Hepatitis A virus and injecting drug misuse in Aberdeen, Scotland: a case-control study

To describe an epidemiological investigation of an outbreak of hepatitis A virus (HAV) infection among injecting drug users in Aberdeen, Scotland. A case-control study to determine whether transmission was facilitated by poor personal hygiene or through sharing injecting equipment. Cases were more likely to report not washing their hands after using the toilet [odds ratio (OR) = 12.9, 95% confidence interval (CI) = 1.58-105.89] or before preparing food (OR = 4.0, 95% CI = 1.01-15.8), and less likely to have washed their hands prior to preparing drugs (OR = 10.67, 95% CI = 2.14-53.07). Cases were also more likely to report recipient sharing of needles/syringes (OR = 8.27, 95% CI = 1.68-40.57), and to have had injecting contact with someone who was jaundiced (OR = 29.4, 95% CI = 3.18-271.44). The results indicate that the lack of hygiene within the context of individuals gathering to prepare and inject drugs provides ample opportunity for the transmission of HAV. Although the promotion of good hygiene and the avoidance of sharing injecting equipment are important measures in preventing HAV transmission, they are unlikely to effect major behavioural change. Such measures should, therefore, be reinforced by routinely offering HAV vaccine to injectors.

Separation of 90Y from 90Sr using zirconium vanadate as the ion exchanger

The sorption and desorption behaviour of several radionuclides, including 241Am, 152,154Eu, 233U, 137Cs, 90Sr and 90Y was studied under varying acidities using zirconium vanadate as ion exchanger. The sorption follows the order: Cs > Eu > Am >Y > U, while Sr was not taken up by the ion exchanger. A radiochemical separation scheme for the 90Y daughter from its 90Sr parent using zirconium vanadate ion exchanger has been developed. The exchanger was synthesized and characterized in our laboratory.

Exploring effects of different antioxidants on dexamethasone-induced lipid peroxidation using common laboratory markers

As a part of our ongoing effort to explore drug-induced lipid peroxidation in relation to drug-induced toxicity, our recent observations on lipid peroxidation induction potential of dexamethasone, a commonly used glucocorticoid compound in inflammatory and allergic conditions, has been presented considering lipid peroxidation a possible mediator of toxicity. An attempt was made to see the suppressive actions of some conventional antioxidant compounds, viz, ascorbic acid, alpha-tocopherol and probucol on dexamethasone-induced lipid peroxidation. It was found from the study that dexamethasone increased malondialdehyde content vis-a-vas decreased the level of reduced glutathione significantly in the liver homogenate. This suggests that dexamethasone caused a significant extent of lipid peroxidation which may be related to the toxic potential of the drug. It was further found all of the above antioxidants could suppress dexamethasone-induced lipid peroxidation to the significant extent.

Risk of hepatitis C virus transmission from patients to surgeons: model based on an unlinked anonymous study of hepatitis C virus prevalence in hospital patients in Glasgow

BACKGROUND

The risk of a surgeon acquiring the hepatitis C virus (HCV) through occupational exposure is dependent on the prevalence of HCV infection in the patient population, the probability of a percutaneous injury transmitting HCV, and the incidence of percutaneous injury during surgery.

AIMS

To estimate the prevalence of HCV infection in the adult surgical patient population in North Glasgow and thereafter estimate the risk of HCV transmission to surgeons through occupational exposure.

METHODS

The prevalence of HCV infection was estimated through the unlinked anonymous testing of samples from male surgical patients, aged 16-49 years, in two North Glasgow hospitals from 1996 to 1997, and adjusting these data for age and sex. Using published estimates of the incidence of percutaneous injury during surgery and percutaneous injury transmitting HCV, the risk of occupational transmission of HCV to surgeons was then derived.

