Association between textual and pictorial warnings on tumbac (waterpipe tobacco) boxes and motivation to quit waterpipe smoking among Lebanese and Iraqi adolescents

BACKGROUND

Waterpipe tobacco smoking has increased tremendously at a global level among all age groups, particularly young people. Previous studies have examined the impact of waterpipe tobacco pictorial health warnings on adults but scarce studies were done on adolescents. The aim of this study was to assess the association of textual versus pictorial warnings on tumbac boxes and the motivation to quit waterpipe smoking among adolescents located in two Eastern Mediterranean countries Lebanon and Iraq.

METHODS

A cross-sectional study was conducted between May and November 2022, involving 294 adolescents waterpipe smokers from Lebanon and Iraq. The questionnaire included the Lebanese Waterpipe Dependence Smoking-11, the Depression, Anxiety and Stress Scale, the Waterpipe Harm Perception Scale, Waterpipe Knowledge Scale, Waterpipe Attitude Scale, the Fagerstrom Test for Nicotine Dependence, and the Motivation to Stop Scale.

RESULTS

When adjusting the results over confounding variables, the results showed that compared to finding the warnings to stop smoking not efficacious at all, adolescents who find the warnings moderately (aOR = 2.83) and very (aOR = 6.64) efficacious had higher motivation to quit. Compared to finding the warnings not increasing their curiosity for information about how to stop waterpipe smoking at all, participants who confessed that warnings increased their curiosity a little (aOR = 2.59), moderately (aOR = 3.34) and very (aOR = 3.58) had higher motivation to quit. Compared to not considering changing the tumbac brand if the company uses pictorial warnings, adolescents who would consider changing the tumbac brand (aOR = 2.15) had higher motivation to quit.

CONCLUSION

Pictorial and textual warnings on waterpipe packs were associated with higher motivation to stop waterpipe smoking. Public health education programs for this purpose seem warranted.

Community pharmacists' knowledge, attitudes, and practices regarding counselling on vitamins and dietary supplements in Malaysia: A study on complementary medicines

Background

The utilization of vitamins and dietary supplements (DSs) among consumers in Malaysia has seen a notable increase. However, there is limited research available on how pharmacists in Eastern countries manage the provision of these products.

Objective

This study aims to assess the knowledge, attitudes, and practices of community pharmacists in Malaysia regarding the provision of counselling services on vitamins and DSs. The findings will inform education strategies in this area.

Methods

A cross-sectional quantitative study was conducted from February to April 2022 using a validated online-based questionnaire. The survey was distributed to community pharmacists across Malaysia through social media channels. t-test and ANOVA test were used for data analysis.

Results

Among the 260 participants, 73.5% were categorized as having average product knowledge. Key concerns included a lack of knowledge about the indications of new products and when to discontinue their use. Regarding dosing in specific patient groups, 33.5% of pharmacists only occasionally consulted references and primarily relied on product labels. Furthermore, 29% of pharmacists believed it was unnecessary to refer patients to doctors when they experienced ongoing symptoms while taking vitamins or DSs. Interestingly, 44.6% of pharmacists believed there was a correlation between the efficacy of vitamins and their price, often recommending more expensive brands despite similar content.

Conclusion

There is an opportunity to enhance the knowledge of pharmacists in Malaysia regarding vitamins and DSs. Education interventions should focus on areas such as dosing for specific patient groups, when to discontinue products, understanding new products, evidence-based efficacy of products for specific conditions, and providing a framework for appropriate referral to support pharmacists in their practice.

Development and validation of a knowledge, attitude, and practice (KAP) questionnaire for skin cancer in the general public: KAP-SC-Q

BACKGROUND

Skin cancer has emerged as a significant worldwide public health issue, with the global reporting of approximately 1.4 million cases of non-melanoma skin cancer and 287,723 cases of melanoma in 2020. Early detection and prevention are pivotal in battling this disease. However, there is an absence of standardized tools designed to comprehensively gauge these elements.

OBJECTIVE

The study aimed to formulate and examine the validity and reliability of the Knowledge, Attitude, and Practice of Skin Cancer Questionnaire (KAP-SC-Q).

METHODS

The research was conducted in two phases. Phase I included the generation and construction of items, content validity, and pilot testing. In Phase II, the questionnaire was distributed to 370 non-health background public adults in Malaysia. The validity and reliability of the questionnaire were ascertained using Item Response Theory (IRT) for the knowledge domain, exploratory factor analysis (EFA) for the attitude and practice segments, and Cronbach's alpha.

RESULTS

The definitive version of the KAP-SC-Q had 108 items, divided into 17 social demographic, 30 knowledge, 32 attitude, and 29 practice items. Knowledge items had an acceptable range of 0.4-2.0 in the IRT. The EFA revealed that attitude and practice sections contributed to 34.25% and 52.94% of the total observed variance, respectively. The Cronbach's α coefficient was 0.85, signifying good internal consistency.

CONCLUSION

The study validated that KAP-SC-Q exhibits commendable psychometric attributes, marking it as a trustworthy instrument to assess the public's knowledge, attitude, and practices concerning skin cancer.

A multinational study on the factors influencing university students' attitudes and usage of ChatGPT

Artificial intelligence models, like ChatGPT, have the potential to revolutionize higher education when implemented properly. This study aimed to investigate the factors influencing university students' attitudes and usage of ChatGPT in Arab countries. The survey instrument "TAME-ChatGPT" was administered to 2240 participants from Iraq, Kuwait, Egypt, Lebanon, and Jordan. Of those, 46.8% heard of ChatGPT, and 52.6% used it before the study. The results indicated that a positive attitude and usage of ChatGPT were determined by factors like ease of use, positive attitude towards technology, social influence, perceived usefulness, behavioral/cognitive influences, low perceived risks, and low anxiety. Confirmatory factor analysis indicated the adequacy of the "TAME-ChatGPT" constructs. Multivariate analysis demonstrated that the attitude towards ChatGPT usage was significantly influenced by country of residence, age, university type, and recent academic performance. This study validated "TAME-ChatGPT" as a useful tool for assessing ChatGPT adoption among university students. The successful integration of ChatGPT in higher education relies on the perceived ease of use, perceived usefulness, positive attitude towards technology, social influence, behavioral/cognitive elements, low anxiety, and minimal perceived risks. Policies for ChatGPT adoption in higher education should be tailored to individual contexts, considering the variations in student attitudes observed in this study.

An accelerated dispensing course for grad entry students - Can we teach dispensing skills over a day?

BACKGROUND AND PURPOSE

This study aimed to evaluate an accelerated dispensing course for graduate entry (GE) pharmacy students with prior science-related degrees to join undergraduate (UG) students in year three of the Monash Pharmacy degree.

EDUCATIONAL ACTIVITY AND SETTING

A one day accelerated dispensing course using MyDispense software was delivered to 59 GE students. The accelerated dispensing course was identical to the standard three-week dispensing course delivered to UG students. The same assessment of dispensing skills was conducted after course completion for both UG and GE students and included dispensing four prescriptions of varying difficulty. The assessment scores of the UG and GE students were compared. Perception data from the accelerated course were also collected.

