[Pharmacoresistance to psychotropic drugs in children and adolescents: Pharmacogenetic anomalies of cytochrome P450 2D6]. / La pharmacorésistance aux psychotropes chez l'enfant et l'adolescent : recherche d'anomalies pharmacogénétiques du cytochrome P450 2D6.

OBJECTIVES: Some patients in child and adolescent psychiatry present resistance to psychotropic drugs, often resulting in polytherapy, an increased risk of adverse events, and more frequent and longer hospitalisation. Psychotropic drugs are mainly metabolised in the liver, in particular by the CYP2D6 subunit of cytochrome P450. Anomalies such as a duplication of the CYP2D6 gene related to an ultra-rapid metaboliser phenotype has been described to be linked to clinical efficacy. However, little research has been done in child and adolescent psychiatry. METHODS: A multi-centric cross-sectional study in the southeast of France explored the relation between pharmaco-resistance to psychotropic drugs and the prevalence of duplications or polymorphisms of CYP2D6 associated with an ultra-rapid phenotype in children and adolescents with severe mental health disease. RESULTS: Twenty-two patients have been included. The presence of an ultra-rapid phenotype concerns one patient in our study. A second patient presents a slow metaboliser phenotype. CONCLUSIONS: This study allows a clinical characterisation of the population of pediatric drug-resistant patients whose severity and the impact of their pathology are major and require long-term care associated with repeated hospitalisations, multiple drug prescriptions and numerous side effects. However, a link between drug resistance to psychotropic drugs and CYP2D6 UFM abnormalities could not be confirmed. An additional pharmacogenetic analysis by a panel of genes applied in the metabolism, transport and action of psychotropic drugs should be considered to answer questions about the resistance and independent effects of CYP2D6.

[Carbamazepine and psychotropic treatment interaction: Two case studies of carbamazepine overdosage]. / Surdosage en carbamazépine par interaction avec les psychotropes : à propos de deux cas.

Drug interaction is a frequent situation in pediatrics and child psychiatry. Carbamazepine (CBZ) is an antiepileptic drug used as a mood stabilizer in child psychiatry. CBZ is known to be a potent inducer of various CYP isoenzymes of cytochrome P450, which might result in a decrease in the plasma concentration of associated treatments. We describe two cases of CBZ overdosage in adolescent inpatients (14 and 16 years). The patients were treated with risperidone associated with fluoxetine in one and with loxapine in the other case, and CBZ was introduced as a mood stabilizer. Patients presented typical clinical symptoms (fatigue, dizziness, gastrointestinal signs, blurred vision). Overdosage was confirmed by an elevated CBZ plasma concentration (17 and 15.5 mg/L, therapeutic range 4-12 mg/L). We recommend introducing CBZ very progressively in patients treated with psychotropics, particularly when it is associated to several treatments. An intensification of clinical and biological follow-up with early plasma concentration testing should allow for better treatment adjustment.

Pomegranate (Punica granatum) as Host of the Broomrapes Phelipanche aegyptiaca and Orobanche crenata in Israel.

