The Thinking Healthy Programme (THP), which is endorsed by WHO, is an evidence-based intervention for perinatal depression. We adapted THP for delivery by volunteer peers (laywomen from the ...community) to address the human resource needs in bridging the treatment gap, and we aimed to assess its effectiveness and cost-effectiveness in Rawalpindi, Pakistan.
In this cluster randomised controlled trial, we randomly assigned 40 village clusters (1:1) to provide either THP peer-delivered (THPP) and enhanced usual care (EUC; intervention group) or EUC only (control group) to the participants within clusters. These villages were randomly selected from eligible villages by an independent researcher. The participants were pregnant women aged 18 years or older who had scored at least 10 on the Patient Health Questionnaire-9 (PHQ-9), who we recruited from households within communities in Rawalpindi, Pakistan. The research teams who were responsible for recruiting trial participants were masked to treatment allocations. Participants attended follow-up visits at 3 and 6 months after childbirth. The primary outcomes were the severity of depressive symptoms (assessed by PHQ-9 score) and the prevalence of remission (defined as a PHQ-9 score of less than 5) in participants with available data 6 months after childbirth, which was assessed by researchers who were masked to treatment allocations. We analysed outcomes by intention to treat, adjusting for covariates that were defined a priori or that showed imbalance at baseline. The trial was registered with ClinicalTrials.gov, number NCT02111915.
Between April 15 and July 30, 2014, we randomly selected 40 of 46 eligible village clusters for assessment, as per sample size calculations. Between Oct 15, 2014, and Feb 25, 2016, we identified and screened 971 women from 20 village clusters that had been randomly assigned to the THPP and EUC group and 939 women from 20 village clusters that had been randomly assigned to the EUC only group. In the intervention group, 79 women were ineligible for inclusion, 11 women refused screening, 597 women screened negative on the PHQ-9, and one woman did not consent to participate. In the control group, 75 women were ineligible for inclusion, 14 women refused screening, 562 women screened negative on the PHQ-9, and one woman did not consent to participate. We enrolled 283 (29%) women in the intervention group and 287 (31%) women in the control group. At 6 months after childbirth, 227 (80%) women in the THPP and EUC group and 226 (79%) women in the EUC only group were assessed for the primary outcome. The severity of depression (assessed by PHQ-9 scores; standardised mean difference -0·13, 95% CI -0·31 to 0·06; p=0·07) and prevalence of remission (49% in the intervention group vs 45% in the control group; prevalence ratio 1·12, 95% CI 0·95 to 1·29; p=0·14) did not significantly differ between the groups 6 months after childbirth. There was no evidence of significant differences in serious adverse events between the groups.
THPP had no effect on symptom severity or remission from perinatal depression at 6 months after childbirth, but we found that it was beneficial on some other metrics of severity and disability and that it was cost-effective. THPP could be a step towards use of an unused human resource to address the treatment gap in perinatal depression.
National Institute of Mental Health (USA).
Epilepsy is a persistent dysfunction of the brain and nervous system that causes seizures and affects patients every day. Epilepsy affects more than 2% of people worldwide. Electroencephalogram (EEG) ...signals continue to play an essential role in diagnosing of patients with epileptic disorders. This article classifies EEG Signals for epilepsy through the Convolutional Deep Neural Network. The EEG signal is first decomposed and converted into a two-dimensional time-frequency image. Using the heuristic mode decomposition format, the EEG signal is divided into a specific category of band-limited signal defined as "intrinsic mode functions (IMFs)". According to this process, data from stable and epileptic patients are classified as IMFs. The time rate function is defined using the support vector machine (SVM), the k-nearest neighbor (k-NN), and ensemble classification using the AlexNet model. The results of this analysis indicate that the new EEG and deep neural network-based detection system is currently the most powerful way to identify epileptic seizures.
For centuries, medicinal plants have served as the cornerstone for traditional health care systems and same practice is still prevalent today. In the Himalayan region, Saussurea heteromalla holds a ...significant place in traditional medicine and is used to address various health issues. Despite its historical use, little exploration has focused on its potential for scavenging free radicals and reducing inflammation. Hence, our current study aims to investigate the free radical scavenging capabilities of S. heteromalla extracts. The n-hexane extract of entire plant revealed promising activity. This extract underwent extensive extraction on a larger scale. Subsequent purification, employing column chromatography, HPLC-DAD techniques, led to the identification of active compounds, confirmed via GC-MS and the NIST database as 1-O-butyl 2-O-octyl benzene-1,2-dicarboxylate and 2,4-ditert-butylphenol. Assessing the free radical scavenging properties involved utilizing RAW-264.7 macrophages activated by lipopolysaccharides. Notably, the compound 2,4-di-tert-butylphenol exhibited remarkable scavenging abilities, demonstrating over 80% inhibition of Nitric oxide. This study stands as the inaugural report on the isolation of these compounds from S. heteromalla.
