Upcycling of seafood side streams for circularity

The upcycling of seafood side streams emerges as a crucial facet in the quest for circularity within the food industry, surpassing other food sources in its significance. Seafood side stream plays an indispensable role in global food security and human nutrition. Nevertheless, losses ensue throughout the seafood supply chain, resulting in substantial waste generation. These underutilized seafood by-products contain valuable resources like edible proteins and nitrogenous compounds. Projections indicate that fishery products' utilization for human consumption will soar to 204 MT by 2030. Yet, the industry annually generates millions of tonnes of waste, predominantly from crab, shrimp, and lobster shells, leading to environmental impacts due to COD and BOD issues. A five-tier circular economic model offers a framework to manage seafood side-streams efficiently, with applications spanning pharmaceuticals, food production, animal feed, fertilizers, and energy fuel, thereby maximizing their potential and reducing waste in line with sustainability goals.

Pulsed electric field treatment of soymilk: Impact on Kunitz trypsin inhibitor allergenicity, antinutritional factor, and aroma characteristics

Allergens, antinutritional factors, and lipoxygenase (LOX) enzyme present in soymilk limit its consumption as vegan milk. Therefore, the present study focuses on reducing these limiting factors using pulsed electric field (PEF) treatment. In this regard, 20-40 kV/cm electric field was applied to soymilk for the effective treatment periods of 450, 1350, and 2250 ms. After the treatment, a reduction in pH (6.60 ± 0.10 to 6.47 ± 0.12) and an increase in the conductivity (173.03 ± 0.40 to 177.33 ± 0.72 µS) were observed. Furthermore, FTIR (Fourier Transform Infrared Spectroscopy), UV (Ultra Violet) intrinsic spectra, and CD (Circular Dichroism) spectra (α-helix reduction and β-sheet increase) data indicated mild structural changes in the proteins of soymilk. As a result, PEF treatment reduced the soymilk allergenicity (67.33 ± 20.48%), LOX activity (69.45 ± 9.38%), and trypsin inhibitor activity (75.61 ± 4.04%). Apart from that, the color, viscosity, and volatiles of soymilk also had significant changes due to PEF treatment. The aroma changes in PEF-treated soymilk were highly influenced by two major principal component (PC1 & PC2) groups and they accounted for about 70% of the aroma variations. However, these changes were mild and did not induce any off-flavors and the treatment remained effective against the quality hazards like allergens, antinutritional factors, and LOX enzyme. PRACTICAL APPLICATION: PEF treatment of soymilk reduces the possible allergic reactions in human body at least by 30%. Further, it reduces the antinutritional factor and off-odor inducing compounds. Therefore, the PEF treatment can be used in industries as a pre-treatment to produce allergen and antinutritional compounds free protein isolates from soybeans.

Tetrahydrobiopterin from cyanide-degrading bacterium Bacillus pumilus strain SVD06 induces apoptosis in human lung adenocarcinoma cell (A549)

Tetrahydrobiopterin (BH4) is an essential biological cofactor and a derivative of pterin which is considered potent anticancer agents. In continuation of our previous study on the identification of BH4 from cyanide-degrading Bacillus pumilus, the present study focuses on evaluating the anticancer properties of BH4 on A549, a human lung adenocarcinoma. Anticancer activity analysis shows that BH4 inhibited A549 cell growth after 24 h of incubation with 0.02 mg/mL. In acridine orange/ethidium bromide staining, BH4-treated A549 cells showed apoptotic morphology. BH4 treatment caused cell cycle arrest at G0/G1 phase compared to control cells. BH4 augmented p53 expression in alveolar cancer cells by downregulating MDM2 levels. There was downregulation of casp-3 and upregulation of iNOS gene in BH4-treated A549 cells. Further, docking studies indicated that BH4 had significant interactions with the above proteins affirming the apoptosis mechanism. Thus, BH4 could be considered a potential anticancer drug.

Virtual, augmented, and mixed reality as a versatile tool in food consumer behavior evaluation: Recent advances in aroma, taste, and texture incorporation

The perceptual behavior of consumers on a product displayed in the market has a vital role in analyzing the importance given to that product. Therefore, various strategies have been developed to understand this consumer behavior in the selection of products. Immersive technologies like virtual, augmented, and mixed reality are among them. With the foremost feature of immersion in the virtual world and interaction of users with virtual objects, virtual reality, and augmented reality have unlocked their potential in research and a user-friendly tool for analyzing consumer behavior. In addition to these technologies, mixed reality also has a significant role in investigating consumer behavior. Studies on immersive technologies in food applications are vast, hence this review focuses on the applications of virtual, augmented, and mixed reality in the food selection behavior of consumers. The behavioral studies are elicited to develop new products based on consumer needs, to understand the shopping behavior in supermarkets for real-time usage, and to know the influence of emotions in a selection of products. The findings suggest that virtual, augmented, and mixed reality induce immersion of the users in food selection behavioral studies. Information on the technological advancements in the tools used for bringing immersion and interaction are discussed for its futuristic applications in food. Though immersive technology gives users a realistic virtual environment experience, its application in food systems is in the budding stage. More research on human response studies would contribute to its innovative and inevitable application in the future.

