Population frequencies of inherited neuromuscular diseases—A world survey

Mycotoxicoses are diseases caused by mycotoxins, i.e. secondary metabolites of moulds. Although they occur more frequently in areas with a hot and humid climate, favourable for the growth of moulds, they can also be found in temperate zones. Exposure to mycotoxins is mostly by ingestion, but also occurs by the dermal and inhalation routes. Mycotoxicoses often remain unrecognized by medical professionals, except when large numbers of people are involved. The present article reviews outbreaks of mycotoxicoses where the mycotoxic etiology of the disease is supported by mycotoxin analysis or identification of mycotoxin-producing fungi. Epidemiological, clinical and histological findings (when available) in outbreaks of mycotoxicoses resulting from exposure to aflatoxins, ergot, trichothecenes, ochratoxins, 3-nitropropionic acid, zearalenone and fumonisins are discussed.

Toxic effects of mycotoxins in humans.

This book marks the first step in a new review of health policy - a review that focuses specifically on sub - Saharan Africa. Several factors make this exercise particularly timely: 1) the concern that the economic downturn of the early 1980s may have adversely affected the health sector in Africa; 2) the need to evaluate the impact of primary health care strategies, especially the key elements of immunization and oral rehydration; 3) the completion of a substantial body of epidemiological and demographic analyses, which provides a much improved empirical basis for assessing health conditions and recent health trends; 4) the concern that the global emergence of Acquired Immune Deficiency Syndrome (AIDS) and its sharp impact in selected African foci have undermined development prospects in some countries; and 5) the potential value of explicitly seeking lessons from the Bank's experience with health sector operations in Africa. The chapters in this book were commissioned to address the third point - to assemble in one place lessons from the analyses of the epidemiological and demographic conditions that define the problems facing Africa's health systems. This book sets an important part of the agenda of work for African health officials over the next decade.

Disease and Mortality in Sub-Saharan Africa

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(10)60550-8.pdf

Diabetes in sub-Saharan Africa

Aflatoxins are dietary contaminants that are hepatocarcinogenic and immunotoxic and cause growth retardation in animals, but there is little evidence concerning the latter two parameters in exposed human populations. Aflatoxin exposure of West African children is known to be high, so we conducted a longitudinal study over an 8-month period in Benin to assess the effects of exposure on growth. Two hundred children 16-37 months of age were recruited from four villages, two with high and two with low aflatoxin exposure (50 children per village). Serum aflatoxin-albumin (AF-alb) adducts, anthropometric parameters, information on food consumption, and various demographic data were measured at recruitment (February) and at two subsequent time points (June and October). Plasma levels of vitamin A and zinc were also measured. AF-alb adducts increased markedly between February and October in three of the four villages, with the largest increases in the villages with higher exposures. Children who were fully weaned at recruitment had higher AF-alb than did those still partially breast-fed (p < 0.0001); the major weaning food was a maize-based porridge. There was no association between AF-alb and micronutrient levels, suggesting that aflatoxin exposure was not accompanied by a general nutritional deficiency. There was, however, a strong negative correlation (p < 0.0001) between AF-alb and height increase over the 8-month follow-up after adjustment for age, sex, height at recruitment, socioeconomic status, village, and weaning status; the highest quartile of AF-alb was associated with a mean 1.7 cm reduction in growth over 8 months compared with the lowest quartile. This study emphasizes the association between aflatoxin and stunting, although the underlying mechanisms remain unclear. Aflatoxin exposure during the weaning period may be critical in terms of adverse health effects in West African children, and intervention measures to reduce exposure merit investigation.

Postweaning exposure to aflatoxin results in impaired child growth: a longitudinal study in Benin, West Africa.

