Association of Placental Histology with the Pulsatility Index of Fetal and Uteroplacental Vessels during Pregnancy and with Birthweight Z-Score.

Aims: To compare macro- and microscopic features of the placenta with the pulsatility index (PI) of the uterine (UtA), umbilical (UA) and middle cerebral arteries at 20-24- and 34-38-weeks' gestation, and with birthweight z-scores (BWZS). Methods: Recruitment for the Safe Passage Study, which investigated the association of alcohol and tobacco use with stillbirth and sudden infant death syndrome, occurred from August 2007 to January 2015 at community clinics in Cape Town, South Africa. The population represents a predominantly homogenous population of pregnant women from a low socioeconomic residential area. This study is a further analysis of the data of the Safe Passage Study. It consists of 1205 singleton pregnancies for which placental histology was available, of whom 1035 had a known BWZS and 1022 and 979 had fetoplacental Doppler examinations performed at Tygerberg Academic Hospital at 20-24 and 34-38 weeks respectively. Features of the placenta were assessed according to international norms. Results: Significantly higher ORs for the presence of individual and combined features of maternal vascular malperfusion (MVM) were found with lower BWZS and higher UtA PI values, more consistently than with higher UA PI values. Strongest associations were for a small placenta for gestational age (UtA OR 4.86 at 20-24 and 5.92 at 34-38 weeks; UA OR 5.33 at 20-24 and 27.01 at 34-38 weeks; low BWZS OR 0.31), for accelerated maturation (UtA OR 11.68 at 20-24 weeks and 18.46 at 34-38 weeks; low BWZS 0.61), for macroscopic infarction (UtA OR 6.08 at 20-24 weeks; UA OR 17.02 at 34-38 weeks; low BWZS OR 0.62) and for microscopic infarction (UtA OR 6.84 at 20-24 and 10.9 at 34-38 weeks; low BWZS OR 0.62). Conclusion: There is considerable variability in the associations between individual features of MVM and increased UtA or UA PI and low BWZS. Although all MVM features currently carry equal weight in defining the condition of MVM, our data suggest that some should carry more weight than others. Macroscopic examination of the placenta may be helpful in identifying placental insufficiency as a small placenta for gestational age and macroscopic infarction were the features most strongly associated with outcomes.

Taxation of sugar-sweetened beverages in South Africa: Perspectives of consumers in Cape Town.

Background: Globally, fiscal measures are deemed effective in combating the obesity epidemic at population level. A health promotional levy (HPL) on sugar sweetened beverages (SSBs) was implemented in April 2018 in South Africa to reduce sugar consumption. Design and methods: This cross-sectional, descriptive study investigated consumers' understanding and opinion of the HPL, and impact on consumption of SSBs. Data was collected outside 15 grocery stores, within four health sub-districts of the City of Cape Town. An interviewer-administered questionnaire was completed with literate, adult consumers (N = 696). Results: Participants (46.0%) were aware of the HPL but regarded it insufficient to change purchasing behaviour (55.4%). The lower income group (56.4%) was most affected by the increased price of SSBs. Those who agreed (46.8%) that the levy would help to reduce the prevalence of obesity was significantly more likely to notice a price increase in SSBs (54.5%) (p < 0.01) and had a higher education level (p < 0.01). Overall, self-reported consumption of SSBs decreased by 7.7% since the HPL was enacted. Participants who were aware of the detrimental effect of consuming large amounts of sugar, were more likely to change their behaviour (p < 0.01). Conclusions: Participants were receptive for legislative measures to combat the prevalence of obesity but lacked clarity of the goal and implementation of the HPL. A multipronged approach is crucial to lower sugar intake sustainably and an environment which offers healthy alternatives to SSBs. A higher HPL combined with transparency of how revenue is utilised could enhance the impact of the sugar tax strategy.

Spatiotemporal Investigation of Antibiotic Resistance in the Urban Water Cycle Influenced by Environmental and Anthropogenic Activity.

