Full recovery from schizophrenia: the prognostic role of premorbid adjustment, symptoms at first admission, precipitating events and gender

A number of long-term studies of course and outcome in schizophrenia report that about a fourth of the cases show good clinical and social recovery. However, very few studies have been carried out examining the main characteristics of schizophrenia patients who have fully recovered according to a strict definition of 'full recovery'. The purpose of the present study was, therefore, to compare a group of 17 fully recovered schizophrenia patients (Group A) with a group of 33 patients (Group B) with current symptoms of schizophrenia on several prognostic factors that have been associated with a good outcome. These clinical groups were matched groupwise with a similar mean on two variables: age range at onset of illness and age at time of interview. Duration of illness (length of time from age of onset of illness to time of assessment) was 22.4 years in group A and 21 years in group B. Mean GAS scores were 72.2 and 46.5, respectively. Positive symptoms (delusions and disorganized behavior) at admission predicted an unfavorable outcome. The results confirmed the prognostic significance of several clinical and demographic factors. However, a good premorbid adjustment did not show significant predictive power, but showed substantial association in the predicted direction. In addition, a clear sex difference was found: women report a significantly better premorbid functioning and demonstrate a more favorable psychosocial functioning than men.     

Maternal mortality in Guinea-Bissau: the use of verbal autopsy in a multi-ethnic population

BACKGROUND: In developing countries with scanty resources it is very important to have reliable data to establish priorities for the health sector; e.g. to reduce maternal mortality it is necessary to determine the most important causes. The majority of deaths, however, occur without previous contact with the health system and consequently conventional analyses of death certificates are not feasible. Instead, studies have been carried out in some developing countries with various forms of post-mortem interviews, the so-called verbal autopsies (VA). METHODS: We developed a structured interview with filter questions, which was applied to all deaths of women of fertile age in a cohort of 10,000 women living in 100 clusters in Guinea-Bissau and followed over a period of 6 years. The cause of death was ascertained by means of a series of diagnostic algorithms for the most common causes of maternal mortality, including postpartum haemorrhage, antepartum haemorrhage, puerperal infection, obstructed labour, eclampsia, abortion, and ectopic pregnancy. RESULTS: Of the 350 deaths of women of fertile age, 32% were maternal and it seems unlikely that a significant proportion of maternal deaths have not been classified correctly. Using the diagnostic algorithm 70% could be given a specific diagnosis, the most important causes being postpartum haemorrhage (42% [29/69]), obstructed labour (19% [13/69]), and puerperal infection (16% [11/69]). We attempted to identify the factors that are critical for obtaining sufficient information to reach a diagnosis. In the univariate analyses, it was important whether the respondent had been present during the last illness (P = 0.04) and whether the death occurred more than one week after delivery (P = 0.04). The husband was a better respondent than a co-wife (P = 0.08), and men in general provided more specific information than women (P = 0.08). Furthermore, information appeared to be better if the woman had died in the rainy season (P = 0.08). The length of the recall period, parity, age of woman, place of death, rural/urban residence, and ethnic group were not decisive. In the multivariate analysis sex and presence of respondent and time after delivery were significantly associated with the risk of not reaching a specific diagnosis. Women are less likely to provide adequate information for a diagnosis than men (odds ratio [OR] 3.1; 95% confidence interval [CI]: 1.2-8.1). Respondents that did not reside in the village during the departed woman's illness/delivery carried equal risk of not reaching a conclusion (OR 3.1; CI: 1.1-9.1). Deaths occurring more than one week after delivery were also less likely to be classified (OR 6.1; CI: 1.7-22.0). CONCLUSION: The VA described in the present paper left 30% of the maternal deaths unclassified without a specific diagnosis. Had all interviews been with husbands, only 14% would have remained unclassified. If we had only asked people who were present during the terminal phase of the victim's illness the proportion of classified deaths would have risen from 70% to 75%. It is likely that delayed maternal deaths have not been adequately covered by the present algorithms, but they may also simply be more difficult to describe due to the duration of the disease episode. In contrast to methods by which cause of death is established by a panel of medical experts, the present VA should be economically and technically viable in areas where health workers have only minimal training.     

Reactions of healthy persons and persons suffering from allergic rhinitis when exposed to office dust

OBJECTIVES: Reactions to airborne office dust among healthy subjects and subjects suffering from allergic rhinitis were investigated. METHODS: Twelve healthy and 11 subjects suffering from allergic rhinitis were exposed to clean air [17 (SD 2) microg/m3] and office dust [439 (SD 68) microg/m3] for 245 minutes. The effect measurements included subjective sensations (questionnaire and potentiometer ratings), mood scale, peak flow, bronchial provocation with histamine using forced expiratory volume in 1 second as the effect measure, nasal mucosal swelling, tear film stability, epithelial damage, foam formation in the eye canthus, threshold for eye irritation with carbon dioxide, eye redness, cellular content of conjunctival fluid, and an addition test for distraction. As many investigations were made and as many statistical analyses (including subgroup analyses) were carried out, the risk of mass significance appeared. This problem was dealt with using the Bonferroni correction for multiple significance tests. RESULTS: The mean ratings of the potentiometer were higher (the subjects showed more irritation) during the dust exposure. The objective investigations showed only indications of effects of dust exposure, and some of the indications were in biologically unexplainable directions. No difference in the reactions to dust was observed between the healthy subjects and the subjects suffering from allergic rhinitis. CONCLUSIONS: Dust does not seem to have objective or subjective effects on humans, as only indications of dust effects were found. Subjects suffering from allergic rhinitis do not appear to be a risk group in relation to dust exposure.     