Blood and urine samples from 252 Sudanese children were investigated for their aflatoxin content by high-performance liquid chromatography. The children comprised 44 with kwashiorkor, 32 with marasmic kwashiorkor, 70 with marasmus, and 106 age-matched, normally nourished controls. Aflatoxins were detected more often and at higher concentrations in sera from children with kwashiorkor than in the other malnourished and control groups. Aflatoxicol, a metabolite of aflatoxins B1 and B2, was detected in the sera of children with kwashiorkor and marasmic kwashiorkor but not in the controls and only once in a marasmic child. The difference between children with kwashiorkor or marasmic kwashiorkor and those in the control or marasmus groups was significant. Urinary aflatoxin was most often detected in children with kwashiorkor but their mean concentration was lower than in the other groups. Aflatoxicol was not detected in urine in any group. These findings suggest either that the children with kwashiorkor have a greater exposure to aflatoxins or that their ability to transport and excrete aflatoxins is impaired by the metabolic derangements associated with kwashiorkor. The presence of aflatoxicol in the sera of children with kwashiorkor but not in the others suggests a difference in metabolism between the two groups. Further studies are needed, and measurement of aflatoxins in the food eaten by these children is already underway.

https://www.bmj.com/content/bmj/285/6345/843.full.pdf

Aflatoxins and kwashiorkor: a study in Sudanese children.

Breast milk from 99 Sudanese mothers was analysed for aflatoxins. Aflatoxins M1 and/or M2 were detected in 37 of the milks. No other aflatoxin was detected. M1 occurred alone in 13 milks, (mean 19.0 pg/ml), M2 in 11 milks (mean 12.2 pg/ml), and in 13 samples both M1 and M2 were detected. There appeared to be a linear relationship between M1 and M2 where both were excreted. No aflatoxin was detected in subcutaneous abdominal wall fat removed during Caesarian section from 15 women, but was present in three out of 14 bloods taken during anaesthesia. The presence of aflatoxins in mothers' milk showed no correlation with duration of lactation, the infants' nutrition, presence of aflatoxin in mothers' blood, or the infant's blood and urine. It is concluded that some Sudanese women excrete aflatoxins in breast-milk at levels similar to or higher than those considered safe in animal milk, for human consumption.

Aflatoxins in human breast milk.

OBJECTIVE To determine the incidence of type I diabetes in children 0–14 yr of age in Khartoum, Sudan.

RESEARCH DESIGN AND METHODS Prospective registration of newly diagnosed patients in a hospital-based registry with independent validation of completeness of case ascertainment. Eligible patients were Sudanese children < 15 yr of age, who developed type I diabetes during the period 1 January 1987 through 31 December 1990, and who were living in Khartoum city at the time of diagnosis. The denominator is the stable childhood population of Khartoum city, as estimated by the National Bureau of Statistics.

RESULTS In 4 yr, 239 cases were notified in the primary source and 268 in the secondary source. Some 196 patients were registered in both sources. Using the capture-recapture method to correct for underascertainment, the estimated total number of cases was 327, and the overall degree of ascertainment was 95%. The incidence of type I diabetes in children 0–14 yr of age increased from 5.9/105) in 1987 to 10.1/105) in 1990 ( P < 0.001). Girls exhibited slightly higher incidence rates than boys in the 10–14-yr age-group throughout the 4 yr, but the differences were not statistically significant. The age distribution at onset was bimodal with a clear peak at age 12 yr in girls and age 14 yr in boys and another smaller peak at age 7 yr in both sexes. The number of new cases was markedly higher in the cooler months of the year, with a peak in January and a nadir in June ( P < 0.01). This trend was consistent over the period of observation.

CONCLUSIONS Childhood diabetes is increasing in Sudan. Our incidence figures are higher than those reported from other Arab countries and is similar to reports from France and Italy.

Epidemiology of Childhood Type I Diabetes in Sudan, 1987–1990

UMMARY
The clinical manifestations, biochemical, electrocardiographic, histological and histochemical features of a severe autosomal recessive muscular dystrophy (MD)-as seen in 15 members of a large Sudanese kindred, both male and female-are reported and discussed. The age of onset ranged from three to five years, the pattern of muscular weakness was similar to that of Duchenne MD and pseudohypertrophy was a remarkable feature. Both sexes became completely dependent by 16 years, and died at or before 20 years of age. The clinical picture in this family and the histological features are compared with those of Duchenne MD and with cases reported from Tunisia, Qatar and Libya. Certain clinical and histological features distinguish all of these types from each other and from the milder autosomal recessive MD of childhood which is more usual in the United Kingdom, Europe, Australia and North America.