With increasing emergence of antimicrobial resistant bacteria (ARB) and the risk this poses to public health, there are growing concerns regarding water pollution contributing to the spread of antimicrobial resistance (AMR) through inadequate amenities and the rapid rate of urbanization. In this study, the impact of different anthropogenic factors on the prevalence of AMR in the urban water cycle in Stellenbosch, South Africa (SA) was examined. Carbapenem, colistin, gentamicin and sulfamethoxazole resistant Gram-negative bacteria were recovered by selectively culturing aqueous, biofilm and sediment samples from sites impacted to varying degrees by informal settlements, residential, industrial, and agricultural activities, as well as a municipal wastewater treatment works (WWTW). A metagenomic approach determined community profiles and dominant AMR genes at various sites, while carbapenem resistant colonies were characterized using whole genome sequencing (WGS). Isolates recovered from agricultural sites exhibited relatively high levels of resistance to carbapenems and colistin, whereas sites impacted by domestic run-off had a higher prevalence of resistance to gentamicin and sulfamethoxazole, corresponding to usage data in SA. Similar microbial taxa were identified in raw sewage, sites downstream of informal settlements, and industrial areas that have limited waste removal infrastructure while WWTW were seen to reduce the prevalence of ARB in treated wastewater when operating efficiently. The results indicate the multiple complex drivers underpinning environmental dissemination of AMR and suggest that WWTW assist in removing AMR from the environment, reinforcing the necessity of adequate waste removal infrastructure and antibiotic stewardship measures to mitigate AMR transmission. IMPORTANCE The results from this study are of importance as they fill a gap in the data available on environmental AMR in South Africa to date. This study was done in parallel with co-investigators focusing on the prevalence of various antimicrobials at the same sites selected in our study, verifying that the sites that are influenced by informal settlements and WWTW influent had higher concentrations of antimicrobials and antimicrobial metabolites. The various locations of the sample sites selected, the frequency of the samples collected over a year, and the different types of samples collected at each site all contribute to informing how AMR in the environment might be affected by anthropogenic activity.

Placental pathology in spontaneous and iatrogenic preterm birth: Different entities with unique pathologic features.

INTRODUCTION: Placental pathology is an important contributor to the understanding of preterm birth and reveals major differences between spontaneous preterm birth (SPTB) and iatrogenic preterm birth (IPTB). The aim of this study was to investigate these relationships. METHODS: Research midwives collected placentas from 1101 women with singleton pregnancies who were enrolled in the Safe Passage Study. Trained pathology technologists prepared and processed placenta specimens for macroscopic and microscopic examination by designated pathologists. Statistical analyses were done with STATISTICA version 13. RESULTS: In SPTB we found more cases of accelerated villous maturation; however, the other features of maternal vascular malperfusion (MVM) were not present. The prevalence rate of funisitis was also increased. In IPTB, multiple features of MVM - accelerated villous maturation, distal villous hypoplasia, decidual arteriopathy, increased syncytial knots, increased perivillous fibrin, and prominent extravillous trophoblast were increased, as were features of fetal vascular malperfusion (FVM) - umbilical cord vessel thrombosis, avascular villi, and fetal vascular thrombosis. Increased syncytial knots were found in 26% of preterm stillbirths and in 29% of preterm infant demises as compared to 81% of IPTB infants alive at one year. DISCUSSION: SPTB and IPTB differ. The detected "abnormal" accelerated villous maturation pattern in SPTB and preterm demises, suggests an inability of the placenta to adapt and may be a trigger for SPTB. Funisitis was the only inflammatory response significant for SPTB. MVM and FVM are implicated in IPTB, but not an inflammatory process.

The Intricate Interactions between Maternal Smoking and Drinking During Pregnancy and Birthweight Z-Scores of Preterm Births.

BACKGROUND: The extent to which smoking and drinking in a local community is associated with nutrition and Z-scores of infants from spontaneous preterm deliveries, is uncertain. AIM: To investigate associations of different levels of maternal smoking and drinking in spontaneous preterm birth with infant birthweight Z-scores. METHODS: Information, including gestational age (determined by earliest ultrasound), maternal arm circumference (measured at enrolment), smoking-drinking data (obtained up to 4 occasions), birthweight data (obtained from medical records) and birthweight Z-scores (calculated from INTERGROWTH- 21st study), collected over a period of nine years was used to compare 407 spontaneous preterm births with 3 493 spontaneous term births Analyses of variance, correlations and multiple regression were performed in STATISTICA. RESULTS: Women with spontaneous preterm birth, had significantly lower gravidity and smaller arm circumference when compared to women with spontaneous birth at term. Women with spontaneous preterm birth drank more and heavier during pregnancy, and more smoked. Gestational age at birth was significantly longer in heavy-smokers-heavy-drinkers compared to heavy-smokers-no-drinkers (7.1 days) and in no-smokers-heavy-drinkers when compared to no-smokers-no-drinkers (11.2 days). Birthweight was significantly lower in low-smokers-heavy-drinkers when compared to low-smokers-no-drinkers (240g) and in heavy-smokers-low-drinkers when compared to no-smokers-low-drinkers (273g). Birthweight Z-scores were significantly lower in low-smokers-heavy-drinkers when compared to low-smokers-low-drinkers and low-smokers-no-drinkers; and, also significantly lower in heavy-smokers-low-drinkers when compared to low-smokers-low-drinkers and no-smokers-low-drinkers. CONCLUSION: Alcohol aggravates the detrimental effect of smoking on birthweight and birthweight Z-scores but seems to counteract the negative association of smoking with gestational age.

