A new dithiolopyrrolone antibiotic triggered by a long fermentation of Saccharothrix algeriensis NRRL B-24137 in sorbic acid-amended medium

Saccharothrix algeriensis NRRL B-24137 is an actinobacterium isolated from Algerian Saharan soil. It produces bioactive compounds belonging to the dithiolopyrrolone class of antibiotics, which are characterized by the possession of a unique pyrrolinonodithiole nucleus. Dithiolopyrrolones are known for their strong antibacterial and antifungal activities. This class of antibiotics generated great interest after the discovery of their anticancer properties. In this study, an antibiotic named PR11, produced after a long bacterial fermentation (11 days) in sorbic acid-containing culture broth, was characterized as a new dithiolopyrrolone derivative. After HPLC analysis and purification, the chemical structure of this antibiotic was determined by ¹ H- and ¹³ C-nuclear magnetic resonance, mass and UV-visible data. PR11 was thus characterized as an iso-hexanoyl-pyrrothine, a novel dithiolopyrrolone derivative. The minimum inhibitory concentrations of the new induced antibiotic were determined against several pathogenic micro-organisms. A moderate to strong activity was noted against all Gram-positive bacteria, filamentous fungi and yeasts tested. SIGNIFICANCE AND IMPACT OF THE STUDY: Given the strong activities of dithiolopyrrolones against diverse prokaryotic and eukaryotic micro-organisms including potent selective-anticancer activity, the discovery of new-related derivatives draw continuous attention for therapeutic research. Depending on nature and concentration of added precursor, Saccharothrix algeriensis NRRL B-24137 produce several dithiolopyrrolone coumpounds. In this study, sorbic acid addition combined to long fermentation duration was shown to induce the biosynthesis of a novel dithiolopyrrolone derivative. After purification and full spectroscopic and spectrometric study, the compound was characterized as iso-hexanoyl-pyrrothine. In the future investigation for novel dithiolopyrrolone discovery, fermentation duration should be regarded as a key parameter as well.

Taxonomy and antimicrobial activity of streptosporangium strain SG163 isolated from a Saharan soil

n a continuing search fornew antimicrobial products from actinobacteriacollected in Algerian Saharan soils, an isolateof actinobacteria,designated Sg163, was selected for its interesting antimicrobial activity.The isolate wasidentified to the genus Streptosporangium by phenotypicand molecular criteria. The cultural and physiological characterizations as well as phylogenetic analysis indicated that the isolate was different from known members of the genus Streptosporangium. Analysis of the 16S rRNA sequence showed 97.09to 98.27% similarity with those of Streptosporangium type strains. The strainSg163 produced antifungal and antibacterial activities on several culture media. The highest antimicrobial activities were obtained in ISP2 medium. Three active products C1, C2 and C3 with both antifungal and antibacterial activities were isolated and purified by chromatographic methodswith C2, as the major compound. The data of the infraredspectroscopy andthe chemical revelations, suggested that the active molecules were glycosylatedaromaticcompounds.

Effective biosynthesis of benzoyl-pyrrothine dithiolopyrrolone antibiotic by cinnamic acid-precursor addition in culture of Saccharothrix algeriensis NRRL B-24137

Dithiolopyrrolone antibiotics, produced by several micro-organisms, are known for their strong antimicrobial and antitumor activities. Among of this micro-organisms, Saccharothrix algeriensis NRRL B-24137, a rare actinobacterium, has the ability to produce several dithiolopyrrolones derivatives depending on precursors added in the culture medium. After 10 days of strain fermentation on semi-synthetic medium supplemented with cinnamic acid and HPLC purification, biosynthesis of benzoyl-pyrrothine dithiolopyrrolone was evidenced through complete spectroscopic (UV-visible and 1H and 13C NMR) and spectrometric (electron impact mass spectrum) analyses. The pure molecule showed appreciable minimum inhibitory concentration values against several Gram-positive bacteria and filamentous fungi. SIGNIFICANCE AND IMPACT OF THE STUDY: Dithiolopyrrolone antibiotics, known for their strong antimicrobial activities, gained greater interest after the discovery of their antitumor properties. Depending on precursors added, Saccharothrix algeriensis NRRL B-24137 has the ability to produce several dithiolopyrrolones derivatives. Since biological activities of dithiolopyrrolones are related to their variable structure, discover of new natural analogues to be therapeutically explored remains a significant framework of research. In this study, a new dithiolopyrrolone derivative was purified from the fermentation broth of S. algeriensis NRRL B-24137. This new antibiotic, characterized as benzoyl-pyrrothine dithiolopyrrolone, was induced by adding cinnamic acid, as precursor, to a semi-synthetic medium.

