Practical Applications of Complementary and Alternative Therapies in Adults and Youth with Anxiety Disorders

The use of complementary and alternative medicine (CAM) therapies is becoming an increasingly popular treatment option for anxiety disorders in adults and youth. Parents often are reluctant to use antidepressants due to fear of potential side effects. Youth are often unwilling to participate in cognitive behaviour therapy (CBT) or it is not readily available. Practitioners are not always knowledgeable or open to considering CAM therapies for their patients. This chapter will review the definition of CAM, prevalence of CAM use, its safety and effectiveness and finally its practical applications. Four case studies are discussed in which practitioners were open to the use of CAM and collaborated successfully with parents of youth with anxiety disorders. Literature review is presented for use of vitamin D, melatonin, acupuncture, acupressure and craniosacral therapy

Breast Cancer Risk and Breast-Cancer-Specific Mortality following Risk-Reducing Salpingo-Oophorectomy in BRCA Carriers: A Systematic Review and Meta-Analysis

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/cancers15051625/s1, Table S1: Search strategy for literature search.Background: Risk-reducing salpingo-oophorectomy (RRSO) is the gold standard method of ovarian cancer risk reduction, but the data are conflicting regarding the impact on breast cancer (BC) outcomes. This study aimed to quantify BC risk/mortality in BRCA1/BRCA2 carriers after RRSO. Methods: We conducted a systematic review (CRD42018077613) of BRCA1/BRCA2 carriers undergoing RRSO, with the outcomes including primary BC (PBC), contralateral BC (CBC) and BC-specific mortality (BCSM) using a fixed-effects meta-analysis, with subgroup analyses stratified by mutation and menopause status. Results: RRSO was not associated with a significant reduction in the PBC risk (RR = 0.84, 95%CI: 0.59–1.21) or CBC risk (RR = 0.95, 95%CI: 0.65–1.39) in BRCA1 and BRCA2 carriers combined but was associated with reduced BC-specific mortality in BC-affected BRCA1 and BRCA2 carriers combined (RR = 0.26, 95%CI: 0.18–0.39). Subgroup analyses showed that RRSO was not associated with a reduction in the PBC risk (RR = 0.89, 95%CI: 0.68–1.17) or CBC risk (RR = 0.85, 95%CI: 0.59–1.24) in BRCA1 carriers nor a reduction in the CBC risk in BRCA2 carriers (RR = 0.35, 95%CI: 0.07–1.74) but was associated with a reduction in the PBC risk in BRCA2 carriers (RR = 0.63, 95%CI: 0.41–0.97) and BCSM in BC-affected BRCA1 carriers (RR = 0.46, 95%CI: 0.30–0.70). The mean NNT = 20.6 RRSOs to prevent one PBC death in BRCA2 carriers, while 5.6 and 14.2 RRSOs may prevent one BC death in BC-affected BRCA1 and BRCA2 carriers combined and BRCA1 carriers, respectively. Conclusions: RRSO was not associated with PBC or CBC risk reduction in BRCA1 and BRCA2 carriers combined but was associated with improved BC survival in BC-affected BRCA1 and BRCA2 carriers combined and BRCA1 carriers and a reduced PBC risk in BRCA2 carriers.Rosetrees Trust CF1\100001Barts Charity ECMG1C3

Anxiety — Is There an App for That? Considering Technology, Psychiatry, and Internet-Assisted Cognitive Behavioral Therapy

Across Western countries, more than a third of people will have a mental health disorder over their lifetime; mood and anxiety disorders are the most common. The effectiveness of psychological interventions is well established. Cognitive Behavioural Therapy (CBT), for example, is as effective for mild and moderate anxiety as medications; combined psychopharmacology and CBT is superior to either modality alone, suggesting a synergistic effect. However, CBT requires a major investment of time and resources. Thus, in public systems, CBT has limited availability and is subject to long waiting times; primary-care physicians and psychiatrists may not offer CBT