Associations of maternal smoking and drinking with fetal growth and placental abruption.

OBJECTIVE: To investigate pregnant women from the Safe Passage Study for the individual and combined effects of smoking and drinking during pregnancy on the prevalence of clinical placental abruption. STUDY DESIGN: The aim of the original Safe Passage Study was to investigate the association of alcohol use during pregnancy with stillbirths and sudden infant deaths. Recruitment for this longitudinal study occurred between August 2007 and October 2016. Information on smoking and drinking was collected prospectively at up to 4 occasions during pregnancy where a modified timeline follow-back method was used to assess the exposure to alcohol. Placentas were examined histologically in a subset of pregnant women. For this study we examined the effects of smoking and drinking on fetal growth and the prevalence rate of placental abruption. High smoking constituted of 10 or more cigarettes per day and high drinking of four or more binge drinking episodes or 32 and more standard drinks during pregnancy. Placental abruption was diagnosed in two ways, by the clinical picture or the macroscopic and microscopic examination of the placenta. RESULTS: When compared to the non-drinking/non-smoking group, the high drinking/high smoking group were significantly older, had a higher gravidity, had a lower household income and booked later for prenatal care; fewer of them were employed and had toilet and running water facilities in their houses. Clinical placental abruption was diagnosed in 49 (0.87 %) of 5806 pregnancies. Histological examination was done in 1319 placentas; macroscopic and microscopic diagnosis of placental abruption was made in 8.2 % and 11.9 % of placentas respectively. These 49 cases were then correlated with seven smoking/drinking patterns during pregnancy. When compared to rates for no smoking/no drinking (0.11 %) and low smoking/no drinking (0.55 %), the prevalence rate of placental abruption was significantly higher (p < .005) in the low smoking/low drinking group (1.25 %). There was also a significant relationship between low maternal employment and methamphetamine use with placental abruption. CONCLUSION: As many conditions and habits are associated with placental abruption, it is impossible to single out one specific cause but concomitant drinking and smoking seem to increase the risk of placental abruption.

Association of socioeconomic status and clinical and demographic conditions with the prevalence of preterm birth.

OBJECTIVE: To examine the effects of socioeconomic and demographic conditions on the prevalence of preterm birth in a local community. METHODS: Pregnant women (aged ≥16 years) willing to provide informed consent in one of the two languages of the community were recruited in South Africa between August 2007 and January 2015. Specifically designed case report forms collected information and measurements prospectively. RESULTS: After reviewing the medical records of 5806 women, it was possible to identify those who had spontaneous preterm birth (SPTB), induced preterm birth (IPTB), or spontaneous term birth (STB). Women with IPTB (vs SPTB) were more obese and had higher education levels and household incomes; more had telephones and running water at home. They enrolled earlier and more developed hypertension and pre-eclampsia. Women with SPTB (vs STB) were less obese, shorter, had smaller arm circumferences and higher gravidities and Edinburgh Depression Scores, lower education, fewer telephones, and less running water at home. More women with SPTB used methamphetamine, cigarettes, and were heavier smokers. CONCLUSION: SPTB and IPTB should not be conflated. Programs to reduce the high prevalence of SPTB should include improving education, lifestyle, and socioeconomic conditions. Addressing hypertension should help reduce preterm inductions.

Plasma Glutamine Levels in Relation to Intensive Care Unit Patient Outcome.