Social challenges of contemporary psychiatry

Psychiatry and society are interrelated and the biopsychosocial model continues to dominate the clinical psychiatric practice. Some doubts have been expressed in recent years about the value and the wide acceptance of the biopsychosocial model. Ghaemi (2009)1 considers it to be anti-humanistic and advocates the use of less eclectic, less generic, and less vague alternatives. The fundamental changes that have been witnessed in our times across the spectrum of biology, psychology and sociology have made necessary that a conceptual clarity should prevail. The remarkable advances in neurosciences, neurobiology and genetics tend to swing the emphasis towards a more biological basis. Psychosis for example is the condition often regarded as being biologically constructed and most independent of the social context. The symptoms, however, of hallucinations and delusions in psychosis have social meaning for the person experiencing them and are primarily defined socially.2 Furthermore, vulnerability is often the result of social trauma, whether in the form of recent stressors that trigger onset, or earlier circumstances that shape cognitive and emotional style. Moreover, the approved treatment and management of long term psychiatric disorders has involved interventions that are either directly social, or psychosocial. Furthermore, doubts have also been raised by the endophenotype project,3 related to the genetics of schizophrenia. Cohen4 suggested that there may be more individual genotypic patterns associated with schizophrenia than people with schizophrenia on the planet. A recent alternative interpretation (network approach) is gaining some support. It suggests that a stressor causes symptoms that activate other symptoms, in a circular, self-reinforcing way.5 This theory moves away from psychiatric disorders being traditionally conceptualised as categorical or dimensional models. While psychiatry has shifted its focus to a more biological approach, social factors still have an important role in crosscultural diagnosis, psychiatric disorders relating to social deprivation, rehabilitation and enabling social inclusion. The degree to which society is willing to accept people with mental health problems has an obvious impact on their quality of life. We live in a period of cataclysmic social changes with disastrous wars, increased poverty and growing income inequality. The consequences on mental health are phenomenal with epidemics of self-harm and suicidality, higher rates of depression, and intensifying diagnosis of mood and conduct disorders in children and young adults. Other adversities include the disproportional number of people with mental health problems in prisons and penal institutions, the massive escalation of dementia sufferers and the shortcomings of the aspirations of community mental health care. In addition, there is an escalating social pathology with significant numbers of refugees and asylum seekers and rising numbers of homeless particularly in urban areas of the developed world. We should not, however, overlook the better rates of treatment for mental health problems, the emphasis on human rights, the empowerment and the service users' participation and the development in global mental health. All these social factors are important to contemporary psychiatry presenting complex challenges and demanding urgent attention and action.6 There is a need to embrace the development of evidence-based mental health services and a pluralistic approach, which balances appropriately the relevance of biological, psychological and social factors associated with mental health problems. The concept Meta-Community mental health builds on the successes of biological, psychological, social and community psychiatry.7 It incorporates neurosciences, sociology, psychology and anthropology and is delivered wherever the evidence shows that it makes a difference, whether in community or hospital, prisons, schools, court-room, place of work, refugee camp or battle-front. New technologies should be included for public information and education together with e-mental health, training of providers, tele-psychiatry and self-help methods delivered via IT. The boundaries of mental health are enlarging very rapidly and indeed new stakeholders and partners should be welcomed. This opens exciting possibilities but also creates some risks and strong evidence base should continue to guide us. Likelihood of finding early diagnostic and individualized treatment for psychosis, autism and dementia are likely to be of high financial cost. The importance of the social challenges of modern psychiatry was recognised by including mental health for the first time in the New Sustainable Development Goals of United Nations that will determine the global development by 2030 aiming at the promotion of life expectancy for all.8 Strengthening the prevention and treatment of mental health problems is a massive task for sustainable development as mental health has a direct impact on the whole range of Sustainable Development Goals.

The Mental Health Advice Centre in Lewisham

Psychiatric disorders in the community are very common and most are dealt with by GPs, only a small proportion reaching psychiatrists (Goldberg and Huxley, 1980; Shepherd et al, 1981). It has been suggested that a large proportion of the psychiatric problems seen by GPs are intimately related to adverse life events and difficulties (Ingham, 1981; Tennant et al, 1981).

Adolescents with a learning disability

The adolescents (n=57, age 13–19 years) attending the special schools for moderate and severe learning disabilities in a South East London health district and their families were assessed. The mothers of adolescents with severe learning disabilities in the transitional stage to adult services and development reported greater behaviour problems in their offspring, greater stress, more negative psycho-social family effects and more negative attitudes. Implications of the results for interventions, needs assessment and future research in family and adolescent functioning and the origins of psychiatric morbidity in young people with learning disabilities were discussed.

Staff perception on reduction of medication in patients with chronic schizophrenia

This exploratory study assessed staff perceptions to the reduction of maintenance neuroleptic medication in patients with chronic schizophrenia living in a long-stay hospital. Ten in-patients were assessed at regular times over six months. In addition to the Brief Psychiatric Rating Scale (BPRS), data were obtained from nursing staff on patients' ward behaviour (Ward Behaviour Interview Schedule, WBIS), clinical global opinion (CGI) and staff reaction (SR) to the reduction of medication plan. The average decrease of BPRS and WBIS was not related to keyworker's clinical global impression. The SR increased against the reduction of medication over the study period (P<0.05). Staff perceptions in the treatment of patients with chronic schizophrenia and their possible influence on prescribed closes should be taken into consideration in addition to psychopathology and clinical symptoms.

Mental health services commissioning and provision: Lessons from the UK?

