Deaths among psychiatric patients: future considerations.
Explore the source record for details and available documents.
Biomedical subjects
Publications and source records attributed to D Venugopal.
Explore the source record for details and available documents.
This review highlights the occurrence of depressive disorders in medically ill patients. It discusses the difficulties in diagnosing depression in the medically ill due to the vegetative symptoms of depression which are also a feature of many medical diseases. Depression in the medically ill may be due to the disease itself, its psychological reaction, due to complications because of metabolic or other disturbances, or due to the medications for the treatment of the disease. The role of active consultation liaison between medical specialists and mental health professionals will help provide total care to the medically ill.
Explore the source record for details and available documents.
Normal emotions like sadness need to be differentiated from depressive illnesses. A number of psychological and social theories have been proposed to explain depression in the psychosocial context in which it occurs. A multifactorial bio-psychosocial approach to causation of depression provides a holistic understanding of the patient and also helps to plan appropriate pharmacological and psychosocial therapies to treat the patient.
Explore the source record for details and available documents.
Ornithine Transcarbamylase Deficiency, an X-linked disorder, is the most common cause of inherited urea cycle disorders. Approx. 90 mutations that produce reduced levels of ornithine transcarbamylase (OTCase) activity have been identified in patients [Tuchman (1993) Hum. Mutat. 2, 174-178; Tuchman and Plante (1995) Hum. Mutat. 5, 293-295]. A model of the three-dimensional structure of OTCase, developed on the basis of its homology to the catalytic subunit of Escherichia coli aspartate transcarbamylase (ATCase) [Tuchman, Morizono, Reish, Yuan and Allewell (1995) J. Med. Genet. 32, 680-688], and in good agreement with the crystal structure of Pseudomonas aeruginosa OTCase [Villeret, Tricot, Stalon and Dideberg (1995) Proc. Natl. Acad. Sci. U.S.A. 92, 10762-10766], indicates that many mutations that produce severe clinical symptoms are at the active site or buried in the interior of the protein. However, one of the few recurrent mutations, R277W, an alteration that produces a milder phenotype of ornithine transcarbamylase deficiency, is located in the model in a loop remote from the active site that is analogous to a similar loop (the 240's loop, a flexible loop of the catalytic chain of Escherichia coli aspartate transcarbamylase, comprised of residues 230-250) of ATCase. Human wild-type OTCase and the R277W mutant have been cloned and overexpressed in E. coli and a rapid and efficient purification method utilizing the bisubstrate analogue, Ndelta-(phosphonacetyl)-L-ornithine, has been developed and used to purify both proteins. Gel chromatography indicates both are trimeric. The pH dependence of the kinetic parameters of the wild-type enzyme is similar to that of E. coli OTCase [Kuo, Herzberg and Lipscomb (1985) Biochemistry 24, 4754-4761], suggesting that its catalytic mechanism is similar, although its maximal activity is approx. 10-fold less. Compared with the wild-type, the R277W mutant has nearly 70-fold lower affinity for L-ornithine, shows no substrate inhibition, and its thermal stability is reduced by 5 degrees C. Its reduced affinity for L-ornithine, which in turn results in lower activity at physiological concentrations of ornithine, as well as its reduced stability, may contribute to the clinical effects that it produces.
Explore the source record for details and available documents.