RESULTS

The estimated prevalence of anti-HCV infection for all adult patients in the two hospitals combined was 1.4% (cardiothoracic/cardiology 0.8%, orthopaedics/rheumatology 1.4%, general surgery/ENT 2.0%). The estimated probability of HCV transmission from an HCV infected patient to an uninfected surgeon was 0.001-0.032% per annum (0.035-1.12% risk over a 35 year professional career).

CONCLUSIONS

The risk of an individual surgeon acquiring HCV through occupational exposure is low, even in an area with an extremely high prevalence of HCV among its injecting drug using population. Surgeons however should be encouraged to observe universal precautions and present for assessment after needlestick injuries to protect themselves and their patients from this insidious infection.

Hepatitis C infection among dental personnel in the West of Scotland, UK

Hepatitis C virus (HCV) is considered a serious occupational hazard for healthcare workers, particularly those performing exposure-prone procedures. In the UK, the majority of dental procedures are classified as exposure prone. In order to gauge the prevalence and determinants of infection among dental healthcare workers, a voluntary anonymous survey of HCV infection among primary care dental workers employed in the West of Scotland was undertaken, in which occupational and personal risk data were collected in parallel with a blood specimen. The overall prevalence of HCV antibodies was 0.1% (1/880, 95% CI 0-0.6); this is no greater than the estimated prevalence of HCV infection in the local population. Personal risk data collected suggested that the single infection identified was acquired through a non-occupational route. These results suggest that HCV infection is not a major occupational risk for dental healthcare workers.

Distribution of Cancer Patients According to Time Taken From Starting Day of Symptoms to Reporting at a Regional Cancer Institute in Eastern India

A retrospective study of the patients registered during 1997 aiming the time taken by the patients from their starting day of symptoms of cancer to reporting i.e. duration of symptoms at Chittaranjan National Cancer Institute (CNCI) a regional cancer institute in Eastern India. During 1997 a total of 3628 cancer patients registered at CNCI. Out of these, 716(19.74%) could not remember the duration of symptoms of their diseases at the time of first reporting. For this reason only the remaining 2912 cases were considered in the present study. Only 83(2.85%) reported within one month of the initial onset of symptoms. The vast majority of patients, a toal of 2829 (97.15%), appeared at hospital after several months, contributing to a moderate to advanced stage of their disease at first contact. This would clearly be expected to lead to poor success in treatment. Late reporting by the patients is most probably due to lack of awareness about the symptoms of cancer. The patients were from rural, semi-urban and urban populations. Measures of association showed significant links between the place of residence (p<0.55), age (p<0.001), sex (p<0.001), general health condition of the patients at first contact (p<0.052), the economic status (p<0.51) and the treatment compliance (p<0.26) with the duration of symptoms. Tumours of some primary sites like the cervix, breast (female), oral cavity, thyroid and penis, for which treatment responses are good to very good in early stages were also considered. For these primary sites, statistical measures showed late reporting by the patients which resulted in poor treatment compliance as well as a poor treatment response.

Distinguishing early and late onset non-melancholic unipolar depression

AIM

We seek to determine whether unipolar non-melancholic major depression commencing early in life has a differing clinical picture, and whether it may have differing determinants.

METHODS

We study a sample of such patients, comparing those with depression onset in their first 25 years against residual subjects, matching exactly by sex and controlling for age.

RESULTS

There were no differences in current depression severity. Despite early onset subjects having a distinctly younger current mean age, they had a lifetime pattern of both greater depression chronicity and disability, and judged themselves as less likely to have benefited from any antidepressant medication or psychotherapy. 'Phenotypically' early onset subjects did not differ in terms of 'depressive' symptoms, but were distinguished by a greater irritability, which we interpret as reflecting a temperament dimension influencing symptom expression. Multivariate analyses indicated that the clinical pattern in those with an early onset was distinguished by more evident irritability and anxiety, that there was a distinct familial contribution to early onset depression, that its forerunners were an early personality style of behavioural inhibition or shyness, and that they were more likely to use alcohol and illicit drugs.