Low and high plasma glutamine levels are associated with increased mortality. This study aimed to measure glutamine levels in critically ill patients admitted to the intensive care unit (ICU) , correlate the glutamine values with clinical outcomes, and identify proxy indicators of abnormal glutamine levels. Patients were enrolled from three ICUs in South Africa, provided they met the inclusion criteria. Clinical and biochemical data were collected. Plasma glutamine was categorized as low (<420 µmol/L), normal (420-700 µmol/L), or high (>700 µmol/L). Three hundred and thirty patients (median age 46.8 years, 56.4% male) were enrolled (median APACHE II score) 18.0 and SOFA) score 7.0). On admission, 58.5% had low (median 299.5 µmol/L) and 14.2% high (median 898.9 µmol/L) plasma glutamine levels. Patients with a diagnosis of polytrauma and sepsis on ICU admission presented with the lowest, and those with liver failure had the highest glutamine levels. Admission low plasma glutamine was associated with higher APACHE II scores (p = 0.003), SOFA scores (p = 0.003), C-reactive protein (CRP) values (p < 0.001), serum urea (p = 0.008), and serum creatinine (p = 0.023) and lower serum albumin (p < 0.001). Low plasma glutamine was also associated with requiring mechanical ventilation and receiving nutritional support. However, it was not significantly associated with length of stay or mortality. ROC curve analysis revealed a CRP threshold value of 87.9 mg/L to be indicative of low plasma glutamine levels (area under the curve (AUC) 0.7, p < 0.001). Fifty-nine percent of ICU patients had low plasma glutamine on admission, with significant differences found between diagnostic groupings. Markers of infection and disease severity were significant indicators of low plasma glutamine.

Alcohol use predicts emergency psychiatric unit admission for non-fatal suicidal behaviour in the Western Cape (South Africa): a case-control study.

Objective: We aimed to describe patterns of substance use among patients admitted to an emergency psychiatric unit for non-fatal suicidal behaviour (NFSB) or another psychiatric reason and establish whether there were significant differences in patterns of substance use between the two groups.Methods: We employed a case-control design (N = 50) and collected data about participants' substance use in Cape Town, South Africa. Data were analysed using Chi-square and Mann-Whitney tests, factor analysis, and logistic regressions.Results: Prevalence of lifetime Alcohol Use Disorder (AUD) was 60% in the NFSB group and 28% in the control group. 12% of the NFSB group and 20% of the control group had a lifetime Tobacco Use Disorder. Prevalence of lifetime illicit Substance Use Disorder was 44% in the NFSB group and 60% in the control group. Hospital admission for NFSB was associated with: any past 24-hour alcohol use; quantity of past 24-hour alcohol use; quantity of past-month alcohol use; lifetime AUD; past 12-month AUD; and current AUD; and was not associated with the use of any other substances (p<.05). Past 12-month AUD was the best predictor of hospital admission for NFSB, controlling for, respectively, any past 24-hour alcohol use (aOR = 13.33, p = .023) and quantity of past 24-hour alcohol use (aOR = 9.01, p = .022)Conclusions: Patients admitted to emergency psychiatric units for NFSB have increased needs for the treatment of AUDs compared to patients admitted for another psychiatric emergency. Findings support calls for interventions to prevent NFSB among psychiatric patients with a history of AUD.Key pointsRates of substance use among patients admitted to emergency psychiatric units in South Africa were high compared to the general population.Hazardous alcohol use was uniquely associated with hospital admission for non-fatal suicidal behaviour compared to another psychiatric emergency.Tobacco use and illicit substance use were not associated with hospital admission for non-fatal suicidal behaviour compared to another psychiatric emergency.The association between hazardous alcohol use and hospital admission for non-fatal suicidal behaviour did not appear to be affected by demographic variables.Patients admitted to hospital for non-fatal suicidal behaviour have increased needs for the treatment of alcohol use disorders compared to other psychiatric patients.

Effects of low maternal heart rate on fetal growth and birthweight.

