Validation of the Arabic version of the short Geriatric Depression Scale (GDS-15)

BACKGROUND: This study aimed to examine the validity and reliability of an Arabic version of the 15-item Geriatric Depression Scale (GDS-15). METHODS: 121 community-dwelling older adults and primary care patients aged 60 and above participated in this study. Older adults with dementia, those with thyroid dysfunction, and hearing or speech impairments were excluded. Test-retest reliability was examined by re-administering the translated GDS-15 to a subset of 38 participants at least seven days after the initial interview. RESULTS: The Arabic GDS-15 had good psychometric properties, but the best properties were reported for the 7/8 cutoff. Cronbach's alpha as a measure of internal consistency reliability was high (0.88) and kappa ranged from 0.57 to 0.75. The performance of the GDS-15 was equally good for both community-dwelling older adults and those in primary care settings, and for both forms of the GDS (examiner administered vs. self-administered). CONCLUSION: The Arabic GDS is a useful measure to assess depression among community-dwelling older adults and primary care patients who do not have dementia. Because of the use of formal Arabic, GDS-15 can be widely used with all Arabic-speaking people.     

Fatty acid synthase inhibition results in a magnetic resonance-detectable drop in phosphocholine

Expression of fatty acid synthase (FASN), the key enzyme in de novo synthesis of long-chain fatty acids, is normally low but increases in cancer. Consequently, FASN is a novel target for cancer therapy. However, because FASN inhibitors can lead to tumor stasis rather than shrinkage, noninvasive methods for assessing FASN inhibition are needed. To this end, we combined (1)H, (31)P, and (13)C magnetic resonance spectroscopy (MRS) (a) to monitor the metabolic consequences of FASN inhibition and (b) to identify MRS-detectable metabolic biomarkers of response. Treatment of PC-3 cells with the FASN inhibitor Orlistat for up to 48 h resulted in inhibition of FASN activity by 70%, correlating with 74% inhibition of fatty acid synthesis. Furthermore, we have determined that FASN inhibition results not only in lower phosphatidylcholine levels but also in a 59% drop in the phospholipid precursor phosphocholine (PCho). This drop resulted from inhibition in PCho synthesis as a result of a reduction in the cellular activity of its synthetic enzyme choline kinase. The drop in PCho levels following FASN inhibition was confirmed in SKOV-3 ovarian cancer cells treated with Orlistat and in MCF-7 breast cancer cells treated with Orlistat as well as cerulenin. Combining data from all treated cells, the drop in PCho significantly correlated with the drop in de novo synthesized fatty acid levels, identifying PCho as a potential noninvasive MRS-detectable biomarker of FASN inhibition in vivo.     

Immunology and epilepsy

Immune mechanisms play a critical role in systemic disorders (systemic lupus erythematosus, Sj?gren's syndrome, Crohn's disease, and sarcoidosis) and in localized central nervous system (CNS) disorders (CNS vasculitis, multiple sclerosis, acute disseminated encephalomyelitis, and encephalitides). Both humoral and cell-mediated mechanisms are involved in the systemic and CNS-limited disorders. Immune mechanisms may also be a factor in a number of epilepsies such as Rasmussen's encephalitis, Lennox-Gastaut syndrome, Landau-Kleffner syndrome, and temporal lobe epilepsy. Immunologic abnormalities are found in routine epilepsy surgical specimens, suggesting a broader role of immunopathology in the etiology of epilepsy. The prevalence and impact of immunopathology in epilepsy syndromes remains to be determined by future research.     

Morbid obesity and outcome of ectopic pregnancy following capped single-dose regimen methotrexate

Purpose

Evaluate whether morbid obesity influenced resolution, number of doses or ultimately surgical management of tubal ectopic pregnancy (TEP) when treated with single-dose regimen methotrexate (SDR-MTX) capped at 100 mg.

Methods

Retrospective cohort study of patients with a diagnosis of TEP who underwent MTX treatment from 2000 to 2013. Patients were excluded if initial β–hCG <1000 mIU/mL, did not have β–hCG follow-up or were not treated with SDR-MTX. Per protocol, dose was administered at 50 mg/m² with a capped maximum of 100 mg. Patients were divided based on their BMI (<40 and ≥40 kg/m²). Demographic variables, β–hCG before treatment, maximum diameter of ectopic size, embryonic heart tones, decrease of β–hCG, need for additional MTX doses and surgery despite treatment were recorded and compared among the groups.

Results

151 women were included in the study, 89.4% (135/151) non-morbidly obese and 10.6% (16/151) morbidly obese. No differences in age distribution, ethnicity, pre-treatment presence of embryonic heart tones, maximum diameter of ectopic size ≥35 mm and β–hCG ≥5000 mIU/ml were found. Following treatment, the proportion of patients with at least an 80% decrease in their β–hCG levels or need for surgery were similar, however, morbidly obese patients were significantly more likely [11/134 vs. 5/16, OR 5.1 (1.5–17.3, p = 0.015)] to require an additional MTX dose.

Conclusion

Among patients with TEP, morbidly obese patients were five times more likely to require an additional dose compared to non-morbidly obese when SDR-MTX capped at 100 mg was used for medical management.