CONCLUSIONS

While early onset unipolar depression is unlikely to be a pure depressive 'type', it may well be that certain familial temperament characteristics lead to an early onset of depression marked by irritability, a process that invokes a spectrum disorder concept linking temperament style and the depressive manifestations. Early onset depression is indicative of a poor prognosis, both in terms of response to interventions and in regard to chronicity and disability.

Monitoring hepatitis C virus infection among injecting drug users in the European Union: a review of the literature

Hepatitis C virus (HCV) among injecting drug users (IDUs) is one of the European Union's (EU) major public health problems. This review examines the current state of knowledge regarding HCV among IDUs in EU countries. Studies published between January 1990 and December 2000, were identified through a computerized search (MEDLINE and EMBASE). Ninety-eight studies have reported prevalence for HCV among groups of IDUs in all EU countries except Luxembourg. The prevalence of anti-HCV ranged from 30 to 98%. Incidence rates ranged from 6.2 to 39.3 per 100 person years. This review provides a comprehensive examination of HCV infection among IDUs in the countries of the EU, and quite clearly demonstrates that the quality and epidemiological relevance of the studies published varies widely. Thus, the reported data may not reflect accurately the current or recent past prevalence of HCV among IDUs in the EU. A strategic approach to the surveillance of HCV among IDUs in the EU, utilizing robust and consistent methods, is required urgently.

Multiple molecular targets of indole-3-carbinol, a chemopreventive anti-estrogen in breast cancer

The mechanism of action of the anti-estrogen indole-3-carbinol (I3C), present in cruciferous vegetables, is being examined in our laboratory with a view to promote the use of this naturally occurring chemopreventive as an alternative to synthetic anti-estrogens in human breast cancer. Our previous results clearly demonstrated that despite its low affinity for the estrogen receptor (ER), I3C abrogated estradiol-mediated cellular and biochemical effects in estradiol-responsive cells and tissues. In an earlier report, we identified ER phosphorylation as one of the targets of I3C, and in this communication we describe the consequence of inhibition of ER phosphorylation. Estradiol-induced DNA-binding proteins that bound to several DNA-responsive elements were inhibited by I3C and this effect was not at the level of DNA-protein physical interaction as inclusion of I3C in vitro in the reaction mix did not affect the binding. We analyzed the spectrum of genes induced by estradiol and modulated and/or intercepted by I3C. Our results conclude that although estradiol-mediated functions are affected by I3C, its biochemical targets are multiple and some of these may be modulated by the oligomeric products of I3C.

Gender differences in depression risk and coping factors in a clinical sample

OBJECTIVE

To examine gender differences in depression risk and coping factors in a clinical sample of patients with a diagnosis of DSM-IV major depression.

METHOD

Patients were assessed for substance use and abuse, family history of psychiatric disorder, interpersonal depressogenic factors and lifetime history of anxiety disorders. Trait anxiety, coping styles when depressed, parental bonding, marital features and personality style were also measured. Patients were reassessed at 12-month follow-up.

RESULTS

There were few gender differences in experience of depression (either in duration, type or severity prior to treatment) in a group with established episodes of major depression but women reported more emotional arousability when depressed. Women reported higher rates of dysfunctional parenting and childhood sexual abuse, and rated their partners as less caring and as more likely to be a depressogenic stressor. Men were more likely to have a generalized anxiety disorder at assessment, to use recreational drugs prior to presentation. Men were rated as having a more rigid personality style and 'Cluster A' personality traits both at assessment and follow-up.

CONCLUSION

There were few gender differences in severity or course of established episodes of major depression. Gender differences were related to levels of arousal, anxiety disorders, and repertoires for dealing with depression, rather than depressive symptoms per se.

Examining the utility of a temperament model for modelling non-melancholic depression

OBJECTIVE

Depression is currently modelled dimensionally, along severity, duration and recurrency dimensions. An alternative model allows dimensional expressions of temperament and personality to influence risk to onset as well as persistence. Here, we examine the utility of a temperament model.