The commissioning and provision of healthcare, including mental health services, must be consistent with ethical principles - which can be summarised as being "fair", irrespective of the method chosen to deliver care. They must also provide value to both patients and society in general. Value may be defined as the ratio of patient health outcomes to the cost of service across the whole care pathway. Particularly in difficult times, it is essential to keep an open mind as to how this might be best achieved. National and regional policies will necessarily vary as they reflect diverse local histories, cultures, needs and preferences. As systems of commissioning and delivering mental health care vary from country to country, there is the opportunity to learn from others. In the future international comparisons may help identify policies and systems that can work across nations and regions. However a persistent problem is the lack of clear evidence over cost and quality delivered by different local or national models. The best informed economists, when asked about the international evidence do not provide clear answers, stating that it depends how you measure cost and quality, the national governance model and the level of resources. The UK has a centrally managed system funded by general taxation, known as the National Health Service (NHS). Since 2010, the UK's new Coalition* government has responded by further reforming the system of purchasing and providing NHS services - aiming to strengthen choice and competition between providers on the basis of quality and outcomes as well as price. Although the present coalition government's intention is to maintain a tax-funded system, free at the point of delivery, introducing market-style purchasing and provider-side reforms to encompass all of these bring new risks, whilst not pursuing reforms of a system in crisis is also seen to carry risks. Competition might bring efficiency, but may weaken cooperation between providers, and transparency too. On the other hand, it is hard to implement necessary governance and control without worsening bureaucracy and inefficiency. The pursuit of market efficiencies has been particularly contentious in mental health care, where many professionals are defensive about the risks to vulnerable patients and to traditional ways of professional working. Developments and debates in the UK may be instructive for others. We conclude this paper with a set of questions that may help inform debate and evaluation of mental health services internationally.

Greek mental health reform: views and perceptions of professionals and service users

The Greek mental health system has been undergoing radical reforms for over the past twenty years. In congruence with trends and practices in other European countries, Greek mental health reforms were designed to develop a community-based mental health service system. The implementation of an extensive transformation became possible through the "Psychargos" program, a national strategic and operational plan, which was developed by the Ministry of Health and Social Solidarity. The Psychargos program was jointly funded by the European Union by 75% of the cost over a period of 5 years and the Greek State. After the period of 5 years, the entire cost of the new services became the responsibility of the Greek National Budget. Over the years the Psychargos program became almost synonymous with the deinstitutionalisation of long term psychiatric patients with the development of a wide range of community mental health services. The Psychargos program ended in December 2009. This article presents the views of service providers and service users as part an ex-post evaluation of the Psychargos program carried out in 2010. Data derived for this part of the evaluation are from the application of the qualitative method of focus groups. The outcomes of the study identified several positive and noteworthy achievements by the reforms of the Greek mental health system as well as weaknesses. There was considerable similarity of the views expressed by both focus groups. In addition the service users' focus group emphasized more issues related to improving their mental health wellbeing and living a satisfying, hopeful, and contributing life.

Ideology, psychiatric practice and professionalism

Psychiatry, associated as it is with social and cultural factors, has undergone profound changes over the last 50 years. Values, attitudes, beliefs and ideology all influence psychiatry. Deinstitutionalisation, the normalization principle, advocacy, empowerment and the recovery model are ideologies that have been closely associated with policy, service developments and clinical practice in psychiatry. A "new professionalism" is emerging as a consequence of a number of changes in mental health care that needs to be guided by the highest standards of care which are best epitomized in psychiatry as a social contract with society. Looking to the future it is important that the profession recognises the impact ideology can make, if it is not to remain constantly on the defensive. In order to engage proactively and effectively with ideology as well as clinical science and evidence based service development, psychiatry as a profession will do best to approach significant future policy, practice and service changes by adopting an ethical approach, as a form a social contract. Psychiatrists must pay increasing attention to understanding values as expressed by ideologies, working in a collaborative way with other mental health professionals, involve service users and manage systems as well as be competent in clinical assessment and treatment. Whether in time of plenty or in times of deprivation, ideology produces effects on practice and in the context of constantly changing knowledge and the current financial stress this is likely to be more the case (and not less) in the foreseeable future. Psychiatrists must take into consideration the new social problems seen in some high income countries with the increased availability of highly potent "street drugs", perceived threats from various immigrant and minority communities and breakdown of "social capital" such as the decline of the nuclear family.

Mycotoxin production by isolates of Fusarium lactis from greenhouse sweet pepper (Capsicum annuum)

Internal fruit rot, caused by Fusarium lactis, is an important disease of sweet pepper (Capsicum annuum) in Canadian greenhouses. Production of the mycotoxins fumonisin B₁ (FB₁), moniliformin (MON) and beauvericin (BEA) by F. lactis (17 isolates) and the related species F. proliferatum (three isolates) and F. verticillioides (one isolate), which are also associated with internal fruit rot, was evaluated on rice medium. All 21 isolates examined were found to produce BEA, at concentrations ranging from 13.28 to 1674.60 ppm, while 13 of 17 F. lactis isolates and two of three F. proliferatum isolates produced MON (0.23 to 181.85 ppm). Only one isolate of F. lactis produced detectable levels of FB₁ in culture, whereas all three F. proliferatum isolates and the F. verticilloides isolate produced this mycotoxin (0.28 to 314 ppm). Production of FB₁, MON and BEA was also evaluated in inoculated pepper fruits showing mild or severe symptoms of infection. FB₁ could be detected in both lightly and heavily diseased fruit tissue after inoculation with F. lactis, F. proliferatum or F. verticilloides, at concentrations ranging from 0.61 to 8.04 ppm. BEA was also detected in lightly and heavily diseased fruit tissue inoculated with F. lactis, as well as in heavily diseased tissue inoculated with F. proliferatum (3.00 to 19.43 ppm), but not in tissue inoculated with F. verticilloides. MON was detected in all tissues inoculated with F. proliferatum or F. verticilloides, and in heavily diseased tissue inoculated with F. lactis (0.03 to 0.27 ppm). The three mycotoxins were also found in naturally infected sweet pepper fruits exhibiting symptoms of internal fruit rot and collected from a commercial greenhouse. The production of MON, BEA and FB₁ alone or in combination by isolates of F. lactis suggests that development of internal fruit rot of sweet pepper is an important food safety concern, and that every effort should be made to cull infected fruit before it makes it to market.

