Zymographic Detection of Aspartic Proteinase Activities in Porcine Ovarian Extracts.

Aims: Tightly regulated proteolytic activity is essential in the mammalian ovary to maintain follicular and luteal functions. Studies conducted on ovarian aspartic proteinases (APs) are limited. Previously it has been noted that the AP activity increases towards the latter part of luteal phase. The aim of this study was to isolate AP from porcine ovarian extract and to identify whether multiple AP activities are found in the extracts. Place and Duration of Study: Department of Biochemistry, between December 2009 and February 2012. Methodology: Porcine ovaries (n= 100) were collected and ovarian extracts were prepared. APs were fractionated, using anion exchange chromatography at pH 8.5, gel permeation chromatography and affinity chromatography. AP activity (U/ml) of the fractions were measured in the presence and absence of Pepstatin A. AP specific activities (U/mg) were calculated after measuring total protein concentrations (mg/ml) of the fractions. Fractions were analyzed using polyacrylamide gel electrophoresis conducted under denaturing (SDS-PAGE) and native (PAGE) conditions. PAGE was followed by zymography. Results: With anion exchange chromatography, AP was recovered during column washing as an unbound fraction (~67%) and during elution as a bound fraction (~33%). Bound AP was recovered around 0.23 M NaCl with 0-1 M NaCl gradient used during elution. Both AP fractions had an apparent molecular mass of 40 kDa. AP activity was completely inhibited in the presence of 1 μM Pepstatin. Specific activity of AP increased with fractionation from 1 in the ovarian extract to 747 and 511 U/mg with unbound and bound AP respectively. SDS-PAGE showed elimination of impurities with the progress of fractionation. PAGE and zymography showed the presence of at least three AP activities in porcine ovaries. Conclusion: Proteinases fractionated using three chromatography procedures were APs. Results showed the presence of multiple AP activities in porcine ovary.

Prevalence of attention deficit hyperactivity disorder in children with unintentional injuries.

Introduction: Attention deficit hyperactivity disorder (ADHD) is characterized by hyperactivity, inattention and impulsiveness. Risk-taking behaviour and accident proneness are well recognized in these children. Objectives: To estimate the prevalence of ADHD among children attending an Accident Service and to describe the injury profile. Method: Data was gathered from children with unintentional-injuries attending Accident Service on randomly selected days. SNAP IV, an 18-item standardized schedule validated for diagnosis of ADHD, was interviewer-administered to parents. Injury-related data was collected using a semi-structured questionnaire. Results: One hundred and fifty one children, aged 4 to 12 years (mean age 8.5 years), participated in the study. Prevalence of ADHD in this group was 18%. Children with and without ADHD did not differ in mean age and gender distribution. Children with ADHD were more likely to sustain injury needing hospitalization, report previous injury needing hospitalization and were perceived by mothers as injury prone, which were all statistically significant (p<0.05). Conclusions: Prevalence of ADHD among children attending an Accident Service was 18%. Children with ADHD were more likely to sustain injury needing hospitalization (p<0.01). Children with ADHD were perceived by parents as prone to injury (p<0.05).

Developmental language regression in autism: a descriptive study in Sri Lanka.

Background: Developmental regression is a feature seen in some children with autism and is defined as loss of either language or social skills or both, after a period of apparently normal development. Objective: To estimate the prevalence of developmental language regression (DLR) in a sample of children with autism aged 18-48 months and study the difference with those without DLR in terms of development, social and family variables and outcome of intervention. Method: Data was obtained from an already existing database of children with autism attending an intervention programme. Information was obtained from the diagnostic assessment, structured parent interview and outcome data on intervention. Results: Data was available for 62 children. Prevalence of DLR in this group was 41.9%. Mean age of regression was 18 months. More children with DLR compared to those without, were born after assisted conception (p<0.05). Effect size of outcome of intervention was less favourable for regressed children at 6 months (but not at 3 months). Conclusion: Prevalence of DLR in this sample of children with autism was 41.9%

Sinhala translation of child behaviour checklist: validity and reliability.

