The use of art therapy to detect depression and post-traumatic stress disorder in pediatric and young adult renal transplant recipients

Pediatric and young adult renal transplant recipients may experience feelings of depression and emotional trauma. A study was conducted to (1) determine the prevalence of depression and emotional trauma and (2) assess the utility of the Formal Elements of Art Therapy Scale (FEATS). Sixty-four renal transplant recipients, 6-21 yr of age, were evaluated using self-report measures (CDI and Davidson) and art-based assessments. Subject art was analyzed by art therapists using seven of the 14 elements of the (FEATS), to assess depression. Unlike CDI and Davidson self-report testing, all patients were able to complete the art-based directives. When self-report measures and art-based assessments were combined, 36% of the study population had testing results consistent with depression and/or post-traumatic stress. The FEATS assessments identified a subset of patients who were not identified using the self-report measures. There was a correlation between CDI and Davidson scores (p < 0.0001), Davidson scores correlated with hospital days (p = 0.05), and FEATS correlated with height Z score (p = 0.04) and donor type (p = 0.01). Patients who required psychological interventions including antidepressant therapy, psychological counseling and psychiatric hospitalization during the year after the study were identified as depressed. Sensitivity for FEATS and CDI were 22 and 50% respectively. The results suggest that while art therapy may be of utility in the identification of pediatric and young adult transplant recipients who are suffering from depression, FEATS analysis appears to lack sufficient sensitivity to warrant its use in this population. Study of other quantitative art-based assessment techniques may be warranted.     

The prevalence of androgen excess among patients with minimal unwanted hair growth

OBJECTIVE: The prevalence of androgen excess (AE) and the value of preemptive endocrine evaluation in women with minimal unwanted hair growth are unclear. SUBJECTS: A total of 228 patients presented with minimal unwanted hair growth and a mF-G score of 5 or less. Total and free testosterone, dehydroepiandrosterone sulfate, 17-hydroxy-progesterone, sex hormone-binding globulin, and basal insulin and glucose levels were measured. RESULTS: Of the patients, 54% demonstrated an AE disorder (50%: polycystic ovary syndrome, 2%: hyperandrogenic insulin-resistant acanthosis nigricans syndrome, 2%: nonclassic adrenal hyperplasia), 29% isolated oligoovulation, 6% isolated hyperandrogenemia, and 10% had a normal evaluation. Of the patients with menstrual irregularities, 65% had an underlying AE disorder compared with 22% of those with normal menstrual function ( P < .001). Of eumenorrheic patients, 11% had oligo-ovulation and an AE disorder. CONCLUSION: Patients with minimal unwanted hair growth should be evaluated endocrinologically because approximately 50% of subjects demonstrate an AE disorder. Eumenorrhea does not preclude an underlying AE disorder, and ovulatory function should be assessed in these women.     

Prefrontal broadband noise, working memory, and genetic risk for schizophrenia

OBJECTIVE: It has been suggested that increased variability of prefrontal physiological responses may represent a fundamental mechanism underlying frontal lobe deficits in schizophrenia. Increased response variability ("noise") is thought to result from impaired phase resetting of stimulus-induced dynamic changes of ongoing rhythmic oscillations (field potentials) generated in the apical dendrites of pyramidal neurons. In the present study, the authors explored whether this particular physiological abnormality predicts working memory performance and is related to the genetic risk for schizophrenia. METHOD: Prefrontal response variability of discrete frequency components was investigated across a broad frequency range (0.5-45.0 Hz) during processing of an oddball paradigm in patients with schizophrenia (N=66), their clinically unaffected siblings (N=115), and healthy comparison subjects (N=89). RESULTS: As hypothesized, prefrontal noise was negatively correlated with working memory performance across all subjects. In addition, it was observed that prefrontal noise possesses trait characteristics and is strongly associated with genetic risk for schizophrenia. CONCLUSIONS: Frontal lobe-related cognitive function depends on the ability to synchronize cortical pyramidal neurons, which is in part genetically controlled. Increased prefrontal "noise" is an intermediate phenotype related to genetic susceptibility for schizophrenia.     

