Summer mortality syndrome bacterial pathogens in farmed Nile tilapia (Oreochromis niloticus).

Background: The high summer mortality in many fish farms, which had detrimental economic and social implications, was a serious challenge that the fish industry had to deal with. Aim: With an examination of the most effective antibiotic, the ongoing research was intended to shed light on the identification of the main bacterial pathogens associated with the summer mortality syndrome in the diseased farmed Nile tilapia. Methods: Six hundred dead Nile tilapia samples that had suffered from summer mortality were collected from several fish farms between May and October of 2022. The gathered fish displayed hemorrhagic areas on the skin, scale detachment, fin degeneration, erosions, skin ulcers, and corneal opacity with unilateral and/or bilateral exophthalmia. The most prominent internal appearance was swelling of the internal organs with sanguineous ascetic fluid. Results: There were 225 bacterial isolates found. Six species were identified through phenotypic and biochemical analysis; they were Aeromonas, Vibrio, Streptococcus, Pseudomonas, Enterococcus, and Edwardsiella spp., in descending percentage, respectively. Aeromonas spp., Vibrio spp., and Streptococcus spp. were the three most frequent isolated bacterial pathogens. The identification of Aeromonas hydrophila, Vibrio spp., and Streptococcus iniae, the three most common bacterial isolates, was confirmed by molecular analysis by polymerase chain reaction. Most of the tested strains were found to be responsive to Ciprofloxacin (CIP), Gentamicin (CN), and Chloramphenicol (C) but resistant to Amoxicillin (AMX), according to an antibiotic sensitivity test. Conclusion: The three most dangerous common bacterial infections discovered during mass-farmed tilapia summer mortality are A. hydrophil a, Vibrio sp., and S. iniae. This makes it clear that high water temperatures may raise the possibility of bacterial infections, which could cause widespread tilapia mortality and substantial financial losses. Therefore, it is crucial to maintain a beneficial fish culture, environment, and husbandry practices to enhance the tilapia-rearing environment and lessen the virulence of the disease. Isolated bacterial strains showed low levels of resistance to AMX but were vulnerable to CIP, CN, and C.

Improved analysis of folpet and captan in foods using liquid chromatography-triple quadrupole linear ion trap mass spectrometry: applying mass filtering, collision, and trapping conditions.

Accurate and highly sensitive analysis of folpet and captan was accomplished using liquid chromatography-triple quadrupole linear ion trap mass spectrometry (LC-QqQIT) with selective ion mode; mass filtering, collision, and trapping condition. Dimensional mass spectrometry (MS3) parameters were optimized for the residue detection of folpet and captan in six food commodities (apples, tomatoes, sweet pepper, wheat flour, sesame seeds, and fennel seeds). The sample preparation method was based on the known QuEChERS protocol, except a mixture of acetonitrile/acetone was used for the sample extraction from the sesame seeds. The robustness and reliability of the developed MS3 method were demonstrated by performing a full validation, according to SANTE/11312/2021, at 0.01-0.25 mg/kg. Recovery ranged from 83 to 118% with a relative standard deviation below 19% in all the tested commodities, and limits of quantifications (LOQs) were 0.01 mg/kg in apples and tomatoes; 0.03 mg/kg in sweet pepper; and 0.05 mg/kg in wheat flour, sesame seeds, and fennel seeds. Monitoring results showed that about 90% of apples contained captan residue, and in sweet pepper, concentrations of captan and folpet as high as 1.57 and 0.97 mg/kg were found, respectively. The novel developed MS3 method enabled more reliable identification of these commonly problematic fungicides at lower LOQs than previously reported methods.

Mannan Oligosaccharide Enhanced the Growth Rate, Digestive Enzyme Activity, Carcass Composition, and Blood Chemistry of Thinlip Grey Mullet (Liza ramada).