OBJECTIVE: To translate the child behaviour checklist (CBCL) into Sinhala and validate it for assessment of mental health status of children aged 5-10 years. DESIGN AND SETTING: Translation/back-translation method was used to translate the English CBCL into Sinhala. Each item in the Sinhala CBCL (CBCL-S) was rated by mental health professionals to determine semantics, content, and conceptual validity types. To ascertain criterion validity, total scores obtained for CBCL-S by administering it to parents or parent surrogates of 49 girls and 80 boys aged 5-10 years attending the specialist psychiatry clinics and 69 boys and 69 girls in the same age group from the community were compared with clinical diagnoses by a child psychiatrist. Receiver operator characteristic curves were drawn to obtain the cut-off points in CBCL-S for boys and girls separately. RESULTS: Semantics, content, and conceptual and criterion validity of CBCL-S were satisfactory. At the cut-off level of 39, CBCL-S had a sensitivity of 90% and a specificity of 88% for boys and a sensitivity of 89% and a specificity of 92% for girls. Internal consistency, test-retest reliability, and inter-interviewer reliability of CBCL-S were satisfactory. INTERPRETATION: CBCL-S is a valid and reliable instrument to measure mental health status of Sinhalese children aged 5-10 years in Sri Lanka.

Prevalence of depression in mothers of children suffering from psychiatric and physical disorders.

Background Adverse impact of child mental disorders on the mental health of mothers is reported from other parts of the world but data is not from South Asia. Objectives To study the prevalence of depression among mothers seeking help for mental disorders in their children and compare it with that of mothers whose children are receiving treatment for physical disorders. Method Depression in mothers was assessed using self-rating and observer-rating standardized scales. The opinions of mothers regarding sensitivity to child and sense of behaviour control were also assessed. Results Prevalence in both groups of mothers was twice that of adult women in the community with regard to moderate and severe depression. Proportionately more mothers with mentally disordered children felt less sensitive towards the child, less in control of behaviour, and less supported by others when compared to those with physically disordered children. Conclusions Mothers of mentally disordered children should be screened for depression, stress and poor coping.

Medically unexplained physical symptoms in children in a non-specialist paediatric setting.

Introduction Medically unexplained symptoms (MUS) are equally common and disabling across countries and cultures. Most prevalent symptoms identified in children are recurrent abdominal pain (RAP), headache, limb pain, and fatigue. Objectives To identify the presenting profile of MUS and associated features in a hospital based, nonspecialist paediatric outpatient setting. Method Randomly selected children attending the study setting were screened to identify those who fit a working definition for MUS, which specified undiagnosed symptoms being present for 3 months or more. Parents of the identified children answered an interviewer administered semi-structured questionnaire designed to investigate the profile of symptoms, their impact on the child's life, beliefs about the cause and anticipated prognosis and any associated stressful experiences in the child's life. Results 125 children (mean age 7.8 years) were identified with MUS. Commonest presenting symptoms were abdominal pain and headache. On average, 6.01 medical consultations were made for the symptoms. Difficulties with attending school and studying were the most prominent impact of the symptoms. Majority of the mothers believed that an underlying physical disorder was present, but an associated psychologically stressful experience was identified by them in 51.2% of cases. Conclusion Children with MUS warrant extended assessments for associated psychosocial and behavioural factors to enable effective management.

Outcome of early intervention in infants at risk of developmental delay: a pilot study.

Objectives To assess the outcome of a home based psychosocial intervention programme on facilitating development in infants at risk of developmental delay. Method Three groups of infants were involved. Group I comprised infants who suffered from adverse pregnancy and perinatal events and received psychosocial intervention. Group II comprised infants born during the same period with no similar risks and no intervention. Group III comprised infants who had adverse pregnancy and perinatal experiences but did not receive any intervention. Group 1 mothers were trained to carry out structured activities at home with the infant, adapted from the Portage Model. Outcome was measured at 12 months of age. The scores in 12 different skills in 5 developmental domains in the three sample groups were compared at the end of 12 months. Results Mean developmental scores in Groups (Gps) I (n=36), II (n=32) and III (n=9) were 10.00, 10.75 and 3.11 respectively. Independent sample t test showed no statistically significant difference in developmental scores at 12 months between Gps I and II (p=0.242, mean difference 0.750, 95% CI 2.019 to 0.519). Difference in developmental scores between Gps I & III was highly significant (p=0.000, mean difference 6.889, 95% CI 4.588 to 9.189). Conclusion Early intervention is effective and feasible in preventing developmental delay.

Evaluation of the usefulness of children’s drawings and story-lines in the assessment of psychological state.

Introduction Children are known to display their thoughts and emotions in drawings and storylines. This study attempts to evaluate their clinical usefulness. Objectives To study the correlation between psychological states assessed through drawings and storylines and that assessed medically, in inpatients with psychological problems. Method Drawings and storylines on selected themes produced by children were assessed by nurses on 6 clinical parameters, using guidelines provided to ensure consistency. This data was compared with the medical assessments on same parameters, which was used as the "gold standard". Results Good correlation was found in identification of mood states and emotional distress. Correlation regarding cognitive development and self esteem was less satisfactory. Conclusions Such methods are useful subsidiary tools to medical assessments but caution in interpretation is necessary in some parameters.