Overcoming the barriers experienced in conducting a medication trial in adults with aggressive challenging behaviour and intellectual disabilities

BACKGROUND

Aggressive challenging behaviour in people with intellectual disability (ID) is frequently treated with antipsychotic drugs, despite a limited evidence base.

METHOD

A multi-centre randomised controlled trial was undertaken to investigate the efficacy, adverse effects and costs of two commonly prescribed antipsychotic drugs (risperidone and haloperidol) and placebo.

RESULTS

The trial faced significant problems in recruitment. The intent was to recruit 120 patients over 2 years in three centres and to use a validated aggression scale (Modified Overt Aggression Scale) score as the primary outcome. Despite doubling the period of recruitment, only 86 patients were ultimately recruited.

CONCLUSIONS

Variation in beliefs over the efficacy of drug treatment, difficulties within multidisciplinary teams and perceived ethical concerns over medication trials in this population all contributed to poor recruitment. Where appropriate to the research question cluster randomised trials represent an ethically and logistically feasible alternative to individually randomised trials.

Neuroleptics in the treatment of aggressive challenging behaviour for people with intellectual disabilities: a randomised controlled trial (NACHBID)

OBJECTIVE(S)

To assess the effects and cost-effectiveness of haloperidol, risperidone and placebo on aggressive challenging behaviour in adults with intellectual disability.

DESIGN

A double-blind randomised controlled trial of two drugs and placebo administered in flexible dosage, with full, independent assessments of aggressive and aberrant behaviour, global improvement, carer burden, quality of life and adverse drug effects at baseline, 4, 12 and 26 weeks, and comparison of total care costs in the 6 months before and after randomisation. At 12 weeks, patients were given the option of leaving the trial or continuing until 26 weeks. Assessments of observed aggression were also carried out with key workers at weekly intervals throughout the trial.

SETTING

Patients were recruited from all those being treated by intellectual disability services in eight sites in England, one in Wales and one in Queensland, Australia.

PARTICIPANTS

Patients from all severity levels of intellectual disability; recruitment was extended to include those who may have been treated with neuroleptic drugs in the past.

EXCLUSION CRITERIA

treatment with depot neuroleptics/another form of injected neuroleptic medication within the last 3 months; continuous oral neuroleptic medication within the last week; those under a section of the Mental Health Act 1983 or Queensland Mental Health Act 2000.

INTERVENTIONS

Randomisation to treatment with haloperidol (a typical neuroleptic drug), risperidone (an atypical neuroleptic drug) or placebo using a permuted blocks procedure. Dosages were: haloperidol 1.25-5.0 mg daily; risperidone 0.5-2.0 mg daily.

MAIN OUTCOME MEASURES

Primary: reduction in aggressive episodes between baseline and 4 weeks using Modified Overt Aggression Scale. Secondary: Aberrant Behaviour Checklist; Uplift/Burden Scale; 40-item Quality of Life Questionnaire; Udvalg for Kliniske Undersøgelser scale; Clinical Global Impressions scale. Economic costs recorded using a modified version of Client Service Receipt Inventory for 6 months before and after randomisation.

RESULTS

There were considerable difficulties in recruitment because of ethical and consent doubts. Twenty-two clinicians recruited a total of 86 patients. Mean daily dosages were 1.07 mg rising to 1.78 mg for risperidone and 2.54 mg rising to 2.94 mg for haloperidol. Aggression declined dramatically with all three treatments by 4 weeks, with placebo showing the greatest reduction (79%, versus 57% for combined drugs) (p = 0.06). Placebo-treated patients showed no evidence of inferior response in comparison to patients receiving neuroleptic drugs. An additional study found that clinicians who had not participated in clinical trials before were less likely to recruit. Mean total cost of accommodation, services, informal care and treatment over the 6 months of the trial was 16,336 pounds for placebo, 17,626 pounds for haloperidol and 18,954 pounds for risperidone.

CONCLUSIONS

There were no significant important benefits conferred by treatment with risperidone or haloperidol, and treatment with these drugs was not cost-effective. While neuroleptic drugs may be of value in the treatment of aggressive behaviour in some patients with intellectual disability, the underlying pathology needs to be evaluated before these are given. The specific diagnostic indications for such treatment require further investigation. Prescription of low doses of neuroleptic drugs in intellectual disability on the grounds of greater responsiveness and greater liability to adverse effects also needs to be re-examined.

Services in the community for adults with psychosis and intellectual disabilities: a Delphi consultation of professionals' views

BACKGROUND

There remains a severe lack of evidence on the effectiveness of community services for adults with psychosis and intellectual disabilities (ID). There has been little consensus even of what services should provide for this service user group.

METHOD

A consultation of multidisciplinary professionals was carried out by using a three-round Delphi exercise. Participants were recruited nationally. They rated their views on the importance of 139 items for the care of adults with psychosis and ID. These included 85 routine service components, 23 service user characteristics for those needing a more intensive service and 31 more intensive service components.

RESULTS

Forty-nine out of 52 participants completed all three rounds of the Delphi consultation. Consensus of opinion (> or = 80% agreement as essential) was obtained on 18 of the routine service components, nine of the service user characteristics and five of the more intensive service components. The routine service components considered essential can be broadly considered under a need for a focused approach on the service user and their illness (e.g. monitoring of mental state) and the added need to work within the wider context of the service user with psychosis and ID (e.g. access to social, leisure or occupational activities). Five of the more intensive service components were considered to be essential (e.g. can react to a crisis that day). However, the routine service components considered essential already contained many components such as out-of-hours support and crisis plans also relevant to more intensive services.