Mannan oligosaccharide (MOS) is prebiotic with high functionality in aquaculture. The current study investigated the potential roles of MOS on the growth performance, digestive enzyme activity, carcass composition, and blood chemistry of Thinlip grey mullet (Liza ramada). Four tested diets with 34.49% crude protein and 6.29% of total lipids were prepared and fortified with 0, 0.5, 1, and 2% MOS. Fish of initial weight = 5.14 ± 0.11 g/fish were distributed in 12 hapas (0.5 × 0.5 × 1 m) at 15 fish per hapa (triplicates) and fed the test diets to the satiation level two times a day (08:00 and 15:00) for eight weeks. At the end of the trial, all fish were weighed individually for growth performance calculation. Blood was collected to check blood chemistry traits, and intestines were dissected for digestive enzyme analysis. Fish treated with MOS had marked enhancement in the final body weight, feed conversion ratio, protein gain, and protein retention regardless of inclusion dose (p < 0.05). The weight gain, specific growth rate, and protein efficiency ratio were meaningfully enhanced by including MOS at 0.5 and 1%, followed by fish fed with 2% MOS, while the lowest values were in the control group (p < 0.05). Insignificant influences of MOS were seen on the chemical composition of carcass components (moisture, crude protein, total lipids, and ash) (p > 0.05). Fish treated with MOS at 0.5 and 1% had marked enhancement in the amylase, lipase, and protease activities regardless of inclusion dose (p < 0.05). The blood total protein and albumin levels were meaningfully enhanced by including MOS at 0.5 and 1%, followed by fish fed with 2% MOS, while the lowest values were in the control group (p < 0.05). The blood globulin was significantly enhanced in fish fed 1% MOS than fish treated with 0, 0.5, and 2% of MOS (p < 0.05). The blood lysozyme activity was meaningfully enhanced by including MOS at 1%, followed by fish treated with 0.5 and 2%, while the lowest values were in the control group (p < 0.05). Phagocytic activity and phagocytic index were markedly improved in fish treated with 1 and 2% MOS, followed by those fed 0.5% compared with fish fed MOS-free diet (p < 0.05). Superoxide dismutase and glutathione peroxidase were markedly improved in fish treated with 1, and 2% MOS, followed by those fed 0.5% compared with fish fed MOS-free diet (p < 0.05). Dietary MOS (0.5, 1, and 2%) meaningfully enhanced catalase activity while decreased the malondialdehyde concentration (p < 0.05). In summary, dietary MOS is required at 0.5-1% for enhancing the growth rate, feed efficiency, digestive enzyme activity, blood chemistry, and antioxidative capacity of grey mullet.

The curious case of miR-155 in SLE.

Epigenetic modifications have been well documented in autoimmune diseases. MicroRNAs (miRNAs), in particular, have long intrigued scientists in the field of autoimmunity. Owing to its central role in the development of the immune system, microRNA-155 (miR-155) is deeply involved in systemic lupus erythematosus (SLE). Despite the advancements made in treating SLE, the disease still remains incurable. Therefore, recent attention has been drawn to the manipulation of epigenetics in the development of curative treatments. In fact, it is a widely held view that miRNA-targeted therapy is a new glimmer of hope in the treatment of autoimmune diseases. However, the duplicity of miRNAs should not be overlooked. A single miRNA can target several mRNAs, and some mRNAs may possess opposing functions. In this review, we highlight the role of miR-155 as a biomarker and review its functions in SLE patients and animal models while discussing possible reasons behind inconsistencies across studies.

Size-exclusion chromatography selective cleanup of aflatoxins in oilseeds followed by HPLC determination to assess the potential health risk.