Thermal properties of different types of starch: A review

Starch is present in high amount in various cereals, fruits and roots & tubers which finds major application in industry. Commercially, starch is rarely consumed or processed in its native form, thus modification of starch is widely used method for increasing its application and process stability. Due to the high demand for starch in industrial applications, researchers were driven to hunt for new sources of starch, including modification of starch through green processing. Thermal properties are significant reference parameters for evaluating the quality of starch when it comes to cooking and processing. Modification of starches affects the thermal properties, which are widely studied using Differential scanning calorimeter or Thermogravimetric analysis. It could lead to a better understanding of starch's thermal properties including factors influencing and expand its commercial applications as a thickener, extender, fat replacer, etc. in more depth. Therefore, the review presents the classification of starches, factors influencing the thermal properties, measurement methods and thermal properties of starch in its native and modified form. Further, this review concludes that extensive research on the thermal properties of new sources of starch, as well as modified starch, is required to boost thermal stability and extend industrial applications.

Cold plasma: a promising technology for improving the rheological characteristics of food

At the beginning of the 21st century, many consumers show interest in purchasing safe, healthy, and nutritious foods. The intent requirement of end-users and many food product manufacturers are trying to feature a new processing technique for the healthy food supply. The non-thermal nature of cold plasma treatment is one of the leading breakthrough technologies for several food processing applications. The beneficial response of cold plasma processing on food quality characteristics is widely accepted as a substitution technique for new food manufacturing practices. This review aims to elaborate and offer crispy innovative ideas on cold plasma application in various food processing channels. It highlights the scientific approaches on the principle of generation and mechanism of cold plasma treatment on rheological properties of foods. It provides an overview of the behavior of cold plasma in terms of viscosity, crystallization, gelatinization, shear stress, and shear rate. Research reports highlighted that the cold plasma treated samples demonstrated a pseudoplastic behavior. The published literatures indicated that the cold plasma is a potential technology for modification of native starch to obtain desirable rheological properties. The adaptability and environmentally friendly nature of non-thermal cold plasma processing provide exclusive advantages compared to the traditional processing technique.

Aqueous extract of Solanum nigrum attenuates Angiotensin-II induced cardiac hypertrophy and improves cardiac function by repressing protein kinase C-ζ to restore HSF2 deSUMOlyation and Mel-18-IGF-IIR signaling suppression

ETHNOPHARMACOLOGICAL RELEVANCE

Solanum nigrum, commonly known as Makoi or black shade has been traditionally used in Asian countries and other regions of world to treat liver disorders, diarrhoea, inflammatory conditions, chronic skin ailments (psoriasis and ringworm), fever, hydrophobia, painful periods, eye diseases, etc. It has been observed that S. nigrum contains substances, like steroidal saponins, total alkaloid, steroid alkaloid, and glycoprotein, which show anti-tumor activity. However; there is no scientific evidence of the efficacy of S. nigrum in the treatment of cardiac hypertrophy.

AIM

To investigate the ability of S. nigrum to attenuate Angiotensin II - induced cardiac hypertrophy and improve cardiac function through the suppression of protein kinase PKC-ζ and Mel-18-IGF-IIR signaling leading to the restoration of HSF2 desumolyation.

MATERIALS AND METHODS

Cardiomyoblast cells (H9c2) were challenged with 100 nM Angiotensin-II (AngII) for 24 h and were then treated with different concentration of S.nigrum or Calphostin C for 24 h. The hypertrophic effect in cardiomyoblast cells were determined by immunofluorescence staining and the modulations in hypertrophic protein marker along with Protein Kinase C-ζ, MEL18, HSF2, and Insulin like growth factor II (IGFIIR), markers were analyzed by western blotting. In vivo experiments were performed using 12 week old male Wistar Kyoto rats (WKY) and Spontaneously hypertensive rats (SHR) separated into five groups. [1]Control WKY, [2] WKY -100 mg/kg of S.nigrum treatment, [3] SHR, [4] SHR-100 mg/kg of S.nigrum treatment, [5] SHR-300 mg/kg of S.nigrum treatment. S. nigrum was administered intraperitoneally for 8 week time interval.

