Prevalence of depression in rural Rwanda based on symptom and functional criteria

The authors' objective was to estimate the prevalence of major depressive disorder among Rwandans 5 years after the 1994 genocidal civil war. They interviewed a community-based random sample of adults in a rural part of Rwanda using the Hopkins Symptom Checklist and a locally developed functional impairment instrument. The authors estimated current rates of major depression using an algorithm based on the DSM-IV symptom criteria (A), distress/functional impairment criteria (C), and bereavement exclusionary criteria (E). They also examined the degree to which depressive symptoms compromise social and occupational functioning. Three hundred sixty-eight adults were interviewed, of whom 15.5% met Criteria A, C, and E for current major depression. Depressive symptoms were strongly associated with functional impairment in most major roles for men and women. The authors conclude that a significant part of this population has seriously disabling depression. Work on appropriate, feasible, safe, and effective mental health interventions should be a priority for this population.     

A Family Study of Autism: Cognitive Patterns and Levels in Parents and Siblings

First-degree relatives of 99 autism probands and of 36 Down's syndrome controls were assessed with standardised tests of intellectual functioning, reading, and spelling. Higher mean verbal IQ scores, and discrepancies in favour of verbal scores, were characteristic of autism relatives. No consistent differences were found on performance scales, reading, and spelling tests. Among autism relatives, siblings affected with the broad phenotype of autism had significantly lower IQ scores and poorer reading and spelling performances than unaffected siblings. However, the small size of the cognitive difference and the lack of a distinctive cognitive profile indicates that standardised cognitive measures used in this study are unlikely to improve the operationalised definition of the broad phenotype of autism. The slightly superior verbal performance of relatives in the autism group might represent some form of heterozygote advantage.     

Attenuation of LPS-induced changes in synaptic activity in rat hippocampus by Vasogen's Immune Modulation Therapy

Systemic injection of lipopolysaccharide (LPS) blocks the expression of long-term potentiation in the hippocampus of the rat. This is coupled with increased IL-1beta concentration and c-Jun NH(2)-terminal kinase activity, as well as an increase in the number of cells displaying apoptotic characteristics in the hippocampus. Vasogen's Immune Modulation Therapy (IMT) is a procedure involving intramuscular administration of syngeneic blood which has been exposed ex vivo to elevated temperature, oxidation and ultraviolet light. We report that Vasogen's IMT significantly abrogates these LPS-induced effects with a concomitant increase in the concentration of the anti-inflammatory cytokine IL-10. These data suggest that Vasogen's IMT may play a protective role against the deleterious effects of immune insults in the brain.     

A critical appraisal of treatment for T3N0 colon cancer

The purpose of this study was to evaluate the impact of adjuvant chemotherapy on survival after surgery for T3N0 colon cancer. All patients with node-negative (N0) colon cancer with tumor invasion beyond the muscularis propria (T3) treated with colectomy between 1982 and 1995 at a single institution were included. Patients were divided into two groups depending on postcolectomy treatment with or without adjuvant chemotherapy. Groups were evaluated to determine perioperative and pathologic variables that could potentially influence outcome and surveillance data to determine disease-free and overall survival. In 253 patients with T3N0 colon cancer 226 remained under observation and 27 were treated with adjuvant chemotherapy. The groups were similar (P = not significant) when compared for tumor location, size, differentiation, number of nodes harvested, and transfusion requirements. Four of the 27 patients who received chemotherapy developed a recurrence (14.8%), whereas 22 of the 226 observation patients developed a recurrence (9.7%). Disease-free survival for the chemotherapy group at 5 years was 84 per cent and for the observation group 87 per cent. Statistical analysis (Mantel-Cox) showed no significant difference between the groups on the basis of survival (P = 0.3743). We conclude that resection alone is a highly effective treatment for T3N0 colon cancer leaving limited opportunity for adjuvant chemotherapy to significantly impact survival. Adjuvant chemotherapy for T3N0 colon cancer patients should be limited to patients enrolled in clinical trials designed to identify subgroups of T3N0 colon cancer patients at a survival disadvantage or less toxic adjuvant chemotherapies.     

