Validation of an Arabic multi-informant psychiatric diagnostic interview for children and adolescents: Development and Well Being Assessment-Arabic (DAWBA-Arabic)

Background

Countries in the Arab region lack a valid Arabic psychiatric diagnostic interview for children and adolescents. We set out to establish the diagnostic validity of the Arabic version of the Development and Well Being Assessment (DAWBA-Arabic), a multi-informant structured interview for predicting DSM-IV-TR diagnoses.

Methods

The DAWBA was translated, updated, and administered to 45 participants (child and adolescent psychiatric outpatients and their parents) as part of a clinic registry. Two clinicians, blinded to their respective diagnoses, formulated the DAWBA diagnoses. Participants also underwent a clinical evaluation by a child and adolescent psychiatrist who generated clinical diagnoses according to the DSM-IV-TR.

Results

Inter-rater reliabilities were .93, .82, and .72 for disruptive disorders, mood disorders and anxiety disorders respectively. Agreement between DAWBA and clinical diagnoses was substantial for disruptive disorders (κ = .0.82) and mood disorders (κ = 0.74), and moderate for anxiety disorders (κ = 0.46).

Conclusion

The DAWBA-Arabic could serve as a valid and reliable clinical tool for assessing psychiatric disorders among children and adolescents in the Arab region.     

Population pharmacokinetic model for human growth hormone in adult patients in chronic dialysis compared with healthy subjects

ObjectiveTo develop a population pharmacokinetic (PK) model of recombinant human growth hormone (rhGH) treatment in patients with end-stage renal disease (ESRD) and healthy volunteers (HVs), to support future study design.DesignThis was an open, non-randomized, single-centre parallel-group study lasting 8–9 days. Various compartment models with first-order and Michaëlis-Menten absorption and elimination were explored. Eleven adult ESRD patients and 10 matched HVs received 50 μg/kg/day rhGH (subcutaneous (s.c.) injection) for 8 or 7 days, respectively. Blood samples were drawn every 30 min for 24 h following dosing on Days 0, 7 and 8 (ESRD patients). Influence of the covariates subject group (ESRD/HV), gender, weight, and dialysis flow-rate on model parameters was examined.ResultsThe final model was one-compartmental with Michaëlis-Menten absorption and elimination. The following estimates were obtained: maximum absorption rate (VMA) – 11.3 μg/kg/h (both groups); amount of drug corresponding to half-maximum absorption rate (KMA) – 1.06 and 18.8 μg/kg (ESRD patients and HVs, respectively; P < 0.001); maximum elimination rate (VM) – 9.37 and 13.0 μg/kg/h (ESRD patients and HVs, respectively; P < 0.001); amount of drug corresponding to half-maximum elimination rate – 18.9 μg/kg (both groups). Significant differences in KMA and VM between HVs and ESRD patients corresponded to higher absorption and lower elimination rates in ESRD, but all GH profiles were back to baseline by 20–22 h and no overall accumulation occurred. Simplified posterior predictive checks indicated that the model satisfactorily captured PK. All non-compartmental estimates for AUC_0–24h and C_max lay within 95% confidence limits of the simulated distributions.ConclusionsA population PK model was established, which showed acceptable performance for trial-simulation purposes.     

Recurrent Ischemic Stroke – A Systematic Review and Meta-Analysis

ObjectivesRecurrent stroke remains a challenge though secondary prevention is initiated immediately post-stroke. Stroke subtype may determine the risk of recurrent stroke and require specific preventive measures. We aimed to identify subtype-specific stroke recurrence and associated risk factors over time.Methods and materialsA systematic review was performed using PubMed and Embase for studies including adults >18 years, first-ever ischemic stroke in population-based observational studies or registries, documented TOAST-criteria and minimum 1-year follow-up. Meta-analysis on stroke recurrence rate was performed. Final search: November 2019.ResultsThe search retrieved 26 studies (between 1997 and 2019). Stroke recurrence rate ranged from 5.7% to 51.3%. Recurrent stroke was most frequent in large artery atherosclerosis (LAA) and cardioembolic (CE) stroke with recurrent stroke similar to index stroke subtype. We identified a lower recurrence rate for small vessel occlusion (SVO) stroke with recurrence frequently of another stroke subtype. Based on a meta-analysis the summary proportion recurrence rate of recurrent stroke in studies using TOAST-criteria = 0.12 and = 0.14 in studies using TOAST-like criteria. Hypertension, diabetes mellitus, atrial fibrillation previous transient ischemic attack, and high stroke severity were independent risk factors for recurrence.ConclusionStroke recurrence rates seem unchanged over time despite the use of secondary prevention. The highest recurrence rate is in LAA and CE stroke eliciting same subtype recurrent stroke. A lower recurrence rate is seen with SVO stroke with a more diverse recurrence pattern. Extensive workup is important in all stroke subtypes - including SVO stroke. Future research needs to identify better preventive treatment and improve compliance to risk factor prevention to reduce stroke recurrence.     

Peripheral blood regulatory T cell measurements correlate with serum vitamin D levels in patients with multiple sclerosis

Vitamin D has been associated with a decreased risk of multiple sclerosis (MS). In this study, serum 1, 25-dihydroxyvitamin D (1, 25-(OH)2 vitD) and 25-hydroxyvitamin D (25-OH vitD), regulatory T cell percentages and naïve and memory T helper cell subsets were measured in 26 patients with multiple sclerosis, 21 who were not on treatment with disease modifying therapy. These studies showed an inverse correlation between 25-OH vitD levels and Treg cell percentages and a direct correlation between Treg cell percentages and 1, 25-(OH)2 vitD:25-OH vitD ratios. In addition, 25-OH vitD levels correlated directly and 1, 25-(OH)2 vitD:25-OH vitD ratios correlated inversely with CXCR3+ naïve T helper cell percentages and CXCR3+naïve:CXCR3+ memory T helper cell ratios. All together, these data demonstrate that vitamin D measurements can reflect measures of immune status among patients with MS.     

A Haemolytic Transfusion Reaction without Demonstrable Antibodies in Vitro

A severe haemolytic reaction after transfusion of apparently compatible blood was observed, without isoantibodies being detectable in the patient's serum.
From survival studies with Wr tagged red cells could be concluded that the abnormal destruction of the transfused red cells is of immunological origin.

Résumé

Une réaction hémolytique grave après transfusion de sang apparemment compatible a été observée, sans que l'on puisse mettre en évidence des iso-anticorps dans le sérum du patient.
Des étudev pratiquées avec des érythrocytes marqués au ⁵¹Cr, on peut conclure que la destruction anormale des érythrocytes transfusés a une origine immunologique.

Zusammenfassung

EB wird eine schwere hämolytische Transfusionsreaktion beschrieben, bei welcher im Empfängerserum Isoantikörper nicht nachgewiesen werden konnten. Auf Grund von Überlebenszeitbestimmungen mit ⁵¹Cr markierten Zellen wurde gescblossen, daß der rasche Abbau der Spendersellen trotzdem auf eincm Immunmechanismus beruht.