RESULTS

Western blotting results indicate that S. nigrum significantly attenuates AngII induced cardiac hypertrophy. Furthermore, actin staining confirmed the ability of S. nigrum to ameliorate AngII induced cardiac hypertrophy. Moreover, S. nigrum administration suppressed the hypertrophic signaling mediators like Protein Kinase C-ζ, Mel-18, and IGFIIR in a dose-dependent manner and HSF2 activation (restore deSUMOlyation) that leads to downregulation of IGF-IIR expression. Additionally in vivo experiments demonstrate the reduced heart sizes of S. nigrum treated SHRs rats when compared to control WKY rats.

CONCLUSION

Collectively, the data reveals the cardioprotective effect of S. nigrum inhibiting PKC-ζ with alleviated IGF IIR level in the heart that profoundly remits cardiac hypertrophy for hypertension-induced heart failure.

Evaluation of GABA Production and Probiotic Activities of Enterococcus faecium BS5

Gamma-aminobutyric acid (GABA) is a principal inhibitory neurotransmitter in the central nervous system and is produced by irreversible decarboxylation of glutamate. It possesses several physiological functions such as neurotransmission, diuretic, and tranquilizer effects and also regulates cardiovascular functions such as blood pressure and heart rate in addition to playing a role in the reduction of pain and anxiety. The objective of this study was to evaluate the GABA producing ability and probiotic capability of certain lactic acid bacteria strains isolated from dairy products. Around sixty-four bacterial isolates were collected and screened for their ability to produce GABA from monosodium glutamate, among which nine isolates were able to produce GABA. The most efficient GABA producer was Enterococcus faecium BS5. Further, assessment of several important and desirable probiotic properties showed that Ent. faecium BS5 was resistant to acid stress, bile salt, and antibiotics. Ent. faecium BS5 may potentially be used for large-scale industrial production of GABA and also for functional fermented product development.

Prevalence of antenatal depression in South Asia: a systematic review and meta-analysis

Background

Antenatal depression carries significant adverse implications for the health and well-being of women, babies and their families. While prevalence of perinatal mental disorders in low-and lower-middle-income countries tends to be higher compared to high-income countries, rates tend to vary widely among countries in certain regions such as South Asia. This study estimated the pooled prevalence of antenatal depression in South Asia and examined variations in individual countries.

Methods

We conducted a systematic review and meta-analysis. A comprehensive search was conducted on thirteen electronic databases and grey sources for articles published between 1·1·2007 and 31·5·2018 from South Asian countries including Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka. Studies reporting quantitative prevalence estimates of antenatal depression using a validated diagnostic/ screening tool identified, screened and appraised using a two-stage process. A meta-analysis was conducted using the proportion (%) of pregnant women identified as having antenatal depression as the primary outcome.

Results

Thirty-three studies involving 13,087 pregnant women were included in the meta-analysis. Overall pooled prevalence was 24·57% (95% CI: 19·34, 30·69). Prevalence rates for India (17·74%, 95% CI: 11·19, 26·96) and Sri Lanka (15·87%, 95% CI: 14·04, 17·88) were lower compared to the overall prevalence whereas the rates for Pakistan (32·2%, 95% CI: 23·11, 42·87) and Nepal (50%, 95% CI: 35·64,64·36) were higher.

Conclusions

While robust prevalence studies are sparse in most South Asian countries, one in four pregnant women is likely to experience antenatal depression in the region. The issue needs to be recognised in health policy and practice for resource allocation and capacity building at regional and national levels for prevention, diagnosis and treatment.

Key messages

One in four pregnant women is likely to experience antenatal depression in South Asia region. Targeted efforts are needed at national and regional levels for prevention, diagnosis and treatment.

Prevalence of Human Immunodeficiency Virus among pregnant women in Nigeria

Background

Human Immunodeficiency Virus (HIV) infection among pregnant women has been associated with a number of adverse maternal and infant outcomes. Nigeria accounts for about 10% of the HIV/AIDS burden worldwide and has the second highest incidence of new HIV infections among women globally. This study estimated the overall prevalence of HIV among pregnant women in Nigeria and examined variations across the geo-political zones of the country.

Methods

We conducted a systematic review and meta-analysis. A comprehensive search was conducted using eight electronic databases and grey sources for studies published from 1·1·2008 to 31·8·2019. Primary studies reporting prevalence estimates of HIV among pregnant women diagnosed using a diagnostic/ screening test were identified, screened and appraised using a two-stage process. A meta-analysis was conducted with the primary outcome measure as proportion (%) of pregnant women identified as having HIV infection.

Results

Twenty three eligible studies involving 72,728 pregnant women were included in the meta-analysis. The overall pooled prevalence of HIV among pregnant women was 7·22% (95% CI: 5·64, 9·21). A high degree of heterogeneity (I2=97·2%) and publication bias (p = 0.728) was reported. Prevalence rate for South-East geo-political zone (17·04%, 95% CI: 9·01, 29·86) was higher compared to the overall prevalence.

