Identification of patients with recent-onset psychosis in KwaZulu Natal, South Africa: a pilot study with traditional health practitioners and diagnostic instruments.

PURPOSE: There is considerable variation in epidemiology and clinical course of psychotic disorders across social and geographical contexts. To date, very little data are available from low- and middle-income countries. In sub-Saharan Africa, most people with psychoses remain undetected and untreated, partly due to lack of formal health care services. This study in rural South Africa aimed to investigate if it is possible to identify individuals with recent-onset psychosis in collaboration with traditional health practitioners (THPs). METHODS: We developed a strategy to engage with THPs. Fifty THPs agreed to collaborate and were asked to refer help-seeking clients with recent-onset psychosis to the study. At referral, the THPs rated probability of psychosis ("maybe disturbed" or "disturbed"). A two-step diagnostic procedure was conducted, including the self-report Community Assessment of Psychic Experiences (CAPE) as screening instrument, and a semi-structured interview using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Accuracy of THP referrals, and test characteristics of the THP rating and the CAPE were calculated. RESULTS: 149 help-seeking clients were referred by THPs, of which 44 (29.5%) received a SCAN DSM-IV diagnosis of psychotic disorder. The positive predictive value of a THP "disturbed" rating was 53.8%. Test characteristics of the CAPE were poor. CONCLUSION: THPs were open to identifying and referring individuals with possible psychosis. They recognized "being disturbed" as a condition for which collaboration with formal psychiatric services might be beneficial. By contrast, the CAPE performed poorly as a screening instrument. Collaboration with THPs is a promising approach to improve detection of individuals with recent-onset psychosis in rural South Africa.

Polyphenols, autophagy and doxorubicin-induced cardiotoxicity.

Doxorubicin is a highly effective, first line chemotherapeutic agent used in the management of hematological and solid tumors. The effective use of doxorubicin in cancer therapy has been severely limited owing to its well-documented cardiotoxic side effect. Oxidative stress, lipid peroxidation, apoptosis as well as dysregulation of autophagy, has been implicated as a major contributor associated with doxorubicin-induced cardiotoxicity. Increased oxidative stress and lipid peroxidation are known to enhance the production of reactive oxygen species, while autophagy has been reported to protect the cell from stress stimuli or, alternatively, contribute to cell death. Nonetheless, to date, no single chemical synthesized drug is available to prevent the harmful action of doxorubicin without reducing its anti-cancer efficacy. Therefore, the search for an effective and safe antagonist of doxorubicin-induced cardiotoxicity remains a challenge. In recent years, there has been much interest in the role plant-derived polyphenols play in the regulation of oxidative stress and autophagy. Therefore, the present review renders a concise overview of the mechanism associated with doxorubicin-induced cardiotoxicity as well as giving insight into the role plant-derived phytochemical play as a possible adjunctive therapy against the development of doxorubicin-induced cardiotoxicity.

Doctors' Use of Laboratory Tests in the Diagnosis and Treatment of Patients

The provincial health budgets in South Africa are under enormous pressure and; annually; budgets are exceeded by most hospitals and clinics. Laboratory tests requested by clinicians are contributing to the problem of over-expenditure. The aim of this study was to determine from patients' files whether doctors were using laboratory tests prudently during their treatment of patients in the outpatient department (OPD) of the National District Hospital in Bloemfontein. A descriptive study was carried out using all the files of patients who visited the OPD in a three-month period (1 July to 30 September 2005) for whom laboratory tests were requested by the attending physician. The majority (31.3) of patients for whom laboratory tests were requested presented to the OPD with cardiovascular complaints or diagnoses; followed by endocrine (27.8) and musculoskeletal (16.3) complaints or diagnoses. Between one and three tests were requested for most patients; i.e. 33and 15; respectively. The most frequently requested tests were erythrocyte sedimentation rate (8.1); urea and electrolytes (7.7); urine microscopy; culture and sensitivity (6.4); cholesterol (6.1); full blood count (5.7) and thyroid profile (TSH 4.6; T4 2.6and thyroid functions 2.3). In 70.4of cases; results were documented and; in 59.1; the physician's management plans indicated the incorporation of laboratory test results into the patient's treatment regimen. Our findings indicated inappropriate documentation and application of test results. Interventions to improve physician behaviour include education; guidelines; feedback; leadership and redesign of requisition forms

Structural, computational, and (59)Co NMR studies of primary and secondary amine complexes of Co(III) porphyrins.

Four novel low-spin bis(amine) Co(III) porphyrins [Co(TPP)(BzNH(2))(2)](SbF(6)), 1, [Co(TPP)(1-BuNH(2))(2)](SbF(6)), 2, [Co(TPP)(PhCH(2)CH(2)NH(2))(2)](SbF(6)), 3, and [Co(TPP)(1-MePipz)(2)](SbF(6)), 4, have been synthesized and characterized by low-temperature X-ray crystallography, IR, electronic, and NMR ((1)H, (13)C, and (59)Co) spectroscopy. The mean Co-N(p) distance for the four structures is 1.986(1) A. The Co-N(ax) distances for the 1 degrees amine derivatives average to 1.980(5) A; the axial bonds of the 2 degrees amine derivative are significantly longer, averaging 2.040(1) A. The porphyrin core conformation of 4 is significantly nonplanar (mixture of S(4)-ruf and D(2d)-sad distortions) due to a staggered arrangement of the axial ligands over the porphyrin core and meso-phenyl group orientations < 90 degrees. The X-ray structures have been used with the coordinates for [Co(TPP)(Pip)(2)](NO(3)) (Scheidt et al. J. Am. Chem. Soc. 1973, 95, 8289-8294.) to parametrize a molecular mechanics (MM) force field for bis(amine) complexes of Co(III) porphyrins. The calculations show that two types of crystal packing interactions (van der Waals and hydrogen bonding) largely control the crystallographically observed conformations. Gas phase conformational energy surfaces have been computed for these complexes by dihedral angle driving methods and augmented with population distributions calculated by MD simulations at 298 K; the calculations demonstrate that the bis(1 degrees amine) complexes are significantly more flexible than the bis(2 degrees amine) analogues. (59)Co NMR spectra have been acquired for a range of [Co(TPP)(amine)(2)]Cl derivatives as a function of temperature. The (59)Co chemical shifts increase linearly with increasing temperature due to population of thermally excited vibrational levels of the (1)A(1) ground state. Activation energies for molecular reorientation (tumbling) have been determined from an analysis of the (59)Co NMR line widths as a function of 1/T; lower barriers exist for the conformationally rigid 2 degrees amine derivatives (2.6-3.8 kJ mol(-1)). The (59)Co chemical shifts vary linearly with the DFT-calculated radial expectation values (3d) for the Co(III) ion. The correlation leads to the following order for the sigma-donor strengths of the axial ligands: BzNH(2) > or = Cl(-) > 1-BuNH(2) > PhCH(2)CH(2)NH(2) > 1-Bu(2)NH > Et(2)NH. The (59)Co NMR line widths are proportional to the square of the DFT-calculated valence electric field gradient at the Co nucleus. Importantly, this is the first computational rationalization of the (59)Co NMR spectra of Co(III) porphyrins.