The possible "calming effect" of subchronic supplementation of a standardised phospholipid carrier-based Melissa officinalis L. extract in healthy adults with emotional distress and poor sleep conditions: results from a prospective, randomised, double-blinded, placebo-controlled clinical trial.

Background: Emotional distress conditions such as depression, anxiety, stress, and poor sleep are widespread health problems that have a significant impact on people's lives. Conventional drugs are commonly prescribed to treat emotional distress and poor sleep conditions; however, these medications have several limitations and have shown multiple side effects. Over recent years botanicals-based pharmacological agents have gained increasing research and clinical interest in the management of emotional distress and sleep disorder. Of note, Melissa officinalis L. (MO) leaf extract has demonstrated considerable neuropharmacological properties both in animal and human studies and has emerged as a promising natural "calming agent." However, research in this area is limited, and more studies are needed to validate its efficacy in amelioration of emotional distress and poor sleep conditions. Objectives: We aimed to assess the pharmacological effects of subchronic supplementation of an innovative standardised phospholipid carrier-based MO aqueous extract on emotional distress and poor sleep conditions. Design: A 3-week prospective, randomised, placebo-controlled, parallel-group, double-blinded clinical trial was conducted in 100 healthy adults complaining of a moderate degree of depression, anxiety, or stress, with scores of ≥14, ≥10, and ≥19, respectively, in the self-report Depression, Anxiety, and Stress Scale (DASS-42) or poor sleep, as indicated by the score of >5 in the Pittsburgh Sleep Quality Index (PSQI) scale. In addition, the impact of emotional distress and/or poor sleep on participants' mental wellbeing, emotional feelings, and quality of life was also assessed using the self-reported Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), Positive and Negative Affect Schedule (PANAS) scale, and quality of life (WHO-QoL-BREF) scale, respectively. Results: Oral supplementation of 200 mg of phospholipid-based MO aqueous extract (Relissa™) tablets twice a day (i.e., 400 mg/day) for 3 weeks led to significant improvements in the depressive mood, anxiety, stress, positive and negative affect (emotional feelings), overall mental wellbeing, and quality-of-life scores (all p values <0.001). Supplementation of MO extract was well tolerated, and no treatment-emergent effects or serious adverse events were reported. Conclusion: According to the results of this study, the phospholipid carrier-based MO aqueous extract possesses considerable neuropharmacological properties, and its supplementation may provide a promising therapeutic option for the management of moderate emotional distress and/or poor sleep conditions. Clinical Trial Registration: clinicaltrials.gov, identifier NCT05602688.

FIT negative cancers: A right-sided problem? Implications for screening and whether iron deficiency anaemia has a role to play.

INTRODUCTION: Faecal Immunohistochemistry Testing (FIT) is recommended as an adjunct to guide referrals from Primary Care for individuals without rectal bleeding, who do not meet the suspected cancer pathway referral guidelines. It has largely replaced Faecal Occult Blood Testing. AIMS: To assess the specificity of FIT. To understand the characteristics of FIT negative cancer patients and whether they have predominantly right sided cancers. Evaluating the efficacy of FIT and Iron deficiency anaemia in combination to capture patients with colorectal cancers. METHODS: A study of 1000 symptomatic patients, undergoing FIT by Clinicians during the 'Digital rectal examination'. Inclusion criteria; all patients referred via our cancer referral pathway. FIT positivity was set at 10 µg g of faeces. RESULTS: There were 7 FIT negative cancers in this cohort; 1 was a lymphoma and the other 6 were caecal adenocarcinomas. 5 were anaemic. The positive predictive value of IDA was 34% compared with 'other symptoms'; 18%. The negative predictive value of FIT was 99.05% in this cohort. Specificity for FIT was 86.9% (CI 96%). CONCLUSION: Two separate referral pathways for IDA and FIT positive tests, would have captured all patients except 2; the lymphoma and 1 advanced caecal adenocarcinoma. FIT is an excellent triage tool prior to colonoscopy however capturing right sided disease remains a weak point. Multivariate analysis of patients in addition to IDA and FIT should improve capture of this subgroup.