Conclusions

Findings imply that 7 out of every 100 pregnant women in Nigeria are likely to have HIV infection. The magnitude of the issue highlight the need for targeted efforts at local, national and international levels towards prevention, diagnosis and treatment.

Key messages

HIV infection among pregnant women is a major public health issue in Nigeria. Targeted efforts are needed at local, national and international levels towards prevention, diagnosis and treatment.

Associations of Long-Term Tea Consumption with Depressive and Anxiety Symptoms in Community-Living Elderly: Findings from the Diet and Healthy Aging Study

OBJECTIVE

To examine the association between long-term tea consumption and depressive and anxiety symptoms in community-living elderly.

DESIGN

Community based cross-sectional study.

SETTING

The Diet and Healthy Aging Study (DaHA), a prospective cohort study in Singapore.

PARTICIPANTS

614 elderly aged 60 years and above, who were free of dementia and cognitive impairment.

MEASUREMENTS

Information on tea consumption was obtained through interviewer-administered questionnaire. Long-term tea drinking was defined as regular consumption for at least 15 years. Depressive and anxiety symptoms were measured using the 15-item Geriatric Depression Scale (GDS-15) and the 20-item Geriatric Anxiety Inventory (GAI), respectively. A generalized structural equation model (gSEM) was applied to ascertain the association between long-term tea consumption and depressive and anxiety symptoms.

RESULTS

About 59% of the subjects had consumed tea for over 15 years. Long term tea consumption was significantly associated with a reduced odds of having depressive and anxiety symptoms, after adjusting for demographics (i.e., age, gender, education and ethnicity), comorbid conditions (i.e., heart disease, diabetes, stroke, hypertension and hyperlipidaemia) and long-term coffee consumption.

CONCLUSION

There was evidence suggesting that long-term tea consumption was associated with reduced depressive and anxiety symptoms among community-living elderly. This suggests that it is worthwhile to further investigate the role of tea's bioactive compounds in promoting mental health in aging.

Effects of Microwave and Cold Plasma Assisted Hydrodistillation on Lemon Peel Oil Extraction

This study aimed to investigate the effect of low-pressure dielectric barrier discharge (DBD) plasma on microwave-assisted hydrodistillation of lemon peel oil extraction. Microwave pre-treated lemon peel powder was exposed to plasma treatment (1.0, 1.5, 2.0, and 2.5 kV) for 10 min. The treated lemon peel powders were subjected to hydrodistillation to extract the essential oil and the extraction yields were calculated. The extracted oil was analyzed for chemical composition with gas chromatography-mass spectrometry (GC-MS). Effect of plasma on the surface morphology of the lemon peel was observed in a scanning electron microscope (SEM) which revealed the formation of fissures and cracks owing to the higher extraction yield. Plasma treatment at 2.5 kV was observed higher extraction yield than conventional hydrodistillation (149.34 % rise) and the chemical composition of plasma treated sample essential oil remains significantly unchanged. Thus, DBD plasma could be a promising technique to enhance the lemon peel essential oil extraction.

Microbial (Enzymatic) Degradation of Cyanide to Produce Pterins as Cofactors

Cyanide is one of the most poisonous substances in the environment, which may have originated from natural and anthropogenic sources. There are many enzymes produced by microorganisms which can degrade and utilize cyanide. The major byproducts of cyanide degradation are alanine, glutamic acid, alpha-amino-butyric acid, beta-cyanoalanine, pterin etc. These products have many pharmaceutical and medicinal applications. For the degradation of cyanide, microbes produce necessary cofactors which catalyze the degradation pathways. Pterin is one of the cofactors for cyanide degradation. There are many pathways involved for the degradation of cyanide, cyanate, and thiocyanate. Some of the microorganisms possess resistance to cyanide, since they have developed adaptive alternative pathways for the production of ATP by utilization of cyanide as carbon and nitrogen sources. In this review, we summarized different enzymes, their mechanisms, and corresponding pathways for the degradation of cyanide and production of pterins during cyanide degradation. We aim to enlighten different types of pterin, its classification, and biological significance through this literature review.

Enhanced recovery after surgery protocol enhances early postoperative recovery after pancreaticoduodenectomy

BACKGROUND

Enhanced recovery after surgery (ERAS) protocol is a multimodal, multidisciplinary and evidence-based approach to reduce surgical stress and enhance recovery in the postoperative period. This study aimed to analyze the outcome of ERAS protocol in patients after pancreaticoduodenectomy (PD).