A systemic type I 5 alpha-reductase inhibitor is ineffective in the treatment of acne vulgaris

Excessive sebum production is a central aspect of the pathophysiology of acne vulgaris. Sebaceous gland function is under androgen control and it is hypothesized that dihydrotestosterone is formed by the action of 5 alpha-reductase. Type I is the controlling isoenzyme. This study describes a 3-month, multicenter, randomized, placebo-controlled clinical trial with a potent, selective inhibitor of type I 5 alpha-reductase used alone and in combination with systemic minocycline. Inhibition of type I 5 alpha-reductase was not associated with clinical improvement of acne when used alone and did not enhance the clinical benefit of systemic minocycline. These results indicate the need for further work at the molecular level to better understand the action of androgens on sebaceous gland function.     

Intraocular telescopic lens evaluation in patients with age-related macular degeneration

PURPOSE: To evaluate the improvement of distance and near visual acuity after removal of cataract and implantation of an 3.0x intraocular miniaturized telescope (IMT) in patients with stable atrophic type age-related macular degeneration (ARMD). SETTINGS: Instituto Oftalmológico de Alicante and a multicenter group. METHODS: In this prospective noncomparative multinational consecutive study, 40 eyes of 40 patients with dry-type ARMD were implanted with IMTs at multiple centers. Standard phacoemulsification procedure followed by enlargement of the incision to 10 mm and implantation in the capsular bag of an 3.0x IMT was carried out in all the cases. Patients were followed for 12 months. Evaluation included the differences between preoperative and postoperative uncorrected and best corrected visual acuity for far and near, position of the IMT, intraocular pressure, and occurrence of any postoperative complications. RESULTS: Mean preoperative uncorrected distance visual acuity (UCDVA) in the operated eye was 0.9 logMAR (0.125 +/- 0.01, range 0.1 to 0.3 in decimal values); at 1 year postoperatively, mean UCDVA in the operated eye was 0.6 logMAR (0.25 +/- 0.14, range 0.1 to 0.5 in decimal values). Mean preoperative uncorrected near visual acuity (UCNVA) in the operated eye was 0.8 logMAR (0.16 +/- 0.13, range 0.1 to 0.5 in decimal values); at 1 year postoperatively, mean UCNVA in the operated eye was 0.4 logMAR (0.4 +/- 0.26, range 0.1 to 1.0 in decimal values). The differences between pre- and postoperative distance and near visual acuities were statistically significant. Six cases were explanted, and 14 developed adverse effects, 7 of which were persistent. The corneal endothelium tolerated the procedure well. CONCLUSION: Implantation of IMT is feasible and plays an effective role in improving far and near visual acuity in patients with stable dry-type ARMD.     

Ibotenic acid and thioibotenic acid: a remarkable difference in activity at group III metabotropic glutamate receptors

In this study, we have determined and compared the pharmacological profiles of ibotenic acid and its isothiazole analogue thioibotenic acid at native rat ionotropic glutamate (iGlu) receptors and at recombinant rat metabotropic glutamate (mGlu) receptors expressed in mammalian cell lines. Thioibotenic acid has a distinct pharmacological profile at group III mGlu receptors compared with the closely structurally related ibotenic acid; the former is a potent (low microm) agonist, whereas the latter is inactive. By comparing the conformational energy profiles of ibotenic and thioibotenic acid with the conformations preferred by the ligands upon docking to mGlu1 and models of the other mGlu subtypes, we propose that unlike other subtypes, group III mGlu receptor binding sites require a ligand conformation at an energy level which is prohibitively expensive for ibotenic acid, but not for thioibotenic acid. These studies demonstrate how subtle differences in chemical structures can result in profound differences in pharmacological activity.     

