Relationship between obsessive compulsive symptomatology and severity of psychotic symptoms in schizophrenia: Meta-analysis and meta-regression analysis

BACKGROUND

Schizophrenia patients often show obsessive-compulsive symptoms (OCS) and obsessive-compulsive disorder (OCD) and their presence has been associated with poorer prognosis. However, the impact of OCS/OCD on psychotic severity remains unclear. The aim of this study is twofold: 1) to investigate the effect of OCS/OCD on the severity of positive, negative, and global psychotic symptoms of schizophrenia patients and 2) to analyze the effect of patient and study-related covariates on moderating this relationship.

METHODS

A systematic review and meta-analysis (SRMA) of studies comparing the severity of psychotic symptoms among schizophrenia patients with and without OCS/OCD was performed. Standardized mean difference (SMD) was calculated for positive, negative, and global psychotic symptoms. The difference of SMD (Diff SMD) was calculated to analyze the effect of covariates on study outcomes using meta-regression.

RESULTS

Sixty-seven studies involving 7740 patients were included. Patients with schizophrenia and OCS/OCD showed a slightly higher severity of positive (SMD = 0.17, p value = 0.0089) and global psychotic symptoms (SMD = 0.24, p value = 0.0104) than patients without OCS/OCD but no differences in negative symptoms were found between groups (SMD = 0.11, p value = 0.0367). Only one covariate "proportion of patients without antipsychotics (AP)" was found to modify the effect on psychotic severity (Diff SMD = -0.008, p value = 0.002).

CONCLUSIONS

Comorbid OCS/OCD in schizophrenia has, at most, a minor impact on psychotic severity. Variability in this effect was considerable and was poorly explained by the covariates analyzed.

Unravelling groundwater and surface water sources in the Esteros del Iberá Wetland Area: An isotopic approach

In the Esteros del Iberá Wetland Area (EIWA, NE Argentina), the southern sector of the transboundary Guarani Aquifer System (SAG) is overlain by the Ramsar listed Iberá Wetlands and several rivers, that combined extend across 37,930 km² and represent one of the largest freshwater systems on the South American continent. Previous hydrogeological studies encompassing the entire SAG proposed preferential discharge of groundwater of various origins and ages to the EIWA. In this study, a multi-tracer study using major ionic species, δ¹⁸O, δ²H and ²²²Rn was conducted in lagoons, rivers, wells, and boreholes in the EIWA to confirm if discharge from the transboundary SAG is contributing to the surface water system. End-member Mixing Analysis (EMMA) determined the existence of four main end-members: groundwater from the SAG, more saline groundwater from the deeper Pre-SAG, and two poorly mineralised end-members from shallow, Post-SAG. EMMA calculations clearly illustrated complex binary and ternary mixing patterns involving the four end-members and highlighted the role of geological structures, specifically regional steep faults, in controlling the mixing patterns. ²²²Rn activities allowed in-situ identification of preferential deep groundwater discharge into both surface waters and shallow groundwaters. These findings provide strong evidence for the widespread existence of upward flows along major faults in this sector of the SAG, inducing complex mixing flow patterns and explaining the presence of old groundwater in shallow aquifers. Mapping the sources of water and the hydrological interactions are relevant for improving water balance estimates and develop management policies towards the preservation of these wetlands.

Groundwater chemical baseline values to assess the Recovery Plan in the Matanza-Riachuelo River basin, Argentina

The two most exploited aquifers in the Matanza-Riachuelo River basin are being monitored in the framework of the Integrated Environmental Sanitation Plan that implements the Basin Authority, Autoridad de Cuenca Matanza Riachuelo. In this context, this work identifies the groundwater chemical types and the natural processes behind them; determines spatial and temporal changes; establishes ranges of variation for chemical components, and proposes concentration values for the upper limit of the natural chemical background. A total of 1007 samples from three aquifer-layers (Upper Aquifer, top and bottom of Puelche Aquifer) have been studied. As concrete guidelines for practical determination of baseline values are not available in the region, the methodology used follows the proposals of European projects which assessed European water directives. The groundwater composition is very stable in terms of both chemical facies and mineralization degree, and the changes observed in the dry and wet periods analysed are subtle in general. Most of the groundwater is Na-HCO3 type, except a few samples that are Ca-HCO3, Na-ClSO4 and Na-Cl types. The Ca-HCO3 waters are the result of calcium carbonate dissolution, Na-HCO3 waters result from cation exchange and carbonate dissolution, while in the Na-ClSO4 and Na-Cl waters, mixing with connate and with encroached old marine water from the underlying and overlying sediments are the most relevant processes. The proposed values for the upper limit of the natural background consider the influence of geology and Holocene marine ingressions in the baseline of coastal groundwater. This study allowed to know the initial chemical conditions of the groundwater system of the Matanza-Riachuelo River basin and to establish the reference from which Basin Authority can start to evaluate trends and monitor the recovery plan. At the same time, it sets a precedent for future studies in the region.