RESUME
Myopathie grave a transmission recessive autosomale

Les manifestations cliniques, biochimiques, electrocardiographiques, histologiques et histochimiques d'une myopathie grave a transmission recessive autosomale observees dans une large fratrie soudanaise de 15 membres, filles et garcons, sont presentees et discutees. L'âge de debut a ete de trois a cinq ans, la distribution de la faiblesse musculaire tout a fait semblable a une myopathie de Duchenne et la pseudohypertrophie a ete un signe caracteristique. Les deux sexes devinrent completement dependants vers 16 ans et moururent tous a 20 ans ou plus tot. La description clinique dans cette famille et les donnees histologiques sont comparees a celles de la myopathie de Duchenne et aux cas rapportes en Tunisie, au Qatar et en Libye. Certaines caracteristiques cliniques et histologiques distinguent ces cas les uns des autres et de ceux de la myopathie infantile moins grave, a transmission recessive autosomale, qui est plus habituellement observee au Royaume Uni, en Europe, en Australie et en Amerique du Nord.

ZUSAMMENFASSUNG
Schwere autosomal rezessive Muskeldystrophie

Die klinischen Befunde und die biochemischen, elektrokardiographischen, histologischen Merkmale einer schweren autosomal rezessiven Muskeldystrophie (MD)-wie sie bei 15 Mitgliedern einer grosen sudanesischen Verwandtschaft erhoben wurden-werden dargestellt und diskutiert. Die Krankheit begann im Alter von drei bis funf Jahren, die Muskelschwache war ahnlich wie bei der MD Duchenne und die Pseudohypertrophie war ein auffalliges Merkmal. Beide Geschlechter wurden bis zum 16ten Lebensjahr vollkommen pflegebedurftig und starben im oder vor dem Alter von 20 Jahren. Das klinische Bild bei dieser Familie und die histoloischen Befunde werden verglichen mit denen bei der MD Duchenne und bei Fallen aus Tunesien, Qatar und Libyen. Bestimmte klinische und histologische Merkmale unterscheiden alle diese Formen voneinander und von der milderen autosomal rezessiven MD des Kindersalters, die im Vereinigten Konigreich, Europa, Australien und Nord Amerika haufiger ist.

Severe autosomal recessive muscular dystrophy in an extended Sudanese kindred.

Conventional flood lubrication techniques have serious impacts on the environment, health, and economy. Thus, the implementation of advanced lubrication techniques such as minimum quantity lubrication (MQL) has gained attraction worldwide as a reliable alternative to flood lubrication due to its effectiveness and eco-friendly characteristics. In order to increase the efficiency of MQL, nanoparticles have recently been added to the base fluids to improve the performance of lubrication thanks to their thermo-physical properties. In this work, an eco-friendly vegetable oil called rice bran oil (RBO) was used as a lubrication fluid with and without the addition of zinc oxide (ZnO) nanoparticles in order to investigate their influence on the turning performance characteristics, in terms of cutting force, surface roughness, flank wear and cutting temperature, during hard turning of AISI D3 steel. Taguchi L16 orthogonal array was implemented to investigate the effect of turning parameters including cutting speed, feed rate, and depth of cut on the response variables. The results showed that ZnO nanoparticles-enriched base fluid gives better performance than machining with a pure oil in terms of mitigating the severity of cutting force by about 10.68–18.48%, reducing tool wear by about 9.33–51.96%, and reducing the roughness of the machined surface by 3.86–12.84%. 

M. I. A. Omer

Papers

Aflatoxins and kwashiorkor: a study in Sudanese children.

Aflatoxins in human breast milk.

Epidemiology of Childhood Type I Diabetes in Sudan, 1987–1990

Severe autosomal recessive muscular dystrophy in an extended Sudanese kindred.

Evaluating the effect of minimum quantity lubrication during hard turning of AISI D3 steel using vegetable oil enriched with nano-additives