Aflatoxins (AFs) are one of the most harmful carcinogenic natural toxins that affect food. Crops containing reasonably high oil content may be affected by Aspergillus species and consequently by AF contamination. In this study, a proposed testing method for AF detection in oilseed was developed, validated, and used for a market survey to assess the probabilistic risk exposure caused by consuming contaminated oilseeds including corn, sunflower seed, and soybean. The test method was optimized for selective extraction and then validated for fitness of purpose; the limits of quantification (LOQs) were 0.2, 0.4, 0.2, and 0.2 µg kg-1 for aflatoxin G1 (AFG1), aflatoxin B1 (AFB1), aflatoxin G2 (AFG2), and aflatoxin B2 (AFB2), respectively. The method was linear from the LOQs up to 20 µg kg-1, and its budget of measurement uncertainties were estimated at 25, 24, 26, and 30 for AFG1, AFB1, AFG2, and AFB2, respectively. The contamination levels were from  10,000 body weight (BW) day-1, respectively. The main finding of the present study highlights the possibility of some risk of AF exposure from corn consumption, which may represent a health concern.

Population Dynamics, Fecundity and Fatty Acid Composition of Oithona nana (Cyclopoida, Copepoda), Fed on Different Diets.

The marine copepod species Oithona nana is considered as one of the most successfully mass cultured Cyclopoida species in marine hatcheries. This study investigated the effects of four feed diets (soybean, yeast, rice bran, and corn starch) on the population growth, growth rate, population composition, fecundity, and fatty acid composition of native isolated Cyclopoida copepod species O. nana. The experiment was continued for 15 days and the copepods were fed on one of the four diets with a concentration of 1 g 10-6 individual day-1. The results revealed that corn starch was found to be the most supportive diet for population growth and population growth rate. For nutritional value, copepods fed on rice bran were detected to have the highest content of MUFA, PUFA, and the lowest SFA and SFA/UFA ratio; more importantly, the rice bran diet was the only treatment that showed C20:5ω3. Moreover, copepods fed on rice bran showed the highest significant female fecundity, copepodite, and nauplii percent. Finally, the protocols described in the current study concluded that the dry feeds, especially corn starch, are very useful and applicable in hatcheries for maximizing the fecundity and density of Cyclopoida copepod species, O. nana.

Synergetic Effects of Lactobacillus plantarum and ß-Glucan on Digestive Enzyme Activity, Intestinal Morphology, Growth, Fatty Acid, and Glucose-Related Gene Expression of Genetically Improved Farmed Tilapia.

The current study was conducted to evaluate the synergetic effects of heat-killed Lactobacillus plantarum (HK L-137) and ß-glucan (BG) on digestive enzyme activity and intestinal morphology of genetically improved farmed tilapia (GIFT) with focus on insulin-like growth factor I (IGF-I), fatty acid synthase (FAS), and glucose-6-phosphate dehydrogenase (G6PD). For 12 weeks, fish fed the control, or three diets incorporated with 100 HK L-137, 100 BG, or 50 HK L-137 + 50 BG mg/kg (HK L-137, BG, and HK L-137/BG diets). After final sampling, fish fed HK L-137 or HK L-137/BG diets exhibited significantly (P < 0.05) increased final body weight and weight gain while the specific growth rate and feed efficiency ratio enhanced only in HK L-137/BG group. Mucosal and villi lengths and muscle thickness significantly (P < 0.05) increased by HK L-137 or/and BG for the middle intestine. Lipase and protease improved significantly (P < 0.05) in fish fed both HK L-137 and BG when compared to the control group. Interestingly, qRT-PCR revealed a significant (P < 0.05) upregulation in the IGF-1 gene expression in fish fed HK L-137 or/and BG additives compared to the control. Muscle and liver G6PD gene expression were upregulated significantly (P < 0.05) in fish fed HK L-137/BG diet as compared to the control group. In addition, feeding HK L-137 or both additives effectively elevated the hematocrit, hemoglobin, and WBCs and decreased triglyceride and glucose levels. Accordingly, the use of both HK L-137 and BG is an efficient scheme to reach economically feasible and sustainable tilapia production.

Evaluation of Yeast Fermented Poultry By-Product Meal in Nile Tilapia (Oreochromis niloticus) Feed: Effects on Growth Performance, Digestive Enzymes Activity, Innate Immunity, and Antioxidant Capacity.