Benzodiazepine Use Among Resident Doctors In Tertiary Care Hospital.

BACKGROUND: Benzodiazepines (BZD) are some of the most common medications in the world. Benzodiazepines useful in treating anxiety, insomnia, agitation, seizures, muscle spasms, alcohol withdrawal. Benzodiazepines are generally considered safe and well tolerated but are commonly misused and taken in combination with other drugs of abuse. The usage and prescription of BDZ in most developed countries are tightly regulated. This is however, not true in developing countries where these medicines are available over-the-counter (OTC). This study was carried out to assess the benzodiazepine use in Ayub Teaching Hospital Trainee doctors. METHODS: This was a cross sectional study carried out in Ayub Teaching Hospital between January and December 2018. Sample size was calculated to be 276 using WHO sample size calculator. These 276 residents and house officers were selected using stratified random sampling to ensure the representation from every year of residency. RESULTS: Hundred and nine (48.7%) participants responded positively to the use of BZD. Male doctors were more likely 57 (52.3%) to use BZD as compared to their female colleges. Most of the doctors 71 (65.1%) purchased BZD over the counter without prescription. Alprazolam was the most preferred benzodiazepine by doctors regardless of their specialty and year of residency except in specialty of Anaesthesia in which prevalence of Midazolam was the highest. This preference of Alprazolam by doctors of all specialty was statistically significant (p=0.007). CONCLUSIONS: Because of the knowledge about medicines and tendency to self-treat, doctors are prone to BZD abuse. Doctors working in psychiatry are more likely to use BZD with Alprazolam the BZD of choice.

Use Of Psychoactive Drugs Among Medical Undergraduates In Abbottabad.

BACKGROUND: Psychoactive substance abuse is prevalent among medical undergraduates of Pakistan, India & Western countries which can adversely affect the physical & psychological grooming of a medical undergraduate thus threatening to compromise their role as future physicians & health-care providers in the society. The objective of the present cross-sectional study was to explore the prevalence and patterns of psychoactive substance/drug consumption among undergraduate students of a public sector medical college in Abbottabad. METHODS: Seven hundred and eighty participants after informed consent were requested to fill a questionnaire seeking information about their demographics, patterns & behaviours regarding ten common psychoactive substances of abuse including (Cigarettes, Benzodiazepines, naswar, cannabis, alcohol, amphetamine, opium, cocaine, heroin & organic solvents). RESULTS: Overall students who responded were 698 (89.48%). One hundred and fifty (21.49%) admitted to the use of a psychoactive substance in past or at present. Majority users (71.33%) were males. Overall (81.33%) users were living in hostel or a rented apartment. Substance abuse was more prevalent among senior students, i.e., 30.06% & 24.24% in 4th year & final year MBBS respectively. Majority of the consumers, i.e., 93 (62%) were falling in an age group between 15-20 years. Main reasons behind substance abuse were: psychological stress (49.33%) and pleasure seeking (42.67%). Substances/drugs used by students in order of preference were Cigarettes 115 (76.67%), Benzodiazepines 48 (32%), naswar 42 (28%), Cannabis 41 (27.33%), Alcohol 24 (16%), Amphetamine 22 (14.67%), Opium 15 (10%), Cocaine 14 (9.33%), Heroin 11 (7.33%) & Organic solvents 05 (3.33%). Use of more than one substance was observed in 70 (46.67%) students. CONCLUSIONS: It is concluded that prevalence of cigarette smoking, naswar, benzodiazepines, cannabis & alcohol is high among medical undergraduates in Abbottabad which is a matter of concern. Efforts are needed to create better awareness among them about the hazards of substance abuse on their health, upcoming professional career and ailing humanity under their care.