METHOD

A questionnaire assessing temperament dimensions and a number of depression variables was administered to a large routine general practice sample and with the temperament measure also completed by a small clinical sample.

RESULTS

'Anxious worrying' and 'irritable' dimensions were identified as internalizing and externalizing expressions of a trait anxiety dimension, three other 'temperament' dimensions (i.e. 'introversion', 'self-centred' and 'obsessive') were refined, while a 'self-blame' dimension intruded into the factor analytic solution. High scores on the 'anxious worrying' dimension were associated with all depression parameters. The 'irritable', 'introversion' and 'self-blame' dimensions were less clearly linked with depression variables, while higher scores on the 'self-centred' and 'obsessional' dimensions did not appear to increase the chance of depression onset, persistence or recourse to treatment.

CONCLUSION

A temperament-based approach appears to have some conceptual utility in modelling depression, and particularly, the non-melancholic disorders. It is likely, however, to require complementing with refined at-risk personality dimensions.

QSAR of matrix metalloproteinase inhibitor N-[(substituted phenyl)sulfonyl]-N-4-nitrobenzylglycine hydroxamates using LFER model

QSAR analyses of matrix metalloproteinase (MMP) inhibitor N-[(substituted phenyl)sulfonyl]-N-4-nitrobenzylglycine hydroxamates, recently reported by Scozzafava and Supuran, have been attempted using linear free energy related (LFER) model of Hansch to explore the contribution patterns of the phenyl ring substitutions (P1' anchoring site of the ligands) to the activities against MMP-1, -2, -8 and -9 (pC1, pC2, pC, and pC9) and C. histolyticum collagenase (pC(ChC)) and also to find out relations among the activities. Multiple regression analyses applied on the data set reveal that electron withdrawing meta substituents and lipophilic ortho and meta substituents are conducive to pC1 while presence of substituents (larger than hydrogen) at vicinal positions on the phenyl ring and bulkier ortho substituents are detrimental to the activity. Again, the electronic and steric parameters of meta substituents (sigmam and MRm) and lipophilicity parameter of ortho substituents (pio) contribute significantly to pC2, pC8 and pC9: sigmam shows parabolic relationships (optimum sigmam values being 0.518, 0.584 and 0.522 respectively) and steric bulk of meta substituents has negative impact while presence of hydrophilic groups at the ortho positions increases the activities. Further, presence of electron withdrawing meta substituents and hydrophilic para substituents is conducive to the C. histolyticum collagenase (pC(ChC)) activity. The study suggests that the structural and physicochemical requirements of the P1' anchoring site for the activities against MMP-2, -8 and -9 are highly intercorrelated and these are comparatively less correlated with those for the activities against MMP-1 and C. histolyticum collagenase.

Protective immune responses elicited in mice by immunization with formulations of poly(lactide-co-glycolide) microparticles

Parenteral administration of microparticle encapsulated DNA elicits immune responses to the encoded antigens. Experiments were performed to test whether the addition of certain lipophilic agents to such formulations enhanced the activity of a beta-galactosidase (beta-gal) DNA vaccine. Addition of either taurocholic acid (TA) or monomethoxy polyethylene-glycol-distearoylphosphatidylehanolamine (PEG-DSPE) increased the efficiency of DNA encapsulation. Immunization of mice with encapsulated DNA formulations containing either compound significantly increased the number of antibody positive responders over that achieved with non-lipid containing particles. Moreover, responding animals demonstrated trends towards higher antibody titers and increased T cell responses. Tumor protection against the CT26.CL25 tumor cell line was demonstrated with lipid and non-lipid containing formulations. These results are the first demonstration of protection obtained by parenteral administration of PLG encapsulated DNA vaccines.

