Armodafinil versus Modafinil in Patients of Excessive Sleepiness Associated with Shift Work Sleep Disorder: A Randomized Double Blind Multicentric Clinical Trial

Aim. To compare the efficacy and safety of armodafinil, the R-enantiomer of modafinil, with modafinil in patients of shift work sleep disorder (SWSD). Material and Methods. This was a 12-week, randomized, comparative, double-blind, multicentric, parallel-group study in 211 patients of SWSD, receiving armodafinil (150 mg) or modafinil (200 mg) one hour prior to the night shift. Outcome Measures. Efficacy was assessed by change in stanford sleepiness score (SSS) by at least 2 grades (responder) and global assessment for efficacy. Safety was assessed by incidence of adverse events, change in laboratory parameters, ECG, and global assessment of tolerability. Results. Both modafinil and armodafinil significantly improved sleepiness mean grades as compared to baseline (P < .0001). Responder rates with armodafinil (72.12%) and modafinil (74.29%) were comparable (P = .76). Adverse event incidences were comparable. Conclusion. Armodafinil was found to be safe and effective in the treatment of SWSD in Indian patients. The study did not demonstrate any difference in efficacy and safety of armodafinil 150 mg and modafinil 200 mg

Spatial and temporal variations in indoor air quality in Lahore, Pakistan

Indoor air pollution is a significant economic burden in Pakistan with an annual cost of 1% of gross domestic product. Moreover, according to the World Health Organization 81% of the population use solid fuels with 70,700 deaths annually attributable to its use. Despite this situation, indoor air pollution remains to be recognized as a hazard at policy level in Pakistan and there are no standards set for permissible levels of indoor pollutants. The current study was designed to monitor the indoor air quality in residential houses (n = 30) in Lahore, Pakistan. PM2.5 and bioaerosols were monitored simultaneously in the kitchens and living rooms. Activity diaries were kept during the measurement periods. It was observed that cooking, cleaning and smoking were the principal indoor sources while infiltration from outdoors, particularly in the semi-urban and industrial areas, also made significant contributions. Maximum and minimum air change rate per hour was determined for each microenvironment to observe the influence of ventilation on indoor air quality. Lahore has a low-latitude semi-arid hot climate, and a significant impact of season was observed upon bacterial and fungal levels. It was also observed that the PM2.5 levels rose during the colder months and decreased significantly during the summer season. Low ventilation rates during the winter season as well as meteorological factors resulted in elevated PM levels

No change in calcium absorption in adult Pakistani population before and after vitamin D administration using strontium as surrogate

Vitamin D, parathyroid hormone levels and calcium absorption was assessed before and after cholecalciferol using Strontium as a surrogate. Increase in 25OHD, lowering of iPTH with no effect on Sr absorption was seen, suggesting the possibility that maximal Ca absorption had already been achieved in these volunteers. Introduction: This paper discusses the determination of calcium (Ca) absorption, using strontium (Sr) as a surrogate, before and after a single IM injection of vitamin D3 (600,000 IU). Methods: Baseline serum 25-hydroxyvitamin D (25OHD), Sr, Ca, P, and intact parathyroid hormone (iPTH) were determined in 53 fasting volunteers, followed by administrating (PO) 0.03 mM (4.8 mg/kg) SrCl2 and collecting blood at 0.5, 1 and 4 h to determine the absorption (AUC0→t ) of Sr. Following the initial absorption test, volunteers received a single IM injection of 600,000 IU vitamin D3. Two months later, the fasting serum and the Sr absorption test were repeated, as described above. Results: The IM injection of vitamin D3 caused a significant increase in fasting 25OHD (from 43.5 ± 19 to 66.1 ± 19.1 nmol/L (p \u3c 0.001)) and a trend toward lower serum iPTH (from 59.8 ± 27.8 to 53 ± 31 ng/L). Fasting serum Ca and P remained unchanged. A higher 25OHD level failed (p = 0.32) to translate into a higher rate of Sr absorption. AUC0→4 h were almost identical before and after the IM injection of vitamin D3. Conclusion: A single vitamin D3 injection of 600,000 IU significantly increase mean 25OHD concentration and tended to lower iPTH concentrations in volunteers with initially low 25OHD status, suggesting to utilize this simple form of treatment to improve vitamin D status and to have a possible biological effect on Ca homeostasis. However, we found no obvious effect on Sr absorption, suggesting the possibility that maximal vitamin D-dependent Ca absorption had already been achieved in these volunteers at a lower vitamin D status

Prediction of pre-eclampsia during early pregnancy in primiparas with soluble fms-like tyrosine kinase-1 and placental growth factor

Background: We hypothesized that pre-eclampsia (PE) can be predicted early in primiparas by measuring serum levels of soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PIGF). Methods: All normotensive primiparas attending the antenatal clinics of Aga Khan University Hospital and Aga Khan Hospital for Women, Karachi, Pakistan without any known risk factor for PE were invited to participate in the study. They were divided into two groups based on the development of PE. Their blood samples were collected at 8-15, 16-22, 23-28, 29-34 weeks of pregnancy and once within 1 week of delivery. All samples were analysed for sFlt-1 and PIGF. Results: Six hundred and eleven (46.7%) of 1307 recruited primiparas completed the study according to the protocol. Of these, 39 (6.4%) women developed PE. The difference in serum sFlt-1 was evident as early as 15 weeks of gestation. Higher levels of serum sFlt-1 were present in women who later developed PE. Relatively higher levels of PIGF were observed in non-PE women compared to PE women up to 22 weeks of gestation. However, after 23 weeks of pregnancy, PIGF levels increased in both the groups, but less so in the PE group. Receiver operator characteristics (ROC) curve analysis showed that even in early pregnancy (gestation), serum sFlt-1 alone has the potential to predict PE with area under the curve (AUC), sensitivity and specificity of 0.81, 75.9 and 72.4, respectively. Conclusion: PE can be predicted in primiparas in the early part of second trimester with serum levels of sFlt-1 and in the later part of second trimester with serum levels of PIGF

Participation in publishing:The demoralizing discourse of disadvantage

The dominance of English in global academic publishing has raised questions of communicative inequality and the possible ‘linguistic injustice’ against an author’s mother tongue. Native English speakers are thought to have an advantage as they acquire the language naturalistically while second language users must invest more time, effort and money into formally learning it and may experience greater difficulties when writing in English. Surveys reveal that English as an Additional Language authors often believe that editors and referees are prejudiced against them for any non-standard language. In this paper I critically review the evidence for linguistic injustice through a survey of the literature and interviews with scholars working in Hong Kong. I argue that framing publication problems as a crude native vs non-native polarisation not only draws on an outmoded respect for ‘native speaker’ competence but serves to demoralizes EAL writers and marginalize the difficulties experienced by novice L1 English academics. The paper, then, is a call for a more inclusive and balanced view of academic publishing