N-acyloxymethyl carbamate linked prodrugs of pseudomycins are novel antifungal agents

We describe herein the synthesis, bioconversion, antifungal activity, and preliminary toxicology evaluation of a series of N-acyloxymethyl carbamate linked triprodrugs of pseudomycins. The syntheses of these prodrugs (3-6) were achieved via simple N-acylation of PSB (1) or PSC' (2) with various prodrug linkers (7-9). As expected, upon incubation with mouse and/or human plasma, many of these prodrugs (3, 5, and 6) were converted to the parent compound within a few hours. Of particular significance, two pseudomycin triprodrugs (5 and 6) showed excellent in vivo efficacy against systemic Candidiasis without tail vein irritation being observed.

Relationship between soil lead and airborne lead concentrations at Springfield, Missouri, USA

This study tests whether lead deposited to soil from automobiles during past years in a medium-sized US city (population 150,000) may present a current health risk. It examines the relationship between current soil lead concentrations at nine locations within the city of Springfield, Missouri, and airborne lead levels measured at the same locations during years (1975-1981) when lead emissions from automobiles were much greater than at present. A strong, significant correlation is found between soil and airborne lead levels at eight of the sites (r = 0.91, P < 0.005 for soil lead vs. 1979 airborne lead), in low-traffic areas as well as in areas adjacent to heavy traffic flow. Residual lead concentrations in these soils are relatively low, even for the high-traffic sites, as expected for a medium sized city.

Posttraumatic stress disorder, trauma exposure, and the current health of Canadian bus drivers

OBJECTIVE

Previous studies of veterans have linked posttraumatic stress disorder (PTSD) after combat-related trauma to increased reports of health problems. It is unclear whether this association between PTSD and increased health problems generalizes to civilians who are exposed to a broader array of traumatic events. We also do not know whether trauma exposure is associated with increased health problems in individuals who do not develop PTSD. Using a non-treatment-seeking civilian sample, we examined whether lifetime PTSD or trauma exposure by itself was associated with current health problems.

METHODS

Using a cross-sectional design and self-report measures, we evaluated urban Canadian bus drivers (n = 342) on trauma exposure, lifetime PTSD, and current health problems. Based on their responses, we divided our sample into individuals who had never experienced trauma (n = 91), trauma-exposed individuals who had never developed PTSD (n = 218), and persons who developed PTSD at some point after trauma (n = 33). We compared these groups on health problems, treatment service use, and health assessment measures.

RESULTS

The PTSD group reported increased health complaints, more frequent use of health treatments, and poorer health self-ratings compared with the exposed non-PTSD and nonexposed groups. Trauma-exposed drivers without PTSD did not differ from unexposed drivers on any health measure. Controlling for sex and trauma frequency did not alter our findings.

CONCLUSIONS

Trauma exposure that leads to PTSD is associated with increased health problems, while trauma exposure alone is not. Our results extend previous findings to a broader civilian context and clarify associations between trauma exposure and health.

[Psychological well-being and related concepts: a conceptual comparative analysis.]

The concept of psychological well-being acquired more importance in the field of health over the last decade. Ever since research paid more attention to "quality of life", psychological well-being became popular. The increasing interest in this concept entailed the development of many scales of measure. However, less importance has been given to the conceptual development of its construct, thus creating confusion between terms which at first appear similar: psychological well-being, subjective well-being, quality of life, spirit, satisfaction in life, happiness and mental health. The objective of this literature review (n:57) was to conduct a conceptual and comparative analysis (Morse et al., 1996) of psychological well-being with competitive concepts according to a comtemporary approach of analysis. Results show that these concepts are distinct and should not be used in an interchangeable way. They are distinct on various levels: type of measure (objective/subjective), type of evaluation (cognitive and affective), attributes, antecedents, consequences and influence of time (temporary/stable). Results of this review brings new light at the conceptual level for several terms. Graphic 1 illustrates its various positions thus favoring a better use of these terms in research.

Emotional distress among couples involved in first-trimester induced abortions

OBJECTIVE

To establish the prevalence of clinically significant psychological distress in women and men involved in first-trimester abortions and to identify related risk factors.