Spatial patterns of morphological diversity across the Indo-Pacific: analyses using strombid gastropods

Biological diversity can be measured using various metrics, but existing knowledge of spatial patterns of diversity is largely based on species counts. There is increasing evidence that trends in species richness might not match trends in other biodiversity metrics, such as morphological diversity. Here, we use data from a large group of Indo-Pacific gastropods (family Strombidae) to show that the species richness of a region is a poor predictor of the morphological diversity present there. Areas with only a few species can harbour an impressive array of morphologies and, conversely, morphological diversity in the most species-rich regions is no higher than in regions with half their taxonomic diversity. Biological diversity in the Pacific is highly threatened by human activity and our results indicate that, in addition to species richness, morphological diversity metrics need to be incorporated into conservation decisions.

MyoD can induce cell cycle arrest but not muscle differentiation in the presence of dominant negative SWI/SNF chromatin remodeling enzymes

Cell cycle arrest is critical for muscle differentiation, and the two processes are closely coordinated but temporally separable. SWI/SNF complexes are ATP-dependent chromatin-remodeling enzymes that have been shown to be required for muscle differentiation in cell culture and have also been reported to be required for Rb-mediated cell cycle arrest. We therefore looked more closely at how SWI/SNF enzymes affect the events that occur during MyoD-induced myogenesis, namely, cell cycle regulation and muscle-specific gene expression, in cells that inducibly express dominant negative versions of Brahma (BRM) and Brahma-related gene 1 (BRG1), the ATPase subunits of two distinct SWI/SNF complexes. Although dominant negative BRM and BRG1 inhibited expression of every muscle-specific regulator and structural gene assayed, there was no effect on MyoD-induced activation of cell cycle regulatory proteins, and thus, cells arrested normally. In particular, in the presence or absence of dominant negative BRM or BRG1, MyoD was able to activate expression of p21, cyclin D3, and Rb, all of which are critical for cell cycle withdrawal in the G1/G0 phase of the cell cycle. These findings suggest that at least one basis for the distinct mechanisms that regulate cessation of cell proliferation and muscle-specific gene expression during muscle differentiation is that SWI/SNF-mediated chromatin-remodeling enzymes are required only for the latter.

Depression in Singapore: failure to demonstrate an age effect on clinical features

OBJECTIVES

Studies comparing older and younger depressed patients have variably identified differing and similar clinical feature patterns, an inconsistency requiring clarification and explanation. If influential, age may have a true phenotypic effect or be a secondary influence reflecting depressive sub-type differences. If age is primarily influential, then, after controlling for depressive sub-type differences its effect should impact on clinical features - even in non-western regions.

METHODS

We therefore undertook a study in Singapore, comparing 42 elderly and 28 younger patients of a Singapore psychiatric hospital, and with the diagnostic sub-type profile similar across the age-based groups.

RESULTS

Despite the elderly group being some 35 years older, both at first episode and when surveyed, and having a distinctly higher rate of physical disorders, few clinical differences were identified. While the elderly group reported a less severe depressed mood and more 'somatic' symptoms, analyses indicated that such differences were accounted for by education and language factors, and were compatible with the view that Chinese subjects historically report depression more 'somatically'.

CONCLUSION

We conclude that, in a non-western, largely Chinese sample of depressed patients, few differences in the phenotypic expression of depression were identified, perhaps reflecting similar distributions of depressive sub-types across the groups, an issue which may have muddied interpretation of western studies.

Adolescent depression: a review

OBJECTIVE

To review the characteristic clinical, illness course and risk factors to adolescent depression.

METHOD

A literature review is provided with interpretive comments.

RESULTS

The clinical feature profile is likely to reflect the rarity of melancholic depression, while the non-melancholic "irritable hostile" pattern appears distinctly increased. A "reactive depressive disorder" is rare in those who get to psychiatric assessment, while comorbidity (e.g. anxiety and personality disorders, illicit drug use) is the rule. Aetiological determinants and the prognosis generally more relate to comorbid factors than to depression per se. Predisposing and precipitating psychological and social determinants are considered, while the efficacies of varying antidepressant strategies remain unclear apart from those with an "anxious" or "irritable" depression where selective serotonin re-uptake inhibitor medication has shown utility and where cognitive-behavioural therapy may be relevant.