FINDINGS

The accelerated dispensing curriculum was well received by students. They found the simulation relevant to practice, easy to navigate, and helpful for preparing them for assessment. Overall, 5.1% of GE students failed the assessment, which was lower than the 32.6% failure rate in the UG cohort. Comparison of assessment grades between UG and GE students showed no notable disadvantage to attainment of learning outcomes with the accelerated curriculum. However, UG students were more likely to provide unsafe instructions compared to GE students in their labeling for three out of four prescriptions.

SUMMARY

An accelerated dispensing curriculum can be effectively delivered to mature learners with a prior science-related degree as no notable deficiencies were identified when comparing the assessment results of GE students against UG students when both student cohorts undertook the same dispensing assessment.

Prevalence and Impact of Fatigue on Quality of Life (QOL) of Cancer Patients Undergoing Chemotherapy: A Systematic Review and Meta-Analysis

BACKGROUND

Fatigue is a typical consequence of cancer that can affect one's quality of life (QOL). The goal of this review is to provide comprehensive data on the impact of fatigue on QOL of cancer patients.

METHODS

An electronic data search in Web of Science, SCOPUS, and PubMed for relevant papers; those written in English; those reporting quantitative data; and those including more than one hundred patients who received just chemotherapy were included. Studies involving participants that received other kinds of anti-neoplastic therapies were excluded.

RESULTS

A total of 35 papers published between January 2000 and December 2021 were retrieved from the search databases of which (11612 patients) met the inclusion criteria. Findings showed that fatigue negatively affected QOL with a pooled prevalence of 49% (95% CI; 25.00-74.00) and the significant heterogeneity between articles was (I²=98%, P <0.001). Further, breast cancer contributed to the majority of selected articles with about 55 % (95%CI; 9:00- 94:00), followed by cancer (unspecified) 44% (95%CI; 5:00 - 92:00). Most studies (71%) (95%CI; 4:00 - 99:00) used the brief fatigue inventory (BFI) tool to assess severity of fatigue and 39% (95%CI; 17:00 -68:00) employed the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire to evaluate QOL among cancer survivors.

CONCLUSION

The prevalence of fatigue in cancer patients is high and fatigue has a negative impact on QOL of cancer patients receiving chemotherapy. Directionality, fatigue needs to be addressed and treated properly for better improvement of health status and QOL in cancer patients.

Exploring the quality of life of cosmetic users: A cross-sectional analysis from eight Arab countries in the Middle East

BACKGROUND

The use of cosmetic products is growing in dominance in the Arab population, making it essential to measure its effects on users. The production of cosmetics has been largely driven by consumerism and a bid to keep abreast with the latest trends in the beauty industry with less attention on how the users' quality of life (QoL) is affected.

AIMS

This study aims to investigate the effect of cosmetic products on users' quality of life in eight Arab countries.

METHODS

A cross-sectional study was carried out using an online data collection approach. A validated and specialist instrument tool called BeautyQoL, which consists of five domains and a total of 52 questions, was distributed to a sample of 2219 cosmetic users. Descriptive and inferential statistical analysis was done using SPSS® version 26.0.

RESULTS

The mean age of participants was 34 ± 11.25 years, and more women were represented in the sample (71%) than men. The majority of respondents had oily skin type (39.6%) and tan skin tone (30.4%). QoL through cosmetic use is computed with a mean score of 51 out of 100. The users' mean score satisfaction from cosmetic use is centred on attractiveness (56.1), followed by self-confidence (51.8). Cosmetics have a statistically significant effect on participants who are young adults, women, single, and employed with high income. As the respondents' skin tone deepens from very fair to dark, the mean score for each domain significantly increases, whereas when skin type changes from very oily to dry, the mean score for each domain decreases.

CONCLUSION

The effect of cosmetics on the users' QoL is limited, contrary to the narrative commonly portrayed in cosmetics' advertisements. Therefore, the use of cosmetics among the Arab population should be from an informed perspective of their specific needs instead of conforming to the viral trends pedaled by influencers and bloggers on social media, which might be irrelevant for them.

Knowledge, Attitude, and Practice of Oncologists toward Chemotherapy Resistance: A Questionnaire Development and Pilot Testing

BACKGROUND

Chemotherapy resistance is caused by a multiplicity of reasons; some of which can be avoided and others that are beyond the scope of current treatment methods. Since chemotherapy is administered under the supervision of health personnel, the role of oncologists cannot be undermined, and yet none is known about their knowledge and perspective. This research is the first-ever study aiming to develop a valid and reliable tool to determine oncologists' knowledge, attitude, and practice (KAP) toward chemotherapy resistance.

METHODS

Based on information gathered from literature searches, in-depth interviews with oncologists, and discussions with experts, an English-language questionnaire was developed. The questionnaire was tested for validity and reliability. A final version of the questionnaire (63 items) was piloted among 64 practicing oncologists and oncology trainees via convenient sampling. Data analysis was done using SPSS.

RESULTS

Correlation coefficients for each of the questionnaire's domains were more than 0.7 (P<0.001), which suggests that the questionnaire had strong test-retest reliability. The overall internal consistency (Cronbach's alpha) for knowledge (0.728), attitude (0.722), and practice (0.716) were greater than 0.7 indicating good internal consistency. Participants demonstrated a low level of knowledge and a positive attitude toward chemotherapy resistance. A statistically significant difference was noted between the knowledge score and education level, years of experience in the medical and oncology field, and experiencing resistance cases.

CONCLUSION

The developed questionnaire was found to be valid and reliable and can be used as an assessment tool for assessing oncologists' knowledge, attitude, and practice toward chemotherapy resistance in future studies. This study also reported that the oncologists have low knowledge on chemotherapy resistance and a predominantly positive attitude towards fighting chemotherapy resistance. Thus, it is essential for current practices in chemotherapy to be optimized to reduce the risk of chemotherapy resistance.

Using COM-B model in identifying facilitators, barriers and needs of community pharmacists in implementing weight management services in Malaysia: a qualitative study

Background

Previous qualitative studies exploring the experiences of community pharmacists (CP) in implementing weight management services (WMS) often lack a theoretical underpinning. This study applied the capability, opportunity, motivation, behaviour (COM-B) model to factors associated with WMS implementation among CPs to develop and recommend better intervention strategies.

Methods

A qualitative study design was used by conducting in-depth, semi-structured interviews with CPs. All the interviews were audio-recorded and duly transcribed. The thematic analysis approach was used to analyse the data, and the themes generated were mapped onto COM-B model components.

Results

The themes that emerged were (1) motivation of pharmacists and (2) knowledge and skills, which were identified as both barriers and facilitators, and (3) the barriers to implementation in aspects of social norms and resources. Factors were subsequently categorised into the subcomponents of the model: physical capability (e.g., training), psychological capability (e.g., lack of knowledge), physical opportunity (e.g., product range), social opportunity (e.g., stigma), automatic motivation (e.g., remuneration) and reflective motivation (e.g., CPs extended roles).

