School-based cognitive-behavioural therapy for children and adolescents with social anxiety disorder and social anxiety symptoms: A systematic review.

BACKGROUND: Social anxiety disorder (SAD) is prevalent among children and adolescents. Cognitive-behavioural therapy (CBT) has been used as the first-line treatment. However, evaluation of CBT conducted in a school setting has been scarce. OBJECTIVES: This study aims to review the CBT and its effectiveness in the school setting for children and adolescents with SAD or social anxiety symptoms. Quality assessment on individual studies was conducted. METHODS: Studies were identified through the search in PsycINFO, ERIC, PubMed and Medline targeting CBT conducted in a school setting with an aim to treat children and adolescents with SAD or social anxiety symptoms. Randomised controlled trials and quasi-experimental studies were selected. RESULTS: A total of 7 studies met the inclusion criteria. Five studies were randomised controlled trials, and two were quasi-experimental studies with 2558 participants aged 6-16 years from 138 primary schools and 20 secondary schools. There were minor effects to reduce social anxiety symptoms for children and adolescents at post-intervention in 86% of the selected studies. Friend for Life (FRIENDS), Super Skills for Life (SSL) and Skills for Academic and Social Success (SASS) conducted in school were more effective than the control conditions. CONCLUSIONS: There is a lack of quality of the evidence for FRIENDS, SSL and SASS, due to inconsistencies on the outcome assessments, statistical analyses, and the fidelity measures adopted in individual studies. Insufficient school funding and workforce with relevant health background, and the low level of parental involvement in the intervention would be the major challenges in school-based CBT for children and adolescents with SAD or social anxiety symptoms.

Pediatric Off-Label COVID-19 Vaccination: The Concerns of Healthcare Professionals in Pakistan.

Global health authorities have emphasized the vital role of healthcare professionals (HCPs) as a reliable source of vaccination information for patients in primary care. However, HCPs are concerned whether COVID-19 vaccinations can be used off-label. Hence, the current study was conducted to assess their perspectives towards off-label COVID-19 immunization in children. The study tool, consisting of 40 items, was utilized to evaluate HCPs' knowledge and attitudes towards the off-label use of the COVID-19 vaccine in children under 12 years of age. To assess the unfavorable attitudes regarding vaccinations, the Vaccination Attitudes Examination Scale was employed. Overall, 477 completed questionnaires were incorporated in the present study, with a response rate of 88.9%. The mean age of the respondents was 38.6 ± 7.5 years; among whom the majority were physicians, n = 209 (43.8%), and pharmacists, n = 112 (23.4%). Approximately 78% of the respondents had a general awareness of off-label vaccination. Around 80% knew the adverse drug reactions associated with the use of COVID-19 vaccines. Females showed more mistrust about vaccine benefits, n = 55 (16.9%), compared to males, n = 21 (13.8%), and concerns about commercial profits of vaccines, n = 59 (18.1%), compared to males, n = 19 (12.5%). By profession, physicians showed statistically significantly lower mistrust, n = 18 (8.6%), and higher concerns about unpredicted effects of vaccines, n = 41 (19.6%). A major portion of the respondents, n = 327 (68.5%), did not consider that HCPs should prescribe/administer off-label COVID-19 vaccination in children. The current findings demonstrated that respondents had an appropriate level of understanding about COVID-19 immunization in children. They showed higher levels of rejection for off-label use of the COVID-19 vaccination.

Dose-dependent alteration of neurobehavioral activities by geraniol a component of essential oil: A study in rats.

Geraniol, a component of essential oil, is reported to have various pharmacological properties. The current study was conducted to demonstrate the dose-dependent neurobehavioral effects of geraniol. Rats were divided into 5 groups (n=7), comprising of control and four test groups for different doses of geraniol including 10, 30, 50 and 100 mg/kg. Geraniol was given for 15 days through intraperitoneal route. Following the administration, anxiety-, depression-like behaviors and memory function were evaluated. Extent of oxidative stress in rat's brain was also assessed by determining the levels of malondialdehyde and antioxidant enzymes activity. The present study revealed that low doses of geraniol produced more potent anxiolytic, antidepressant, nootropic, and antioxidant effects as compared to the higher doses. The findings highlight the dual characteristic of geraniol, acting as antioxidant at lower doses while at higher doses it produces pro-oxidant effects. The results are discussed in the context of dual characteristic of antioxidant compounds.

