Comorbid psychopathology and clinical symptomatology in children and adolescents with obsessive-compulsive disorder.

Comorbid psychopathology in children and adolescents with obsessive-compulsive disorder (OCD) has been investigated in a number of studies over the last twenty years. The aim of the present study was to investigate the phenomenology of illness and broader psychopathology in a group of Greek children and adolescents with OCD. The investigation of parental psychopathology in children and adolescents with OCD was a secondary aim of the present study. We studied 31 children and adolescents with OCD (n=31, age range 8-15 years) and their parents (n=62, age range 43-48 years) and compared to children and adolescents with specific reading and written expression learning disorders (n=30, age range 7-16 years) and their parents (n=58, age range 40-46 years). Appropriate testing showed specific reading and learning disorders, which were of mild to moderate severity for the 85% of this latter group. The diagnosis of learning disorder of reading and written expression was made through the use of standardized reading material, appropriate for ages 10-15 years. Reading comprehension and narration were tested. The written expression (spelling, syntax, content) was examined by a written text, in which the subject developed a certain theme from the reading material. Based on their level of education and occupation, the index families were classified as high (29%), average (45%) and low (26%) socioeconomic status, whereas 6.7% of control families belonged to high, 63.3% to average, and 30% to low status. In order to investigate psychopathology, the Schedule for Affective Disorders and Schizophrenia for School Aged Children, Present and Life-time version was administered to children and their parents, as well as the Child Behavior Checklist 4/18 (CBCL) to both parents and adolescents (Youth Self-Report). Also the Yale- Brown Obsessive Compulsive Scale (Y-BOCS) was rated for both children and parents. Moreover, the children were given the Children's Depression Inventory (CDI) and the Revised Children's Manifest Anxiety Scale (RCMAS). In the OCD group, 48% had contamination obsessions, 42% aggressive obsessions and 52% had washing and cleaning compulsions. Moreover, 32% had one additional disorder and 16.1% had two additional disorders. In comparison, only 17.2% of the control group children had one comorbid disorder. The OCD proband group had higher Total Problems score, as well as higher Anxiety/Depression, Thought Problems and Externalizing scores on the CBCL. When proband parents and control parents (29 mothers and 21 fathers) were compared, the percentage of fathers in the clinical range was significantly higher in the study group (Fisher's exact test: p=0.011, two tailed), whereas for mothers the difference did not attain significance (Fisher's exact test: p=0.106, two tailed). The fathers and mothers of children with OCD were more clinically affected than those of controls. Mothers of probands differed from controls in compulsions, compared to fathers, who differed in both obsessions and compulsions. Comorbidity rate was higher to children and adolescents with OCD. A considerable number of children and adolescents with OCD had higher symptomatology of anxiety and depression than controls, as well as higher rates of thought problems. Children and adolescents with OCD also exhibited higher rates of externalizing problems. This latter finding is considered as important and needs to be highlighted in terms of case management and treatment. Moreover, the parents of children and adolescents with OCD had more OCD symptomatology than the parents of children and adolescents with learning disorders. The symptomatology of the parents may create difficulties in interactions within the family and become burdensome for a vulnerable child. In turn, the child's symptomatology may create or increase some of the symptoms in the parents i.e. anxiety and depression. These findings suggest that at least for a percentage of children and adolescents with OCD, parental and especially paternal influence may contribute to the development and severity of their symptoms, not only through hereditary factors but also through the control exerted and the anxiety created in the family context.

Plasmalogen levels in full-term neonates.

AIM: Plasmalogens are phospholipids characterized by the presence of a vinyl ether bond at the sn-1 position of the glycerol backbone. They are particularly abundant in the nervous system, the heart and striated muscle. Peroxisomes are essential for their biosynthesis and red blood cell (RBC) plasmalogen levels are a reliable test in the investigation of patients suspect for a peroxisomal defect. The functions attributed to them include protection against oxidative stress, myelin formation and signal transduction. The aim of the present study was the investigation of RBC plasmalogen levels in neonates. METHODS: A total of 25 healthy full-term, appropriate for gestational age neonates were studied. RBC plasmalogens were estimated using gas chromatography within the first five days of life. Fifteen healthy children 1-8-year olds served as controls. RESULTS: Statistically significant lower plasmalogen levels were found in neonates compared to older children. CONCLUSION: Our results indicate that a different range of normal values for plasmalogen levels should be used in the investigation of peroxisomal diseases in neonates. The lower levels of plasmalogens in neonates found in our study could render them more vulnerable to oxidative stress.

Burnout, staff support, and coping in Pediatric Oncology.