Conclusions

In conclusion, programs or training For Cps should develop their psychological capability to change their behaviour by being more proactive in promoting and providing weight management services, with a vital educational component. This behavioural change will improve the promotion of this service and will help many customers who were unaware of this service. Learning opportunities will leave CPs to feel more empowered and overcome barriers to implementing and maintaining WMS in primary care. The study findings provided essential insights into the factors that affect this provided service in Malaysia. The results will help to encourage the embedding of nutrition counselling in academic curricula.

Evaluation of hepatoprotective effect of Nebivolol and sodium copper Chlorophyllin on CCL4-induced hepatotoxicity in mice

OBJECTIVE

In this study, the protective effect of sodium copper chlorophyllin and nebivolol was evaluated in a mice model of CCL4 induced hepatotoxicity. Silymarin was used as a traditional hepatoprotective drug.

MATERIALS AND METHODS

Thirty (30) mice were used as they were divided into five groups: the first group was the control group which received distilled water + olive oil, the second group which received 1.5 ml/kg of CCl4 diluted in olive oil three times a week, the third group which received CCl4 + Silymarin 50 mg/kg/day, the fourth group which received CCl4 + nebivolol 4 mg/kg/day, and the fifth group which received 1.5 ml/kg of CCl4+ Cu-chlorophyllin 50 mg/kg/day. The drugs were given by intraperitoneal route for 5 weeks. The detection, quantification of CCl4 induced hepatotoxicity and possible protective effect of either silymarin, nebivolol, or sodium copper chlorophyllin were assessed using biochemical analysis of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), total protein, lipid profile, an assay of oxidants and antioxidants, assay of interleukin 6 (IL6) and tumor necrosis factor-alpha (TNF-α), and histopathological examination.

RESULTS

The administration of carbon tetrachloride (CCl4) produced pronounced liver impairment. It significantly increased ALT, AST, ALP, malondialdehyde, and serum nitric oxide levels compared to normal control group besides a decrease in total protein, serum catalase, tissue SOD, and GSH levels. IL-6 and TNF-α levels were significantly higher while total cholesterol was significantly lower in mice receiving CCL4 compared to the normal control group. CCL4 induced severe hyperemia and congestion inside the portal area with leukocytic infiltration, hepatic degeneration, and bridge fibrosis.

CONCLUSIONS

Co-administration of either silymarin, nebivolol, or sodium copper chlorophyllin with CCl4 was able to ameliorate up to almost contradict CCl4 induced hepatic injury through their anti-inflammatory and antioxidant activities.

Lockdown Fatigue and University Students: Exploring the Factors That Play Significant Roles in the Level of Lockdown Fatigue Among University Students in the Era of COVID-19

Background

Due to the COVID-19 global pandemic, the educational sector has undergone a series of changes which have affected both learners and students alike. As a result, the distortion of the students’ daily routine, isolation, social distancing and potential exposure to the COVID-19 virus changed almost all of the aspects of student life which has led to exhaustion of students, with both psychological and emotional challenges. Therefore, the main aim of this study is to determine the factors that have a significant impact on the level of lockdown fatigue among university students in the era of COVID-19.

Methods

A cross sectional was undertaken for this study. A questionnaire was designed and then shared electronically with the respondents of this study. The respondents were 819 students from tertiary institutions in Iraq. Some of the scales used in ranking the responses of the participants are the Lockdown Fatigue scale, Brief Resilience Scale and Coping Behaviours questionnaire. Data analysis was.

Results

Overall, the students had a high level of fatigue due to lockdown-measurement. Emptiness was one of the dominant feelings experienced by the students, along with concern for the safety and well-being of their own families. There was general agreement that students take a long time to return to normal routines after stressful events. The students also indicated that they cope with the lockdown through a variety of activities, ranging from making jokes about the situation to putting their faith in a higher power. Male student were less likely to suffer from lockdown-fatigue, however, studying in public university, being from urban areas, and studying in science field are the most significant factors that increase the level of lockdown. However, lower levels of lockdown fatigue were linked to significantly higher levels of personal resilience and coping abilities.

Conclusion

High level of lockdown fatigue among students is noticed, and several factors have been identified. Therefore, it is helpful for students to consistently work on reinforcing positive habits which would help them to build resilience when they are subjected to stressful conditions and scenarios.

Exploring the level of lockdown fatigue and effect of personal resilience and coping behaviours on university students during the covid-19 pandemic: a cross-sectional analysis from Iraq

Governments worldwide have imposed lockdowns in their countries to restrict unnecessary movement and curb the spread and transmission of the Covid-19 as a mitigation measure. The education sector has also implemented rapid changes, and this has transformed the operational procedures for both students and lecturers. As the pandemic has progressed, its emotional and psychological toll is equally bearing on students, leading to lockdown fatigue. This study aimed to investigate the level of lockdown-induced fatigue and its correlation with personal resilience and coping skills among university students in Iraq. This study used quantitative methods of research using a cross-sectional study design. A questionnaire survey was distributed electronically among 819 university students in Iraq. The study used three standardised scales: the lockdown fatigue scale, brief resilience scale, and coping behaviours questionnaire for data collection. Descriptive and inferential statistical analysis were done using SPSS. Overall, students indicated a high level of lockdown fatigue with a mean score of 33.48out of 50. Fear of personal safety and the wellbeing of the family was the most fear expressed by the students. The ability to go through stressful times and unpleasant events was the most common worry among the students. Female, urbanised, and science field students were the most students who suffered from lockdown-induced fatigue. However, positive coping behaviours and personal resilience were significantly correlated with decreasing fatigue levels during the lockdown period. Level of lockdown fatigue accelerated in an alarming stage among university students in Iraq. Hence, students need to build their emotional resilience and learn how to navigate surviving hard times and bounce back after a loss. This could be facilitated by counselling services being availed to educational and social institutions to benefit university students.

Knowledge and Attitude of Pharmacy Students Regarding Geriatric Care: Questionnaire-Based Analysis in Malaysia

INTRODUCTION

There is a predicted growth of up to 17% in an older adult of Malaysian above 60 years of age by 2040. This will increase the workload of almost every healthcare provider to ensure optimal geriatric care.

PURPOSE

This study aimed to assess pharmacy students' knowledge and attitudes towards geriatric pharmacy education and older patients to determine their preparation in delivering appropriate medical care to the geriatric population.

METHODS

Self-administered questionnaires were distributed among pharmacy students in different Malaysian universities. The survey included several sections to assess multiple aspects such as sociodemographic information, assessment of knowledge using a validated 28-item Geriatric Knowledge Assessment Scale (GKAS), and attitudes towards geriatrics education.

RESULTS

The response rate was around 70% of the respondents. The mean (± standard deviation) age of the cohort was 22.28 (±1.12) years. Despite around 78% of pharmacy students claiming that their knowledge of geriatric care is adequate, their GKAS score showed that only around 20% have high geriatric knowledge. Around 80% of them showed a positive attitude on the importance of taking courses focused on geriatric care and demonstrated interest to further knowledge and training in geriatric care. However, more than half of the students were uncertain of their answers towards their attitudes regarding older patients.