Association of Acne with Face Mask in Healthcare Workers Amidst the COVID-19 Outbreak in Karachi, Pakistan.

BACKGROUND: In the wake of coronavirus (COVID-19) global alert, people have begun to practice safety measures in order to reduce the exposure to life-threatening disease. The largest at risk population is undoubtedly the frontline healthcare workers (HCWs) who are using personal protective equipment (PPE), essentially face masks, to battle against this deadly virus. This study was conducted with the prime intention to reveal an association between face mask and acne and measure the prevalence of acne amongst HCWs amidst COVID-19 outbreak in Karachi. Furthermore, this study aimed to identify the type of mask generating acne, locate the common sites, assess the severity and establish an association of mask use with the skin type. METHODS: This cross-sectional study was carried out at Medicare Cardiac and General Hospital, Jinnah Medical College Hospital, Jinnah Postgraduate Medical Centre and Jamal Noor Hospital located in Karachi, Pakistan. A total of 348 HCWs were interviewed, of which only 193 met the inclusion criteria. All information was recorded on a predesigned proforma and analyzed using SPSS 25.0. RESULTS: Among 193 participants, acne was prevalent in 103 (53.4%) participants with maximum cases reported in female HCWs, and in doctors (p<0.05). Out of 73 HCWs using N-95 masks, 46 (44.7%) developed acne, with a p-value of 0.036. Skin type and past history of acne also yielded statistically significant results. Among all the skin types, HCWs with oily skin (64, 62.1%) were prone to face resurgence of acne or new-onset acne. The most common sites of eruption of acne were along the cheeks (45.1%) followed by the nose (40.9%). Majority of the population suffered from mild acne. Moderate and severe acne eruption was particularly observed in those wearing N-95 and surgical masks. CONCLUSION: The use of face masks is associated with high rates of acne eruption. Disseminating the guidelines and indications of World Health Organization (WHO) regarding proper use of mask, encouraging awareness among HCWs and following proper doffing and donning protocol as endorsed by Centers for Disease Control and Prevention (CDC) will possibly minimize the adverse reactions.

Anxiolytic and memory enhancing potential of aloe vera and flax seed oil in rats: A comparative study with valproic acid.

For centuries, herbs and herbal oils are used for pharmacological purpose. Aloe vera is well-known as silent healer and flax seed oil is known to contain rich amount of omega-3 fatty acids, both are having effects on central nervous system. Valproic acid is anticonvulsant drug with some side effects and has shown effects on behaviors. This study was designed to monitor the effects of valproic acid, aloe vera and flax seed oil on cognitive and anxiolytic behaviors in rats. Animals were categorized into four groups: Control, valproic acid, aloe vera and flax seed oil which were respectively treated with water, valproic acid (300mg/kg), aloe vera (0.4ml/kg) and flax seed oil (1.8ml/kg). The treatment was continued 2 weeks for drug and 3 weeks for aloe vera and flax seed oil. Anxiolytic effect as well as increased GABA levels were observed following drug and oil treatments. Improvement in cognitive function with decrease in acetylcholine esterase activity in aloe vera and flax seed oil while impairment in learning memory with increase acetylcholine esterase activity was observed in rats treated with valproic acid. Results showed substantial decrease in acetylcholinesterase level in aloe vera and flax seed oil supporting the cognitive impact of oils in contrary to drug.

Neurobehavioral and biochemical effects of magnesium chloride (MgCl2), magnesium sulphate (MgSO4) and magnesium-L-threonate (MgT) supplementation in rats: A dose dependent comparative study.