The aim of the present study was to examine the effects of dietary inclusion of fermented poultry by-product meal (FPBM) on growth performance, digestive enzymes activity, innate immunity, and antioxidant capacity in Nile tilapia (Oreochromis niloticus). A basal diet containing fish meal and soybean meal was considered as a control (Con), and four other diets were produced by inclusion of 10, 20, 30, or 40% FPBM (FPBM10, FPBM20, FPBM30, and FPBM40 diets). The experiment was done in triplicates (20 fish per replicate) and the fish were fed the test diets to visual satiety twice daily for 8 weeks. The groups of fish fed the FPBM10 and FPBM20 diets showed significantly (P < 0.05) higher weight gain and specific growth rate, and lower feed conversion ratio than those fed the Con and FPBM40 diets. Moreover, inclusion of 40% FPBM led to significant reduction of feed intake compared to the other treatments. FPBM at all the tested levels improved intestinal protease activity and lipase activity was enhanced at 10-30% inclusion levels. Furthermore, the FPBM10 and FPBM20 groups revealed significantly higher amylase activity than the other treatments. The FPBM10 group exhibited significantly higher phagocytic activity than the control group and phagocytic index was enhanced by dietary inclusion of 10-30% FPBM. However, inclusion of over 30% FPBM led to significant reduction of lysozyme, phagocytic, and bactericidal activities compared to the control group. Further, FPBM10 and FPBM20 diets increased the serum IgM levels, while NBT was significantly increased by feeding FPBM10 diet compared with FPBM30 and FPBM40 groups (P < 0.05). The group fed the FPBM30 diet showed significantly higher glutathione peroxidase activity than the control group. According to the analysis of the data by the polynomial regression, the inclusion of FPBM at 11.17-25.14% can be applied effectively in the diets of tilapia for better growth performance and health condition.

GATA3 rs3824662 gene polymorphism as possible risk factor for systemic lupus erythematosus.

BACKGROUND: There is no report about the association between GATA3 rs3824662 polymorphism and systemic lupus erythematosus (SLE). OBJECTIVE: To investigate the possible role of GATA3 rs3824662 polymorphism as a susceptibility risk factor for either adult SLE (aSLE) or pediatric SLE (pSLE) and to evaluate its role in the development of lupus nephritis (LN) in pSLE. METHODS: Typing of GATA3 rs3824662 polymorphism was done using real-time polymerase chain reaction for three groups; 104 pSLE patients, 140 aSLE patients and 436 age- and sex-matched healthy controls. RESULTS: Non-significant differences were found between SLE patients and healthy controls for the allele and genotype frequencies of GATA3 rs3824662 ( p > 0.05). In pSLE; the AC genotype was associated with LN ( p = 0.04); the A allele and AC genotype were associated with persistent proteinuria ( p = 0.036 and 0.01, respectively) and both the A allele and AA genotype were associated with higher chronicity index ( p = 0.031 and 0.04, respectively). In aSLE; the C allele was associated with cellular cast ( p = 0.03) and thrombocytopenia ( p = 0.01). Logistic regression analysis revealed significant association between the AC+AA genotypes and the prediction of LN and renal active disease in pSLE ( p = 0.04 and 0.01, respectively). CONCLUSION: GATA3 rs3824662 is not associated with susceptibility to SLE either in adult or in pediatric patients; however, in pSLE patients, the heterozygous AC genotype could be considered a risk factor for LN. At the same time, the AC and AA genotypes could be considered as predictors for LN and active renal disease. However, the small sample size is a limiting factor of the present study when interpreting the positive association.

Metal Ion Removal from Wastewaters by Sorption on Activated Carbon, Cement Kiln Dust, and Sawdust.