     

Endometrial endometrioid adenocarcinoma: a pathologic analysis of 827 consecutive cases

We reviewed 827 consecutive cases of pure endometrial endometrioid adenocarcinoma (EEA) treated by hysterectomy to update the distribution of pathologic features. Tumor grade (reported in a 2-tiered system), depth of myometrial invasion, presence of cervical involvement, lymphovascular invasion (LVI), and evidence of extrauterine disease were recorded.The median age at diagnosis was 62 years (range, 30-94 years). The tumor was high grade in 94 cases (11.4%), invaded into the outer half of the myometrium in 249 (30.1%), was positive for cervical involvement in 171 (20.7%), and was positive for LVI in 182 (22.0%). Lymph nodes (sampled in 85 cases) were positive in 13 (1.6%), and ovarian metastases were present in 15 cases (1.8%). High tumor grade was significantly associated with deep myometrial invasion (P > .0001), cervical involvement (P = .0065), and LVI (P > .0001).EEA manifests most commonly with low tumor grade and without deep myometrial invasion. High tumor grade is significantly associated with deep myometrial invasion, cervical involvement, and LVI.     

Adenomyosis is associated with myometrial invasion by FIGO 1 endometrial adenocarcinoma.

Adenomyosis is commonly seen in hysterectomy specimens for endometrial adenocarcinoma where it could be involved with the tumor. When adenocarcinoma involves adenomyosis, the tumor may remain limited to the adenomyosis or proceeds to invade the adjacent myometrium. The purpose of this study was to investigate whether the risk of myometrial invasion by grade 1 endometrioid adenocarcinoma in cases with cancer-positive adenomyosis is different from that of cases where cancer occurs in the absence of adenomyosis. Forty-six consecutive hysterectomy specimens with International Federation of Gynecology and Obstetrics (FIGO) grade 1 endometrial endometrioid adenocarcinoma involving adenomyosis and 49 consecutive specimens with the same tumor occurring in the absence of adenomyosis were retrospectively studied by 4 experienced gynecologic pathologists. In cases with adenomyosis, myometrial invasion was confirmed by CD10-negative staining around glands with irregular outline surrounded by inflamed desmoplastic stroma. Myometrial invasion was found in significantly more adenomyosis cases (n = 42, 91.3%) than in cases without adenomyosis (n = 38, 77.5%) (chi = 4.79, P = 0.03). In 16 cases of the former group, the invasion only occurred from the foci of adenomyosis. Although myometrial invasion in the outer half was more common in the adenomyosis group (n = 16, 34.8%) than in cases without adenomyosis (n = 9, 18.4%), the difference was not statistically significant (chi = 3.29, P = 0.07). By involving coexistent adenomyosis, FIGO grade 1 endometrial endometrioid adenocarcinoma is associated with myometrial invasion, probably through increasing the surface area of its interface with the adjacent myometrium. When compared with their counterparts that occur in the absence of adenomyosis, these tumors are significantly more likely to invade the myometrium.     

Psychometric properties of the Lebanese-Arabic TEMPS-A: a national epidemiologic study

BACKGROUND: Several measures have been proposed to evaluate temperament traits and their connection to psychopathology. One recent development in this area is the TEMPS-A (Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto-questionnaire). The purpose of this study is to psychometrically validate the Lebanese-Arabic version of TEMPS-A. METHODS: The TEMPS-A was adapted to Lebanese-Arabic and administered to 1320 Lebanese (593 males, 727 females, mean age of 43+/-16 years) representing the adult population of Lebanon (total population: 4.2 million). This section was added by the Institute for Development Research and Applied Care (IDRAC) to the cross-national World Mental Health (WMH) initiative Lebanese chapter. Chronbach-alpha and Pearson's correlation were used to test the internal consistency and correlation among the subscales. Factor loadings were calculated using the principal component analysis with varimax rotation. RESULTS: Internal consistency varied between 0.66 (depressive) and 0.88 (anxious). As formulated by the originators of the instrument, five main factors emerged from the factor analysis, with some overlap between the depressive, the cyclothymic and the anxious temperaments, but almost none for the hyperthymic and irritable temperaments. The strongest correlation was observed between the anxious and the cyclothymic temperament subscales. Women had higher mean scores on the depressive, cyclothymic, and anxious subscales, whereas men scored higher on the hyperthymic subscale. There was a trend of increase by age in scores of the depressive subscale, and a trend of decrease in the cyclothymic and irritable subscales. CONCLUSION: The Lebanese-Arabic TEMPS-A has a good internal consistency, is easy to use, and opens new and interesting research avenues in large epidemiologic national studies on temperament.     

Metabolic syndrome in Tunisian bipolar I patients

Background

The metabolic syndrome is a growing global public health problem which is frequently associated with psychiatric illness.

Objectives

To evaluate the prevalence of metabolic syndrome and to study its profile in Tunisian bipolar I patients.

Methods

Our study included 130 patients with bipolar I disorder diagnosed according to the DSM-IV and assessed for metabolic syndrome according to the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III modified criteria. The mean age was 37.9 ±12.1 years, 45 were women (mean age 37.5±13.4 years) and 85 were men (mean age 38.1 ± 11.4 years).

Results

The prevalence of metabolic syndrome was 26.1%.The highest prevalence of this syndrome was obtained by association between obesity, low c-HDL and hypertriglyceridemia (44.1%). In the total sample, 59.2% met the criteria for low c-HDL, 53.1% for hypertriglyceridemia, 33.8% for obesity, 16.1% for high fasting glucose and 5.4% for hypertension. Gender, age, illness episode and treatment were not significantly associated with metabolic syndrome, while patients under lithium had higher prevalence of metabolic syndrome than those under valproic acid, carbamazepine or antipsychotics. Patients with metabolic syndrome had significant higher levels of HOMA-IR and uric acid than metabolic syndrome free patients (p< 0.001).

Conclusions

Bipolar patients have high prevalence of metabolic syndrome which is associated with insulin resistance and an increase of uric acid values that raise the risk of cardiovascular disease.