CONCLUSION

Given the growing role of pharmacists in the ageing population, this study highlights the importance of geriatric care education among potential pharmacists. Therefore, we urge the need to improve/develop geriatrics education and training into the pharmacy curriculum to ensure sufficient preparation for actual practice after graduation.

Antibiotic use and resistance in a tertiary care hospital: knowledge and attitude among patients of orthopaedic and surgical wards in Malaysia

Objectives

The prevalence of antimicrobial resistance (AMR) is rising globally as well as in Malaysia. AMR can lead to difficulty in the treatment of chronic infection if being neglected. This study aimed to assess the level of knowledge and attitude about antibiotic usage and AMR.

Methods

A cross-sectional study design was carried out at the Hospital Kuala Lumpur (HKL), Malaysia, where participants were recruited by using the non-probability convenience sampling from the six orthopaedic and four surgical wards. A self-administered questionnaire was used to collect the required data which were then analysed by using SPSS.

Key findings

A total number of 390 adult Malaysians (286 from orthopaedic wards and 104 from surgical wards) were involved in the study. This study showed that the level of knowledge and attitude about antibiotics among the majority of respondents were moderate. However, their knowledge regarding AMR was very low (i.e. lack of knowledge). In contrast, the majority of them (69.8%) showed a positive attitude towards antibiotics. Statistical analysis of data revealed that the level of knowledge of AMR was significantly associated with gender, age, race, marital status, educational level and knowledge about antibiotic resistance terms (P &lt; 0.05) while respondents’ attitude towards antibiotic usage was significantly associated with gender, race, marital status and education level (P &lt; 0.05).

Conclusions

It was necessary to formulate and develop strategies to improve the knowledge and awareness about antibiotics and AMR among health professionals. These might help them to improve their skills in delivering health information to the patients through a proper counselling technique.

Prevalence of Vitamin D Deficiency Between Type 2 Diabetes Mellitus Patients and Non-Diabetics in the Arab Gulf

BACKGROUND

The link between the risk of type 2 diabetes mellitus (T2DM) and vitamin D deficiency has perplexed the medical society due to the controversy in the data available. Saudi Arabia (SA) is a sunny region; however, ample amount of data reported the increased prevalence of vitamin D deficiency along with T2DM. Thus, this study aimed to compare vitamin D deficiency between healthy and T2DM patients in SA, alongside with the risk factors associated with that.

METHODS

A cross-sectional study was conducted in the Medical Unit, Taibah University in Al-Madinah Al-Munawarah, SA, from November 2017 to May 2018. The involved participants were non-diabetics and T2DM men. Measuring vitamin D for T2DM and non-diabetics group was done by trained technicians. Data analysis was done via SPSS.

RESULTS

Sixty-four participants (T2DM group = 32; non-diabetics group = 32) were recruited, and the mean age of T2DM patients was 48.6 ± 10.4, while that of the non-diabetics was 42.4 ± 6.5. The mean of vitamin D level was found higher in the non-diabetic participants than in diabetic patients. There was statistically significant association between vitamin D deficiency and T2DM (P = 0.001). Besides, duration of diabetes was the only factor, found to be positively correlated with vitamin D deficiency in T2DM patients.

CONCLUSION

Early screening for vitamin D serum-level is recommended for T2DM patients in Saudi Arabia. Therefore, early correction of vitamin D levels should be considered, and medical and scientific societies, along with other sectors such as the media, should highlight and increase the awareness of the importance of vitamin D and the seriousness of its deficiency.

Challenges of prescribing antidepressants for the elderly: a scoping review

Objectives

With a shift in global demographic trends favouring the older population, depression, which is increasingly common to older adults, is fast becoming a significant public health phenomenon that can result in rising healthcare costs, co-morbidities and fatalities. In particular, challenges to prescribing antidepressants to older people given their altered pharmacodynamic and pharmacokinetic profiles is of major concern to healthcare providers. We aimed to review the challenges encountered by prescribers when diagnosing and selecting older patients suited to receive an antidepressant.

Methods

English articles published between 2011 and 2021 were searched from the three databases which were MEDLINE, Cochrane Library and EMBASE to identify studies related to challenges in prescribing antidepressants for older people with the combination of search keywords such as depression, antidepressants, elderly and challenges, but not limited to them. Studies were excluded if the age of the participant is below 65 years old. The relevancy of the studies to be included were examined initially based on their titles and abstracts. Additional articles were searched from the reference lists of relevant articles.

Key findings

Out of 2500 studies, 11 articles was included in this study. The challenges were classified into three themes: challenges associated with the ageing processes, difficulty in recognising depressive symptoms and challenges in distinguishing depression from cognitive impairment.

Conclusions

Antidepressant prescribing in the elderly is complicated, in which there is a lack of proof for beneficial approaches. The study highlighted pertinent challenges to prescribers when older patients seek drug therapy for depression. This could have easily led to many depression cases gone undiagnosed or misdiagnosed.

Perception and attitude of adults toward cosmetic products amid COVID-19 pandemic in Malaysia

BACKGROUND

The use of cosmetics is growing among both male and female consumers due to the availability of different brands. While there is an increase in the usage of cosmetic products, it is concerning whether the consumers are aware of the safety of the products.

AIMS

This study aimed to widely explore consumers' perceptions and attitudes toward cosmetics within the context of the COVID-19 pandemic.

METHODS

A cross-sectional study was carried out among adults in Selangor, Malaysia. Thirty-three questions divided into three dimensions (socio-demographic parameters, assessment of perception, and assessment of attitude) were developed and validated to be answered by cosmetics consumers. Descriptive and inferential statistical analysis was done using SPSS.

RESULTS

A response rate of 87% was achieved, and the mean age of participants was 33 ± 7.2. The overall perception of consumers indicates low levels of perception and moderate level of attitude toward cosmetic products. There was a positive correlation and high relationship between participants' perception and attitude (p = 0.001, r = 0.72). A significant association was observed between demographic data of respondents and their attitude and perception toward cosmetic products. Participants were unaware that sharing of cosmetic products could lead to bacterial infection and possibly increased the chance of contracting COVID-19.

CONCLUSION

This study displayed a nonchalant perception and attitude of Malaysian adults toward cosmetic products by focusing on aesthetics rather than health safety. Therefore, it is recommended to raise awareness on the composition and effects of cosmetic products, increase the practice of hygiene and dissuade the sharing of cosmetics to reduce transmissions of COVID-19.

Impact of fatigue on quality of life among breast cancer patients receiving chemotherapy

Objectives

Fatigue is the most frequently reported symptom experienced by cancer patients and has a profound effect on their quality of life (QOL). The study aimed to determine the impact of fatigue on QOL among breast cancer patients receiving chemotherapy and to identify the risk factors associated with severe fatigue incidence.