This study assessed the efficiency of activated carbon, cement kiln dust (CKD), and sawdust for the removal of cadmium (Cd), copper (Cu), lead (Pb), and zinc (Zn) from aqueous solutions under mono-metal and competitive sorption systems and the removal of Cd, Cu, and Zn from different industrial wastewaters. Batch equilibrium experiments were conducted in a mono-metal and competitive sorption system. The efficiency of the sorbents in the removal of Cd, Cu, and Zn from industrial wastewaters was also investigated. Cement kiln dust expressed the highest affinity for the metals followed by activated carbon and sawdust. Competition among the metals changed their distribution coefficient (Kd) with the sorbents. Sorption of Pb and Cu was higher than Cd and Zn. The average metal removal from the wastewaters varied from 74, 61, and 60% for Cd, Cu, and Zn, respectively, to nearly 100%. The efficiencies of CKD and activated carbon in removing metals were higher than sawdust, suggesting their potential as low-cost sorbents for the removal of toxic metals from wastewaters.

C1q rs292001 polymorphism and C1q antibodies in juvenile lupus and their relation to lupus nephritis.

C1q deficiency is related strongly to systemic lupus erythematosus (SLE), but very few and inconsistent studies explored the single nucleotide polymorphisms of the C1q gene in relation to juvenile SLE (jSLE) and lupus nephritis (LN). The objective of this study was to analyse whether C1q rs 292001 polymorphism is associated with SLE and disease phenotype, especially nephritis, and to investigate the relation between this polymorphism and clinical data, treatment outcome, serum level of C1q protein and antibodies. Typing of C1q rs292001 polymorphism using restriction fragment length polymorphism and measuring serum levels of C1q protein and antibodies by enzyme-linked immunosorbent assay (ELISA) were performed for 130 children with SLE and 208 healthy controls. The A allele of C1q rs292001 was associated with jSLE and LN (P = 0·005 and 0·013, respectively) and the AA genotype was associated with jSLE (P = 0·036). Low serum levels of C1q protein were found in jSLE and LN (P < 0·001 and 0·009, respectively), and these levels were increased after treatment in patients with LN (P = 0·009) and active renal disease (P = 0·027). Higher titres of C1q antibodies were found in patients with LN (P = 0·015) and correlated negatively with C1q protein level (P < 0·001) and patient age (P = 0·04). The A allele and AA genotype of C1q rs292001 can be considered a susceptibility risk factor and the GG genotype could be considered protective for jSLE and LN in the studied cohort of Egyptian children. Decreased serum levels of C1q protein and increased titres of C1q antibodies may be involved in the pathogenesis of jSLE, especially LN.

Infection complications and pattern of bacterial resistance in living-donor liver transplantation: a multicenter epidemiologic study in Egypt.

INTRODUCTION: Data on the prevalence and pattern of infection after living-donor liver transplantation (LDLT) are scarce in Egypt. We therefore conducted this study to quantify the incidence, risk factors, and pattern of bacterial resistance post-LDLT in 3 hospitals in Egypt. PATIENTS AND METHODS: We conducted a retrospective, multicenter study of the medical records of 246 patients who underwent LDLT between January 2006 and April 2011 at 3 transplant centers in Egypt. RESULTS: Of 246 patients enrolled in this study, 127 (52%) developed infectious complications after LDLT, with 416 episodes of infection occurring within 3 months of transplantation. Biliary tract infection was the most common, occurring in 169 (40.6%) patients. The rate of infection with Gram-negative bacteria was higher than that of infection with Gram-positive bacteria (310 [74%] vs 87 [21%]; P < .001). Overall, 75% of Gram-negative isolates were multidrug resistant. Significant independent risk factors for infection were portal vein thrombosis (odds ratio, 2.4; P = .037) and biliary complications (odds ratio, 5.4; P < .001). CONCLUSIONS: Our data showed a high-resistance pattern of bacterial infection after LDLT in Egypt. Early biliary complications were an independent risk factor for bacterial infection.

Histopathology and cytotoxicity as biomarkers in treated rats with cadmium and some therapeutic agents.