CONCLUSION

These findings can be used to develop further the evidence base for services in the community for this user group and to assist in the preparation of much needed service evaluation studies.

Deep venous thrombosis and cancer (about 68 cases)

19672

Background: The association between cancer and deep venous thrombosis (DVT) has been known for a century. The goal of this retrospective study is to evaluate the risk factors and the characteristics of patients presenting with a DVT to determine the interest of a malignancy work up. Methods: This is a monocentric retrospective study of 405 DVT’s ± pulmonary embolism reported between January 2003 and July 2006, confirmed by sonogram and spiral CT. The risk factors for the embolic events as well as the diagnosis work up done to determine the origin of the embolism were analyzed. Results: In our population the mean age was 50 years, 300 patients (74 %) presented with at least one risk factor for thrombosis event, 68 cases were found to have a malignancy (16.8%) from which 9 were occult malignancies (found among 109 cases of idiopathic DVT’s).The mean age of the patients diagnosed with cancer was significantly higher with a female predominance. These malignancies were distributed as follow: 50% gynecologic origin, 25% gastrointestinal, 10% pulmonary, 9 % urologic and 6% of hematologic origin. The risk factors identified were: Surgery (OR = 4) and Chemotherapy (OR=6). The occult malignancies were mentioned during the encounter with 6 patients. The physical exam, abdomino-pelvic sonograms were sufficient for the etiologic diagnosis in 8 cases. Other exams like (tumor markers, gastrointestinal endoscopies) were non contributive, a part of the clinical orientation they provided. Conclusions: DVT’s do occur more frequently in operated cancer patients or those who received chemotherapy. The malignancies are more frequently of gynecologic or gastrointestinal origin. It appears that an extensive diagnosis work up is not cost effective, a basic work up including: a thorough history, a complete physical exam, simple blood tests (inflammatory markers and CBC) as well as a abdomino-pelvic sonogram are sufficient for the screening of a malignancy, extensive work up should be done as a second option.

No significant financial relationships to disclose.

Epidemio-clinic and evolutionary profile of laryngeal cancer at oncology department of Mohamed VI University Hospital

16536

Background: Larynx cancer is one of the most frequent cancers of the superior airways. Narrowly linked to the chronic tobacco use, often associated with other addictive behaviours notably chronic alcoholism. It touches males in more than 90% of cases, with preponderance between 40 and 59 years old. It is often epidermoïd carcinoma of which the overall prognosis is one of the better within the cancers of the superior airways. Methods: Our study concerned 58 cases of larynx cancer treated at the oncology department of Mohamed VI university hospital in Marrakech between October 2002 and December 2005. Results: The mean age was of 55 years. 90% patients were males and 62% of urban origin. The tobacco use was discovered in 91% of the cases and the alcoholism in 40%. Symptoms at diagnosis were essentially dysphonia in 95% and dyspnea in 88% of case the lather having necessitated a tracheotomy in urgency in 55% of cases. The pathology showed that it was exclusively an epidermoïd carcinoma, well differentiated in 80% of the cases, 80% of the patients were initially locally advanced (T3 - T4), while 5% only had a localized stage . 27% of patients received a radiation therapy after surgery (total laryngectomy + lymphadenectomy in all cases) and 61% an exclusive radio-chemotherapy. 5% were lost from view before the beginning of the radiotherapy. On the assessable patients, 73% were in complete remission. Conclusions: The delay to the diagnosis in our country strongly darkened the prognosis of this cancer. The adoption of an information and sensibilisation strategy (anti-tobacco campaign) is necessary.

No significant financial relationships to disclose.

Effect of amino acids containing sulfur on dithiolopyrrolone antibiotic productions by Saccharothrix algeriensis NRRL B-24137

AIMS

To study the effect of sulfur-containing amino acids (L-cysteine, L-cystine, L-methionine and DL-ethionine) on the production of dithiolopyrrolone antibiotics by Saccharothrix algeriensis NRRL B-24137.

METHODS AND RESULTS

The production levels of dithiolopyrrolones were investigated by using high performance liquid chromatography in a chemically semi-synthetic medium. The production of the studied antibiotics depends upon the nature, concentration and the time of addition of these sources in the culture medium. Both cysteine and cystine favoured the specific productions of dithiolopyrrolones; iso-butyryl-pyrrothine (ISP) by cysteine, however butanoyl-pyrrothine, senecioyl-pyrrothine and tigloyl-pyrrothine by cystine, when added initially to the culture medium. The maximum specific productions of dithiolopyrrolones were observed in the presence of 5 mmol l(-1) cystine for thiolutin, 5 mmol l(-1) cysteine for ISP, and 10 mmol l(-1) cystine for others studied dithiolopyrrolones as shown in Fig. 3. The production of these antibiotics was decreased when the concentrations of cysteine and cystine were in excess. All dithiolopyrrolone specific productions were strongly inhibited by addition of methionine and ethionine, without inhibition of mycelial growth.

CONCLUSIONS

Among all studied amino acids, cystine and cysteine can be used as supplements for improvement the production of dithiolopyrrolone antibiotics by S. algeriensis NRRL B-24137.

SIGNIFICANCE AND IMPACT OF THE STUDY

Dithiolopyrrolone antibiotics have many important applications for employing them as medicaments, particularly in the treatment of human and animal cancers. In the present work, the influence of containing-sulfur amino acids on dithiolopyrrolone antibiotic productions was studied. The obtained results can be employed for the optimization of the culture medium for the dithiolopyrrolone productions in higher quantities.