DESIGN

Prospective cohort study.

SETTING

A downtown Montreal public abortion clinic and the Montreal metropolitan area.

PARTICIPANTS

We recruited 197 women and 113 men involved in first-trimester abortions and compared them with control groups composed of 728 women and 630 men 15 to 35 years old who had taken part in a previous public health survey (Enquête Santé Québec 1987). One hundred twenty-seven women and 69 men completed the follow-up questionnaire.

MAIN OUTCOME MEASURES

Level of distress as measured by the Ilfeld Psychological Symptom Index.

RESULTS

Before the abortion, 56.9% of women and 39.6% of men were much more distressed than their respective controls. Three weeks after the abortion, 41.7% of women and 30.9% of men were still highly distressed. Predictors of distress for women were fear of negative effects on the relationship, unsatisfactory relationships, relationships of less than 1 year, ambivalence about the decision to abort, not having a previous child, and suicidal ideation (this association was weaker than in controls). Predictors for men were fear of negative effects on the relationship, relationships of less than 1 year, preoccupation with the abortion and anxiety about its accompanying pain, negative perceptions of their own health, suicidal gestures in the past, and suicidal ideation in the past year (only the association with suicidal gestures was marginally stronger than in controls).

CONCLUSION

Being involved in a first-trimester abortion can be highly distressing for both women and men.

Syntheses and biological evaluation of novel pseudomycin side-chain analogues. Part 2

A series of aliphatic side-chain analogues of pseudomycin was synthesized and evaluated during the course of our side-chain SAR effort. We found that several of the pseudomycin side-chain analogues (e.g., 10) exhibited good in vitro activity against all three major fungi responsible for systemic fungal infections.

Serendipitous synthesis of novel dehydro- and dechloro-pseudomycin B (PSB) derivatives

The syntheses and preliminary investigation of antifungal activities of two dehydro PSB derivatives 8 and 10 as well as one 3-imido-9-dechloro PSB analogue 13 are described.

Anxiety, significant losses, depression, and irrational beliefs in first-offence shoplifters

OBJECTIVE

To evaluate the relationship among demographic data, anxiety, significant losses, depression, and irrational beliefs reported by first-offence shoplifters.

METHOD

One hundred and six adult shoplifters who were first-time offenders completed a self-administered questionnaire.

RESULTS

Men and women were equally likely to be arrested for this offence. The majority of offenders were poor and unemployed. Depression, but not anxiety, was the most common psychiatric disorder associated with shoplifting. Subjects with depression presented the greatest number of irrational beliefs related to shoplifting.

CONCLUSIONS

The authors suggest 2 categories of shoplifters: those who shoplift through rational choice; and those for whom shoplifting is a response to depression or leads to the fulfillment of some psychological needs. In conclusion, shoplifting does not have a unitary motive, and the clinical implications are that the affective and cognitive aspects of shoplifters' behaviours must be taken into account.

Decompressive craniotomy in medically uncontrollable malignant infarction

Patients with progressive neurological deficit following large cerebral infarctions are viewed to have a uniformly poor prognosis. We present two patients with large middle cerebral artery infarctions in which a decompressive craniotomy was life saving and resulted in functional outcome. The clinical course of patients with malignant infarction and the treatment issues involved including patient selection and the timing and extent of cranial decompression are discussed.

Outcomes in a referral cohort of patients with anxiety disorders

This study describes 6- and 12-month outcomes in a referral cohort with anxiety disorders and identifies treatment and prognostic factors related to these outcomes. Patients were recruited at three general hospital clinics, two psychologist-run clinics, and one psychiatric hospital clinic. Outcomes included severity of symptoms, physical and mental health status, and subjective global change in problem severity. Of 254 patients eligible for follow-up, 165 (65.0%) completed a follow-up questionnaire. Methods of treatment included consultation with return to the primary care physician (38.2%); or continued treatment at the clinic, with medications (16.4%), psychotherapy (22.4%), or both (23.0%). Both severity of symptoms and mental health status improved but remained abnormal at follow-up. In multiple logistic regression, subjective global improvement was related to a diagnosis of panic disorder only, treatment with psychotherapy, and type of referral. Change over time in symptom severity was related to clinic type, and change over time in mental health was related to clinic type and duration of previous treatment.