The present study aimed to investigate the protective role of ascorbic acid (vitamin C) and zinc (Zn) against cadmium (Cd) induced histopathological changes in tissues of liver, kidney, lung and testis of rats as well as chromosomal aberrations. For this purpose, 60 male albino rats were divided into six groups; each group contained 10 animals. The first group served as control and was given only distilled water. The second and third groups received distilled water supplemented with 2 g ascorbic acid/l and 500 mg Zn/l, respectively. The fourth group received a daily oral dose containing 3 mg Cd/kg b.w. (1/30 LD50). The fifth group received Cd + ascorbic acid (3 mg Cd/kg b.w. + 2 g ascorbic acid/l), while the sixth group received Cd + Zn (3 mg Cd/kg b.w. +500 mg Zn/l). The treatment in all groups lasted for 90 consecutive days. Rats exposed to cadmium showed severe histopathological changes in the liver, kidney, lung and testicular tissues as well as chromosomal aberrations such as: break, ring, centromeric separation and polyploidy. Co-treatment with zinc partially improved the histopathological changes and chromosomal aberrations while co-treatment with vitamin C exhibited a more protective role and markedly reduced tissues damage induced by Cd.

Heavy metals removal from aqueous solutions and wastewaters by using various byproducts.

Water contamination with heavy metals (HM) represents a potential threat to humans, animals and plants, and thus removal of these metals from contaminated waters has received increasing attention. The present study aimed to assess the efficiency of some low cost sorbents i.e., chitosan (CH), egg shell (ES), humate potassium (HK), and sugar beet factory lime (SBFL) for removal of cadmium (Cd), copper (Cu), lead (Pb) and zinc (Zn) from wastewaters. For this purpose batch equilibrium experiments were conducted with aqueous solutions containing various concentrations of the metals and sorbents in a mono-metal and competitive sorption system. Sorption isotherms were developed, and sorption parameters were determined. The potential applicability of the tested sorbents in the removal of Cd, Cu, and Zn from contaminated wastewaters was also investigated by equilibrating different sorbents and water ratios. Chitosan expressed the highest affinity for the metals followed by SBFL, ES, and HK. Nearly 100% of the metals were removed from aqueous solutions with the lowest initial metal concentrations by the sorbents especially CH and SBFL. However, the sorption efficiency decreased as the initial metal concentrations increased. Competition among the four metals changed significantly their distribution coefficient (Kd) values with the sorbents. The selectivity sequence of the metals was: Pb > Cu > Zn > Cd. The metal removal from the wastewaters varied from 72, 69, and 60 to nearly 100% for Cd, Cu and Zn, respectively. The efficiency of the studied byproducts in removing metals from the wastewaters differed based on the source of contamination and metal concentrations. Cadmium removal percentages by HK and CH were higher than SBFL and ES. The HK and CH exhibited the highest removal percentage of Cu from water with high concentrations. The SBFL and ES revealed the highest removal percentage of Zn from water with high concentrations. The results, demonstrate a high potential of CH, SBFL, HK, and ES for the remediation of HM contaminated wastewaters.

Tamoxifen alleviates hepatitis C virus-induced inhibition of both toll-like receptor 7 and JAK-STAT signalling pathways in PBMCs of infected Egyptian females.