Psychiatric co-morbidity and gender differences in intellectual disability

BACKGROUND

Although gender differences in psychopathology among the general psychiatric population appear to be well documented, such differences have been either ignored or inconsistently investigated among people with intellectual disability (ID).

METHODS

The study examined psychiatric co- morbidity in 295 men and 295 women with ID and significant social impairments living in community settings. The sample was drawn from consecutive clinical referrals to a specialist mental heath service of South-East London. Psychiatric diagnoses were based on ICD-10 criteria.

RESULTS

Personality disorder was more common among men, although dementia and adjustment reaction were more common among women. There were also gender differences in marital status, with a larger percentage of women being either married or in a stable relationship. Gender differences in the source of referral were also observed, with more women being referred through primary care and more men being referred through generic mental health services.

CONCLUSIONS

Female patients seem to have at some extent different mental health needs from male patients. Such differences should be taken into account in the design and delivery of clinical service for people with ID.

Nutritional and environmental risk factors of nasopharyngeal carcinoma in Morocco

15535

Background: The nasopharyngeal carcinoma (NPC) has a high incidence in north Africa and in southeast Asia. The goal of this study is to analyze the implication of nutritional and environmental factors in the raise of this cancer. Methods: It is a retrospective investigation with 274 affected by the NPC and 394 witnesses. Results: The nasopharyngeal carcinoma affects mens more then womens with a sex ratio of 1.8. We observed a peak between 20 and 29 years with the women and between 40 and 49 years with the men. We noted also a high frequency of the young population touched by this disease: 10.5% less than 20 years old, which was also observed in Tunisia, Algeria and Sudan while the young patients are rarerly affected in the Asian southeast. The patients have mostly rural origin with agricultural parents, having lived during their childhood in precarious habitat and hygiene conditions and with an instruction level generally low, often without function or exercising in the primary or secondary sector. The study of nutritional and environmental risk factors showed a statistically meaningful relation between this cancer and some factors bound to the food: consumption of pickle, of smen (butter fermented), and to the environment: life in agricultural environment, practice of the farm, absence of drinkable water and contact with toxic substances. Conclusions: It seems that the exposition to environmental risk factors could increase the risk to contract this cancer, especially with the already exposed persons to nutritional risk factors. We observed a territorial variability of the exposition to the NPC risk factors that explains the gradient south north of the incidence of this cancer in Morocco. The results of this study show the complexity of factors being able to take to a cancerogenesis.

No significant financial relationships to disclose.

Psychiatric symptoms and problem behaviours in people with intellectual disabilities

BACKGROUND

Previous studies have suggested different patterns of associations between psychiatric symptoms and problem behaviours in people with intellectual disabilities (ID). The aim of this study was to investigate which problem behaviours are associated with specific psychiatric symptoms and the relative strength of these specific associations.

METHOD

A cross sectional survey using the Psychiatric Assessment Schedule for Adults with Developmental Disabilities Checklist and the Disability Assessment Schedule was carried out in a sample of 214 adults with ID.

RESULTS

Self-injurious and, to a lesser extent, aggressive problem behaviours were most associated with affective type symptoms. Screaming and destructive behaviours tended to be more associated with autism-related social impairment rather than conventional psychiatric symptoms.

CONCLUSIONS

This study gives further evidence of associations between psychiatric symptoms and specific problem behaviours in people with ID. It may be particularly useful to consider the diagnosis of affective disorders if a person with ID shows self-injurious or aggressive behaviours.

An exploratory study of assertive community treatment for people with intellectual disability and psychiatric disorders: conceptual, clinical, and service issues

BACKGROUND

Assertive community treatment (ACT) has been applied to a number of disorders in the adult population, such as schizophrenia, with some degree of success; its use in the treatment of people with intellectual disability (ID) and mental illness has received little attention. Despite the high costs of ID in health and social care, there has been very little evidence-based practice for people with ID and mental illness, and it remains a neglected area of research. Aims The aims of this study were an exploratory comparison of the effectiveness of an ACT model for the treatment of mental illness in people with ID (ACT-ID) with a standard community treatment (SCT-ID) approach.

METHOD

A Randomized controlled trial design was adopted and allocation was made by stratified randomization by an independent statistician. The prognostic factors used in the randomization were gender and psychiatric diagnosis (psychosis vs. affective). Service users were randomly allocated to either ACT-ID or SCT-ID.

RESULTS

There were no statistically significant differences between ACT-ID and SCT-ID in terms of the level of unmet needs, carer burden, functioning and quality of life, but borderline evidence of a difference between treatment groups in quality of life in favour of SCT-ID. Both SCT-ID and ACT-ID groups decreased level of unmet needs and carer burden, and increased functioning. SCT-ID also led to a small increase in quality of life.

Schizophrenia-spectrum psychoses in people with and without intellectual disability

BACKGROUND

Although there is an increased risk of schizophrenia-spectrum psychoses (SSP) in people with intellectual disability (ID), there is a paucity of research evidence into clinical presentation of the disorder in comparison with research into SSP in people without ID.

AIMS

The aims of the study were to compare clinical, functional, and social factors in patients with mild ID (ICD-10: F70) and SSP (ICD-10: F20-9) attending a specialist mental health service for people with ID, with a control group of patients without ID but with SSP attending a generic adult mental health (GAMH) outpatient clinic.

