The value of referral status as a solitary indicator to predict severity of illness in children

Tijdschrift voor Kindergeneeskunde -     

Current issues in bipolar disorder: a critical review.

Although awareness on bipolar disorder has increased during the last decade, this condition remains characterized by a disabling burden, in terms of morbidity and functional impairment. This paper aims to review some critical issues in the current knowledge on Bipolar disorder. Although large European epidemiological studies are lacking, Bipolar disorder is characterized by a set of severe features, including an early age of onset, a chronic outcome and an important suicidal risk. A majority of bipolar patients also experience a comorbid Axis I condition, including substance abuse, anxiety disorder and attention-deficit hyperactivity disorder. This situation presents a therapeutic challenge, since antidepressants or methylphenidate may be associated with the risk of inducing mania. Recently, a large number of studies have provided evidence for the efficacy of new compounds in the treatment of both mania and bipolar depression, but also in long-term relapse prevention. Recent research has also allowed for the redefinition of the concept of mood stabilizer and for improving existing guidelines on the clinical management of Bipolar disorder.     

2-Hydroxypropyl-beta-cyclodextrin extracts 2-phenylphenol from silicone tubing

Cyclodextrins are capable to solubilise lipophilic drugs via (partial) inclusion in their lipophilic cavity. This, however, also provides the potential for the extraction of small molecules from production materials. In the present study, the potency of the commercially available and used cyclodextrin, 2-hydroxypropyl-beta-cyclodextrin (HPbetaCD) to extract the preservative 2-phenylphenol (2-PP) from platinum cured silicone tubing was tested. The presence of 2-PP was structurally confirmed with HPLC-UV and LC/MS/MS in HPbetaCD solutions after incubation with platinum cured silicone tubing. HPbetaCD concentration and prior tubing sterilisation were found not to influence the levels of 2-PP extracted. Interestingly, extraction to ethanol was 15-fold higher than observed for HPbetaCD solutions. 2-PP was extracted from silicone tubing during routine manufacture of a blank dosage form formulated with only HPbetaCD, resulting in detectable levels of 2-PP in the final product. In a freeze-dried dosage form containing HPbetaCD and an active pharmaceutical ingredient (exhibiting a stability constant for HPbetaCD/drug of 1045 L/mol), on the other hand, 2-PP was undetectable.     

Depressive symptoms and muscular fitness contribute independently to the ability to perform daily life activities in people with bipolar disorder

Background: Compared with healthy controls, people with bipolar disorder experience muscle weakness. The extent to which muscle weakness influences the performance of daily life activities such as walking in people with bipolar disorder requiring hospitalization is unclear. Aims: The primary aim of the current study was to explore whether depressive symptoms and muscular fitness independently contribute to the walking capacity in people with bipolar disorder. A secondary aim was to identify variables that could explain the variability in muscular fitness. Methods: Forty-two inpatients with bipolar disorder performed a standing broad jump test (SBJ), a measure of muscular performance, and the six minute walk test (6MWT) in addition to the International Physical Activity Questionnaire (IPAQ), the Depressive Symptomatology Self Report (QIDS) and a full-fasting metabolic screening. Results: The correlation between the 6MWT (595.0?±?127.3m) and SBJ (126.2?±?48.6m) was high (r?=?0.72, p?Conclusions: Depressive symptoms and muscular fitness contribute independently to daily life functioning in people with bipolar disorder. Thus, muscular rehabilitation strategies might offer a strategy for improving performance of daily life activities in this group.     

Self-referred paediatric patients with abnormal vital signs only seen by an emergency physician,are we missing severe ill patients?

Tijdschrift voor Kindergeneeskunde -     

Structural features of thePip/AzPip couple in the crystalline state: influence of the relative AzPip location in an azadipeptide sequence upon the induced chirality and conformational characteristics

Abstract: Azapipecolic (AzPip) is a pipecolic (Pip) residue analogue containing a nitrogen atom in place of the C^αH group. AzPip was introduced into two reverse dipeptide sequences,Piv‐AzPip‐l ‐Ala‐NHiPr I and Boc‐l ‐Ala‐AzPip‐NHiPr II in order to evaluate, in the crystalline state, the influence of thel ‐Ala‐induced chirality upon the prochiral AzPip residue, and therefore the resulting conformational characteristics, according to the relative position of the AzPip residue. Piv‐dl ‐Pip‐NHMe III served as a control derivative for comparison between the properties of the two different heterocycles of Pip and AzPip residues. Piperidine and hexahydropyridazine rings have a few characteristics in common: chair conformation, axial disposition of the C‐terminal backbone substituent and the cisoid form of the N‐terminal tertiary amide function. An almost pure sp³ hybridization state is observed for the substituted nitrogen atom N^α, so that l ‐Ala induces an AzPip (R) or (S) chirality when it follows or precedes, respectively, the azaresidue in such a pseudodipeptide sequence. If both I and II compounds present a short NH…N contact between the sp² tertiary amide nitrogen atom and the NH of the next secondary amide function, whatever the chiral nature of the sequence, the heterochiral azadipeptide I adopts a rather totally extended conformation while the homochiral azadipeptide II is folded by a β‐VI turn‐like structure stabilized by a classical 4→1 intramolecular hydrogen bond.     