Summary. Hepatitis C virus (HCV) is a major health concern in Egypt being highly prevalent among Egyptians. The two genders experience different responses to HCV infection and show variations in response to interferon (IFN)-based therapy that may be attributed to sex hormones. We previously demonstrated the suppressive effect of 17ß-estradiol (E2) on the expression of the IFN-stimulated gene MxA in HCV-infected peripheral blood mononuclear cells (PBMCs). The selective oestrogen receptor (ER) modulator Tamoxifen has been shown to have an antiviral effect against HCV, but its effect on the host immune response is unknown. We investigated the effect of Tamoxifen on the IFN signalling pathways in PBMCs of HCV-infected Egyptian females. We pooled PBMCs and treated then with exogenous interferon alpha (IFNα) or the TLR7 ligand, Imiquimod, and quantified the relative expressions of MxA using RTqPCR. Studies were performed with and without Tamoxifen pretreatment. Pretreatment with Tamoxifen reversed the suppressive effect of E2 on the JAK-STAT pathway in IFNα-treated PBMCs as indicated by a significant increase in MxA expression (P = 0.05*). Tamoxifen pretreatment also significantly upregulated MxA expression in Imiquimod-treated PBMCs (P = 0.0011**), an effect not ascribed to ER blocking nor to an upregulation in TLR7 expression because Tamoxifen showed no potentiating effect on the expression of the receptor. In conclusion, our findings reveal that Tamoxifen has immunomodulatory effects whereby it enhances the host IFN signalling pathways during HCV infection.

Unilateral pulmonary edema: unusual presentation of acute rheumatic fever.

Cardiogenic unilateral pulmonary edema (UPE) is a rare clinical condition and not readily recognized early and managed accordingly. Acute rheumatic fever, which is a common disease in developing countries, does not commonly present with UPE. We report a 13-year-old girl presenting with UPE following acute rheumatic fever mimicking pneumonia. We conclude that UPE should be considered in the differential diagnosis for the patient with clinical criteria of rheumatic fever who presents with unilateral lung opacification. With early recognition and antifailure treatment, it is possible to reduce morbidity and mortality in such patients.

Personality and disease outcome in malignant melanoma.

OBJECTIVE: The objective of this study is to evaluate the role of personality in the prediction of recurrence and survival times in early-stage malignant melanoma. METHODS: Sixty patients with Stage I malignant melanoma were assessed shortly after surgery and followed for 10-year outcome. Survival analyses were conducted (i.e., log-rank test and Cox proportional hazards regression method), with covariates and personality type as measured by the Eysenck Personality Questionnaire (EPQ). RESULTS: Men were three times more likely to recur and seven times more likely to die from malignant melanoma than were women. Every millimeter of tumor depth also increased the risks of both recurrence and death twofold. In contrast to medical indices, personality type could not be used to determine risk for either outcome. CONCLUSION: In the present study, personality type did not predict recurrence and survival times. Rather, malignant melanoma prognosis was overwhelmingly determined by disease biology.

Malignant melanoma: effects of a brief, structured psychiatric intervention on survival and recurrence at 10-year follow-up.

BACKGROUND: The influence of psychiatric intervention on cancer outcome remains a topic of considerable debate. We previously reported the survival benefits for 68 patients with malignant melanoma 5 to 6 years following their participation in a structured psychiatric group intervention. In this article, we report the effects of the intervention on disease outcome in these same patients at the 10-year follow-up. METHODS: In this univariate analysis, the survival and recurrence distributions for the intervention and control groups were estimated using the Kaplan-Meier method, and were tested for equality by the log-rank test. The multivariate analysis used the Cox proportional hazards regression model with the following prognostic factors: age, sex, Breslow depth, tumor site, and treatment status (ie, intervention group vs control group). RESULTS: When analyzed as single covariates, differences between the intervention and control groups were not significant for outcome at the 10-year follow-up. However, being male and having a greater Breslow depth were predictive of poorer outcome. Analysis of multiple covariates also revealed that sex and Breslow depth were significant for recurrence and survival. In addition, participation in the intervention was significant for survival. After adjusting for sex and Breslow depth, participation in the intervention remained significant for survival. CONCLUSIONS: These findings suggest that the survival benefit of the intervention has weakened since the 5- to 6-year follow-up; however, it has not entirely disappeared. At the 10-year follow-up, participation in the intervention remained predictive of survival when statistically controlling for the effects of other known prognostic indicators. Despite the potential health benefits, we do not propose that psychiatric intervention be used in lieu of standard medical care, but as one of its integral components.