Medicinal plants have significant contribution in pharmaceutical industries being producers of compounds utilized as precursors for drug development. A plant of Lamiaceae family;
had not been ...investigated for its biomedical potential. Current research was aimed to investigate phytochemical analysis, cytotoxic potential and antioxidant activity of crude methanolic extract and fractions of
(leaves). The preliminary phytochemical analysis of crude methanolic extracts and fractions of
revealed that plant is rich in phenolic and flavonoid classes of secondary metabolites while presence of tannin was observed only in crude methanolic extract. The cytotoxicity was determined using brine shrimp lethality test. Different concentrations (25, 50, 100, 150, 200 and 250 µg/mL) of crude methanolic extract and fractions exhibited dose dependent cytotoxicity. However, The LD
for all the extracts was more than 200 µg/mL indicating weak cytotoxic potential of
The antioxidant capabilities of crude methanolic extract and fraction of
were analyzed by in vitro bio assays including DPPH, ABTS, Reducing power and phosphomolybdate antioxidant assays using ascorbic acid as standard. The crude methanolic extract showed IC
(256.38 ± 0.6 and 314.95 ± 1.1 µg/mL) for DPPH and ABTS respectively, while total antioxidant capacity was calculated as 55.79 ± 0.5 µg/mL for crude methanolic extract of
while ascorbic acid indicated total antioxidant capacity of 71.89 ± 2.3 µg/mL. Study concluded that leaves of
were the rich source of antioxidant phytochemicals. Based on preliminary investigations further research should be focused to isolate bioactive phytochemicals as leading source of clinical medicines in future.
Plants have been a source of medicine since ancient times, and such traditional medications are widely practiced nowadays. Saussurea heteromalla is widely used in traditional medicine in the ...Himalayan region for the treatment of different ailments. However, despite its traditional uses, it is not widely explored for its free radical scavenging abilities and other biological activities. Thus, the current study is aimed at exploring the free radical scavenging ability of S. heteromalla extracts, along with the isolation and evaluation of its compound through bioassay-guided purification. From different solvent fractions, an n-hexane extract of a whole plant is found to be most active; thus, it is processed for large-scale extraction and column chromatography. Further, the purification of an active fraction is performed using HPLC–DAD, which led to the isolation of an active peak, identified by GC/MS, as 2-ethylhexyl 2-cyano-3, 3-diphenylprop-2-enoate. This compound, commonly known as octocrylene, is widely recommended for UV-B filter, to be used in the cosmetic industry as photoprotection products. The presence of free radical scavenging activity enhances the sun protection factor of octocrylene. The present study presents the first report on the isolation of this compound from the family Asteraceae. The compound has good free radical scavenging activity and is widely used in the cosmetic industry as a sun protectant and is much less reported from botanical sources.
Background: Knee pain is a typical grievance among adults and frequently connected with general mileage from every day exercises like strolling, bowing, standing and lifting. Competitors who run or ...play sports that include bouncing or fast rotating are additionally bound to encounter knee torment and issues. However, regardless of whether a person's knee torment is brought about by maturing or injury, it very well may be a disturbance and in any event, weakening in certain conditions. Objective: To determine the Frequency of pain or joints complaint in elderly people. Methodology: A cross-sectional survey was conducted on 150 patients from Aug 2020 to Nov 2020 via convenient sampling technique data was collected from private clinics of Hyderabad and Physiotherapy OPD, Suleman Roshan Medical college hospital using standard questionnaire the Western Ontario McMaster Universities osteoarthritis index (WOMAC), and VAS scale for self-reported pain measurement. Data was analyzed using SPSS v.21 Result: Shows that unilateral or predominantly affected knee were found 47%, bilateral Knee 16%, unilateral hip 20%, hip bilaterally 6%, both knee-hip pain reported about 11% among participants. And Patient having none or mild pain 21.3%, moderate pain 26.0%, severe pain 36.7%, extremely severe pain 16.0%. Participants having pain while performing ADLs (Activity of daily livings) reported, No Pain 60.7%, Moderate Pain 33.3%, worst possible pain 6.0% were found. Conclusion: The results of this study indicate that knee joint pain or other complains are high Frequent than hip joint. Keywords: Elderly, Hip, Knee, Frequency , Self-Reported Pain
Medicinal plants have significant contribution in pharmaceutical industries being producers of compounds utilized as precursors for drug development. A plant of Lamiaceae family; Pseudocaryopteris ...foetida had not been investigated for its biomedical potential. Current research was aimed to investigate phytochemical analysis, cytotoxic potential and antioxidant activity of crude methanolic extract and fractions of Pseudocaryopteris foetida (leaves). The preliminary phytochemical analysis of crude methanolic extracts and fractions of Pseudocaryopteris foetida revealed that plant is rich in phenolic and flavonoid classes of secondary metabolites while presence of tannin was observed only in crude methanolic extract. The cytotoxicity was determined using brine shrimp lethality test. Different concentrations (25, 50, 100, 150, 200 and 250 µg/mL) of crude methanolic extract and fractions exhibited dose dependent cytotoxicity. However, The LD50 for all the extracts was more than 200 µg/mL indicating weak cytotoxic potential of Pseudocaryopteris foetida. The antioxidant capabilities of crude methanolic extract and fraction of Pseudocaryopteris foetida were analyzed by in vitro bio assays including DPPH, ABTS, Reducing power and phosphomolybdate antioxidant assays using ascorbic acid as standard. The crude methanolic extract showed IC50 (256.38 ± 0.6 and 314.95 ± 1.1 µg/mL) for DPPH and ABTS respectively, while total antioxidant capacity was calculated as 55.79 ± 0.5 µg/mL for crude methanolic extract of Pseudocaryopteris foetida while ascorbic acid indicated total antioxidant capacity of 71.89 ± 2.3 µg/mL. Study concluded that leaves of Pseudocaryopteris foetida were the rich source of antioxidant phytochemicals. Based on preliminary investigations further research should be focused to isolate bioactive phytochemicals as leading source of clinical medicines in future.
