ObjectivesThe C282Y allele is the major cause of hemochromatosis as a result of excessive iron absorption. The mutation arose in continental Europe no earlier than 6,000 years ago, coinciding with the arrival of the Neolithic agricultural revolution. Here we hypothesize that this new Neolithic diet, which originated in the sunny warm and dry climates of the Middle East, was carried by migrating farmers into the chilly and damp environments of Europe where iron is a critical micronutrient for effective thermoregulation. We argue that the C282Y allele was an adaptation to this novel environment.Materials and MethodsTo address our hypothesis, we compiled C282Y allele frequencies, known Neolithic sites in Europe and climatic data on temperature and rainfall for statistical analysis.ResultsOur findings indicate that the geographic cline for C282Y frequency in Europe increases as average temperatures decrease below 16°C, a critical threshold for thermoregulation, with rainy days intensifying the trend.DiscussionThe results indicate that the deleterious C282Y allele, responsible for most cases of hemochromatosis, may have evolved as a selective advantage to culture and climate during the European Neolithic. Am J Phys Anthropol 160:86–101, 2016. © 2016 The Authors American Journal of Physical Anthropology Published by Wiley Periodicals, Inc.
Acute renal disease is common in sub-Saharan Africa, with high mortality. Its etiology is poorly understood; quartan malaria owing to Plasmodium malariae was implicated in previous series. Few previous studies have included histological data; furthermore, much of the literature pre-dates the human immunodeficiency virus (HIV) epidemic. We report prospective analysis of acute proteinuric renal disease in children in rural Uganda. Clinical and laboratory data are presented on 65 patients (aged 2-14 years, mean 8.4; 35 male, 30 female) in 41 of whom histological diagnosis was obtained by renal biopsy. The most frequent histological finding was endocapillary proliferative glomerulonephritis (GN) in 27/41 cases, in 20 of which eosinophils were very prominent. No cases showed features of HIV nephropathy. Malarial films were positive in 11 cases: all owing to Plasmodium falciparum. Patients were treated with diuretics, antihypertensives, and supportive measures. Corticosteroids were rarely used, being reserved for patients with minimal changes on renal biopsy. Clinical outcomes were fair: 91% of patients survived to discharge. We conclude that acute GN is common in children in Uganda, that an unusual eosinophilic proliferative GN is the most frequent histological finding, that HIV is not implicated as an important factor in this age group, and that good outcomes can be achieved using simple clinical and laboratory diagnostic methods. Renal biopsy in selected cases is feasible and helpful, especially in allowing rational use of corticosteroids and other potentially toxic treatments. Symptomatic treatments and careful supportive care will allow the majority of children to recover.
Summary The case histories of four children and two adults who were accidentally given toxic amounts of Merthiolate are recorded. The possible modes of action of Merthiolate in causing symptoms are discussed. Five out of the six patients died, and necropsy showed extensive renal tubular necrosis in each case, and in two, evidence of diffuse intravascular coagulation.
Alcoholism is now not usually associated with nutritional deficiency,' but when it occurs, inadequate vitamin B, in the diet may lead to heart failure. In this condition (wet beriberi) there is fluid retention and cardiac dilatation in a high output state. The following report is of one of two cases of wet beriberi seen in six months in a small catchment area.Case Report A retired bricklayer aged 65 was referred for psychiatric treatment after his second admission to a surgical ward with ascites and gross oedema of both legs. The third night after admission he became confused and aggressive and signed himself out, only to be readmitted within a week with an identical picture; on the second night he was again confused and aggressive.He gave a history of severe chronic abuse of alcohol and a prolonged inadequate diet. Drinking had occurred up to and between admissions and periods of confusion had occurred at home over six months. He had had amnesias for years but never delirium tremens or fits. All other aspects of the history were regarded as insignificant. Crepitations were heard at both bases of the lungs, and nothing abnormal was found on extensive and sophisticated investigations except an increase in heart size with congestion of both lungs in the presence of repeatedly normal electrocardiograms (E.C.G.s). Psychiatric opinion was sought before laparotomy. The patient was very flushed with a dry hot skin and the blood pressure was 160/90 mm Hg. There was no tremor or anxiety. He seemed calm but fatuous and he confabulated, showed a total loss of secondary memory, and was disorientated for date but not for person and place. There was no thought disorder. He showed the mental symptoms combined with a high output cardiac failure described in the unitary diagnosis of wet beriberi (see table).2
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