Methods

This was an observational prospective study carried out at multiple centers. In total, 172 breast cancer patients were included. The Functional Assessment of Chronic Illness Therapy-Fatigue Questionnaire was used to measure QOL, while the Brief Fatigue Inventory (BFI) was used to assess the severity of fatigue.

Results

The total average mean and standard deviation of QOL were 84.58±18.07 and 4.65±1.14 for BFI scores, respectively. A significant association between fatigue and QOL was found in linear and multiple regression analyses. The relationships between fatigue severity and cancer stage, chemotherapy dose delay, dose reduction, chemotherapy regimen, and ethnicity were determined using binary logistic regression analysis.

Conclusion

The findings of this study are believed to be useful for helping oncologists effectively evaluate, monitor, and treat fatigue related to QOL changes.

Evaluation of the impact of anaemia on quality of life among breast cancer patients undergoing chemotherapy in Malaysia

Objectives

The purpose of this study was to evaluate the impact of anaemia on the quality of life (QOL) among breast cancer patients.

Methods

A total of 120 anaemic (haemoglobin &lt; 12 g/dL) breast cancer patients were identified through chart review. Patients were followed-up for three cycles of chemotherapy filled in a QOL questionnaire Functional Assessment Chronic Therapy –Anaemia at each follow-up session. Data such as haemoglobin Hb levels and chemotherapy regimens were also recorded on each follow-up. Data were analysed using SPSS.

Key findings

The Hb level and QOL mean scores of all follow-ups were 10.34 ± 0.73 g/dL and 96.37 ± 16.15 g/dL, respectively. QOL was adversely affected by anaemia severity, and the curves declined significantly from the first follow-up to the third follow-up (P &lt; 0.001).

Conclusion

It is crucial to consider developing a guideline for the treatment of anaemia, which is not available currently, and improve the QOL for the wellbeing of cancer patients.

Use, Awareness, Knowledge and Beliefs of Medication During Pregnancy in Malaysia

Objectives

This study aimed to assess medication use in pregnant women in Malaysia by measuring use, knowledge, awareness, and beliefs about medications.

Methods

This was an observational, cross-sectional study involving a total of 447 pregnant women who attended the Obstetrics and Gynecology Clinic, Hospital Kuala Lumpur (HKL), Malaysia. A validated, self-administered questionnaire was used to collect participant data.

Results

Most of pregnant women had taken medication during pregnancy and more than half of them (52.8%) showed a poor level of knowledge about the medication use during pregnancy. Eighty-three percent had a poor level of awareness and 56.5% had negative beliefs. Age and education level were significantly associated with the level of knowledge regarding medication use during pregnancy. Multiparous pregnant women, and pregnant women from rural areas were observed to have a higher level of awareness compared with those who lived in urban areas. Use of medication during pregnancy was determined to be significantly associated with education level, and race.

Conclusion

Although there was prevalent use of medication among pregnant women, many had negative beliefs, and insufficient knowledge and awareness about the risks of taking medication during pregnancy. Several sociodemographic characteristics were significantly associated with the use (race and education level), level of knowledge (age and education level), awareness (parity and place of residence), and beliefs (race, education level, and occupation status) towards medication use during pregnancy.

The Risk and Impact of COVID-19 Pandemic on Immunosuppressed Patients: Cancer, HIV, and Solid Organ Transplant Recipients

Toward the end of the year 2019, there was the eruption of an acute respiratory syndrome, which is widely referred as coronavirus disease (COVID-19) from Wuhan, Hubei Province. The disease causes a range of respiratory illnesses, which are fatal. The COVID-19 disease has spread globally and has significantly impacted the health delivery systems, travel regulations, and economic activities and has posed and upsurge of responsibilities for the frontline healthcare workers. Due to the nature of the COVID-19 disease, it has typically caused complications which include pneumonia, multiple organ dysfunction together with renal failure, and acute respiratory distress syndrome. As of date, there is no approved vaccine or treatment for COVID-19 though there are ongoing research studies to formulate a treatment. COVID-19 is highly contagious, and the risk of infection is higher for patients with immunesuppressed patients than regular patients. The immunesuppressed conditions include cancer, HIV, and patients with solid organ transplants (SOT). This paper aims to review the risk and impact of COVID-19 on immunesuppressed patients, with a focus on cancer, HIV, and patients with SOT and the essence of special parameters for their care and management. Despite the fatal effects of this global pandemic, the findings of this study indicate the high risk which immunosuppressed patients have to contract the disease; thus, the governments and health delivery systems have to offer them extra support and treatment.

Factors associated with the level of knowledge about hypertension in Malaysia: A short communication

Objective

The aim of this study was to identify factors that have a correlation with hypertensive patients’ knowledge in Malaysia.

Methods

A cross-sectional survey and face-to-face interview methods were applied, and 1000 Malaysian adults were recruited to be involved in this study. The study was carried out in Hospital Kuala Lumpur, and self-administered questionnaire was adopted from previous literature study.

Key findings

Most respondents were female, and the mean age was 48 years old. Analytical test showed that there is an association between gender, age, race, location, education level, and source of information and their knowledge about hypertension. The odds of knowledge were higher among female, urban, higher level of education, young (≤50 years old), and Chinese and Malay respondents and those who got their information from health professionals.

Conclusions

There are several factors have a great impact on hypertension knowledge in Malaysia; hence, understanding them makes it possible for the community to change public policies and educational programmes for the population that need it the most.

Correction to: Direct oral anticoagulants for the treatment of venous thromboembolism in patients with active malignancy: a systematic review and meta-analysis

Unfortunately the author list in the original article is incomplete. The correct list of contributing authors is given in this Correction.

Sub-optimal serum gentamicin concentrations in sickle cell disease patients utilizing the Hartford protocol

WHAT IS KNOWN AND OBJECTIVES

Several studies have reported that use of the Hartford nomogram in different patients' population was associated with low serum gentamicin concentrations (SGC) at different intervals or midpoints. This study was intended to determine the prevalence and predictors of SGC in patients with sickle cell disease (SCD) as another population representing low SGC while utilizing the Hartford protocol.

METHODS

This retrospective observational study was carried out in a University-teaching hospital in Oman. The study was conducted from January 2005 through May 2008 and included all adult patients with SCD admitted during that time. Four-hundred and seven SGC representing 248 SCD patients were evaluated. The serum gentamicin concentration was considered sub-optimal if it was <2μg/mL (baseline of Hartford nomogram). Analyses were performed using univariate and multivariate statistical techniques.

RESULTS AND DISCUSSION

Eighty-three percent (n=339) of SGC were sub-optimal. Multivariate analysis using logistic regression revealed that sub-optimal SGC were associated with younger patients with higher creatinine clearance. Specifically, patients who were ≤23years old were twice more likely to have sub-optimal SGC compared with those who were >23years of age (95% CI: 1·14-3·45; P=0·015). Patients with creatinine clearance of ≥200mL/min were 5·20 times more likely to have sub-optimal SGC compared with those with creatinine clearance <200mL/min (95% CI: 1·81-14·49; P=0·002). Furthermore, the logistic model also demonstrated that higher serum urea was associated with low SGC, with each one unit increase in serum urea, patients were 17% less likely to have sub-optimal SGC (95% CI: 0·72-0·96; P=0·011). Additionally, patients who were on piperacillin±tazobactam therapy given concurrently with gentamicin were 53% less likely to have sub-optimal SGC (95% CI: 0·28-0·83; P=0·009).