Psychological distress and adaptational problems associated with discontinuation of benzodiazepines

This study compared subjects who had received standard tapered withdrawal of benzodiazepine (BZD) (group 1) with a group with comparable diagnosis still receiving BZD (group 2) and a control group of comparable diagnosis not yet receiving treatment (group 3). Sixty subjects aged 21-65 years with a diagnosis of nonpsychotic anxiety or insomnia were included. The assessment of psychological distress and quality of life was timed to coincide with the maximum immediate effect of BZD discontinuation, as calculated according to drug half-life. Subjects diagnosed with insomnia reported lower distress in all three groups. The pattern of distress experienced by group 1 was closer to group 3 than to group 2, indicating the potential importance of re-emergence of anxiety. High neuroticism, lower education level, and lower quality of life were associated with higher levels of distress during withdrawal.

[How to prevent post-traumatic stress disorder before traumatization occurs?]

OBJECTIVE

To provide an update on methods of preventing the onset of posttraumatic stress disorder (PTSD) before trauma occurs.

METHOD

Survey and analysis of the literature (mainly articles) found in the Medline, Psychinfo, and Pilot databases.

RESULTS

Most research focuses on identifying risk factors and reinforcing individual resistance as the prime means of preventing PTSD. The severity of the trauma is by far the most serious risk factor. To reinforce resistance and prevent the onset of PTSD, the army has favoured psychoeducational approaches. However, the literature survey has found no pretrauma prevention program for other high-risk occupations.

CONCLUSION

The usefulness of identified risk factors for the primary prevention of PTSD is limited, since with the exception of the trauma itself, they play a minor role on the onset of severe-trauma PTSD. Psychoeducational approaches aimed at reinforcing the resistance of individuals at risk are promising, but their potential has to be further explored in individuals in high-risk trades. Finally, it has been suggested that other avenues of research in the primary prevention (pretrauma) of PTSD be explored. These include the identification of possible protection factors, the influence of genetic make-up and of biological variables, the cumulative effects of exposure to stressors, and the presence of chronic stressors.

Lifetime exposure to traumatic events among a sample of city bus drivers

Lifetime exposure to traumatic events was assessed retrospectively among a representative sample of city bus drivers (228 men and 54 women) from Montréal, Canada. Among them, 68.1% reported at least one exposure to a traumatic event of any type. Among the 68% exposed. 70.4% reported multiple traumatic exposures (M = 2.6, SD = 1.67), with ratings ranging from 0 to 12. This report underlines the fact that the prevalence of traumatic events is not yet well known. Epidemiological research should devote more effort to assess fully the lifetime prevalence of traumatic events and not only cases of PTSD.

Pathogenesis of adenocarcinoma in Peutz-Jeghers syndrome

Peutz-Jeghers syndrome (PJS) is an autosomal dominant condition characterized by intestinal hamartomatous polyps, mucocutaneous melanin deposition, and increased risk of cancer. Families with PJS from the Johns Hopkins Polyposis Registry were studied to identify the molecular basis of this syndrome and to characterize the pathogenesis of gastrointestinal hamartomas and adenocarcinomas in PJS patients. Linkage analysis in the family originally described by Jeghers in 1949 and five other families confirmed linkage to 19p13.3 near a recently identified gene responsible for PJS. Germ-line mutations in this gene, STK11, were identified in all six families by sequencing genomic DNA. Analysis of hamartomas and adenocarcinomas from patients with PJS identified loss of heterozygosity (LOH) of 19p markers near STK11 in 70% of tumors. Haplotype analysis indicated that the retained allele carried a germ-line mutation, confirming that STK11 is a tumor suppressor gene. LOH of 17p and 18q was identified in an adenocarcinoma but not in hamartomas, implying that allelic loss of these two regions corresponds to late molecular events in the pathogenesis of cancer in PJS. The adenocarcinomas showing 17p LOH also demonstrated altered p53 by immunohistochemistry. None of the 18 PJS tumors showed microsatellite instability, LOH on 5q near APC, or mutations in codons 12 or 13 of the K-ras proto-oncogene. These data provide evidence that STK11 is a tumor suppressor gene that acts as an early gatekeeper regulating the development of hamartomas in PJS and suggest that hamartomas may be pathogenetic precursors of adenocarcinoma. Additional somatic mutational events underlie the progression of hamartomas to adenocarcinomas, and some of these somatic mutations are common to the later stages of tumor progression seen in the majority of colorectal carcinomas.