IN-HOSPITAL MORTALITY ASSOCIATED WITH ACUTE KIDNEY INJURY AMONG NEWBORNS AT A TERTIARY CARE HOSPITAL

Objective; To determine association of in-hospital outcome of AKI with etiology in newborns at a tertiary care hospital. Methods; This descriptive cross-sectional study was conducted at Department of Pediatric Medicine, Nishtar Hospital, Multan by using non-probability purposive sampling technique from June 2016 to December 2017. A total of 101 newborns diagnosed with acute kidney injury were registered. Etiological factors were assessed and these patients were followed till discharge to monitor in-hospital outcomes. Results; Of these 101 newborns, 75 (74.3%) were boys while 26 (25.7%) were girls. Mean age of these newborns was 7.59 ± 6.13 days (range; 1 day to 28 days). Mean age of the boys was 5.73 ± 7.20 days while that of girls was 6.77 ± 6.16 days. (p=0.515). Mean weight of these neonates was 2545.05 ± 600.42 grams (range; 1000 grams to 4000 grams). Mean serum potassium level was 4.94 ± 0.92 mgEq/L ranging from 3.1 mgEq/L to 7.0 mgEq/L. Mean urea level was 73.35 ± 27.65 mg/dl ranging from 18 mg/dl to 206 mg/dl. Mean serum sodium level was 145.72 ± 12.64 mgEq/L ranging from 126 to 166 mEq/L. Eighty one (80.2%) were term babies while 20 (19.8%) were pre-term babies. Of these 101 study cases, 29 (28.7%) delivered vaginally while 72 (71.3%) through cesarean section. Delayed crying was noted in 48 (47.5%), dehydration 13 (12.9%), sepsis in 36 (35.6 %) and renal malformation in only 4 %. Neonatal mortality in these patients was 15 (14.9%) while 86 (85.1%) were discharged from hospital after recovery. Conclusion; Acute kidney disease in newborns is associated with significant disease morbidity and mortality with asphyxia and sepsis are the main etiological factors responsible. It is predominantly more common in boys compared with girls. Mortality rate was high in our study and it was significantly associated with female gender. Mortality was also associated with elevated serum sodium and urea level. Keywords; Acute Kidney Injury, Sepsis, Etiology

BURDEN OF THROMBOCYTOPENIA IN CRITICALLY ILL PATIENTS AT A TERTIARY CARE HOSPITAL

Background; Neonatal thrombocytopenia is one of the commonest hematological abnormality encountered in neonatal intensive care unit. Though thrombocytopenia is prevalent it is often overlooked assuming it will resolve spontaneously. However, if it is not detected and managed properly can result in devastating complications. Objective; To determine the frequency of thrombocytopenia in sick neonates admitted in neonatal intensive care unit (NICU). Material and Methods; A total 282 newborns admitted to NICU of department of Pediatrics, Nishtar Hospital, Multan were included in this cross-sectional were enrolled, their blood samples were taken for estimation of platelet count to diagnose thrombocytopenia and all the data was analyzed by SPSS. Results; Of these 282 study cases, 198 (70.2 %) were male patients while 84 (29.8 %) were female patients. Mean age of our study cases was 5.18 ± 3.69 days. Of these 282 study cases, 85 (30.1 %) belonged to rural areas and 197 (69.9 %) belonged to urban areas. Of these 282 study cases, 187 (66.3%) mothers were illiterate while 95 (33.3%) were literate. Preterm birth was noted in 116 (41.1 %) of our study cases. Of these 282 study cases, 188 (66.7%) were born through vaginal deliveries while 94 (33.3%) by cesarean section. Mean duration of disease was 2.34 ± 1.10 days and 241 (85.5%) had disease duration up to 3 days. Mean platelet count of our study cases was 156575.24 ± 50250.53 mm3 and thrombocytopenia was present in 104 (36.9%).  Conclusion; High frequency of thrombocytopenia was observed in sick neonates in our study. Thrombocytopenia was significantly associated with age, residential status, maternal literacy, preterm births, mode of delivery and disease duration. All the clinicians treating such patients should regularly monitor platelet count of all the patients admitted to NICU for early diagnosis and timely management to save them further complications. This will not only decrease disease morbidity but will also reduce mortalities in these patients. Keywords; Thrombocytopenia, sick neonates, Frequency. DOI: 10.7176/JMPB/52-1

The Internet and CBT: A New Clinical Application of an Effective Therapy

Mental disorders are disabling and common. Depression, for example, has greater global burden of disease than any physical disorder, and almost a third of people will experience some form of mental disorder in their lifetime. The effectiveness of psychological interventions is well established. Cognitive Behavioral Therapy is particularly effective for mood and anxiety disorders. But CBT is demanding of time and resources, partly explaining its limited availability, even in public systems. More and more people have access to the Internet and smartphones, even in the developing world. Internet therapies (including smart-phone apps) have been developed, offering CBT. Can technology help with access to CBT? In this chapter, we will look at the effectiveness of iCBT for several illnesses, based on new evidence from recent randomized controlled trials and meta-analyses, noting that while there is evidence for this therapy, not all programs have the same results. We consider iCBT in the real world, by looking at some popular apps and websites, including MoodGYM, and also present a case from The Scarborough Hospital (where we implemented a free-at-the-point-of-use iCBT program), demonstrating how it can be applied in an outpatient setting. We also present the current strengths and limitations associated with iCBT. Finally, we consider future directions for this field, considering chatbots and the possibilities with Artificial Intelligence

