the latter association was present in both towns, suggesting that it was due to iron deficiency anemia independent of lead exposure. The findings suggest that the brain is vulnerable to the effects of both lead exposure and anemia before 2 years of age. On a global basis, the developmental consequences of anemia may exceed those of lead exposure.

Anemia, Hypochromic↗

Rationality/antiemotionality personality and selected chronic diseases in a community population in Japan.

OBJECTIVE: To clarify the relationships of the rationality/antiemotionality (R/A) personality with past histories of seven chronic diseases and current smoking habits in a community population in Japan. METHODS: A questionnaire survey was conducted of all residents aged 35 years old or over (n = 37,287) in Takayama city, Gifu prefecture, Japan; the response rate was 90.3%. Data from 13,091 males and 14,061 females who completed all relevant questions were analyzed. The subjects were asked to complete an 11-item R/A personality scale developed by Grossarth-Maticek et al. (1985). Past histories of seven major chronic diseases and current smoking habit were also asked in the questionnaire. RESULTS: Among males, the R/A scale score was significantly lower in those who had stroke, diabetes or allergy than in those who did not. Among females, the R/A scale score was significantly lower in those who had stroke, allergy or stomach cancer than in those who did not. Among females, current smokers had significantly lower R/A scores than non-smokers. After controlling for age, smoking and drinking, the R/A score was significantly and negatively associated with stroke among males and females; it was significantly and negatively associated with diabetes and allergy among males. CONCLUSION: Our findings are contrary to those observed in Yugoslavia and West Germany, and suggest a cultural difference in the relationship between the R/A personality and disease occurrence.

Adult↗

Effects of coagulation processes on aldehydes formation in groundwater treated with common oxidative agents.

This work is concerned with the effects of coagulation processes with two different coagulants (polyaluminum chloride (PACl) and Al2(SO4)3) on aldehydes formation during oxidation with common oxidants (ozone, chlorine and chlorine dioxide) in a particular groundwater source in Northern Banat region, Yugoslavia. Aldehydes concentrations in coagulated water were lower than in raw water. In contrast, obtained results showed that specific contents of these disinfection byproducts (microg mg(-1) TOC) showed an increase after coagulation processes in a number of samples. Results indicate that the choice of the coagulant-oxidant combination may be important as well as the type of filtration bed, retention time, and filter washing regime in the removal of aldehydes from water.

Aldehydes↗

Superoxide dismutase biosynthesis by two thermophilic bacteria.

Some high-molecular weight antioxidant defense system components of two thermophilic bacteria isolated from spa waters of Serbia (Yugoslavia) and identified as Bacillus stearothermophilus and Thermothrix sp. were studied. In addition to superoxide dismutase (SOD; EC 1.15.1.1), qualitative analyses demonstrated the presence of catalase (EC 1.11.1.6), peroxidases and oxidases in both bacterial strains. Cell-free extracts were subjected to nondenaturing polyacrylamide gel electrophoresis (PAGE) and SOD activity in the eluates of the corresponding bands was examined in the presence of several specific inhibitors. A slight decrease of SOD activity observed in the presence of 0.3 M potassium cyanide and its complete insensitivity to hydrogen peroxide (5 mM) and sodium azide (20 mM) action suggest that the enzyme occurring in the two thermophiles represents Mn SOD. A high SOD activity recorded in cell-free extracts strongly recommends these two bacterial strains as potential producers of this important antioxidant defense system component at industrial scale.

Journal Article↗

Dobrava virus infection: serological diagnosis and cross-reactions to other hantaviruses.

Recent data have shown that Dobrava (DOB) hantavirus is the cause of severe haemorrhagic fever with renal syndrome (HFRS) in central and eastern Europe. To determine whether serological assays need to be based on the homologous viral antigen rather than on closely related hantavirus antigens, acute and convalescent sera from patients with HFRS collected in former Yugoslavia were examined for IgM and IgG to three hantavirus antigens; DOB, Hantaan (HTN) and Puumala (PUU). Focus reduction neutralization test was included for comparison and confirmation of the enzyme-linked immunosorbent assay (ELISA) results. Although the results showed that the cross-reactivity was high between these three antigens during the acute phase of the disease, one of 155 patients serum samples reacted only in the DOB antigen-based IgM assay. The evaluation of IgG reactivities revealed that a DOB antigen-based IgG ELISA has to be used in sero-epidemiological studies; 7.1% (11/155) of the acute phase/early convalescent sera and 12.5% (2/16) of the late convalescent sera, respectively, reacted only with the homologous DOB antigen.

Convalescence↗

ESTRO Breur Gold Medal Award Lecture 2001: irradiation accidents-- lessons for oncology?

Considering the number of radioactive sources in use all over the world (both in industry and medicine) irradiation accidents are exceedingly rare, as demonstrated by the main databases registering such cases: UNSCEAR, IAEA, REAC/TS (Oak Ridge, USA), the German group in Ulm and the Paris Institut Curie. The precise causes of most accidents have been openly analyzed, allowing to reduce the risk of subsequent identical accidental exposures. In addition, a rapid retrospective overview shows that positive lessons could be drawn from such accidents: 1)Lessons for patient management: one should keep in mind that the first ever allogeneic bone marrow transplantations were performed in 1958, on scientists from Yugoslavia who had been severely irradiated in a nuclear Research laboratory. Apart from what was learned from such accidents for the management of severe aplasia, the treatment of superficial accidental exposures has also benefited radiotherapy patients in certain specific situations. 2) Lessons for technology: the efforts to improve safety in nuclear plants are well known; the (successful) efforts to reduce the once-elevated risks when changing the therapeutic Cobalt 60 sources are less well known. Today, most irradiation accidents (by far) are related to misuse or loss of radioactive sources from industrial radiography sets. However, here again, various technological improvements significantly reduced the risks. 3) Lessons for radiobiology: the need for more and more sophisticated biological dosimetry has led to studies allowing better understanding of the short- and long-term effects of radiation on human cells. Analyses of samples taken in areas which were heavily accidentally irradiated also helped to identify, in particular, the cardinal role of TGF beta and TNF alpha in the development of fibrosis and necrosis after irradiation. 4) Lessons for prevention of accidents in radiotherapy: only three large-scale accidents involving external radiotherapy have been registered in the last decade, but deciphering the cause(s) of such problems clearly participated in the setting of demanding Quality Assurance programmes and strict national and international recommendations. Such open circulation of the information about these (fortunately rare) accidents appears to be one of the ways to improve Quality Assurance in Radiotherapy.

Humans↗