WHAT IS NEW AND CONCLUSION

A majority of patients with SCD had sub-optimal SGC. The pharmacokinetic profile of such patients is apparently too variable to fit the existing Hartford protocol. The Hartford nomogram should be modified to address this issue. Otherwise, clinicians should revert to multiple daily dosing.

Consistent behavioral phenotype differences between inbred mouse strains in the IntelliCage

The between-laboratory effects on behavioral phenotypes and spatial learning performance of three strains of laboratory mice known for divergent behavioral phenotypes were evaluated in a fully balanced and synchronized study using a completely automated behavioral phenotyping device (IntelliCage). Activity pattern and spatial conditioning performance differed consistently between strains, i.e. exhibited no interaction with the between-laboratory factor, whereas the gross laboratory effect showed up significantly in the majority of measures. It is argued that overall differences between laboratories may not realistically be preventable, as subtle differences in animal housing and treatment will not be controllable, in practice. However, consistency of strain (or treatment) effects appears to be far more important in behavioral and brain sciences than the absolute overall level of such measures. In this respect, basic behavioral and learning measures proved to be highly consistent in the IntelliCage, therefore providing a valid basis for meaningful research hypothesis testing. Also, potential heterogeneity of behavioral status because of environmental and social enrichment has no detectable negative effect on the consistency of strain effects. We suggest that the absence of human interference during behavioral testing is the most prominent advantage of the IntelliCage and suspect that this is likely responsible for the between-laboratory consistency of findings, although we are aware that this ultimately needs direct testing.

WITHDRAWN: Ultrasonic characterization of formation damage

This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

Effects of cholinesterase inhibitors on learning and memory in rats: a brief review with special reference to THA

Research on memory enhancing effects of acetylcholinesterase (AChE) inhibitors was stimulated by the finding of diminished cholinergic markers in patients with Alzheimer's disease, and the correlation of cognitive impairment to cholinergic deficits in these patients. The rationale for the use of AChE inhibitors is based on their abilities to prevent breakdown of acetylcholine released from surviving nerve terminals. In experimental animals the AChE inhibitor has been found by some investigators to be efficacious in improving cognitive function. Recent work has focused more on the performance and memory enhancing effects of tetrahydroaminoacridine (THA). THA has been found to improve performance in experimental animals with cognitive impairments induced by a variety of experimental manipulations such as by pharmacological blockade, cholinergic lesions, chronic alcohol or barbital treatment and ischemic lesion. These findings are compatible with the view that AChE inhibitors can be efficacious in "restoration" of some cholinergic functions.

Portal venous gas--case report and review of the literature

A 74-year-old man with chronic renal failure was admitted to the renal unit with non-specific symptoms and positive blood cultures. He later deteriorated and was admitted to the Intensive Care Unit with septic shock, respiratory failure and deranged liver function. Initial improvement was followed by abdominal distension and discomfort. Portal venous gas (PVG) and thrombosis were diagnosed on computed tomography. A conservative line of management was adopted. Improvement was soon followed by deterioration with septic shock. Extensive portal venous gas and free intra-abdominal gas were now evident on repeat computed tomography. The patient was too unwell to withstand surgery and a decision was made not to escalate therapy. He died on day 16. Portal venous gas is not a disease; it is a diagnostic clue in patients who may be harbouring an intra-abdominal catastrophe. Successful management of these cases requires early identification of the underlying pathology and can range from simple observation to extensive surgical intervention.

Portal venous gas--case report and review of the literature

A 74-year-old man with chronic renal failure was admitted to the renal unit with non-specific symptoms and positive blood cultures. He later deteriorated and was admitted to the Intensive Care Unit with septic shock, respiratory failure and deranged liver function. Initial improvement was followed by abdominal distension and discomfort. Portal venous gas (PVG) and thrombosis were diagnosed on computed tomography. A conservative line of management was adopted. Improvement was soon followed by deterioration with septic shock. Extensive portal venous gas and free intra-abdominal gas were now evident on repeat computed tomography. The patient was too unwell to withstand surgery and a decision was made not to escalate therapy. He died on day 16. Portal venous gas is not a disease; it is a diagnostic clue in patients who may be harbouring an intra-abdominal catastrophe. Successful management of these cases requires early identification of the underlying pathology and can range from simple observation to extensive surgical intervention.

Levels of neurotrophic factors in the hippocampus and amygdala correlate with anxiety- and fear-related behaviour in C57BL6 mice

The present study tested whether individual differences in anxiety- and fear-related behaviour are associated with between-subjects variation in postmortem brain levels of selected neurotrophic factors. Naïve C57BL6/J mice of both sexes were subjected either to an elevated plus maze test or to a Pavlovian fear conditioning paradigm. Two days after behavioural assays, the mice were sacrificed for postmortem quantification of the protein levels of brain derived neurotrophic factors (BDNF), nerve growth factor (NGF) and neurotrophin-3 (NT-3) in the hippocampus and amygdala. Significant correlations between behavioural measures and postmortem regional neurotrophic factor contents were revealed. The magnitude of anxiety-like behaviour in the elevated plus maze was positively related to dorsal hippocampal BDNF levels, but negatively related to NGF levels in dorsal hippocampus and in the amygdala. On the other hand, the expression of conditioned fear is positively related to amygdala BDNF and NGF levels, and to dorsal hippocampal NGF levels. Our results add to existing reports in human as well as in animals of correlation between anxiety trait and gross measures of hippocampal volume or activation levels. Moreover, a distinction between spontaneous and learned (or conditioned) anxiety/fear would be relevant to the identification of neurotrophin signalling mechanisms in the hippocampus and amygdala implicated in anxiety and related psychopathology.

Stimulation of D2 receptors in the prefrontal cortex reduces PCP-induced hyperactivity, acetylcholine release and dopamine metabolism in the nucleus accumbens

The aim of the present study was to investigate the effects of stimulation of D2 receptors in the prefrontal cortex (PFC) on spontaneous motor activity and the hyperactivity induced by the psychomimetic phencyclidine (PCP). In addition, the effects of prefrontal D2 stimulation under PCP treatment on dialysate concentrations of acetylcholine, choline, dopamine, DOPAC and HVA in the nucleus accumbens were also investigated. Sprague-Dawley male rats were implanted with guide cannulae to perform bilateral injections into the medial PFC of the D2 agonist quinpirole (1.5 and 5 microg/side). Horizontal and vertical spontaneous motor activity and the motor activity induced by systemic injections of the PCP (5 mg/kg i.p.) were monitored in the open field. PFC injections of quinpirole (1.5 and 5 microg/side) significantly decreased horizontal and vertical spontaneous motor activity in a dose-related manner. These effects were blocked by the D2 antagonist raclopride (5 microg/side). Microinjections of quinpirole (1.5 and 5 microg/side) into the PFC also significantly attenuated the hyperactivity produced by PCP (5 mg/kg i.p.). PCP also increased dialysate concentrations of acetylcholine, and dopamine metabolites in the nucleus accumbens. These increases were also reduced by injections of quinpirole (5 microg/side) into the PFC. These results suggest that the stimulation of prefrontal D2 receptors plays an inhibitory role in regulating spontaneous and PCP-induced motor activity and also in the neurochemical changes produced by PCP in the nucleus accumbens.