METHOD

A total of 106 patients with SSP (53 with ID and 53 from GAMH) were assessed on psychopathological symptoms, functioning scales and quality of life. They were compared using chi-squared and regression analysis where appropriate.

RESULTS

People with ID and SSP appear to be more debilitated by the co-occurring disorder than those with the same disorder but without ID. Increases in observable psychopathology and "negative" schizophrenic symptoms, and decreased functional abilities were observed in the group with ID when compared to the GAMH group. The clinical implications of these findings are discussed.

Psychiatric inpatient care for adults with intellectual disabilities: generic or specialist units?

BACKGROUND

When adults with intellectual disabilities (ID) require a psychiatric admission, general adult mental health units are often used. Specialist units have emerged recently as a care option but there is only limited evidence of their effectiveness. Thus this study aims to describe and evaluate the effectiveness of a specialist inpatient unit and report on the utilization of generic and specialist inpatient services.

METHOD

All patients admitted to a specialist ID psychiatric unit were evaluated on admission and immediately after discharge on a number of outcome measures. In addition, they were compared with those admitted to general adult mental health units covering the same catchment area.

RESULTS

Significant improvements were demonstrated within the specialist unit cohort on measures including psychopathology, global level of functioning, behavioural impairment and severity of mental illness. The specialist unit patients had a longer length of inpatient stay but were less likely to be discharged to out-of-area residential placement.

CONCLUSIONS

Specialist units are an effective care option for this group of people.

Referral trends of people with intellectual disabilities and psychiatric disorders

BACKGROUND

The Specialist Mental Health Service for people with an intellectual disability (ID) and psychiatric disorder (referred to throughout this paper as 'the Service') has been in operation in south-east London for the last 18 years, during which time two local, long-stay institutions have closed.

AIMS

To measure the number of referrals to the Service from 1983 to 2001 and identify trends.

METHODS

Data were recorded on 752 new referrals using the assessment and information rating profile. Diagnoses according to the International Classification of Diseases (10th edition) were made by two psychiatrists. Referrals for a one off consultation or assessment, or with an IQ>70 were excluded from analysis.

RESULTS

Over time more non-white clients and more clients with mild ID were referred. More referrals were made in later years, and a greater proportion came from primary care. Later referrals were also more likely to have a psychiatric diagnosis than those in earlier years.

CONCLUSION

Significant trends in referrals were identified, which may be explained by various external factors.

[Adenocarcinoma of the cervix uteri: a retrospective study of 83 cases]

The frequency of the adenocarcinoma of cervix uteri is increasing.

AIM OF THE STUDY

To define the characteristics of the entity.

PATIENTS AND METHODS

Between 1986 and 1992, 83 adenocarcinoma of cervix uteri, were treated at the Ibn Rochd Oncology Centre in Casablanca. It's a retrospective study with univariate analysis of the prognostic factors. This analysis was done for patients who were followed until the death or have 5 years or more follow up and the survival was calculated according the Kaplan & Meier method at 5 years. The local and regional recurrence factors were evaluated statically according the chi 2 and those for survival rate according the Logrank test.

RESULTS

The frequency increased during the period with 2.1% in 1986 and 8.2% in 1992. The median of aged was 49 years. Fifty one patients have localised stage. Combined radiotherapy and surgery was performed in 66 cases and 17 received radiation alone. The loco-regional control was obtained in 83% among 73 available patients for results. The univariate analysis showed that the histological type was not a significant factor. However, age, tumor size, stage, histological grade and lymph node involvement were significant factors. These factors, the degree of differentiation and the lymph node involvement were significant for the 5-years survival.

CONCLUSION

The prognosis factors of the cervix uteri adenocarcinoma are, size tumor more than 4 cm, lymph node involvement, microscopic involvement to the parameters and positives excision merges.

[Conformal therapy of locally advanced cholangiocarcinoma of the main bile ducts]

PURPOSE

Retrospective study of 23 patients treated with conformal radiotherapy for a locally advanced bile duct carcinoma.

PATIENTS AND METHODS

Eight cases were irradiated after a radical resection (R0), because they were N+; seven after microscopically incomplete resection (R1); seven were not resected (R2). A dose of 45 of 50 Gy was delivered, followed by a boost up to 60 Gy in R1 and R2 groups. Concomitant chemotherapy was given in 15 cases.

RESULTS

Late toxicity included a stenosis of the duodenum, and one of the biliary anastomosis. Two patients died from cholangitis, the mechanism of which remains unclear. Five patients are in complete remission, six had a local relapse, four developed a peritoneal carcinosis, and six distant metastases. Actuarial survival rate is 75%, 28% and 7% at 1, 3 and 5 years, respectively (median: 16.5 months). Seven patients are still alive with a 4 to 70 months follow-up. Survival is similar in the 3 small subgroups. The poor local control among R0N+ cases might be related to the absence of a boost to the "tumor bed". In R1 patients, relapses were mainly distant metastases, whereas local and peritoneal recurrences predominated in R2.

CONCLUSION

Conformal radiochemotherapy delivering 60 Gy represents a valuable palliative approach in locally advanced biliary carcinoma.

[Primitive seminoma of the mediastinum: a case report]

In this study, the case has been reported of a 36-year old male who was treated at the Ibn Rochd Oncology Center in Casablanca for a primary mediastinal seminoma revealed by a symptomatology including cough, dyspnea, laterocervical swelling, rachidial pain and gait disorder. The preliminary investigation showed significant mediastinal enlargement with a right pleuritis and vertebral metastases; tumor markers were normal. The diagnosis of seminoma was confirmed by pathological and immunohistochemical analysis of the cervical adenopathy. Disease management consisted of BEP/cisplatin type chemotherapy and lumbar, mediastinal, and supraclavicular radiotherapy. The response after four courses of combined chemo-/radiotherapy was estimated at 25%, but the patient died from respiratory failure five months after the initiation of treatment.