Magnesium (Mg) is an essential biomineral that acts as an intracellular cofactor for more than 300 enzymes. It is an important modulator of the N-methyl-D-aspartate (NMDA) receptor which is involved in memory function and depression. The purpose of this study was to compare the dose dependent effect of oral supplementation of Magnesium chloride (MgCl2), Magnesium sulphate (MgSO4) and Magnesium-L-threonate (MgT) on memory and depression-related behaviors in rats. Rats were orally administered with different doses (50 mg/kg, 100 mg/kg and 150 mg/kg) of each Mg salt. Following 28 days of oral supplementation, animals were subjected to behavioral tests. After completion of behavioral test, rats were decapitated. Brain and plasma samples were used for neurochemical and biochemical analysis. Assessment of behaviors in elevated plus maze (EPM) test and forced swim test (FST) showed that MgT more significantly improved memory of rats and decreased depression-like symptoms in healthy rats as compared to controls. Biochemical analysis indicated significant increase in plasma Mg levels dose dependently following MgT administration. This increase might be related to observe enhanced cholinergic functions and decline in oxidative stress in rats in the present study. This comparative study highlights that MgT (100mg/kg) is the most appropriate Mg salt and dose for oral treatment that strengthens cholinergic system and improves brain related functions through attenuation of oxidative burden in adult healthy rats.

Alteration in redox profile and behavioral effects following repeated administration of citral in rats.

Essential oils are natural products having several important chemical constituents. Traditionally used worldwide as natural alternatives for treating various pathological conditions due to their antibacterial, anti-inflammatory, antifungal and antioxidants properties. Citral is one of the mono terpene present in lemon peel oil. The present study aimed to evaluate the effects of citral at low (0.1 mg/kg) and high (1 mg/kg) doses. In this study rats were subjected to different behavioral parameters such as tail suspension test (TST) to monitor depressive behavior, open field test (OFT) for locomotor activity, light/dark transition test (LDT) for the assessment of level of anxiety and the strength of muscles were monitored by Kondziela's inverted screen test. Plasma corticosterone and antioxidant enzymes activities were also estimated. The results from the present study showed that citral at 0.1mg/kg dose significantly increased the mobility time in TST, increased number of square crossed in OFT, increased time spent in LDT and showed muscles strengthen activity in Kondziela's inverted screen test. Lipid per oxidation (LPO) was decreased and antioxidant profile was improved along with the decrease in plasma corticosterone following the administration of 0.1mg/kg dose of citral in rats. However, at a high dose of 1 mg/kg of citral, behavioral alterations were observed along with the increased plasma corticosterone and decreased activities of antioxidant enzymes in rats. Therefore present findings suggested that citral at low dose has therapeutic potential as compared to high dose. It can be used as an alternative therapy for the treatment of various ailments in humans and animals.

Role of ibuprofen and lavender oil to alter the stress induced psychological disorders: A comparative study.

Stress has become an integral feature of everyday living. Each individual that lives encounters some manifestation of stress in life. Stress causes certain alterations in the structure and functions of the body and is considered to be a major factor in many health problems. Many synthetic and natural compounds are used for the attenuation of stress induced changes in the body. Medicinal plants are used since ancient times to prevent from neurological disorders. Lavender (Lavandula angustifolia) is very efficacious and possesses the ability to improve several neurological disorders. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used against pain and inflammation. However, effectiveness of NSAIDs in the treatment of various psychiatric ailments is also reported. The present study investigated the effects of ibuprofen and lavender oil on stress induced behavioral and biochemical alterations in rats. The rats were subjected to restraint stress and behavioral parameters like open field test (OFT), light/dark transition box activity (LDT) and forced swim test (FST) were used to assess exploratory, anxiolytic and anti-depressant activity, respectively. Corticosterone, lipid peroxidation (LPO) and endogenous antioxidant enzymes activities were also estimated. Results of OFT, LDT and FST showed substantial effects of lavender oil and standard drug ibuprofen. A significant decrease in plasma corticosterone and LPO levels with increase in antioxidant enzyme activities was observed in the study. However, the effects of lavender oil were more as compared to standard drug ibuprofen in diminution of stress induced behavioral and biochemical changes in rats. This study demonstrates that lavender oil is more remedial than ibuprofen in stress related disorders.