Orobanche and Phelipanche, commonly known as broomrape, are dicotyledonous holoparasitic flowering plants that cause heavy economic losses in a wide variety of plant species. Egyptian broomrape (Phelipanche aegyptiaca Pomel.) parasitizes more than 30 food and ornamental crops, including tomato, sunflower, tobacco, chickpea and many others in different parts of the world. Crenate broomrape (Orobanche crenata Forsk.) parasitizes important legume crops, such as lentil, faba bean, chickpea, pea, vetches, and grass pea, as well as some apiaceous crops, such as carrot (4). This is the first report of pomegranate (Punica granatum L.) as a new host for broomrape. This is also the first report of broomrape parasitism on a Lythraceae family member. Because of their high value for human health, the demand for pomegranate fruits has increased tremendously in the last few years and the extent of pomegranate growth has increased significantly in many regions throughout the world. In March 2013, heavy broomrape infection of a 10-year-old pomegranate orchard near the village Kfar Pines was reported. The infected area of about 2 ha was located in the middle of a big pomegranate orchard (variety 116). Broomrape inflorescence counts in the infected area revealed 14 and 0.6 P. aegyptiaca and O. crenata shoots per m2, respectively. Both broomrape species were uniformly distributed over all the infected area. No differences of infection rate between the pomegranate trees could be observed. The inflorescences of the two species were normal and healthy and produced germinable seeds. Digging up the inflorescences verified a direct connection between the parasites and the pomegranate roots. The parasite species were identified morphologically according to Flora Europea (2) and Flora Palaestina (3). Detailed description of the two parasites may be found in (4). Identification was confirmed using unique DNA marker based on the photosynthetic gene rbcL of O. crenata. rbcL primers were able to distinguish between the above two species according to differences in PCR products yielding 390 bp for P. aegyptiaca and 300 bp for O. crenata (1). This was the first time that broomrapes had appeared in the orchard since its establishment, on fields that had been intensively used for processing tomato. No legume cropping history in the infected areas is known. It may be hypothesized that the broomrape seeds were dormant in the soil for over 10 years (4).The extremely wet and hot weather conditions of winter 2012/13 induced their germination. A total of 730 mm of rainfall was measured for that year as compared to the annual average of 560 mm for the region. High-level infestations with P. aegyptiaca and O. crenata were also reported from two other pomegranate orchards, Givat Ada and Evron, 11 km west and 81 km north of Kfar Pines, respectively. Neither symptoms nor visible qualitative or quantitative damage could be observed on the infected vs. non-infected pomegranate trees. However, pomegranate appears to be an alternate host for P. aegyptiaca and O. crenata serving as a seed inoculum source for nearby sensitive field crops. References: (1) R. Aly et al. Joint Workshop of the EWRS Working Groups, 29 September - 3 October, Chania, Crete, Greece, 2013. (2) A. O. Chater and D. A. Webb. Orobanche. Page 285 in: Flora Europaea, Vol. 3. T. G. Tutin et al., eds. University Press, Cambridge, 1972. (3) N. Feinbrun-Dothan. Page 210 in: Flora Palaestina, Vol. 3. Israel Academy of Sciences and Humanities, Jerusalem, 1978. (4) D. M. Joel et al., eds. Parasitic Orobanchaceae: Parasitic Mechanisms and Control Strategies. Springer Verlag Berlin Heidelberg, 2013.

[Catatonia in a 14 year-old girl: treatment with clorazepam and carbamazepine, a 10-year follow-up]. / Catatonie chez une adolescente de 14 ans: traitement par clorazépam et carbamazépine et évolution à dix ans.