GOALS OF WORK: The goals of the study were the following: (1) to study the rate of burnout of the staff in Pediatric Oncology and compare it with that of a group of staff in other pediatric specialties, (2) to find out if job satisfaction, role clarity, staff support, and ways of coping are related to the burnout of these two groups, and (3) as a secondary aim, to identify other parameters, i.e., profession, experience, having children, etc., which might affect burnout, staff support, and ways of coping. MATERIALS AND METHODS: The study group (n = 58) consisted of the staff of two Pediatric Oncology units and a Bone Marrow Transplantation unit, and the control group (n = 55) consisted of the staff of two Pediatric departments and one Pediatric Orthopedics department. The Maslach Burnout Inventory, the Staff Support Questionnaire, the Shortened Ways of Coping Questionnaire-Revised, and the Social Readjustment Scale were used. MAIN RESULTS: No differences were found in burnout between Pediatric Oncology staff and that of other specialties, the existing staff support, and the ways of coping. Decreased role clarity and wishful thinking, as a way of coping, were positively correlated to emotional exhaustion, whereas a negative correlation of the lack of role clarity existed with personal accomplishment. Not having children and less experience increased burnout in both groups studied. CONCLUSIONS: The hospital management and the heads of departments should be knowledgeable of ways to prevent burnout in their staff. Strategies targeting role clarity and wishful thinking are useful toward this goal.

Serum S100B levels in X-linked adrenoleukodystrophy and Gaucher disease.

S100B, a small acidic protein, is a member of a multigenic family of calcium-modulated proteins. It is mainly produced by astrocytes and the secreted protein, depending on its concentration, can exert either trophic or toxic effects. In humans increased S100B levels have been detected in brain trauma and ischaemia, and neurodegenerative, neurometabolic, inflammatory and psychiatric disease. Serum S100B concentrations have been used as markers of brain disease. In the present study S100B serum levels were determined in patients with the neuroinflammatory disease X-linked adrenoleukodystrophy (X-ALD) and in patients with both the acute neuronopathic (type II) and the non-neuronopathic (type I) types of Gaucher disease (GD). Sixteen X-ALD patients (10 with the childhood, 4 with the adult cerebral forms, 2 asymptomatic) and 22 Gaucher disease patients (19 type I, 3 type II) were studied. No statistically significant differences were observed between the X-ALD (median 0.13 microg/L, p=0.191) or Gaucher type I patients (median 0.07 microg/L, p=0.095) and controls of similar age (median 0.10 microg/L, n=22). Serum S100B levels of type II Gaucher disease patients were also within the normal for their age range (patients 0.2, 0.22, 0.65; control median 0.81 microg/L, n=44). Lack of clinical symptoms and/or MRI findings in X-ALD patients was not associated with lower S100B values. Our results indicate that serum S100B levels cannot serve as peripheral marker in the evaluation of brain disease in X-ALD and GD.

Elevated plasma chemokine CCL18/PARC in beta-thalassemia.

Plasma CCL18/PARC, a member of the CC chemokine family, has been found to be several ten-fold increased in symptomatic Gaucher type I patients. Elevated plasma chitotriosidase levels are a well-known abnormality in Gaucher patients, however, its diagnostic use is limited by the frequent genetic deficiency in the protein. Like the situation in Gaucher disease, lipids accumulate in macrophages of patients suffering from beta-thalassemia, and, in both conditions, increased chitotriosidase levels occur. We here report that plasma CCL18/PARC is also significantly increased in patients with beta-thalassemia major (range 76.8-4977.8, median=650.8 ng/ml, n=36 and control range 10-72, median=33 ng/ml n=36 respectively, P<0.001). The CCL18/PARC levels are lower than in Gaucher patients (range 174.8-10798.7, median 2538.2 ng/ml, n=28, P<0.001). In our cohort of beta-thalassemic patients, CCL18/PARC showed a significant negative correlation to iron chelation therapy and a significant positive correlation to ferritin and chitotriosidase levels, the latter only in the patients with the wild type genotype for the enzyme. Our study demonstrates that beta-thalassemic patients have increased CCL18/PARC levels that could be of value in monitoring iron overload and compliance to therapy.

Comparative assessment of natural radioactivity in fallout samples from Patras and Megalopolis, Greece.

Bulk deposition samples were collected simultaneously from two Greek cities, Patras and Megalopolis, with different emission sources of natural radioactivity, on a monthly basis, during a whole year. Gross beta-activity and 238U- and 232Th-activities were determined in a total of 95 samples of deposited dust. The results were statistically analyzed in order to determine the natural radioactivity levels and their variations in the above cities. No significant difference was found in deposited dust amount between the two cities, while the values of gross beta-, 238U- and 232Th-activities were about 3, 71 and 4 times higher in Megalopolis than in Patras, respectively. This was attributed to the operation of lignite power plants A and B in the vicinity of the city of Megalopolis, while natural radioactivity concentrations in Patras' fallout samples were of natural sources.

Inflammatory mediators in perinatal asphyxia and infection.