The Influence of Epidural Steroids on Postoperative Pain and Hospital Stay in Patients Having a Single-Level Lumbar Discectomy

Objective:   In this study, we looked at how intra-operative epidural steroids affected postoperative pain and stay duration in patients with unilateral single-level lumbar discectomy. Material & Methods:  A randomized control trial was conducted at Ayub Teaching Hospital Abbottabad. Group A (n = 30) was given intraoperative epidural methylprednisolone, while group B (n = 30) was given normal saline only. The outcome was measured between the two groups in terms of postoperative pain (visual analog scale), time of mobilization, length of hospital stay, and duration to return to work. Results:  At discharge, the VAS score in group A was 0.40 compared to 2.4 in group B (p = 0.000). At 2 weeks follow-up, the mean VAS score was 1.10 in group A in contrast to 1.4 in group B (p = 0.001). Patients who received local epidural methylprednisolone were mobilized after an average of 1 day, stayed for an average of 1.16 days, and returned to work following 18.2 days, whereas patients in the control group were mobilized after an average of 1.2 days, stayed for an average of 1.86 days and returned to work following 25.9 days. An incidental Dural tear occurs in 2 cases. Conclusion:  Intra-operative epidural steroid is beneficial in reducing post-operative pain, hospital stay, and time to return to work. It allows early mobilization with enhanced recovery and few complications

To determine the frequency of Group B Streptococcal colonization of vagina in women at 35-37 week pregnancy

BACKGROUND: Group B streptococci (GBS) is the usually present in vaginal canal in micro-flora, which usually do not exhibit any symptoms. Instead, in pregnancy, there are certain situations in GBS colonization in vagina, which may lead to several complications. OBJECTIVE: To determine the frequency of Group B Streptococcal colonization of vagina in women at 35-37 week pregnancy. STUDY DESIGN: Cross sectional survey SETTING: Antenatal clinic, Shalamar Hospital Lahore STUDY DURATION: 6 month i.e. From: 05-09-2014 to 06-03-2015 SUBJECTS & METHODS: 350 Booked Patients attending antenatal clinic at Shalamar hospital at 35-37 weeks of pregnancy for routine antenatal checkup were included. Lower vaginal swabs were taken without speculum using sterilized disposable cotton swab and transported to Amies Agar jell and transported to microbiology lab within 24 hours. Laboratory report was collected and reviewed by researcher regarding positive or negative culture for GBS. Patients with positive GBS culture were given intrapartum antibiotics. RESULTS: In our study, out of 350 cases, with the mean age of 26.92+4.84 years. Frequency of GBS colonization of vagina in women at 35-37 week pregnancy was recorded in 12.29% while remaining 87.71% had no findings of the morbidity. CONCLUSION: It was concluded that the frequency of GBS colonization of vagina in women at 35-37 week pregnancy is not very higher and in accordance with other regions of our country, but routine screening may further decline its incidence. KEYWORDS: Pregnancy, last trimester, Group B Streptococcal colonization of vagin

Correlation of Foot Wears with MSK Disorders in Ankle Joints Among Females

AIM: This paper is a report of study conducted to explain the factors that causes ankle sprain by wearing high heels among students of Sargodha medical college and university of Sargodha.BACKGROUND: High heeled shoes have been worn for several centuries and despite numerous cautions against their use, they remain extremely popular. Wearing high heeled shoes is thought to increase the individual’s likelihood of experiencing a lateral ankle sprain. The 19th century saw the first warnings that wearing high heels footwear could lead to trips and falls. Previous investigations have shown that high heeled shoes align the foot in planter flexion, modifying the relative orientation of the skeletal structures of ankle, midtarsal, and metatarsophalangeal joints, and alter the insertion angles of the foot and gliding joint muscles, therefore increasing the risk factor for ankle sprain.METHODS: observational non-experimental study was conducted via a questionnaire which was distributed among 500 female students of SMC (Sargodha medical college) and university of Sargodha. These female students fall in age group between18-26.RESULT: The result of our study concluded that the types of heel and height of heel are the most significant factors that cause ankle sprain. The ankle sprain caused by wearing pencil heels and by use of <3 inch heels are greatest. Keywords: Pencil heel, height of heel, Ankle sprain, SMC, Female student. DOI: 10.7176/JHMN/80-09 Publication date:September 30th 202