INTRODUCTION: Child and adolescent catatonia has been poorly investigated. Moreover, diagnosis criteria only exist for adult psychiatry, and there are no therapeutic guidelines. The aim of this paper is to describe the case of a 14-year-old girl presenting an overlap between psychogenic and neuroleptic induced catatonia, acute treatment and ten year's follow-up. CASE REPORT: A 14-year-old Caucasian French girl, Elsa, was admitted in February 1998 to a University adolescent mental health center with an acute psychotic disorder. She showed agitation, impulsivity (sudden engagement in inappropriate behaviour), paranoid delusions, visual and auditory hallucinations, diurnal and nocturnal urinary incontinence, lack of self-care, inadequate food intake because of fear of poisoning, and vomiting after meals leading to rapid weight loss of 5 kg. Clinical examination, laboratory tests, EEG and RMI were normal. Toxicological tests were negative. Her IQ, assessed six months before admission, was in the dull average range (70-75). Elsa was treated with loxapine 150 mg per day for one week without improvement and this was then replaced by haloperidol 30 mg per day. One week after the start of haloperidol her agitation, impulsivity, and hallucinatory symptoms decreased. Twenty four days after loxapine introduction and 17 days after the haloperidol, her condition deteriorated rapidly over less than 48 hours. She exhibited immobility, minimal response to stimuli, staring and catalepsy with waxy flexibility. The diagnosis of catatonia was established. Examination revealed tremulous extremities, tachychardia (110 pm) and apyrexia. Creatine phosphokinase levels were 106 UI/l (normal range 0-250). Human immunodeficiency virus, hepatitis, listeria and Lyme serology were negative. Cerebrospinal fluid analysis was normal. Haloperidol was stopped and intravenous clonazepam 5mg/kg was begun. It was not possible to obtain signed consent from the two parents for Electroconvulsive therapy. The patient was transferred to a pediatric intensive care unit. The treatment was standard parenteral nutrition, nursing, intravenous clonazepam 0.05 mg/kg, with regular attendance by a child psychiatrist. Elsa stayed three weeks in this condition. She then began to notice the child psychiatrist, and a few days later she was able to carry out simple requests. Elsa was transferred to an adolescent psychiatric unit. As soon as she could eat by herself again, carbamazepine 400mg per day was begun. Her agitation reduced at a carbamazepine level of 7 mg/l. One month later her condition was stable. However, language difficulties persisted for a further six months. One year after the episode she scored 66 on a repeat IQ test and her RMI was normal. She exhibited no significant residual symptoms except some cognitive impairment. She integrated into a special education facility. These attempts to stop the carbamazepine were followed by depressed mood, aggressiveness and impulsivity; carbamazepine was finally stopped successfully after seven years. Ten years later, Elsa is the mother of two young children and is able to take care of them. She has never had a relapse of her psychotic disorder or catatonic state. DISCUSSION: The etiopathogenic diagnosis is problematic. Some indices in the familial history may suggest a traumatic event. But one to the total residual amnesia it was never confirmed, and traumatic catatonia are extremely rare. Normal CPK levels, with autonomic disturbance limited to tachycardia and the lack of resolution after discontinuance of medication, argues against a diagnosis of neuroleptic malignant syndrome (NMS). But CPK levels are non specific, and NMS without pyrexia has been described. The occurrence of the catatonic syndrome 21 days after the first dose of a neuroleptic could be diagnostic. This case involved a non organic catatonic psychosis followed by neuroleptic induced catatonia. Catatonia is described as a risk factor for the development of NMS and some consider NMS to be a variant of malignant catatonia. The interest of this report is (1) it reinforces the need to be cautious before prescribing neuroleptics in adolescents presenting with symptoms of catatonia; (2) the complete recovery from catatonia after treatment with intensive care and more than three weeks of intravenous clonazepam without the use of ECT and (3) the effectiveness of carbamazepine over a long period of follow-up. Although trials on carbamazepine in catatonia are published, there are no data available for the control of residual symptoms or the long term prognosis, especially in child and adolescent psychiatry.

Reflectance spectroscopy is an effective tool for monitoring soot pollution in an urban suburb.

This study examines whether converting the fossil fuel of the Tel Aviv power station from oil to gas influences air pollution in the local urban environment. To this end, the spectral properties of accumulated dust on tree leaves and paper bags were assessed before (2004) and after (2006) the conversion. The sampling site was a garden in a neighborhood located 2700m downwind of the power station. In addition, air pollution concentrations and particulate matter parameters recorded by a local meteorological station were analyzed (PM(10), NO(x), NO(2), NO, and SO(2)). Although differences in the average monthly concentration of pollution parameters are mostly insignificant between the two periods, the accumulated particulate matter exhibits considerably different spectral patterns. All first period samples exhibit a distinctly concave slope in the spectral region between 400 and 1400nm, indicative of high amounts of soot, most likely due to the combustion products of fuel oil exhausted by the power plant. In contrast, the second period samples exhibit spectra that indicate reduced soot content and even appear slightly convex, evidencing the presence of dust of mineral origin, a feature likely masked by the soot in the first period. Thus, the spectral data support that the power plant conversion results in less pollution. More generally, this study corroborates that VIS-NIR-SWIR spectroscopy characterizes key properties of the particulate layer accumulating on sampled surfaces and thus, is a powerful method for monitoring the urban environment.