BIOMED-MEROPE project: service provision for adults with intellectual disability: a European comparison

The aim of the present paper is to describe and compare services for adults with intellectual disability (ID) and mental health needs in five European countries: Austria, England, Greece, Ireland and Spain. A framework and structure for collecting information about service provision was designed. This information was collected through a mixture of interviews with service providers, questionnaires and a review of the research literature within each country. Information was collected on historical context, policy, legislation, assessment, treatment and the structure of services for people with ID and mental health problems. Overall, the needs of those with additional mental health needs have not been specifically addressed at a national level with perhaps the exception of England and Ireland, although there are still gaps in services in these nations. Normalization has been adopted in each of the five countries, and there are moves toward deinstitutionalization, integration and inclusion. Families and self-advocacy groups have grown. The pace of this change varies between and even within countries. The main findings of the study include: unclear policy, trends for legislative changes, increased prevalence of mental health problems, inadequate generic service provision, a need for specialist mental health services, a need for improved interconnections of services, and a need for training developments. Policy and legislation in the five European countries under consideration tend to separate the disability aspects of people with ID from their mental health needs. Consequently, the service needs of this group remain largely invisible. This might be a direct reflection of policy clarity and legislation, or could be the result of a failure to implement existing guidelines. This has a detrimental effect on the lives of people with ID, and their families and carers.

[Colorectal cancer in patients younger than 40 years of age]

Between 1988 and 1994, 326 patients with colorectal cancers were treated at the Ibn Rochd Oncology Centre in Casablanca; 88 patients were less than 40 years old (27%). There were 79 males and nine females. A family history of colorectal cancer was noted in 5%. The most frequent symptoms were bleeding and rectal pain. The localisation of the tumour was the rectum in 70 cases. According to the anatomopathological profile, Dukes stages C and D were the most frequent and mucosal adenocarcinoma was noted in 24 cases. Seventy patients had surgery, associated with radiation therapy in 59 cases. Adjuvant chemotherapy was given in 44 cases and palliative treatment in 17 cases. Recurrence occurred in 14 cases and metastasis in other six cases. At five years, overall survival and disease-free survival rates were 24% and 17%, respectively. Worse prognostic factors were mucosal adenocarcinoma, poor differentiated adenocarcinoma and Dukes C and D stages.

Use of the atypical antipsychotics Olanzapine and Risperidone in adults with intellectual disability

The present study was designed to monitor the use of atypical antipsychotics in adults with intellectual disability and to evaluate the clinical effectiveness of these drugs. Twenty-one patients were commenced on an atypical antipsychotic: 12 on Olanzapine and nine on Risperidone. The ICD-10 diagnoses of the subjects were mild (13 cases) or moderate (8 cases) mental retardation, and psychiatric disorders (17 cases) with significant impairment of behaviour in 10 cases. Tolerability was good for 15 patients experiencing minimum or no side-effects, and medication was only stopped as a result of side-effects in one case. Clinical global outcome was rated as minimally improved or better for 16 cases. The present findings suggest that the atypical antipsychotics Olanzapine and Risperidone are well tolerated by patients with intellectual disability and psychiatric disorders, and are broadly effective against target symptoms.

Mental health services for people with intellectual disability: a conceptual framework

The present paper discusses the application of the 'matrix model' to mental health services for people with intellectual disability. There is great variability between the service models in this area, which makes comparisons and conclusions difficult. The present model facilitates the breaking down of these complexities into understandable parts so that future directions for research, service planning and delivery can be logical, coherent and evidence-based.

Nasopharyngeal carcinoma in children under 15 years of age: a retrospective review of 65 patients

BACKGROUND

Nasopharyngeal carcinoma constitutes comprises up to 5% of primary childhood cancers but literature lacks modern uniformly treated large series.

PATIENTS AND METHODS

A retrospective review was performed of sixty-five previously untreated patients younger than 16 years of age diagnosed and treated at the Ibn Rochd Centre in Casablanca between 1988 and 1992. Forty-four percent of them were stage T3 to T4 and 66% stage N2 or N3. All patients were irradiated. Prior adjuvant chemotherapy was administered in 33 patients. Thirteen patients were lost to follow-up.

RESULTS

Local control was obtained in 85% of the 52 evaluable patients. The five-year overall survival was 42% and disease-free survival 38%. Ten relapses occurred at local and/or regional sites. Six patients have distant metastases. All 24 patients with relapse or persistent disease died despite salvage therapy. Stage, histology and dose of radiation, were statistically significant prognostic variables. Patients treated with chemotherapy followed by irradiation had a better outcome than those treated with radiation alone.

CONCLUSIONS

Nasopharyngeal carcinoma in children is a rare chemosensitive tumor. However, conclusive treatment guidelines cannot be drawn from this series and prospective co-operative studies are needed for the development of more effective and less toxic therapeutic strategies.

[Combination of endoscopic resection and external radiotherapy in carcinoma of the bladder]

The authors present results that were obtained by combining endoscopic resection and external beam radiation therapy in a population of 55 patients presenting with bladder cancer. They also explain the difficulties they encountered in the management of bladder cancer at the Ibn Rochd Cancer Center (Casablanca, Morocco).