Comparison Of Efficacy Of Phenytoin And Levetiracetam For Prevention Of Early Post Traumatic Seizures.

BACKGROUND: The incidence of early post-traumatic seizures after civilian traumatic brain injury ranges 4-25%. The control of early post-traumatic seizure is mandatory because these acute insults may add secondary damage to the already damaged brain with poor outcome. Prophylactic use of anti-epileptic drugs have been found to be have variable efficacy against early post-traumatic seizures. The objective of this study was to compare the efficacy of Phenytion and Levetiracetam in prevention of early post-traumatic seizures in moderate to severe traumatic brain injury. METHODS: This randomized controlled trial was conducted in department of Neurosurgery, Ayub Medical College, Abbottabad from March, 2012 to March 2013. The patients with moderate to severe head injury were randomly allocated in two groups. Patients in group A were given phenytoin and patients in group B were given Levetiracetam. Patients were followed for one week to detect efficacy of drug in terms of early post traumatic seizures. RESULTS: The 154 patients included in the study were equally divided into two groups. Out of 154 patients 115 (74.7%) were male while 29 (25.3%) were females. Age of patients ranges from 7-48 (24.15±9.56) years. Ninety one (59.1%) patients had moderate head injury while 63 (40.9%) patients had severe head injury. Phenytoin was effective in preventing early post traumatic seizures in 73 (94.8%) patients whereas Levetiracetam effectively controlled seizures in 70 (90.95%) cases (p-value of .348). CONCLUSIONS: There is no statistically significant difference in the efficacy of Phenytoin and Levetiracetam in prophylaxis of early posttraumatic seizures in cases of moderate to severe traumatic brain injury.

RELIABILITY AND VALIDITY OF BECK DEPRESSION INVENTORY AMONG GENERAL POPULATION IN KHYBER PAKHTUNKHWA, PAKISTAN.

BACKGROUND: Beck Depression Inventory is frequently used for assessing depression across different cultures. Despite widely application of Beck Depression Inventory, there is surprisingly lack of empirical research on psychometric validation of this scale in Pakistan. In this regard the current study has determined the reliability and validity of Beck Depression Inventory in Pakistan. METHODS: Urdu version Beck Depression Inventory was administration to 250 Inpatient and Outpatient Department visitors in Ayub Teaching Hospital, Abbottabad, Khyber Pakhtunkhwa, Pakistan. Initially reliability was determined and later on validly analysis was done. RESULTS: The reliability results show that Cronbach alphas ranged from 0.75 to 0.92, whereas inter-item correlations ranged from 0.53 to 0.78. The validity analysis show that factor loadings for all items of Beck Depression Inventory ranged from 0.77 to 0.93. Furthermore, the two subscales presented good model fit indices, thus conforming its construct validity. CONCLUSION: The results of current study show that Beck Depression Inventory has good psychometric properties followed by its administration to general population in Khyber Pakhtunkhwa, Pakistan; therefore this scale could be effectively used for assessing depression in Pakistan

ACUTE FLACCID PARALYSIS SURVEILLANCE: A 5 YEARS STUDY OF BANNU, PAKISTAN.

BACKGROUND: Acute flaccid paralysis (AFP) is clinical presentation marked by acute onset of weakness and reduced tone. Aetiologies of AFP are diverse including infectious agents, trauma or autoimmune reaction. Currently only three countries in the world that are Nigeria, Pakistan and Afghanistan have endemic poliomyelitis. Pakistan's polio crisis represents one of the last hurdles in a 23-year campaign run by the World Health Organization. Bannu due to its geographical location stands out to be one of highest risk areas for Poliomyelitis. The objective of this study was to determine frequency of AFP and their aetiologies in District of Bannu during time period of four years from 2007 to 2011. METHODS: It was a cross-sectional descriptive study. Data was collected from EDO office District Bannu and analysed using Microsoft Excel 2007. Results: During this period there were 180 cases of AFP in district Bannu. 15% of cases were diagnosed as Guillian Barre Syndrome, making it the leading aetiology. Only 3 (1.66%) cases were diagnosed with Poliomyelitis. Out of 180 AFP cases 104 cases were male and 76 cases were female. CONCLUSION: Bannu needs enthusiastic educational and vaccination campaigns to eradicate Polio from the area and henceforth from the Pakistan.