Psychological distress and use of ambulatory medical services in the Quebec Medicare system

OBJECTIVE

To document the impact of psychological distress symptoms on the use of ambulatory medical services in a universal insurance coverage context.

DATA SOURCES

Data from the Quebec Health Survey (1987) linked with billing data from the Quebec Medicare system. The time frame for the utilization variables is one year before and one year after the QHS survey.

STUDY DESIGN

LISREL was used to test a model introducing perceived health need as an explanatory factor of the relationship between psychological distress and the number of visits to a physician. Two samples were formed from the matched file. Sample A (n = 2,000) was used in an exploratory phase to adequately specify the model. Sample B (n = 2,000) was used to confirm the results obtained with Sample A.

PRINCIPAL FINDINGS

The proposed model explained 35 percent of the number of visits to a physician in Sample A and 24 percent in Sample B. The effect of psychological distress symptoms on the respondent's perceived health need was as important as the effect of physical health status. The effect of the respondent's previous health services utilization on the number of visits to a physician was also significant.

CONCLUSIONS

These results may be interpreted to indicate that in a universal insurance coverage context, psychological distress is a significant predictor of perceived health need.

Use of health services for anxiety disorders: a multisite study in Quebec

OBJECTIVE

We investigated patient characteristics and use of services for anxiety disorders among patients seeking care from participating clinicians at 7 anxiety clinics in Quebec: 3 general hospital clinics, 3 psychologist-run clinics, and one psychiatric hospital clinic.

METHODS

Persons eligible for the study were those who were visiting the clinics for the first time, had a current diagnosis of an anxiety disorder, and could communicate in French or English. Subjects recruited through advertisements were excluded. Data, collected by a self-administered questionnaire, included demographics, treatment history, use of services for anxiety, and the Beck Anxiety Inventory (BAI).

RESULTS

The sample comprised 235 subjects: 146 seen at 3 general hospital clinics, 54 at 3 psychologist-run clinics, and 35 at a psychiatric hospital clinic. There were statistically significant differences by clinic type in the prevalence of specific anxiety diagnoses, BAI score, referral source, antidepressant use, and use of services. High-intensity use (10 or more consultations during the previous year) was reported by 23.4% of the sample for medical services and 19.6% for mental health services. Multiple logistic regression identified variables associated with high-intensity use of medical services (higher BAI score, 1 to 4 years since first sought treatment, and less than 12 years of education) and high-intensity use of mental health services (clinic type, obsessive-compulsive disorder [OCD], and 5 or more years since first sought treatment).

CONCLUSIONS

The patient populations seen at different types of anxiety clinics differ in several respects, including referral source, previous treatment, and severity of symptoms. Regardless of type of clinic, patients with a longer time since they first sought treatment use more services, particularly mental health services. Those with less education use more medical services than those with greater education.

Mutation in the alpha-synuclein gene identified in families with Parkinson's disease

Parkinson's disease (PD) is a common neurodegenerative disorder with a lifetime incidence of approximately 2 percent. A pattern of familial aggregation has been documented for the disorder, and it was recently reported that a PD susceptibility gene in a large Italian kindred is located on the long arm of human chromosome 4. A mutation was identified in the alpha-synuclein gene, which codes for a presynaptic protein thought to be involved in neuronal plasticity, in the Italian kindred and in three unrelated families of Greek origin with autosomal dominant inheritance for the PD phenotype. This finding of a specific molecular alteration associated with PD will facilitate the detailed understanding of the pathophysiology of the disorder.