OBJECTIVE: To evaluate the association between birthweight and maternal heart rate (MHR) or heart rate variability (HRV) under resting conditions at 20-24 gestational weeks and 34 weeks or later (34+ weeks). METHODS: Data were retrospectively reviewed from the Safe Passage Study, a prospective longitudinal cohort study of alcohol use in pregnancy and birth outcomes in Cape Town, South Africa, between August 2007 and January 2015. Using custom-designed software, MHR and indicators of HRV were obtained from the recorded maternal electrocardiograms and compared with birthweight and z-scores of birthweight adjusted for gestation and gender. RESULTS: Data from 5655 women were included. MHR increased from 84.6 bpm at 20-24 weeks to 88.3 bpm at 34+ weeks. Increasing MHR from 70-80 to 80-90 and 90-100 bpm at 20-24 weeks was associated with increasing birthweight from 2940 to 2998 and 3032 g, respectively (P<0.05). MHR and HRV contributed 29% to the variability associated with birthweight, whereas maternal body mass index at recruitment contributed 44%. Similar associations were observed for MHR at 34+ weeks. CONCLUSION: The observed association of low maternal heart rate with birthweight might help to identify pregnancies at risk of poor fetal growth.

The association between tuberculosis and the development of insulin resistance in adults with pulmonary tuberculosis in the Western sub-district of the Cape Metropole region, South Africa: a combined cross-sectional, cohort study.

BACKGROUND: The existence of a bi-directional relationship between tuberculosis (TB) and insulin resistance (IR)/diabetes has been alluded to in literature. Although diabetes has been linked to increased tuberculosis risk, the relationship between tuberculosis as a causative factor for IR remains unclear. The study aimed to determine if an association existed between tuberculosis and IR development in adults with newly diagnosed pulmonary tuberculosis at baseline. It was additionally aimed to document changes in IR status during TB follow-up periods. METHODS: This cross-sectional study evaluated ambulatory participants at baseline for IR prevalence via anthropometry, biochemistry and diagnostic IR tests [homeostasis model assessment-IR (HOMA-IR) and quantitative insulin sensitivity check index (QUICKI)]. A prospective cohort sub-section study was additionally performed on approximately half of the baseline study population, who were followed-up at two and five months whilst on tuberculosis treatment. Summary statistics, correlation co-efficients and appropriate analysis of variance were used to describe and analyse data. Participants were excluded if they presented with other forms of tuberculosis, were HIV-positive, obese or had any pre-disposing IR conditions such as diabetes or metabolic syndrome. RESULTS: Fifty-nine participants were included from August 2013 until December 2014 (33.95 ± 12.02 years old; 81.4% male). IR prevalence was 25.4% at baseline, determined by a calculated HOMA-IR cut-off point of 2.477. Patients with IR were younger (p = 0.04). Although the difference between IR levels in participants between baseline and follow-up was not significant, a decrease was observed over time. The majority of participants (61.0%) presented with a normal BMI at baseline. Mean baseline values of fasting glucose were within normal ranges (4.82 ± 0.80 mmol/L), whereas increased mean CRP levels (60.18 ± 50.92 mg/L) and decreased mean HDL-cholesterol levels (males: 0.94 ± 0.88 mmol/L; females: 1.14 ± 0.88 mmol/L) were found. CONCLUSIONS: The study found an association between tuberculosis and IR development in newly diagnosed pulmonary tuberculosis patients. Although not significant, IR levels decreased over time, which could be indicative of a clinical improvement. A high prevalence of IR amongst young tuberculosis patients therefore highlights the need for early identification in order to facilitate a reversal of IR and prevent possible IR-related complications.

Fetal foot length at delivery as a tool for determining gestation length in non-macerated stillbirths.

OBJECTIVE: To assess whether fetal foot length at autopsy could reliably indicate gestation duration at stillbirth and the effects of maceration on this method. METHODS: The present cross-sectional secondary analysis was part of the Safe Passage Study; all Safe Passage Study participants who experienced a stillbirth at Tygerberg Academic Hospital, Cape Town, South Africa, between August 1, 2007, and January 31, 2015, were eligible to participate. After providing written informed consent for autopsy, the duration of gestation calculated using early ultrasonography and fetal foot length were compared. RESULTS: There were 69 fetal autopsies included in the present study; placental histology was available for 65. Generally, the gestation length calculated from the first ultrasonography scan correlated well with that calculated from the fetal foot length (Spearman correlation=0.85). However, significant differences were found in the gestation lengths calculated when the fetus was macerated (P<0.001), or when umbilical cord pathology (P<0.001) or maternal vascular malperfusion (P<0.001) was the cause of fetal death. CONCLUSION: Foot length at stillbirth was a good indicator of gestation length; however, it was a weaker indicator if fetal maceration had occurred.

The aetiology of adult burns in the Western Cape, South Africa.