Relation between pregnancy-associated plasma protein A (PAPP-A) in human peri-ovulatory follicle fluid and the collection and fertilization of human ova in vitro

In 42 patients, blood-free peri-ovulatory follicular fluid was aspirated from 86 follicles for estimation of pregnancy-associated plasma protein A (PAPP-A) and related to several variables associated with the fertilization of human ova in vitro. Follicle growth was stimulated by clomiphene citrate alone or in combination with human menopausal gonadotrophin (hMG) and ovulation was triggered by human chorionic gonadotrophin (hCG) except in six patients who had a spontaneous surge of luteinizing hormone (LH). PAPP-A was detected in 83 of the 86 follicles aspirated, ranging from 'undetectable' to 1044 micrograms/l. The concentration of PAPP-A was statistically significantly correlated with increasing follicle size, follicular oestradiol-17 beta concentration and oocyte recovery. At PAPP-A concentrations of greater than 200 micrograms/l, there was no correlation noted with the ability of the ovum to be fertilized, to cleave, or between PAPP-A levels in follicles from pregnant and non-pregnant cycles. There was no significant difference in the mean PAPP-A concentration for the two stimulation regimens, but concentrations were greater in follicular fluid from patients who surged spontaneously (P less than 0.001). It appears PAPP-A levels may provide an index of follicle maturity but not of the pregnancy potential of the ovum.     

The development and validation of a radioimmunoassay for human pregnancy-associated plasma protein A (PAPP-A)

A specific and sensitive radioimmunoassay for human pregnancy-associated plasma protein A (PAPP-A) is described. This assay utilized tracer repurified by affinity chromatography on heparin-Sepharose. The most sensitive assay developed had a detection limit of 5 microliters PAPP-A in serum, and this protein could not be detected in sera from non-pregnant subjects. During pregnancy, mean circulating levels rose from 0.6 mg/l at 6 weeks gestation to 110 mg/l at term, and PAPP-A was detected in 44 of 101 umbilical blood samples. The use of the anticoagulants EDTA and acid citrate dextrose resulted in significantly different results in the plasma compared to the corresponding serum sample. PAPP-A was also measured in amniotic fluid.     

Determination of pipothiazine in human plasma by reversed-phase high-performance liquid chromatography

A method is described for the determination of pipothiazine in human plasma, based on reversed-phase HPLC. The method has been applied in a pharmacokinetic study of pipothiazine in six psychiatric patients receiving repeated depot intramuscular injections for six months. A number of compounds likely to be taken concurrently by patients were tested for potential to interfere with the assay. There was no evidence of "dose-dumping" in the period following injection. Comparison of the pharmacokinetic profiles after the first and sixth injections showed no evidence of drug accumulation.     

Cognitive deficits in normally intelligent patients with tuberous sclerosis

Webb, Thomson, and Osborne [1991: Arch Dis Child 66:1375-1377] reported on the pattern of cerebral lesions found in an epidemiological sample of patients with tuberous sclerosis (TS) and clinically judged to be of normal intellect. Varying numbers of tubers and subependymal nodules were found, but clinically there appeared to be few associated neuropsychological impairments. Our objectives in this study were to conduct a detailed neuropsychological assessment to determine whether these patients were indeed free of cognitive deficits. We report the results of a detailed neuropsychological assessment in this sample and a matched comparison group. Although of average intelligence, most TS individuals had a significant cognitive deficit of one sort or another, and in a number of cases the pattern of cognitive impairments matched that seen in other neurological disorders. Additionally, the overall rate of cognitive deficits was significantly greater than in the controls. We conclude that normally intelligent individuals with TS are prone to specific cognitive difficulties. Further research will be required to clarify the nature of the links between the brain abnormalities and type of neuropsychological dysfunction. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 88:642-646, 1999.