Biochemical properties of a bushmaster snake venom serine proteinase (LV-Ka), and its kinin releasing activity evaluated in rat mesenteric arterial rings

A serine proteinase with kallikrein-like activity (LV-Ka) has been purified to homogeneity from bushmaster snake (Lachesis muta muta) venom. Physicochemical studies indicated that LV-Ka is a single chain glycoprotein with a molecular mass (Mr) of 33 kDa under reducing conditions which was reduced to 28 kDa after treatment with N-Glycosidase F (PNGase F). LV-Ka can be bounded and neutralized by serum alpha2-macroglobulin (alpha2-M), a prevalent mammalian protease inhibitor that is capable of forming a macromolecular complex with LV-Ka (Mr >180 kDa). Cleavage of alpha2-M by the enzyme resulted in the formation of 90-kDa fragments. The proteolytic activity of LV-Ka against dimethylcasein could be inhibited by alpha2-M, and the binding ratio of the inhibitor:enzyme complex was found to be 1:1. The Michaelis constant, Km, and catalytic rate constant, kcat, of LV-Ka on four selective chromogenic substrates were obtained from Lineweaver-Burk plots. LV-Ka exhibits substrate specificities not only for the glandular kallikrein H-D-Val-Leu-Arg-pNA (S-2266) but also for the plasmin substrates S-2251 and Tos-Gly-Pro-Lys-pNA. Bovine kininogen incubated with LV-Ka generated a polypeptide that dose dependently contracted mesenteric arterial rings from spontaneously hypertensive rats (SHR) in a similar way as bradykinin (BK) does. As it happens with BK, LV-Ka generated polypeptide was inhibited by HOE-140, a bradykinin B2-receptor antagonist and by indomethacin, a cyclo-oxygenase inhibitor. These results strongly suggest that the polypeptide generated by LV-Ka by cleavage of bovine kininogen is bradykinin. In addition, our studies may help to understand the mechanism of action involved in hypotension produced by envenomation of bushmaster snake.     

Detection and determination of chemical groups in an extract of Allophylus cominia (L.)

The preliminary chemical characterization of the aqueous extract of Allophylus cominia (L.) Sw leaves was carried out by a phytochemical screening, the determination of the protein concentration by Lowry's method, as well as the composition of fatty acids and carbohydrates by gaseous chromatography (GC). The presence of the free amine groups, free phenolics, tannins, leucoantocianidines, saponines, triterpens, and steroids was detected. The concentration of proteins were 6.22 mg/mL. The composition of fatty acids (%) were: lauric acid (C12): 1.87; miristic acid (C14): 9.13; palmitic acid (C16): 19.87; stearic acid (C18): 8.35; and araquidic acid (C20): 7.83. The identified carbohydrates (mg/mg totals) were: arabinose: 0.06; xilose: 0.025; galactose: 0.241; and glucose: 1.2. Some members of these analyzed groups are reported in literature as potent hypoglycemic agents. For this reason, the presence of these substances in the analyzed extract may be one of the factors that contribute to the pharmacological effect of their administration in experimental diabetic models.     

Control of mucocutaneous leishmaniasis, a neglected disease: results of a control programme in Satipo Province, Peru

Mucocutaneous leishmaniasis (MCL) is an important health problem in many rural areas of Latin America, but there are few data on the results of programmatic approaches to control the disease. We report the results of a control programme in San Martin de Pangoa District, which reports one of the highest prevalences of MCL in Peru. For 2 years (2001--2002), the technicians at the health post were trained in patient case management, received medical support and were supplied with antimonials. An evaluation after 2 years showed the following main achievements: better diagnosis of patients, who were confirmed by microscopy in 34% (82/240) of the cases in 2001 and 60% of the cases (153/254) in 2002; improved follow-up during treatment: 237 of 263 (90%) patients who initiated an antimonial therapy ended the full treatment course; improved follow-up after treatment: 143 of 237 (60%) patients who ended their full treatment were correctly monitored during the required period of 6 (cutaneous cases) or 12 (mucosal cases) months after the end of treatment. These achievements were largely due to the human and logistical resources made available, the constant availability of medications and the close collaboration between the Ministry of Health, a national research institute and an international non-governmental organization. At the end of this period, the health authorities decided to register a generic brand of sodium stibogluconate, which is now in use. This should allow the treatment of a significant number of additional patients, while saving money to invest in other facets of the case management.