Application of visible, near-infrared, and short-wave infrared (400-2500 nm) reflectance spectroscopy in quantitatively assessing settled dust in the indoor environment. Case study in dwellings and office environments.

The aim of this study was to apply a novel sensitive technique, involving reflectance spectroscopy in the 400-2500-nm region, to assess dust loads. A spectral library was created to enable identification of the possible sources of settled dust in indoor samples -- mineral versus organic-anthropogenic. Two field experiments were carried out at different dates, the first in dwellings and the second in office environments. Two main spectral patterns were found. Type A spectra indicate a high proportion of minerals in the sample and are characteristic of dust samples taken from the dwelling environment during April (when there were 5 dust storm events). Type B spectra denote a high proportion of organic matter in the sample and are characteristic of the dust samples taken from the offices during March (when there were only 2 dust storm events). The spectral shape within the visible range can be used to estimate the relative amount of mineral and organic components in the sample. Multivariate data analysis, based on Partial Least Squares (PLS) regression, was utilized to predict the relationship between the reflectance of a dust sample and its mass. The relative Root Mean Square Error of Predictions (%RMSEP) generated for the dust sampled in dwellings (6.5%) and offices (7.0%) are quite impressive considering the relatively small amounts of settled dust and its precise gravimetric weight accurate to +/-0.01 mg (min and max values are 0.1-3.2 mg). In addition, PLS regression analysis was used to identify which variables influence dust load. Possible applications of the proposed method are discussed.

First Report of Orobanche crenata Parasitism on Ornamental Anemone (Anemone coronaria) in Israel.

Broomrapes (Orobanche spp.) are obligatory parasitic weeds that infect roots of vegetables and field crops worldwide, resulting in severe damage. Orobanche crenata Forsk is common in agricultural fields in the Mediterranean Basin, Southern Europe, and the Middle East and is known as an important scourge of grain and forage legumes and of some Apiaceous crops such as carrot (Daucus carota L.) and celery (Apium graveolens L.) (3,4). To our knowledge, in this note, we report for the first time on Anemone coronaria L. (Ranunculaceae) as a new host for O. crenata and this is also the first report of Orobanche parasitism on a geophytic crop. Anemone (Anemone coronaria L.) is a high-value ornamental crop, which is commercially grown for cut flowers. Four anemone cultivars (Meron Red, Galil White, Jerusalem Blue, and Jerusalem Pink) were planted in September 2006 in a 2-ha field in Israel. The previous crop, broad bean (Vicia faba L.), was heavily infected during 2005 by O. crenata. In February 2007, O. crenata parasitized the anemone plants and developed numerous fertile flowering stalks throughout the field. The four anemone cultivars were equally infected by the parasite. Additional flowering stalks were still emerging on anemone plants during July 2007. Washing the root system clearly verified direct connection between the parasite and anemone roots. The parasite species was identified morphologically after Flora Europea (1) and Flora Palaestina (2). In addition, the stem had the fragrance typical of O. crenata. Neither symptoms nor visible qualitative or quantitative damage could be detected on infected anemone plants compared with noninfected plants. However, anemone appears to be an alternate host on which O. crenata can produce additional seed for the parasite seed bank. References: (1) A. O. Chater and D. A. Webb. Orobanche. Page 285 in: Flora Europaea. T. G. Tutin et al., eds. Vol. 3. University Press, Cambridge, 1972. (2) N. Feinbrun-Dothan. Page 210 in: Flora Palaestina. Vol. 3. Israel Academy of Sciences and Humanities, Jerusalem, 1978. (3) D. M. Joel et al. Hortic. Rev. 33:267, 2007. (4) C. Parker and C. R. Riches. Page 111 in: Parasitic Weeds of the World: Biology and Control. CAB International, Wallingford, Great Britain, 1993.

[For or contra Crédé's method? (author's transl)]. / Pour ou contre la méthode de Crédé.

We no longer see newborn gonococcal endophtalmia. In France, it was the direct consequence of practical obligations. As gonococcic infection is growing up all over the world, is it wise to give up every prophylactic procedure? That is the question.