Antinociceptive activity of Euphorbia heterophylla roots

Following an identified use of the plant as analgesic in traditional medicine, the hexane, chloroform and ethyl acetate extracts of Euphorbia heterophylla root have been tested for antinociceptive activity in rats. All extracts showed significant effects at doses of 150-300 mg/kg i.p.

Genetic dissection of nicotine-related behaviour: a review of animal studies

Nicotine has a broad spectrum of behavioural effects. A considerable body of data has emerged indicating genetic factors regulate the behavioural effects of nicotine. Experimental genetic techniques have been invaluable in generating knowledge on the interrelationship of genetic factors and behavioural responsiveness to nicotine. Three different approaches have been invoked to explore the relationship of genetic factors to response to nicotine. Firstly, the classical genetic tool of inbred lines has been exploited to delineate genetic influences in the effects of nicotine. Secondly, the use of selectively bred lines has been profitably employed to reveal genetic differences in behavioural responses, such as cognition and exploration, to nicotine. These approaches have also provided useful information on the contribution of genetic factors influencing nicotinic receptors function. Finally the molecular genetic technique of gene targetting to create mice with null mutations of specific genes in the central nervous system, which is having a tremendous impact in drug addiction research, has also been employed to gain insight into the molecular and cellular basis of nicotine action. These techniques are proving to be invaluable in dissecting the role of different subunits of the nicotinic acetylcholine receptors on behaviour. This paper provides a survey of the animal studies that have used the above mentioned techniques to gain insight into genetic basis of the behavioural effects of nicotine.

Long-term environmental enrichment leads to regional increases in neurotrophin levels in rat brain

A number of studies have demonstrated that both morphological and biochemical indices in the brain undergo alterations in response to environmental influences. In previous work we have shown that rats raised in an enriched environmental condition (EC) perform better on a spatial memory task than rats raised in isolated conditions (IC). We have also found that EC rats have a higher density of immunoreactivity than IC rats for both low and high affinity nerve growth factor (NGF) receptors in the basal forebrain. In order to determine if these alterations were coupled with altered levels of neurotrophins in other brain regions as well, we measured neurotrophin levels in rats that were raised in EC or IC conditions. Rats were placed in the different environments at 2 months of age and 12 months later brain regions were dissected and analyzed for NGF, brain-derived neurotrophic factor (BDNF), and neurotrophin-3 (NT-3) levels using Promega ELISA kits. We found that NGF and BDNF levels were increased in the cerebral cortex, hippocampal formation, basal forebrain, and hindbrain in EC animals compared to age-matched IC animals. NT-3 was found to be increased in the basal forebrain and cerebral cortex of EC animals as well. These findings demonstrate significant alterations in NGF, BDNF, and NT-3 protein levels in several brain regions as a result of an enriched versus an isolated environment and thus provide a possible biochemical basis for behavioral and morphological alterations that have been found to occur with a shifting environmental stimulus.

Changes in brain nerve growth factor levels and nerve growth factor receptors in rats exposed to environmental enrichment for one year

This study examined the effects of long-term differential rearing on levels of brain nerve growth factor, its receptors, and their relationships to cognitive function. Adult rats (two months old) were placed into either enriched or standard housing conditions where they remained for 12 months. Animals from the enriched condition group had significantly higher levels of nerve growth factor in hippocampus, visual and entorhinal cortices compared with animals housed in isolated condition. Immunohistochemical analysis of brain tissue from the medial septal area revealed higher staining intensity and fibre density with both the low-affinity and the high-affinity nerve growth factor receptors. Enriched rats performed better than isolated rats in acquisition of spatial learning and had lower locomotion scores in the open field. These results provide further evidence that experimental stimulation results in increased production of trophic factors and structural reorganization in specific brain regions known to be involved in cognitive function.

Neonatal handling in rats induces long-term effects on dynorphin peptides

The effects of neonatal handling on the opioid dynorphin peptides in the brain and pituitary gland of Sprague-Dawley rats were investigated. Ten weeks after the neonatal handling, handled rats had higher tissue levels of dynorphin A and B in the hypothalamus, pituitary gland and striatum and slightly higher dynorphin B levels in the hippocampus, medulla oblongata and midbrain as compared with non-handled controls. The results indicate a persistent upregulation of the dynorphin system in certain brain areas after neonatal handling, which could contribute to the behavioural changes in these rats observed later in life. Observation in the open field and the elevated plus-maze tests confirmed behavioural effects of neonatal handling, i.e. showing that handled rats exhibit attenuated fearfulness in novel environments as compared with non-handled rats.

Effects of environmental enrichment on cognitive function and hippocampal NGF in the non-handled rats

In this study we examine whether exposure to differential housing after weaning would counteract the effects of postnatal handling (H) or nonhandling (NH) treatment by affecting learning and memory processes in young rats. In addition, we seek to determine if experience in enriched environment would alter hippocampal nerve growth factor (NGF) levels which is one of the factors known to be involved in the regulation of the survival and differentiation of developing basal forebrain neurones. Rats were either exposed to handling treatment, or left undisturbed starting day 1 after birth through day 21. After weaning on day 22, we exposed half of the H rats and half of the NH rats to environmental enrichment for 60 days. The other respective half of the rats was housed in isolated environmental condition (IC). Behavioural measures were taken in open field test, and spatial water maze test. Exposure to enriched environment following postnatal handling and nonhandling increased hippocampal NGF levels, and improved cognitive function in the both groups, with NH rats being more responsive to the effects of enrichment. Our results suggest that environmental enrichment has the potential to prevent or reduce the cognitive and neurochemical deficits in the adult animals associated with nonhandling.