METHODS

A total of 50 consecutive patients with pancreatic/periampullary cancer who underwent PD between January 2016 to August 2017 were included in the study. As per the institute ERAS protocol, nasogastric tube (NGT) was removed on postoperative day (POD) 1 if output was less than 200 mL and oral sips were allowed; oral liquids were allowed on POD2; semisolid diet by POD3; abdominal drain was removed on POD 4 if output was less than 100 mL with no evidence of postoperative pancreatic fistula (POPF); normal diet was allowed on POD5. Discharge criteria on POD6 were afebrile, tolerating oral normal diet, pain free and no surgery related complications (defined as per the ISGPS definitions).

RESULTS

NGT was removed on POD1 in 45 (90%) patients, abdominal drain removed by POD4 in 41 (82%) and 43 (86%) patients were discharged on POD6. There was no 30-day postoperative mortality. Three (6%) patients had delayed gastric emptying (DGE). None had postoperative hemorrhage and POPF. Readmission rate was 8%. A significant relation was found between the length of hospital stay (LOS) with age (P < 0.05) and a marginal relation between LOS and postoperative albumin (P = 0.05).

CONCLUSIONS

ERAS protocol can be safely followed in the perioperative care of patients who undergo PD. Early removal of NGT and allowing oral diet restore bowel function early. ERAS decreases the LOS and postoperative complications.

Symptom clusters of subjective cognitive decline amongst cognitively normal older persons and their utilities in predicting objective cognitive performance: structural equation modelling

BACKGROUND AND PURPOSE

Prior literature on subjective cognitive decline (SCD) has mostly focused on memory complaints. It is uncertain whether the other non-memory complaints are equally relevant and can be used, alongside memory complaints, to identify populations at high risk of cognitive impairment. How the memory and non-memory complaints of SCD cluster with each other amongst community-dwelling individuals was investigated, and the differential utility of the symptom clusters of SCD in predicting objective cognitive performance was evaluated.

METHODS

This study included 736 participants who were ≥60 years and had normal cognition, using the baseline data of an ongoing cohort study. Participants completed baseline assessments which comprised an SCD scale, a global cognitive measure and neuropsychological tests. Symptom clusters of SCD - as identified from exploratory and confirmatory factor analyses - were included in structural equation models to predict baseline changes in neuropsychological tests.

RESULTS

The symptoms of SCD were split into two distinct factors, of which factor 1 was reported much more frequently than factor 2. Each standard deviation (SD) increment in factor 1 led to a 0.16-0.50 SD increase in global cognition, immediate memory, visuospatial abilities, language, attention and delayed memory (P < 0.05). In contrast, each SD increment in factor 2 worsened some of the cognitive domains by 0.18-0.37 SD.

CONCLUSIONS

The various complaints of SCD can have different implications amongst cognitively normal older persons and may possibly be classified into age-related symptoms and pathological symptoms. The findings highlight the need for caution when selecting SCD measures, and illustrate the potential utility of SCD subtypes to inform on the underlying neurobiology.

Identification and in silico characterization of a novel peptide inhibitor of angiotensin converting enzyme from pigeon pea (Cajanus cajan)

BACKGROUND

Plants are important sources of bioactive peptides. Among these, angiotensin converting enzyme (ACE) inhibitory peptides have a major focus on their ability to prevent hypertension. Inhibition of ACE has been established as an effective approach for the treatment of ACE associated diseases.

HYPOTHESIS/PURPOSE

Some synthetic ACE inhibitory drugs cause side effects and hence there is a constant interest in natural compounds as alternatives.

STUDY DESIGN

The study was designed to identify and characterize a peptide molecule from pigeon pea which has the biological property to inhibit ACE and can be developed as a therapeutic approach towards hypertension.

METHODS

Seeds of pigeon pea (Cajanus cajan (L.) Millsp.) was fermented with Aspergillus niger, a proteolytic fungus isolated from spoiled milk sweet. The extract was purified by size exclusion chromatography by FPLC system. The fractions that showed ACE inhibition was subjected to LC-MS/MS for sequence identification. The stability of the peptide was analyzed by molecular dynamic simulations and the interaction sites with ACE were identified by molecular docking.

RESULTS

The study report a novel ACE inhibitory octapeptide Val-Val-Ser-Leu-Ser-Ile-Pro-Arg with a molecular mass of 869.53 Da. The Lineweaver-Burk plot indicated that the inhibition of ACE by this peptide is in competitive mode. Also, molecular docking and simulation studies showed a strong and stable interaction of the peptide with ACE.

CONCLUSION

The results clearly show the inhibitory property of the peptide against ACE and hence it can be explored as a therapeutic strategy towards hypertension and other ACE associated diseases.