Persistent trophoblast disease following partial molar pregnancy

OBJECTIVE: Human chorionic gonadotrophin (hCG) follow-up data were analysed retrospectively in all patients registered in the Hydatidiform Mole Registry at the Royal Women's Hospital, Melbourne from January 1992 to January 2001 to determine the risk of persistent trophoblast disease following partial molar pregnancy and to review the present follow-up protocol of patients suffering from partial hydatidiform molar pregnancy (PHM). METHODS: Demographic factors were determined for all 344 cases with a review diagnosis of PHM, included age, history of previous hydatidiform mole, gestation length, hCG levels and compliance with follow-up. FINDINGS: Six of the 344 patients diagnosed with PHM required treatment with single-agent methotrexate and folinic acid rescue. All six patients achieved and maintained a complete biochemical remission after chemotherapy. hCG regression assays were analysed for 235 patients: 225 patients had at least one normal hCG measurement during follow-up, of whom 152 (64.7%) patients obtained normal values within 2 months after evacuation. All patients obtained normal levels within 32 weeks after evacuation of the partial hydatidiform mole. Only 63 (25.6%) patients completed the recommended follow-up program. No patient who achieved normal hCG levels required chemotherapy because of a recurrent gestational trophoblastic tumour. RECOMMENDATIONS: This study indicates that 1.7% of all partial mole pregnancy patients needed treatment for malignant sequelae. In contrast, no patient diagnosed with partial mole had a biochemical or clinical relapse after achieving normal levels of hCG, consistent with previous studies. Patients who have had a partial hydatidiform mole should be followed by hCG assays until normal levels are achieved and then follow-up can be safely discontinued.     

A comparison of physical fitness in patients with bipolar disorder,schizophrenia and healthy controls

Purpose: To compare the physical fitness of inpatients with bipolar disorder, schizophrenia and healthy controls.

Method: Twenty-two inpatients with bipolar disorder, and 22 age-, gender- and body mass index-matched inpatients with schizophrenia and healthy controls were included. All participants performed the Eurofit test battery and the International Physical Activity Questionnaire. One way analyses of variance with post hoc Scheffe were applied to examine differences.

Results: Both patient groups were significantly more physically inactive and had a significantly impaired speed of limb movement, explosive muscle strength and abdominal muscular endurance compared to the healthy controls. No significant differences between the patient groups were found.

Conclusions: The results suggest that physical fitness and physical activity participation are similar among inpatients with bipolar disorder and schizophrenia but markedly lower than healthy controls. Chronic inpatients with lower levels of physical activity may particularly benefit from rehabilitation interventions aimed at increasing physical fitness.

• Implications for Rehabilitation

• Physical fitness should receive similar attention in the treatment of bipolar disorder and schizophrenia.

• Sedentary patients with a longer duration of illness need additional support in changing lifestyle behaviours.

• Rehabilitation should not only consider cardio-respiratory fitness but also muscular endurance, muscular strength and balance.

     

Guidelines following hydatidiform mole: a reappraisal

OBJECTIVE: The aim of this study was to determine how often patients with complete hydatidiform mole (CHM) who spontaneously achieve normal human chorionic gonadotrophin (hCG) levels subsequently develop persistent or recurrent gestational trophoblast disease. METHODS: Four hundred and fourteen cases of CHM registered at the Hydatidiform Mole Registry of Victoria were reviewed retrospectively after molar evacuation. Maternal age, gestational age, gravidity and parity were determined for each patient, as well as the need for chemotherapy. RESULTS: Among the 414 patients, 55 (13.3%) required chemotherapy for persistent trophoblastic disease. None of the patients whose hCG levels spontaneously fell to normal subsequently developed persistent molar disease. CONCLUSION: Weekly hCG measurements are recommended for all patients until normal levels are achieved. For patients who attain normal hCG levels within 2 months after evacuation, it seems safe to discontinue monitoring once normal levels are achieved. Patients who fail to achieve normal hCG levels by 2 months after evacuation should be monitored with monthly hCG measurements for 1 year after normalisation to assure sustained remission.