Diffusion-weighted (DW) and dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) for monitoring anticancer therapy.

There is an increasing awareness that anatomical approaches based on measurements of tumor size have significant limitations for assessing therapy response. Functional imaging techniques are increasing being used to monitor response to therapies with novel mechanisms of action, often predicting the success of therapy before conventional measurements have changed. Dynamic contrast-enhanced and diffusion magnetic resonance imaging (MRI) are the most advanced in their evidence base, and in this manuscript we focus on them as response parameters. Technology, data gathering methods, and current limitations for these techniques are addressed. With few exceptions, most studies shows that successful treatment is reflected by increases in tumor water diffusion values visible as increased apparent diffusion coefficient values. Most response assessment studies also show that successful treatment results in decreases in tumor vascularization and microvessel permeability.

Vanadium complexes having [V(IV)O](2+) and [V(V)O(2)](+) cores with binucleating dibasic tetradentate ligands: Synthesis, characterization, catalytic and antiamoebic activities.

Binucleating hydrazones CH(2)(H(2)sal-bhz)(2) (I) and CH(2)(H(2)sal-fah)(2) (II), derived from 5,5'-methylbis(salicylaldehyde) and benzoylhydrazide or 2-furoylhydrazide, react with [V(IV)O(acac)(2)] to give dinuclear V(IV)O-complexes [CH(2){V(IV)O(sal-bhz)(H(2)O)}(2)] 1 and [CH(2){V(IV)O(sal-fah)(H(2)O)}(2)] 4, respectively. In the presence of KOH or CsOH.H(2)O, oxidation of 1 and 2 results in the formation of dioxidovanadium(v) complexes, K(2)[CH(2){V(V)O(2)(sal-bhz)}(2)].2H(2)O 2, K(2)[CH(2){V(V)O(2)(sal-fah)}(2)].2H(2)O 5, Cs(2)[CH(2){V(V)O(2)(sal-bhz)}(2)].2H(2)O 3 and Cs(2)[CH(2){V(V)O(2)(sal-fah)}(2)].2H(2)O 6. These complexes have also been prepared by aerial oxidation of in situ prepared oxidovanadium(iv) complexes 1 and 4. The compounds were characterized by IR, electronic, EPR, (1)H, (13)C and (51)V NMR spectroscopy, elemental analyses and thermogravimetric patterns. Single crystal X-ray analysis of 3 confirms the coordination of the ligand in the dianionic (ONO(2-)) enolate tautomeric form. The V(V)O(2)-complexes were used to catalyze the oxidative bromination of salicylaldehyde, therefore acting as functional models of vanadium dependent haloperoxidases, in aqueous H(2)O(2)/KBr in the presence of HClO(4) at room temperature. It is shown that the V(IV)O-complexes [CH(2){V(IV)O(sal-bhz)(H(2)O)}(2)] 1 and [CH(2){V(IV)O(sal-fah)(H(2)O)}(2)] 4 are catalyst precursors for the catalytic oxidation of organic sulfides using aqueous H(2)O(2). Plausible intermediates involved in these catalytic processes are established by UV-Vis, EPR and (51)V NMR studies. The vanadium complexes along with ligands I and II are also screened against HM1:1MSS strains of Entamoeba histolytica, the results showing that the IC(50) values of compounds 3 and 6 are lower than that of metronidazole. The toxicity studies against human cervical (HeLa) cancer cell line also showed that although compounds 3 and 6 are more toxic than metronidazole towards this cell line, the corresponding IC(50) values are relatively high, the cell viability therefore not being much affected.