Quinazoline derivative from indigenous isolate, Nocardiopsis alba inhibits human telomerase enzyme

AIM

Aim of this study was isolation and screening of various secondary metabolites produced by indigenous isolates of soil Actinomycetes for human telomerase inhibitory activity.

METHODS AND RESULTS

Extracellular extract from culture suspension of various soil Actinomycetes species were tested for telomerase inhibitory activity. The organism which produced telomerase inhibitor was identified by 16S rRNA gene sequencing. The active fraction was purified by HPLC and analysed by GC-MS to identify the compound. In GC-MS analysis, the active principle was identified as 3-[4'-(2″-chlorophenyl)-2'-thiazolyl]-2,4-dioxo-1,2,3,4-tetrahydro quinazoline. The G-quadruplex stabilizing ability of the compound was checked by molecular docking and simulation experiments with G-quadruplex model (PDB ID-1L1H). The selective binding ability of the compound with G-quadruplex over Dickerson-Drew dodecamer DNA structures showed that the compound possess high selectivity towards G-quadruplex.

CONCLUSIONS

Quinazoline derivative isolated from an indigenous strain of Nocardiopsis alba inhibited telomerase. Molecular docking and simulation studies predicted that this compound is a strong stabilizer of G-quadruplex conformation. It also showed a preferable binding to G-quadruplex DNA over normal DNA duplex.

SIGNIFICANCE AND IMPACT OF THE STUDY

This particular compound can be suggested as a suitable compound for developing a future anticancer drug. The selectivity towards G-quadruplex over normal DNA duplex gives a clue that it is likely to show lower cytotoxicity in normal cells.

Prescribing Pattern of Antidepressants in Children and Adolescents: Findings from the Research on Asia Psychotropic Prescription Pattern

OBJECTIVE

Pharmacotherapy of depression in children and adolescents is complex. In the absence of research into the efficacy and safety of antidepressants in this group of patients, their off-label prescription is common. This paper aimed to illustrate the prescription pattern of antidepressants in children and adolescents from major psychiatric centres in Asia.

METHODS

The Research on Asia Psychotropic Prescription Pattern on Antidepressants worked collaboratively in 2013 to study the prescription pattern of antidepressants in Asia using a unified research protocol and questionnaire. Forty psychiatric centres from 10 Asian countries / regions participated and 2321 antidepressant prescriptions were analysed.

RESULTS

A total of 4.7% antidepressant prescriptions were for children and adolescents. Fluoxetine, sertraline, and escitalopram were the most common antidepressants prescribed for children and adolescents. Almost one-third (30.3%) of prescriptions were for diagnoses other than depressive and anxiety disorders. There was less antidepressant polypharmacy and concomitant use of benzodiazepine, but more concomitant use of antipsychotics in children and adolescents compared with adults.

CONCLUSION

Off-label use of antidepressants in children and adolescents was reported by 40 Asian psychiatric institutions that participated in the study. In-service education and regulatory mechanisms should be reinforced to ensure efficacy and safety of antidepressants in children and adolescents.

Hyperglycaemia in patients treated with second generation antipsychotics

AIM

The association of second generation antipsychotic medications and hyperglycaemia has been reported for Caucasian populations but is unknown for asian patients who unfortunately are predisposed to diabetes. We report the findings from a health quality improvement project which tracked patients with schizophrenia and schizoaffective disorder newly started on second generation antipsychotics.

MATERIALS AND METHODS

266 patients were newly started on second generation antipsychotics in a 2 year period. Amongst the baseline parameters monitored was the fasting plasma glucose levels. Repeat testing was done at 4 weeks, 12 weeks and 12 months.

RESULTS

14 patients were excluded form the analysis as they had diabetes at the start of treatment with second generation antipsychotics. Hyperglycaemia was found in 88 patients (34.9%). 68 (77.3%) of these patients experienced the Hyperglycaemia at 12 weeks, 3 patients (3.4%) at 4 weeks and 17 patients (19.3%) at 12 months. Fasting plasma glucose levels were highest at 4 weeks.

CONCLUSIONS

Despite the limitations of the project, the one third prevalence of hyperglycaemia amongst patients newly started on second generation antipsychotics is a cause for concern and suggests the need for further extensive follow-up and assessment of the problem.

Survey of the practices of laser users in the UK in the treatment of port wine stains

BACKGROUND

Laser treatment for the management of port wine stains (PWS) is well established but there are some variations in practices amongst clinicians in the UK.

OBJECTIVES

To identify areas of consensus and highlight issues where sufficient variation existed to warrant further debate or clinical research using a postal questionnaire survey of clinicians carrying out laser treatments for PWS in the UK.

METHODS

A 29-item questionnaire was constructed regarding the laser treatment of PWS and was sent to 55 members of the British Skin Laser Study Group in 2000. The questions related to the usual clinical practice of the respondents and facilities available.