The origin of groundwater composition in the Pampeano Aquifer underlying the Del Azul Creek basin, Argentina

The Pampean plain is the most productive region in Argentina. The Pampeano Aquifer beneath the Pampean plain is used mostly for drinking water. The study area is the sector of the Pampeano Aquifer underlying the Del Azul Creek basin, in Buenos Aires province. The main objective is to characterize the chemical and isotopic compositions of groundwater and their origin on a regional scale. The methodology used involved the identification and characterization of potential sources of solutes, the study of rain water and groundwater chemical and isotopic characteristics to deduce processes, the development of a hydrogeochemical conceptual model, and its validation by hydrogeochemical modelling with PHREEQC. Groundwater samples come mostly from a two-depth monitoring network of the "Dr. Eduardo J. Usunoff" Large Plains Hydrology Institute (IHLLA). Groundwater salinity increases from SW to NE, where groundwater is saline. In the upper basin groundwater is of the HCO3-Ca type, in the middle basin it is HCO3-Na, and in the lower basin it is ClSO4-NaCa and Cl-Na. The main processes incorporating solutes to groundwater during recharge in the upper basin are rain water evaporation, dissolution of CO2, calcite, dolomite, silica, and anorthite; cationic exchange with Na release and Ca and Mg uptake, and clay precipitation. The main processes modifying groundwater chemistry along horizontal flow at 30 m depth from the upper to the lower basin are cationic exchange, dissolution of silica and anorthite, and clay precipitation. The origin of salinity in the middle and lower basin is secular evaporation in a naturally endorheic area. In the upper and middle basins there is agricultural pollution. In the lower basin the main pollution source is human liquid and solid wastes. Vertical infiltration through the boreholes annular space during the yearly flooding stages is probably the pollution mechanism of the samples at 30 m depth.

[Value of the serum measurement of alpha-L-fucosidase in the diagnosis of hepatocarcinoma]

The serum catalytic concentration of alpha-L-fucosidase (AFU) was measured to evaluate its usefulness for the diagnosis of hepatocarcinoma (HPC). Fifty-one patients with hepatocarcinoma, 30 with hepatic metastases, 40 with hepatic cirrhosis, 22 with other hepatic diseases and 48 healthy individuals were evaluated. The values of serum AFU were significantly higher in all groups (p less than 0.001), than in the reference group; there were also significant differences between those with HPC and hepatic cirrhosis (p less than 0.01), and between HPC and other hepatic diseases (p less than 0.05). The highest effectiveness of the test was achieved with a catalytic concentration of serum AFU of 210 nKat/l, with a 37% sensitivity and a 91% specificity. When the AFU measurement was used concomitantly with that of alpha-fetoprotein (AFP) for the diagnosis of HPC, sensitivity increased to 72% when AFI or AFP were elevated, and specificity reached 99% when both were increased. We think that the measurement of serum AFU may be helpful for the diagnosis of hepatocarcinoma.

Hepatitis B virus replication in acute hepatitis B, acute hepatitis B virus-hepatitis delta virus coinfection and acute hepatitis delta superinfection

To evaluate the effect of hepatitis delta virus on the level of replication of hepatitis B virus and to assess the clinical significance that such an effect might have on the final outcome of the infection, the serological profile of hepatitis B virus DNA was investigated in 153 patients with acute or chronic hepatitis B virus infection with or without associated delta infection. Serum hepatitis B virus DNA was detected in 57% of patients with acute hepatitis B, 67% of those with acute hepatitis B virus-hepatitis delta virus coinfection and 25% of HBsAg carriers with hepatitis delta virus superinfection during the first week after the onset of symptoms. Patients with acute hepatitis B and those with acute hepatitis B virus-hepatitis delta virus coinfection did not differ significantly with respect to the serological profile of hepatitis B virus DNA and final clinical outcome. Within the group of HBsAg carriers with hepatitis delta virus superinfection, all patients who were initially negative for hepatitis B virus DNA developed chronic hepatitis delta virus infection, whereas 3 of the 4 patients with active hepatitis B virus infection at the time of superinfection showed transient inhibition of hepatitis B virus replication followed by termination of hepatitis delta virus infection in two patients. Therefore, although delta virus may inhibit the replication of hepatitis B virus among chronic HBsAg carriers, this effect is not readily apparent among patients with hepatitis B virus-hepatitis delta virus coinfection.