CONCLUSIONS

For the majority who develop adolescent depression, its expression and outcome appear more a reflection of the propagating determinants, most commonly anxiety and personality style. The clinician should determine a treatment plan that not only addresses the depression but which identifies and addresses the contributing features.

The differential impact of age on the phenomenology of melancholia

BACKGROUND

We pursue an observation that age may influence the clinical features of melancholia and, in particular, psychomotor disturbance.

METHODS

Two large clinical databases were amalgamated allowing the clinical features of 124 depressed subjects meeting DSM-III-R and clinical criteria for melancholia to be contrasted with 218 subjects diagnosed as having a non-melancholic depression by both criteria sets. Psychomotor disturbance was assessed by the CORE measure and by seven classical endogeneity symptoms of melancholia which, when summed, created a ENDOG score.

RESULTS

There was no impact of age on ENDOG scores in either the melancholics or non-melancholics. In the melancholics, increasing age was associated with increasing CORE scores and with agitation scale scores in particular. In a set of discriminant function analyses seeking to identify the comparative utility of a set of predictors of melancholic (versus non-melancholic) groups, age was significant, and while CORE and ENDOG scores were individual predictors, their combined entry established that the CORE score alone made the ENDOG score redundant, and that the addition of age then made little impact.

CONCLUSIONS

Melancholia appears to have a later age of onset than non-melancholic depression, while its phenotypic expression appears to change with age, with psychomotor disturbance being more distinct in older subjects. Such an effect may have a number of clinical implications, including possible differential effects of varying antidepressant treatments.

Evaluation of alpha-tocopherol, probucol and ascorbic acid as suppressors of digoxin induced lipid peroxidation

Protective effects of three free radical scavengers, tocopherol (TOC), probucol (PR) and ascorbic acid (AA), on cardiotonic glycoside digoxin (DIG) induced lipid peroxidation in goat liver homogenate, have been studied by measuring malondialdehyde and glutathione contents as indicator parameters. The level of reduced glutathione decreased vis-a-vis malondialdehyde content increased in the drug treated samples in comparison with the controls. This suggests that DIG may have significant lipid peroxidation induction capacity. Considering lipid peroxidation as a toxicity mediating process, this may be related to the toxic potential of the drug. When the liver homogenate samples were incubated with antioxidant (TOC/PR/AA) in conjunction with the drug (DIG), lipid peroxidation was suppressed as indicated by increased level of reduced glutathione and decreased level of malondialdehyde in comparison with those of drug treated samples. This indicates that TOC, PR and AA may have considerable suppressive action on DIG induced lipid peroxidation. Thus, these antioxidants merit further extensive study to explore their potential in reducing DIG induced toxicity that may be mediated by free radical mediated process.

Purification, characterization and partial amino acid sequencing of a 70 kD inhibitor protein of Na+,K+-ATPase from goat testis cytosol

A protein isolated from goat testis cytosol is found to inhibit Na+,K+-ATPase from rat brain microsomes. The inhibitor has been purified by ammonium sulphate precipitation followed by hydroxyapatite column chromatography. The purified fraction appears as a single polypeptide band on 10% SDS-PAGE of approximate molecular mass of 70 kDa. The concentration at which 50% inhibition (I50) occurs is in the nanomolar range. The inhibitor seems to bind Na+,K+-ATPase reversibly at ATP binding site in a competitive manner with ATP, but away from ouabain binding site. It does not affect p-nitrophenyl-phosphatase activity. The inhibitor is found to inhibit the phosphorylation step of the Na+,K+-ATPase. The enhancement of tryptophan fluorescence and changes in CD pattern suggest conformational changes of Na+,K+-ATPase on binding to the inhibitor. Amino acid sequence of the trypsinised fragments show some homology with aldehyde reductase.