RESULTS

Completed questionnaires were returned from 45 clinicians (28 dermatologists, 14 plastic surgeons, two maxillofacial surgeons and one ENT surgeon) at 36 laser centres. The following areas of consensus were identified. The majority of centres used a pulsed dye laser (PDL) for the treatment of PWS, either alone or in conjunction with a KTP laser, and medical personnel assessed and treated patients. Written information and consent was obtained in 89% of centres before starting treatment. Test areas were usually performed before embarking on a full treatment by 98% of the clinicians. The majority of respondents (84%) considered 2-3 months as the optimum interval between treatments. All the clinicians were prepared to treat patients with skin types I-IV, but skin type VI was often not treated. The vast majority of laser users treated most PWS affecting the face, neck and upper limb. The majority of clinicians used local or topical anaesthesia frequently or sometimes in the treatment of PWS and 81% of the respondents used general anaesthesia, especially when treating children. When using the PDL, 91% of respondents selected an initial fluence based on experience and/or the appearance of the skin immediately after the laser pulse. Postoperatively, most clinicians advised patients to avoid the sun, avoid injury and use an emollient. Areas of variation in practice included some centres using non-medical in conjunction with medical staff to review and treat patients. The earliest age at which the clinician thought it appropriate to treat PWS varied from newborn to 8 years old; 25% of the clinicians who treat children would treat from the age of 2-3 months old and 34% would only treat patients over 1 year old. There was considerable variation in the initial fluence selected. The usual number of treatments given to each area of the PWS varied from 3 to 16.

CONCLUSIONS

This survey has demonstrated a number of areas where there appears to be a consensus of opinion about laser treatment of PWS. However, issues where there are significant variations in practice have also been identified and require further evaluation to help direct further clinical research.

Pruritus ani

INTRODUCTION

Pruritus ani is a common condition with many causes, predominately anorectal pathology. There are some new insights and therapies, but the most recommendations are based on low-level evidence.

PATIENTS AND METHODS

A literature search was carried out using Medline and the internet with the keywords 'pruritus ani' from 1950 to 2007.

RESULTS

A review of the evidence is presented and a management plan based on the elimination of irritants and scratching, general control measures and active treatment measures is offered.

CONCLUSIONS

Treatment of primary and secondary pruritus ani has a good prospect of regression of symptoms and skin changes.

Hypericin photoactivation triggers down-regulation of matrix metalloproteinase-9 expression in well-differentiated human nasopharyngeal cancer cells

Recently, we have shown that hypericin-mediated photodynamic therapy (PDT) is a promising modality for the treatment of nasopharyngeal cancer (NPC). The present study evaluated the expression of matrix metalloproteinase-9 (MMP-9) following hypericin-PDT in well-differentiated HK1 NPC cells. Down-regulation of MMP-9 by hypericin-PDT was observed at the mRNA level in HK1 cells in vitro and in vivo and at the protein level in vitro. Transcriptional activities of the activator protein-1 (AP-1) and nuclear factor (NF)-kappaB regulatory elements were inhibited by PDT. We also found that PDT reduced secreted granulocyte-macrophage colony stimulating factor (GM-CSF), which is known to activate transcription of NK-kappaB and AP-1. However, incubation of untreated HK1 cells with exogenous GM-CSF abrogated the reduction of MMP-9 production in hypericin-PDT-treated cells. It would appear that PDT downregulates MMP-9 expression via inhibition of GM-CSF production, which in turn modulates AP1/NF-kappaB transcriptional activities. Suppression of MMP-9 by hypericin-PDT may have therapeutic implications.

Psychiatric morbidity in patients referred to an insomnia clinic

INTRODUCTION

Insomnia is a common complaint associated with psychiatric disorders. Detection and diagnosis of insomnia can be a challenge at the primary care level. Patients often present with various kinds of psychological symptoms. Therefore, a high index of suspicion and careful assessments are crucial in eliciting signs and symptoms and making an accurate diagnosis of primary insomnia or a psychiatric disorder.

METHODS

This study was undertaken at the end of 2005, and is a retrospective review of all patients referred to the Insomnia Clinic and seen by the principal author in a three-year period between 2002 and 2005. Relevant data was collected from the medical records of patients who attended the clinic during this period.

RESULTS

In this study of 141 patients seen at an Insomnia Clinic, 47.5 percent had primary insomnia, while 52.5 percent had a primary diagnosis of a psychiatric disorder. 41.1 percent of those diagnosed with a primary psychiatric disorder had comorbid psychiatric disorders and 4.3 percent had substance abuse problems.

CONCLUSION

The various psychiatric disorders present in this group of patients highlight the need for careful assessment and recognition of these associations.