Improving the nicotinic pharmacophore with a series of (Isoxazole)methylene-1-azacyclic compounds: synthesis, structure-activity relationship, and molecular modeling

A series of (isoxazole)methylene-1-azacyclic compounds was prepared. The compounds were tested for affinity to central nicotinic acetylcholine receptors (nAChRs) and central muscarinic receptors. The compounds covered a broad range of affinities for the nAChRs (IC(50) = 0.32 to >1000 nM), with selectivities for the nAChRs over the muscarinic receptors in the range of 3-183. The high-affinity compound (Z)-26 (3-(4-methyl-5-isoxazolyl)methylene-1-azabicyclo[2.2. 2]octane, IC(50) = 3.2 nM) having only one energy minimum was used as the reference structure in a computational study. This ligand has enabled definition of an important distance parameter, and the existence of this parameter was supported by showing that other potent nicotinic ligands (for example, nicotine and epibatidine) fit the model.     

Congenital pulmonary atresia with ventricular septal defect: angiographic and surgical correlates

Of 181 patients with severe congenital pulmonary atresia and ventricular septal defect or "type IV truncus" (an obsolete term), all but 11% had true central pulmonary arteries. These arteries were demonstrable by large serial biplane angiograms using multiple selective injections into collateral vessels, frequent photographic subtraction, and occasional pulmonary vein-wedge angiograms. These techniques are extremely important for accurate diagnosis and in planning corrective or palliative surgery, which was done in 77% of patients with pulmonary arteries.     

On the botanical distribution of chiral forms of gossypol

Plants belonging to Malvaceae (about 90 species belonging to 33 genera) were analysed for the presence of gossypol by reversed-phase HPLC using absorbance detection at 365 nm, and the chirality and optical purity of gossypol were determined whenever the analysis was positive. Only plants belonging to the cotton tribe (Gossypieae) contained gossypol (detection limit better than 0.001%). In particular, no gossypol could be detected in ABELMOSCHUS ESCULENTUS (ocra), HIBISCUS TILIACEUS, H. SABDARIFFA, and HEREA BRASI-LIENSIS, earlier claimed to contain this compound. Gossypol-containing plants usually produced dextrorotatory gossypol of varying optical purity; an enantiomeric excess of (-)-gossypol was detected in only one plant, GOSSYPIUTN BARBADENSE.     

Correlations of pseudouridine in 8-hour and 24-hour urinary samples determined by high-performance liquid chromatography

Summary The correlations of Pseudouridine () values in 8 h and 24 h urinary samples from 23 healthy persons were determined. Pseudouridine in the 8 h urinary samples was measured by high-performance liquid chromatography and the 24 h excretion was calculated from the results of three 8 h determinations. Simultaneous determinations of urinary creatinine were performed by Jaffe's reaction. Based on the 8 h values of urinary Pseudouridine the results demonstrated a constant excretion of Pseudouridine in the 24 h periods, if the values were related to the urinary creatinine. The precision in using this ratio as an indicator for normal 24 h excretion of Pseudouridine was 90.5% for males and 92.5% for females.     

Post-operative pain and inflammatory reaction reduced by injection of a corticosteroid

Summary In a controlled crossover study, identical surgical procedures, the prophylactic removal of bilateral non-erupted 3rd molar teeth, were performed on two separate occasions in 24 healthy patients. Prior to each procedure, either betamethasone 9 mg (Celeston Chronodose^®) or placebo was administered intramuscularly, in a randomized fashion. Objective and subjective assessments were recorded for paired comparison of the post-operative course, including swelling, pain, trismus, local temperature, bleeding, wound-healing and preference for treatment. In 23 patients, less swelling occurred when betamethasone was given pre-operatively. The mean reduction on the 3rd and 6th post-operative days was 55% (p<0.001) and 69% (p<0.001), respectively. Pain assessments (visual analogue scale) were significantly lower after the corticosteroid injection; mean response: 1st evening 17 vs 56 mm, 2nd evening 5 vs 37 mm, and 3rd evening 2 vs 13 mm. No significant correlation between the steroid-induced reduction in swelling and pain could be made. This may indicate that dissociation may exist between pain and other inflammatory events like swelling. No clinically apparent infection or other disturbance of wound-healing was noted after corticosteroid administration. This treatment course was preferred by 23 of the 24 patients.     

Tryptophan tolerance and metabolism in endogenous depression

The concentration of free and total tryptophan and kynurenine in plasma from 49 female depressives and 26 female controls was measured following oral loading with l-tryptophan, 100 mg/kg body weight. There was no significant difference between five depressives and six controls in the area under curve for free or total tryptophan or kynurenine in plasma. The peak concentration of kynurenine occured 4 h after loading and it correlated significantly with the area under curve for kynurenine. There was no significant correlation between the l-tryptophan dose (g) and the plasma concentration of kynurenine at 4 h in the 49 depressives or 26 controls. The mean plasma levels of tryptophan and kynurenine at 4 h in the depressives were not significantly different from control levels. There was no clear relationship between the plasma levels of tryptophan or kynurenine at 4 h and the therapeutic response in 13 depressives treated with l-tryptophan for 14 days.It is concluded that the absorption, the plasma clearance, and the degradation to kynurenine of loading doses of l-tryptophan are normal in depressed patients. Results further-more suggest that the plasma levels of tryptophan and kynurenine at 4 h are poor predictors of the response to l-tryptophan treatment in depressives.