Role of Cyclooxygenase Inhibitors in Diminution of Dissimilar Stress-induced Depressive Behavior and Memory Impairment in Rats.

Memory functions can be considerably affected by various life events and stress has shown to be a chief regulator. Different stress patterns have distinct effects on the overall functioning of the brain. Stress provokes inflammation not only in the periphery but also in the brain. Neuroinflammation causes alterations in neuronal structure and function, which eventually progress to the development of neurodegenerative diseases. Inflammatory reactions are modulated through communication between the nervous, endocrine and immune systems. An excessive release of stress hormones and changes in the neurotransmission system may cause cognitive impairments. The present study investigated dissimilar stress-related memory deficits and their diminution by non-steroidal anti-inflammatory drugs (NSAIDs). Treatment with cyclooxygenase inhibitors, which inhibit prostaglandin synthesis, has enhanced memory functions in a number of neuroinflammatory states. In this study, rats were exposed to a series of dissimilar stressors and behavioral parameters for depression and memory functions were examined. Corticosterone, serotonin (5-HT) and dopamine (DA) levels were also estimated. Results from the forced swim test, elevated plus maze test and Morris water maze test showed significant effects of NSAIDs. A significant decrease in plasma corticosterone and increased DA and 5-HT levels were observed in NSAID-treated dissimilar-stressed rats. This study demonstrates the therapeutic potential of NSAIDs for dissimilar stress-induced depressive behaviors and impaired memory functions and related hormonal and neurochemical changes in the rat brain.

Enhanced physical endurance and improved memory performance following taurine administration in rats.

Energy drinks enhance physical endurance and cognitive ability. The ingredients present in these drinks are considered as ergogenic and have memory boosting effects. In the present study effects of taurine administration for one week was monitored on physical exercise and memory performance in rats. Animals were divided into two groups namely control and test. Taurine was injected intraperitoneally to the test group at the dose of 100mg/kg. After one week of treatment rats were subjected to physical exercise and memory task. Results of this study revealed that rats injected with taurine for one week exhibited improved muscular strength as well as enhanced memory performance in Morris water maze and elevated plus maze. Biomarker of lipid peroxidation was significantly reduced in brain and plasma of test animals. Taurine administration also resulted in higher levels of corticosterone in this study. The results highlight the significance of taurine ingestion in energy demanding and challenging situations in athletes and young subjects.

Enhancement of memory function by antioxidant potential of Nigella sativa L. oil in restrained rats.

Stress is a vulnerable state to cellular homeostasis which leads to oxidative damage via free radical generation. The acute stress induces alteration in antioxidant enzyme activities to an extent which produce oxidative stress and causes certain pathological conditions. The use of Nigella sativa L. oil (NSO) in folk medicine has increased throughout the world for the prevention or treatment of various ailments because of potent antioxidant properties. In the present study, potential therapeutic effects of NSO on memory in both unrestrained and 2h restrained rats were observed. Shortterm memory (STM) and long-term memory (LTM) were assessed by elevated plus maze (EPM) and Morris water maze (MWM) respectively. The present study also demonstrated the effect of NSO on lipid peroxidation (LPO) and activities of antioxidant enzymes (superoxide dismutase, catalase and glutathione peroxidase) along with the activity of acetyl cholinesterase (AChE). The results obtained from the present study showed that 2h restraint stress significantly enhanced both short-term memory (p<0.01) and long-term memory (p<0.05) in rats. Pretreatment with NSO at a dose of 0.2ml/kg/day also significantly improved STM (p<0.05) in restrained rats and LTM (p<0.01) in unrestrained rats. This study also showed significantly decreased (p<0.01) LPO and significantly increased (p<0.01) endogenous antioxidant enzymes activity in NSO treated restrained rats. Similarly significant decreased (p<0.01) AChE activity was also observed in NSO treated unrestrained and 2h restrained rats. Therefore, current findings suggested that repeated administration of NSO may exert memory enhancing effects against restrained stress and it can be used for therapeutic purpose because of having fewer side effects.