Plants have been a source of medicine since ancient times, and such traditional medications are widely practiced nowadays. Saussurea heteromalla is widely used in traditional medicine in the ...Himalayan region for the treatment of different ailments. However, despite its traditional uses, it is not widely explored for its free radical scavenging abilities and other biological activities. Thus, the current study is aimed at exploring the free radical scavenging ability of S. heteromalla extracts, along with the isolation and evaluation of its compound through bioassay-guided purification. From different solvent fractions, an n-hexane extract of a whole plant is found to be most active; thus, it is processed for large-scale extraction and column chromatography. Further, the purification of an active fraction is performed using HPLC-DAD, which led to the isolation of an active peak, identified by GC/MS, as 2-ethylhexyl 2-cyano-3, 3-diphenylprop-2-enoate. This compound, commonly known as octocrylene, is widely recommended for UV-B filter, to be used in the cosmetic industry as photoprotection products. The presence of free radical scavenging activity enhances the sun protection factor of octocrylene. The present study presents the first report on the isolation of this compound from the family Asteraceae. The compound has good free radical scavenging activity and is widely used in the cosmetic industry as a sun protectant and is much less reported from botanical sources.
Worldwide, more than half a billion women of reproductive age are anaemic. Each year, about 70 000 women who give birth die from postpartum haemorrhage. Almost all deaths are in low-income or ...middle-income countries. We examined the association between anaemia and the risk of postpartum haemorrhage.
We did a prospective cohort analysis of data from the World Maternal Antifibrinolytic-2 (WOMAN-2) trial. This trial enrols women with moderate or severe anaemia giving birth vaginally in hospitals in Pakistan, Nigeria, Tanzania, and Zambia. Moderate anaemia was defined as a haemoglobin concentration of 70–99 g/L and severe anaemia as less than 70 g/L. Hospitals in each country where anaemia in pregnancy is common were identified from a network established during previous obstetric trials. Women who were younger than 18 years without permission provided by a guardian, had a known tranexamic acid allergy, or developed postpartum haemorrhage before the umbilical cord was cut or clamped were excluded from the study. Prebirth haemoglobin, the exposure, was measured after hospital arrival and just before giving birth. Postpartum haemorrhage, the outcome, was defined in three ways: (1) clinical postpartum haemorrhage (estimated blood loss ≥500 mL or any blood loss sufficient to compromise haemodynamic stability); (2) WHO-defined postpartum haemorrhage (estimated blood loss of at least 500 mL); and (3) calculated postpartum haemorrhage (calculated estimated blood loss of ≥1000 mL). Calculated postpartum haemorrhage was estimated from the peripartum change in haemoglobin concentration and bodyweight. We used multivariable logistic regression to examine the association between haemoglobin and postpartum haemorrhage, adjusting for confounding factors.
Of the 10 620 women recruited to the WOMAN-2 trial between Aug 24, 2019, and Nov 1, 2022, 10 561 (99·4%) had complete outcome data. 8751 (82·9%) of 10 561 women were recruited from hospitals in Pakistan, 837 (7·9%) from hospitals in Nigeria, 525 (5·0%) from hospitals in Tanzania, and 448 (4·2%) from hospitals in Zambia. The mean age was 27·1 years (SD 5·5) and mean prebirth haemoglobin was 80·7 g/L (11·8). Mean estimated blood loss was 301 mL (SD 183) for the 8791 (83·2%) women with moderate anaemia and 340 mL (288) for the 1770 (16·8%) women with severe anaemia. 742 (7·0%) women had clinical postpartum haemorrhage. The risk of clinical postpartum haemorrhage was 6·2% in women with moderate anaemia and 11·2% in women with severe anaemia. A 10 g/L reduction in prebirth haemoglobin increased the odds of clinical postpartum haemorrhage (adjusted odds ratio aOR 1·29 95% CI 1·21–1·38), WHO-defined postpartum haemorrhage (aOR 1·25 1·16–1·36), and calculated postpartum haemorrhage (aOR 1·23 1·14–1·32). 14 women died and 68 either died or had a near miss. Severe anaemia was associated with seven times higher odds of death or near miss (OR 7·25 95% CI 4·45–11·80) than was moderate anaemia.
Anaemia is strongly associated with postpartum haemorrhage and the risk of death or near miss. Attention should be given to the prevention and treatment of anaemia in women of reproductive age.
The WOMAN-2 trial is funded by Wellcome and the Bill & Melinda Gates Foundation.
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