Rural to urban migration to major cities in South Africa continues to lead to the proliferation of informal settlements. There is little recent published data on the epidemiology of adult burns in the Western Cape, South Africa. A retrospective review of patients on the Burn Unit database was undertaken, looking at patients admitted to the Burn Unit between January 2003 and December 2008. This study discusses the characteristics and outcome of patients who were treated at the Tygerburg Burn unit. A total of 1908 patients were admitted to the burn unit during the 6 year period under review. Most fatal injuries occurred in the 20-40 year age group. Injuries due to shack fires and fuel stoves comprised 21% (399) of all admissions. Mortality due to these injuries comprised 28% (137) of total mortality. Gas stoves accounted for 24% with kerosene stoves accounting for 71% of injuries. The burn death rate in this study (25%) was found to have increased dramatically from the last audit done from 1986 to 1995 in which a burn death rate of 7.5% was observed. Reasons for this are explored. It is likely that those with HIV/AIDS have poorer outcomes. Shack fires and injuries due to fuel stoves are a common reason for admission to the burn unit and mostly involve young male individuals. Other research from the Southern African region does not mention shack fires as a separate entity making it difficult to obtain an accurate idea of the scale of the problem. Their injuries are severe with a high mortality. The use of kerosene stoves are a major contributing factor. Recommendations include enforceable legislation to promote safer stove design, research into safer bio fuels and materials for building shacks as well promoting fire safety among schoolchildren in the community. Further research is needed to determine the impact of HIV/AIDS on the outcome of acute burns within the Southern African region.

Alcohol-induced psychotic disorder: brain perfusion and psychopathology--before and after anti-psychotic treatment.

Alcohol-induced psychotic disorder (AIPD) also known as alcohol hallucinosis is a rare complication of alcohol abuse. The pathogenesis and treatment of AIPD are still unclear. Few prospective treatment studies are available but case reports generally suggest that anti-psychotic treatment is effective. Brain imaging changes in relation to treatment response have also not been studied except for case reports. The aim of this study was to investigate the effect of anti-psychotic treatment on psychopathology and regional cerebral blood flow (rCBF) in patients with AIPD before and after 6 weeks of treatment. Nineteen patients with AIPD were assessed by the Positive and Negative Syndrome Scale (PANSS) and single photon emission computed tomography (SPECT) before and after 6-weeks of open-label treatment with a fixed dose of haloperidol (5 mg/day). Highly significant improvements were noted on the positive, general and total scores of the PANSS. Post-treatment increased rCBF to the left caudate and left frontal lobe was noted. Changes in frontal, temporal, parietal, occipital, thalamic and cerebellar rCBF showed significant negative correlations with the degree of symptom improvement, suggesting dysfunction of these areas in AIPD. Psychopathological and rCBF findings suggest reversible generalised cerebral dysfunction in AIPD.

Alcohol-induced psychotic disorder: a comparative study on the clinical characteristics of patients with alcohol dependence and schizophrenia.

OBJECTIVE: Alcohol-induced psychotic disorder (AIPD) is a rare complication of excessive alcohol use for which limited comparative studies are available. The aim of this study was to prospectively investigate demographic and psychopathological characteristics in patients with AIPD, schizophrenia, and uncomplicated alcohol dependence. We postulated that AIPD is a discrete clinical entity that can be differentiated from schizophrenia and uncomplicated alcohol dependence by means of standardized clinical assessments. METHOD: Twenty-eight patients with AIPD, 21 with schizophrenia and 20 with uncomplicated alcohol dependence were assessed using psychiatric rating scales, including the positive and Negative Syndrome Scale. RESULTS: Patients with AIPD had a significantly lower educational level, later onset of psychosis, higher levels of depressive and anxiety symptoms, fewer negative and disorganized symptoms, better insight and judgment, and less functional impairment compared with patients with schizophrenia. CONCLUSION: The study provides further supportive evidence that AIPD can be clinically distinguished from schizophrenia.

The neuropsychiatry and neuropsychology of lipoid proteinosis.

Lipoid proteinosis is a rare hereditary disease which often results in bilateral calcifications in the medial temporal region. Thirty-four adults living with lipoid proteinosis (>10% of the world population) were extensively assessed with standardized neuropsychiatric and neuropsychological measures. Of these, 27 patients representing a homogenous group living in the Northern Cape were matched with 47 controls. Subjects with lipoid proteinosis had a high incidence of neuropsychiatric disorders and performed poorly on facial recognition of positive and negative emotions and on many neuropsychological measures. These findings are consistent with involvement of the medial temporal areas in cognitive and emotive processing.