Attenuation of cadmium-induced decline in spatial, habituation and recognition memory by long-term administration of almond and walnut supplementation: Role of cholinergic function.

Excessive exposure of cadmium which is regarded as a neurotoxin can stimulate aging process by inducing abnormality in neuronal function. It has been reported that supplementation of almond and walnut attenuate age-related memory loss. Present study was designed to investigate the weekly administration of cadmium for one month on learning and memory function with relation to cholinergic activity. Cadmium was administered at the dose of 50 mg/kg/week. Whereas, almond and walnut was supplemented at the dose of 400 mg/kg/day along with cadmium administration to separate set of rats. At the end of experiment, memory function was assessed by Morris water maze, open field test and novel object recognition test. Results of the present study showed that cadmium administration significantly reduced memory retention. Reduced acetylcholine levels and elevated acetyl cholinesterase activity were also observed in frontal cortex and hippocampus of cadmium treated rats. Malondialdehyde levels were also significantly increased following the administration of cadmium. Daily supplementation of almond and walnut for 28 days significantly attenuated cadmium-induced memory impairment in rats. Results of the present study are discussed in term of cholinergic activity in cadmium-induced memory loss and its attenuation by nuts supplementation in rats.

Development of AD like symptoms following co-administration of AlCl3 and D-gal in rats: A neurochemical, biochemical and behavioural study.

Alzheimer's disease (AD) is an age-related neurodegenerative disorder associated with neurochemical and neurobehavioural alterations. Aluminium (Al) is considered as a contributing factor in the etiology of several neurodegenerative disorders like AD. D-galactose (D-gal) is a physiological nutrient but over supply induces some neurochemical and biochemical changes that exacerbate natural aging process. In this study, we aimed to develop AD animal model by co-administration of Al and D-gal in rats. Male albino Wistar rats were intraperitoneally injected with AlCl3 and D-gal at a dose of 150mg/kg and 300mg/kg respectively for one week. After one week rats were subjected to behavioural analysis. After behavioural analysis rats were decapitated to remove their brain. Biochemical and neurochemical analysis were conducted in whole brain. AlCl3+D-gal significantly induced depressive and anxious behaviour in rats. Rats cognitive abilities were also significantly impaired following AlCl3 and D-gal co-administration. AlCl3+D-gal significantly altered antioxidant enzyme activities and biogenic amine levels in whole brain. A marked increase in brain lipid peroxidation and acetylcholinesterase activity was found in test rats. These findings suggest that co-administration of AlCl3 and D-gal for one week could induce AD like symptoms and may be used to develop AD animal model.

Attenuation of stress induced memory deficits by nonsteroidal anti-inflammatory drugs (NSAIDs) in rats: Role of antioxidant enzymes.

BACKGROUND: Repeated stress paradigms have been shown to cause devastating alterations on memory functions. Stress is linked with inflammation. Psychological and certain physical stressors could lead to neuroinflammation. Inflammatory process may occur by release of mediators and stimulate the production of prostaglandins through cyclooxygenase (COX). Treatment with COX inhibitors, which restrain prostaglandin production, has enhanced memory in a number of neuroinflammatory states showing a potential function for raised prostaglandins in these memory shortfalls. In the present study, potential therapeutic effects of indomethacin and diclofenac sodium on memory in both unrestraint and restraint rats were observed. METHODS AND RESULTS: Two components, long term memory and short term memory were examined by Morris water maze (MWM) and elevated plus maze (EPM) respectively. The present study also demonstrated the effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on lipid peroxidation (LPO) and activities of antioxidant enzymes along with the activity of acetylcholinesterase (AChE). Results of MWM and EPM showed significant effects of drugs in both unrestraint and restraint rats as escape latency and transfer latency, in respective behavioral models were decreased as compared to that of control. This study also showed NSAIDs administration decreased LPO and increased antioxidant enzymes activity and decreased AChE activity in rats exposed to repeated stress. CONCLUSION: In conclusion this study suggests a therapeutic potential of indomethacin and diclofenac against repeated stress-induced memory deficits.