Environmental enrichment results in higher levels of nerve growth factor mRNA in the rat visual cortex and hippocampus

Evidence for structural modifications in the brain following environmental changes have been provided during the last decades. The most pronounced alterations following environmental manipulations have been found in the visual cortex. These plastic changes are supposed to reflect reorganization of neuronal connections involved in postnatal development and adult adjustments of connections involved in sensori-perceptual processing and learning. Potential candidates to mediate these changes are neurotrophins. Nerve growth factor (NGF) has been associated with cognitive functions and shown to improve the performance of aged rats in spatial learning and memory task. In the central nervous system, NGF is of importance for development and maintenance of cholinergic neurons and atrophy of cholinergic neurons is strongly correlated with learning and memory impairments. Exposure to enriched environmental conditions improves learning and problem-solving ability and results in plastic changes in the brain. This study examined the effect of environmental enrichment on expression of NGF mRNA in the rat visual cortex and hippocampus. Rats housed in groups in a stimulus-rich environment for 30 days had significantly higher levels of NGF mRNA than rats housed individually in single cages without stimulus-enrichment. We have recently presented results showing higher levels of neurotrophin-3 (NT-3) mRNA and improved spatial learning following environmental enrichment, and suggest that an interplay involving the neurotrophins NGF and NT-3 may be mediating experience-induced structural changes.

Environmental enrichment selectively increases 5-HT1A receptor mRNA expression and binding in the rat hippocampus

Environmental enrichment augments neuronal plasticity and cognitive function and possible mediators of these changes are of considerable interest. In this study, male rats were exposed to environmental enrichment or single housing for 30 days. Rats from the enriched group had significantly higher 5-HT1A receptor mRNA expression in the dorsal hippocampus (62%, 59% and 44% increase in the CA1, CA2 and CA3 subfields, respectively). This was associated with significantly higher [3H]8-OH-DPAT binding in the inferior part of CA1. No changes were seen for 5-HT2A or 5-HT2C receptor mRNAs. The neuronal plasticity detected after environmental change may be mediated, in part, through 5-HT1A receptors.

Effects of neonatal stimulation on later cognitive function and hippocampal nerve growth factor

This study examined the behavioural and physiological effects of chronic mild stress on neonatally handled and non-handled rats. Neonatally handled and non-handled rats were exposed to chronic mild stress from weaning time to 6 months of age. They were behaviourally tested at 6 months of age, and sacrificed for analysis of nerve growth factor (NGF) in the hippocampus and hypothalamus. In contrast to the reported deleterious effect of acute strong stress, mild stress appeared to stimulate production of NGF in the hippocampus and improve spatial learning in both handled and nonhandled rats. Because neonatal handling produces neuroanatomical changes in the rat hippocampus and enhances cognitive function throughout the rats life span, these results implicate hippocampal NGF in the neuroprotective effects of handling.

Reciprocal changes in expression of mRNA for nerve growth factor and its receptors TrkA and LNGFR in brain of aged rats in relation to maze learning deficits

Quantitative in situ hybridization was used to examine the expression of mRNA for nerve growth factor (NGF) and its receptors, p140Trk (TrkA) and p75LNGFR (LNGFR), in different brain regions of adult (3-month-old) and aged (27-month-old) Wistar rats. The brain regions studied were hippocampus (dentate gyrus, CA3 region), basal forebrain (medial septum, diagonal band) and caudate-putamen. Prior to hybridization histochemistry behaviorally impaired as well as severely impaired animals were selected from a large group of old rats according to their performance in the Morris water maze. The impaired rats showed longer escape latencies and, thus, implicitly impaired performance in the place version of the task, but did not differ from adult controls on the platform crossing measure registered during the spatial probe trial. The severely impaired rats were significantly impaired on both measures, both in comparison with the adult animals and in comparison with the impaired aged rats. Inspection of the hippocampus revealed no age- or performance-related changes in NGF mRNA levels. The overall expression of TrkA mRNA in basal forebrain and caudate was found to be decreased in the impaired (-20%) as well as the severely impaired aged rats (-17%). A significant increase in p75LNGFR mRNA was found in the basal forebrain of the impaired rats in comparison with the severely impaired aged rats (+35%) and adult animals (+33%). These findings show that age-related maze performance deficits are accompanied by a decrease in basal forebrain and striatal TrkA mRNA expression. The increase in basal forebrain LNGFR mRNA levels observed in impaired, but not severely impaired, aged rats may reflect an early manifestation of processes underlying age-related cognitive deficits and may constitute a restorative and/or compensatory mechanism, since these rats displayed fewer deficits in navigation of the maze.

Expression of neurotrophin-3 mRNA in the rat visual cortex and hippocampus is influenced by environmental conditions

Environmental enrichment results in structural changes in the brain. Recent findings indicate involvement of neurotrophins in neuronal plasticity. This study examined the effect of environmental complexity on the levels of neurotrophin-3 (NT-3) mRNA in the rat visual cortex and hippocampus, studied by in situ hybridization. Rats housed in groups in a complex, stimulating environment had significantly higher levels of NT-3 mRNA in the visual cortex and the hippocampus than rats housed in individual cages without stimulating objects. These results indicate a possible role for NT-3 in synaptic plasticity.

Sleep fragmentation, and changes in locomotor activity and body temperature in trypanosome-infected rats

The rest-activity and body temperature 24 h cycles, as well as the structure of spontaneous sleep, were studied in rats 3 weeks after infection with monomorphic Trypanosoma brucei brucei. This parasite belongs to the species of trypanosomes that causes in humans African sleeping sickness, a neuropsychiatric syndrome that involves alterations of endogenous biological rhythms. In the infected rats, entrained to a 12 h:12 h photoperiod, a considerable hypokinesia was detected during the hours of darkness. A significant oscillation of the body temperature during 24 h was lost in some infected animals. In the other infected animals, the body temperature cycle displayed a lower amplitude and a phase advance. The mean temperature was slightly higher in the infected than in control rats during the period of light. A detailed analysis of the structure of spontaneous sleep, based on daytime electroencephalographic recordings, revealed during trypanosome infection an increased relative proportion of wake, and a decreased percent value of synchronized sleep. A marked reduction of the mean REM latency and a fragmented pattern of synchronized sleep, resulting in a considerable alteration of the REM-non-REM sleep sequences, were also observed in the infected animals. These findings indicate that trypanosomiasis in the rat results in a striking sleep fragmentation, as well as in changes of locomotor activity and body temperature rhythm. Thus, trypanosome infection in the rat provides an experimental model of sleep dysregulation in a structurally intact brain, and may provide an animal model of endogenous rhythm changes documented in African sleeping sickness.

Interferon-gamma and a factor derived from trypanosomes cause behavioural changes in the rat

A newly isolated interferon-gamma (IFN-gamma) immunoreactive molecule, "neuronal IFN-gamma", and recombinant lymphocyte-derived IFN-gamma were injected intracerebroventricularly (i.c.v.) through a previously implanted cannula into adult male rats during both the light and the dark phases of the light/dark cycle. The two molecules caused a reduction in both frequency and duration of rearing and locomotion during the dark, but not the light, phase. A molecule isolated from Trypanosoma brucei brucei, a parasite of the same subspecies of trypanosomes which causes African sleeping sickness, can induce production and release of IFN-gamma and "neuronal IFN-gamma" from lymphocytes and neurons, respectively. I.c.v. injection of this factor also reduced rearing during the dark period, but to a less extent. Thus, "neuronal IFN-gamma" appears to have effects on animal behaviour in common with lymphocyte-derived IFN-gamma. This study highlights the potential role of these cytokines in behaviour disturbances.