Parent battering and the psychiatric and family correlates in children and adolescents.

The term "battered parents" was first used over two decades ago, but very few studies are available on the subject. This study examines an outpatient sample of children and adolescents where a key presenting feature was violent behaviour towards their parents. The commonest DSM IV axis I diagnosis was obsessive compulsive disorder with a prevalence of 25%. The same diagnosis in the control group was 6.4%. Anxiety and depressed mood dominated the clinical pictures in the study sample. Several crosscultural differences were apparent in age, behaviour and family context of the subjects when compared with the available studies. This study highlights the relevance of examining for presence of violence towards parents in children and adolescents who present with anxiety.

Mental health of adolescent school children in Sri Lanka – a national survey.

Objectives To assess prevalence of mental health problems in adolescent school children and measure impact of such problems on their well-being. Method Study group was randomly selected from 14 districts of 7 provinces. Participants completed validated self-assessment questionnaires, which assessed symptoms of mental health problems and their impact on emotional, educational and social functioning. Results 2007 adolescents aged 13-18 years participated in study. 18.9% showed an abnormal range in emotional and behavioural parameters of assessment schedule. 12.6% reported a definite or severe impact of their difficulties. Most impact was felt in educational functioning (15.5%) and peer relationships (12.4%). Males had significantly higher prevalence for mental health problems compared to females. Conclusions Prevalence of mental health problems among adolescents in Sri Lanka is similar to that reported elsewhere in the world. Knowledge gained can be utilized for providing school and community based preventive mental health services.

Met and unmet needs of children with epilepsy in a paediatric tertiary care setting.

OBJECTIVE: To investigate the extent to which the health needs were met or unmet in children with epilepsy attending a tertiary care outpatient setting. PATIENTS AND METHOD: A semi-structured interview was used to collect relevant information from the parents. It focused on ascertaining the quality of health care received by the children, including the extent to which attention was given to epilepsy related physical, behavioural, social and educational impairments that were identified by the parents. RESULTS: There was satisfactory seizure control in the majority. Most children received only one anticonvulsant and side-effects were reported to be minimal. A large majority had behavioural problems, and social and educational difficulties to a lesser extent. Parents were concerned about the implications of these problems, but there was little communication about them in the doctor-patient contact. Even where the problems were communicated, parent satisfaction about the interventions was low. Parents identified the availability of more consultation time and provision of more information on epilepsy as their expectations from doctors. CONCLUSIONS: This study shows that awareness and communication about the multiple health problems of children with epilepsy are necessary to improve the quality of health care given to them.

A clinical study of child mental health inpatient care.

Objectives To explore whether admissions to a child mental health inpatient unit in a tertiary care paediatric hospital were justified and estimate whether inpatient unit provided a beneficial service to patients and their families. Method A retrospective analysis of 191 consecutive admissions to unit over 15 months. Relevant information was obtained from clinical case notes recorded and maintained during hospital stay. Additional data was obtained from standardized assessment schedules used for validation of diagnoses and neuropsychological assessment carried out during admission. Results Ages ranged from 2-12 years. Most patients were referred by paediatricians. Medically unexplained somatic symptoms and disruptive behaviour were the most prevalent presenting features. Multidisciplinary approach to care and objectively supported assessment and intervention strategies were beneficial in over 80% of patients. Average duration of hospitalisation was 6.4 days. None dropped out of treatment. There was a 12% readmission rate and an 18.4% unsatisfactory rating for outcome.

User satisfaction with child psychiatry outpatient care: implications for practice.

INTRODUCTION: Satisfaction with outpatient care is determined by the extent to which the expectations of users are met. Obtaining the opinion of users is considered a reliable method of assessing the quality of service. The objective of our study was to assess the degree of satisfaction expressed by users of a child psychiatry outpatient service and to match degree of satisfaction with the dropout rate. METHOD: A questionnaire was used to assess the users' expectation of the service and degree of satisfaction. Dropout rate was determined from the clinical records. RESULTS: 165 new referrals to the outpatient service were recruited for the study. 41.2% expected a cure for the child's mental health problem. 65.5% expressed satisfaction with the treatment intervention and time provided at the first consultation. Positive free text comments supported this opinion, but were incongruent with the 32.8% dropout rate after the first and second visits to the clinic. Behaviour problems in children and serious social problems in the families increased the risk of dropout from treatment. CONCLUSIONS: Initial expression of satisfaction with the service by the users does not guarantee continued co-operation with follow up care. Sensitivity in the approach to treatment is needed where there is a higher risk of dropout.