Psychiatric health needs and services before and after complete deinstitutionalization of people with intellectual disability

Before total deinstitutionalization in Norway, many believed that the ordinary health care system could give people with intellectual disability the same or even better health care than that which they received in institutions. It was said that institutions created psychiatric problems, and that these would diminish or even disappear with the closing of these establishments. The present study is a prospective cohort study without a control group. It examines the frequency of mental health problems and the psychiatric health services which 109 subjects aged between 16 and 65 years received before (1987) and after (1995) deinstitutionalization. Mental health problems were defined as behavioural disturbances, and psychiatric disorders and symptoms. Psychiatric disorders were identified with the Psychopathology Instruments for Mentally Retarded Adults (PIMRA), which were filled in by the carers. Behaviour disturbances were identified as having occurred or not during the previous year. Psychiatric problems remained frequent, and there was a significant increase in behavioural problems in spite of total deinstitutionalization and improved physical living conditions. Access to qualified help, such as psychologists and psychiatrists, had been substantially reduced. Most mental health problems among people with intellectual disability are not solved by reorganization or deinstitutionalization, and such measures are no substitution for professional assistance.     

Bioactive natural products from marine sponges belonging to family Hymedesmiidae

Natural products of marine origin exhibit extensive biological activities, and display a vital role in the exploration of new compounds for drug development. Marine sponges have been reported at the top with respect to the discovery of biologically active metabolites that have potential pharmaceutical applications. The family Hymedesmiidae belonging to the Demospongiae class includes ten accepted genera, of which four genera were explored for their bioactive metabolites, namely Phorbas, Hamigera, Hemimycale, and Kirkpatrickia. Genus Phorbas has received more attention due to the isolation of various classes of compounds with unique structures mainly diterpenes, alkaloids, sesterterpenes, and steroids that exhibited diverse biological activities including: antiviral, antimicrobial, and anti-inflammatory, whereas anticancer compounds predominated. This review focuses on the isolated secondary metabolites from family Hymedesmiidae with their biological potential and covers the literature from 1989 to 2020.

Natural products of marine origin exhibit extensive biological activities, and display a vital role in the exploration of new compounds for drug development.     

Validation of Montreal Cognitive Assessment-Basic in a sample of elderly Egyptians with neurocognitive disorders

Background and Objectives: Montreal Cognitive Assessment-Basic (MoCA-B) is a modified version of the MoCA that is especially suitable for use in elderly subjects with low education. The Authors translated the tool into Arabic and they aimed at validation of this tool in a sample of elderly Egyptians.

Methods: The study included 93 patients, 60 years and older, fulfilling the DSM-5 criteria of Mild Neurocognitive Disorder (NCD) (39 patients) and Major Neurocognitive Disorder (54 patients) that were compared to 112 community dwelling elder subjects. All subjects were assessed using the MoCA-B, Mini-Mental State Examination (MMSE), and the Clinical Dementia Rating Scale (CDR) in addition to the required laboratory and radiological investigations.

Results: MoCA-B demonstrated good internal consistency (Cronbach's alpha = 0.915) and content validity in discrimination between normal and diseased subjects. It showed superior sensitivity and specificity when compared to MMSE in screening for Mild NCD (AUC MoCA-B = 0.988 versus MMSE = 0.939). The recommended cut-off was 21/22 with sensitivity of 92.5% and specificity of 98.2% for detecting Mild NCD and 16/17 with sensitivity of 90.7% and specificity of 97.4% for detecting Major NCD (dementia).

Conclusion: The Arabic MoCA-B is a valid cognitive assessment tool in elderly Egyptian subjects.     

Benefits and drawbacks of preimplantation genetic diagnosis (PGD) for reciprocal translocations: lessons from a prospective cohort study

Preimplantation genetic diagnosis (PGD) using fluorescence in situ hybridisation probes was carried out for 59 couples carrying reciprocal translocations. Before treatment, 85% of pregnancies had resulted in spontaneous miscarriage and five couples had achieved a healthy live-birth delivery. Following treatment, 33% of pregnancies failed and 21of 59 couples had a healthy live-born child. The accuracy of diagnosis was 92% (8% false abnormal and 0% false normal results). The overall incidence of 2:2 alternate segregation products was 44% however, products consistent with 2:2 adjacent segregation were ∼twice as likely from male heterozygotes, and those with 3:1 disjunction were three times more likely from female heterozygotes. Our results indicate that up to three stimulation cycles per couple would give an ∼50% chance of a successful live birth, with the risk of miscarriage reduced to the level found in the general population. In our study, 87% of all normal/balanced embryos available were identified as being suitable for transfer. We conclude that PGD provides benefit for couples with high-risk translocations by reducing the risk of miscarriage and avoiding a pregnancy with an unbalanced form of the translocation; however, for fertile carriers of translocations with a low risk of conceiving a chromosomally unbalanced offspring, natural conception may be a more viable option.