The psychopathology of musical hallucinations

Musical hallucinations are a rare phenomenon in neurological and psychiatric patients. There are clinical case reports and a few studies which describe the condition. Musical hallucinations have a heterogeneous clinical and pathophysiological aetiology, and have been reported in the elderly and in those with hearing impairment, central nervous system disorders and psychiatric disorders. The psychopathology is reviewed and three cases seen in a psychiatric setting are reported.

Co-sleeping and clinical correlates in children seen at a child guidance clinic

INTRODUCTION

Co-sleeping or bed-sharing is a common practice that has been little researched. While often viewed as being "cultural" in nature, there is a suggestion that it may be a parental response to sleep problems. Some studies link co-sleeping with behavioural and temperamental difficulties. The objectives of the current study were to determine the prevalence of co-sleeping and how they relate to sleeping problems among a cohort of children and adolescents seen in a child guidance clinic.

METHODS

Parents or guardians of all new patients seen at the child guidance clinic were asked to complete a questionnaire upon their consent to participate in the study. The questionnaire included socio-demographical data and frequency of sleep problems in the past six months. A list of nine common sleep problems was included.

RESULTS

The prevalence of co-sleeping was found to be 72.7 percent. The children who co-sleep were significantly younger and there was a decrease in the practice with increasing age. Sleep starts and nightmares were significantly more among those sleeping alone.

CONCLUSION

Co-sleeping was not associated with significant sleep problems in our cohort. Co-sleeping may have been initiated in response to an existing sleep problem but eventually resolved the problem. If co-sleeping is not permitted, the sleep problem could be compounded, giving rise to a higher prevalence of sleep starts and nightmares among those in our cohort who slept alone.

Clinical practice guidelines for depression

The Ministry of Health Clinical Practice Guidelines for Depression were prepared and distributed to all doctors in Singapore in early 2004. This article highlights salient points and discusses pharmacotherapy, psychotherapy and psychoeducation in managing cases of depression. Assessment of suicide risk is elaborated upon, although this was not discussed in the guidelines. The learning points will be enhanced if this article is reviewed together with the Ministry of Health Clinical Practice Guidelines.

An evaluation of the role of a store-and-forward teledermatology system in skin cancer diagnosis and management

There is currently much interest in the potential role of telemedicine in improving the delivery of dermatological care in the UK. The two teledermatology systems available at present are divided into live video and store-and-forward technology. We investigated the value of a store-and-forward teledermatology system in the diagnosis and management of lesions suspicious of skin cancer. A total of 163 store-and-forward referrals of patients with one lesion each were assessed independently by a Consultant and a third-year trainee dermatologist. The accuracy of diagnosis and appropriateness of management from these assessments was compared to a subsequent face-to-face consultation with the Consultant. Analysis of the Consultants' diagnoses showed that 48% were identical for teledermatology and conventional face-to-face consultations. A further 17% of teledermatology diagnoses included the actual clinical diagnosis as a possibility but 20% were either incorrect or a diagnosis could not be made. In the remaining 15% of cases the digital image was of insufficient quality for assessment. Of the trainee's reports, 44% were identical to the clinical diagnoses and another 20% included the clinical diagnosis as a possibility. The management plan was appropriate in 55% of the total teledermatology referrals assessed by the Consultants and in 52% assessed by the trainee when compared with the conventional consultation. This study illustrates that the store-and forward type telemedicine system has limited diagnostic accuracy for skin lesions. However, our results suggest that store-and-forward teledermatology may be suitable and safe for screening out clearly benign lesions but the study casts doubt on its efficiency.

Medical students' behaviour, attitudes and knowledge of sleep medicine

INTRODUCTION

A seminar on sleep disorders was recently introduced for third, fourth and final year medical students rotating through the psychiatry posting in the Institute of Mental Health. This survey was conducted to assess the attitudes as well as knowledge of medical students towards sleep medicine.

METHODS

Verbal consent was taken from the students who were willing to take part in the survey. The MED Sleep Survey, which is an inventory to assess behavior, attitudes and knowledge about sleep, was used to assess the same in the students.

RESULTS

A total of 240 medical students completed the survey. There were 149 male and 91 female medical students. In terms of their basic sleep knowledge, 46.7 percent scored between 1 and 10 points, 51.7 percent scored between 11 and 20 points, and 1.7 percent scored between 21 and 30 points. There was no significant difference between the different groups in their scores on basic sleep knowledge.

CONCLUSION

Most of the medical students scored between 1 and 20 points on basic sleep knowledge items in part III of the survey. Of these, almost one-half had scores between 1 and 10 points. Education is clearly important, and the introduction of the teaching programme on sleep medicine is timely and necessary.