Mutation in the alpha-synuclein gene identified in families with Parkinson's disease

Parkinson's disease (PD) is a common neurodegenerative disorder with a lifetime incidence of approximately 2 percent. A pattern of familial aggregation has been documented for the disorder, and it was recently reported that a PD susceptibility gene in a large Italian kindred is located on the long arm of human chromosome 4. A mutation was identified in the alpha-synuclein gene, which codes for a presynaptic protein thought to be involved in neuronal plasticity, in the Italian kindred and in three unrelated families of Greek origin with autosomal dominant inheritance for the PD phenotype. This finding of a specific molecular alteration associated with PD will facilitate the detailed understanding of the pathophysiology of the disorder.

Displaying electroencephalographic dipole sources on magnetic resonance images

A simple, inexpensive method of displaying electroencephalographic (EEG) dipole sources on magnetic resonance images (MRIs) is presented. It consists of measuring the head according to the 10-20 system but instead of placing electrodes, benzonatate capsules (Tessalon Perles) (100 mg) are affixed to the patient's scalp. MRI is obtained with the capsules in place. In addition to the routine images, thin-section (1.0-1.3-mm) scans in a three-dimensional volume are obtained and the coordinates for each electrode position ascertained. The capsules are then replaced by electrodes and a waking and sleep recording is performed with a digital EEG instrument. Phenomena of interest are then averaged and interfaced with a source analysis program. The three-dimensional electrode coordinates are placed in a file and used to establish the electrode cloud on the basis of which source analysis proceeds. The three-dimensional source locations are then superimposed on the MRIs. The method is useful in the workup of epilepsy patients, by relating focal epileptogenic activity to definable lesions, and it also allows more precise localization of normal EEG phenomena.

Involvement of the pontomedullary corticospinal tracts: a useful finding in the diagnosis of X-linked adrenoleukodystrophy

PURPOSE

To determine whether pontomedullary corticospinal tract involvement is a common and specific finding of adrenoleukodystrophy on MR images.

METHODS

MR images of 10 patients with biochemically proved adrenoleukodystrophy who were examined during the last 6 years were reviewed retrospectively to determine the frequency of corticospinal tract involvement in the medulla, pons, mesencephalon, internal capsules, and corona radiata. MR images of 10 patients with other leukodystrophies (three with Krabbe disease, two with Alexander disease, two with metachromatic leukodystrophy, two with Pelizaeus-Merzbacher disease, and one with Canavan disease) were reviewed with specific attention to the pontomedullary corticospinal tracts.

RESULTS

Medullary and pontine corticospinal tract involvement was present in eight of the 10 patients with adrenoleukodystrophy. Mesencephalic and internal capsular involvement was present in three patients. The coronal radiata portion of the corticospinal tracts was not involved in any of the 10 patients. No pontomedullary corticospinal tract involvement was identified in any of the 10 patients with other leukodystrophies. The difference in the frequency of pontomedullary corticospinal tract involvement between the two groups was highly significant.

CONCLUSION

Pontomedullary corticospinal tract involvement is a common finding in adrenoleukodystrophy and is unusual in other leukodystrophies. Awareness of this finding can facilitate the radiologic diagnosis of this disease and may expedite management of affected patients.

HIV seropositive gay men: understanding adoption of safe sexual practices

The aim of this study was to determine the best predictors of safe sex practices among HIV seropositive gay men. A group of 96 homosexual men living with HIV completed a questionnaire that investigated theoretical constructs of the Ajzen's (1988) theory of planned behavior with respect to condom use for anal intercourse and sexual practices without anal intercourse. Other variables such as Triandis's (1977) construct of personal normative belief, psychological distress, and alcohol and drug use before sexual encounters were also investigated. Results indicated that the best predictor of intention to use condoms was perceived behavioral control. Personal normative belief was another important predictor of this intention. Although the best predictor of intention to have only sex without anal intercourse was perceived subjective norm, this intention was also significantly explained by perceived behavioral control. Moreover, perceived behavioral control was a significant predictor of having only sex without anal intercourse. Public health interventions among HIV seropositive gay men should aim mainly at increasing perception of behavioral control.