Cluster analysis of obsessive-compulsive symptomatology: identifying obsessive-compulsive disorder subtypes.

BACKGROUND: There is increasing evidence that obsessive-compulsive disorder (OCD) is a heterogeneous disorder. Different clinical subtypes may be characterized by differing pathophysiological mechanisms and treatment outcomes. METHODS: A cluster analysis was performed on 45 items of the Yale-Brown Obsessive-Compulsive Symptoms Checklist (YBOCS-CL) for 261 patients with OCD. Cluster solutions emerging at different linkage distance levels, and the associations of identified clusters with demographic, clinical and relevant genetic variables, were investigated. RESULTS: A 6-cluster solution emerged at a linkage distance level of 1.5, and a 3-cluster solution emerged at a linkage distance level of 2.1. The 3 clusters in the latter solution were labeled I) Contamination / washing, II) Hoarding / symmetry / ordering, and III) Obsessional / checking. Increased Cluster III scores were associated with earlier age of OCD onset and the Met/Met (L/L) genotype of the COMT Val158Met polymorphism. CONCLUSION: The data here are consistent with previous work delineating the different symptom subtypes of OCD, also with previous work suggesting that the Met/Met (L/L) genotype of the COMT Val158Met polymorphism may be associated with anxiety symptoms, as well as with previous work suggesting that dopaminergic genes may be particularly important in early-onset OCD.

Exploratory and confirmatory factor analysis of the Multidimensional Anxiety Scale for Children among adolescents in the Cape Town metropole of South Africa.

There are no published data on the factor structure of the Multidimensional Anxiety Scale for Children (MASC) among adolescents in the Cape Town metropole of South Africa. The objectives of this study were (i) to establish the exploratory factor structure of the MASC using a principal components exploratory factor analysis (EFA); (ii) to confirm the derived factor structure using confirmatory factor analysis (CFA); and (iii) to examine gender, age, and race effects among adolescents in the Western Cape of South Africa. A convenience sample of 1,051 adolescents was selected from nine different schools in the Cape Town metropole of South Africa. An EFA yielded a four-factor structure congruent to the factor structure established previously in other samples. Furthermore, the CFA showed that the four-factor structure fit the data well. Black participants reported significantly higher levels of Harm Avoidance than other racial groups, and Black and Coloured (mixed race) participants reported significantly higher levels of Anxious Coping than White and Asian participants. Black and Coloured participants reported significantly higher levels of Separation/Panic than White participants, and Black participants reported higher levels than Asian and Coloured participants. Finally, there were no significant age effects, but females scored significantly higher overall and on all MASC subscales. The MASC seems to be a useful tool for assessing and distinguishing anxiety symptoms among adolescents in the Cape Town metropole of South Africa.

Fluoxetine decreases stereotypic behavior in primates.

BACKGROUND: Primates reared in captivity may display stereotypic behaviors. These behaviors are arguably reminiscent of human obsessive-compulsive or posttraumatic symptoms, which respond to selective serotonin reuptake inhibitors (SSRIs). Captive primates with marked stereotypic behaviors were entered into a randomized controlled study of the SSRI, fluoxetine. METHODS: A sample of 10 vervet monkeys with behaviors such as marked saluting, somersaulting, weaving, or head tossing was selected. Subjects were randomized to receive fluoxetine 1 mg/kg for 6 weeks (n=5) or no treatment (n=5). A rater blind to the medication status of subjects noted the frequency of the stereotypic behaviors. RESULTS: Repeated-measures analysis of variance (RM-ANOVA) demonstrated a significant GroupxTime difference with significantly fewer stereotypic symptoms in the fluoxetine group by endpoint. At this time, three of the five fluoxetine-treated subjects (but none of the no-treatment subjects) were responders on the Clinical Global Impressions (CGI) change item (CGI < or =2). CONCLUSIONS: Stereotypic behaviors in captive vervets gradually and partially decrease in response to administration of an SSRI, paralleling research on human anxiety symptoms. Further research on animal stereotypies may be useful in providing appropriate veterinary care, and in exploring the underlying neurobiology of certain psychiatric disorders.