AIM: To determine serum levels of interleukin-6 (IL-6), IL-1beta, tumor necrosis factor-alpha (TNF-alpha), soluble intercellular adhesion molecule-1 (sICAM-1) and C-reactive protein (CRP) in asphyxiated neonates and compare these inflammatory factors with those found in neonates with perinatal infection. METHODS: 88 neonates were studied, of whom 36 were asphyxiated, 18 were infected and the remaining 34 were controls. Peripheral blood samples were obtained on the 1st, 3rd and 5th postnatal days. RESULTS: Cytokines IL-6 and IL-1beta as well as sICAM-1 serum levels did not differ between asphyxiated and infected neonates; however, at most time periods, their values were significantly higher than controls. TNF-alpha was similar in the three groups of neonates. CRP serum values were significantly higher in the infected neonates than in the asphyxiated or control subjects. Among the 54 asphyxiated and infected neonates, 15 were considered as severe cases and 39 as mild. The severe cases, at most time periods, had significantly higher IL-6, IL-1beta and sICAM-1 levels compared with the mild ones. Through receiver operating characteristic curves the cut-off points, sensitivities, and specificities for distinguishing neonates at risk or at high risk for brain damage were established. CONCLUSION: Similar increases in serum levels of IL-6, IL-1beta and sICAM-1 were found in perinatally asphyxiated and infected neonates. As these increases correlated with the severity of the perinatal insults, neonates at high risk for brain damage might be detected.

Iron overload and kidney lysosomes.

Iron overload has been associated with damage of the liver and other organs of patients with primary or secondary increased iron load. In order to study the effect of iron overload on the pathophysiology of kidney lysosomes, experimentally induced iron overload models were employed. Iron overload was achieved through intraperitoneal injections of Fe-dextran (Imferon) in male rats, at different final iron concentrations (825 and 1650 mg/kg, single and double dose groups respectively). Controls were injected with dextran following a similar protocol. The animals were killed at different time points after the last injection. Subcellular fractionation studies of kidney homogenates were carried out by differential centrifugation and density gradient centrifugation. The kidney iron load was increased with both doses. Iron appeared to accumulate mainly in the lysosomes, bringing about distinct changes in the behaviour of the organelles as judged by subcellular fractionation studies. Lysosomes became more fragile and showed increased density. The extent of the above changes seemed to correlate with the extent and duration of iron accumulation and could be reversed when the iron load was reduced.

Heterosexual relationship characteristics, condom use and safe sex practices.

It was examined whether sexual relationship characteristics were associated with condom use and safe sex practices against HIV. Characteristics investigated were: (1) age difference between sexual partners, (2) previous knowledge of partner, (3) type of relationship, (4) duration, and (5) exclusiveness. Safe sex practices (risky, non-safe, safe) were defined by condom use consistency, previous knowledge of partner and monogamy. Participants (N = 458, were Greek, sexually active and between 18-25 years old) responded to a questionnaire on sexual and condom use practices in their sexual relationships of the past 12 months, condom use negotiation and variables a-e. Only age difference between partners was found to differentiate consistent from inconsistent condom use. Inconsistent condom use was more frequent among partners whose age difference was over two years. Safe sex practices (risky, non-safe, safe) varied across different relationships of 36% and remained consistently non-safe or risky across those of 40%. Risky practices occurred more frequently in relationships where the man was older than the woman. When condoms had not been used, they had not been negotiated in 80% of the cases. These findings reconfirm the importance of negotiation in condom use, call attention to the neglected role of age differences between partners in safe sex and bring forward the issue of studying actual variation of safe sex practices across relationships as an indication of people's response to health campaign messages of risk reduction.

In vivo effect of sodium valproate on mouse liver.

The in vivo effect of sodium valproate (SV) on the activity of uridine diphosphate glucuronosyltransferase (UDP-GT) and hepatotoxicity in the mouse liver was studied. Mice were injected intraperitoneally (IP) with SV at doses varying from 50 to 800 mg/kg per day, for six consecutive days (dose-response group) or at a standard dose of 300 mg/g per day for 2-10 days (time-response group), whereas the controls were injected with normal saline. Valproic acid levels had a positive correlation to the dose (P < 0.001) and duration of drug administration (P = 0.006). A gradual increase in UDP-GT activity was observed in doses of up to approximately 400 mg/kg per day, whereas in higher doses the enzyme activity gradually decreased. The time course of UDP-GT activity at the standard dose of 300 mg/kg per day increased progressively, with a maximum up to the sixth day and then had a gradual reduction. Hepatic necrosis (which was unrelated to the dose or the duration of drug administration) was found in 13% of the SV-treated animals and in none of the controls. We conclude that at an optimal dose (300-400 mg/kg per day) and at a time course of 6 days, SV causes liver UDP-GT induction, whereas in higher doses and longer duration of administration, UDP-GT activity is gradually reduced. SV also causes hepatotoxicity unrelated to dose and time course.