American University of Antigua

Pregnancy is a critical window for tobacco cessation; socio-demographic correlates and prenatal care (PNC) utilization behaviors associated with quitting e-cigarette and dual use with conventional cigarettes remain understudied. To examine the influence of socio-demographic characteristics and PNC utilization in the cessation of cigarette, e-cigarette, and dual-use during pregnancy, using Pregnancy Risk Assessment Monitoring System (2016-2022) data. We analyzed data from 223,793 respondents (weighted count = 11,475,844) with singleton births who reported cigarette and/or e-cigarette use during the three months before and the last three months of pregnancy. Socio-demographic and PNC cessation correlates for cigarette, e-cigarette, and dual-use were examined versus continuation using logistic regression analysis. The Adequacy of Prenatal Care Utilization (APNCU) Index assessed PNC. Associations were expressed as adjusted odds ratios with 95% confidence intervals [AOR (95%CIs)]. Tobacco product use declined from 16.9% pre-pregnancy to 7.5% by late pregnancy. Pregnancy-associated cessation rates were 53.7% for cigarettes, 81.0% for e-cigarettes, and 48.1% for dual-use. Primiparity was associated with higher odds of quitting across all groups: cigarettes [1.8 (1.6‒2.0)], e-cigarettes [1.6 (1.2‒2.1)], and dual-use [2.3 (95% CI: 1.7‒3.1)]. Black race and Hispanic ethnicity were positively associated with cessation of cigarettes and dual-use, while Black race was also associated with higher odds of EC cessation. A higher smoking frequency was associated with reduced cessation odds of cigarette [0.2 (0.2‒0.3)] and dual-use [0.3 (0.2‒0.4)], while a higher vaping frequency was associated with reduced e-cigarette cessation [0.3 (0.2‒0.5)]. Inadequate APNCU Index was associated with lower odds of quitting cigarettes [0.6 (0.5‒0.7)] and dual-use [0.6 (0.4‒0.9)], but showed no significant association with e-cigarette cessation [0.9 (0.6‒1.5)]. Distinct socio-demographic and PNC factors influence cessation patterns by product type. Findings underscore potential opportunities to integrate PNC with targeted cessation support, particularly for high-risk groups amid rising e-cigarette and dual use during pregnancy.

Aluminium (Al) deposition in different parts of the brain contributes significantly for the progression of neurodegenerative changes. The present study was undertaken to find out the influence of Ficus religiosa leaves against Al induced deposition of neurofibrillary tangles (NFT) and amyloid plaque in Wistar rats. We used rats of around 12-week age for the study. The animals were divided into 7 groups classified as control, Al, T200 & 300 as two extract treatment groups, FR200 & 300 which served as FR extract control and PRL, the prophylactic group. Aluminium exposure increased the expression of NFT and amyloid plaques along with decreased locomotor activity in the present study. However, these deleterious effects were improved in the form of reduced number of NFT and amyloid plaques by Ficus religiosa leaf extract treatment in a dose dependent manner. The outcomes of our study reveal the therapeutic potential of FR leaves against neurological disorders by combating the amyloid plaque and NFT formation.

Background: The restraint stress can cause reproductive dysfunction and infertility due to oxidative damage, because of the reactive oxygen species. Reproductive dysfunction is associated with the apoptosis of spermatozoa, interference in spermatogenesis, and sperm motility. Since resveratrol (RES) is a well-known natural polyphenol possessing a very high antioxidant potential, the objective of this research was to assess its anti-oxidative role against the restraint stress-induced histomorphological changes in the seminiferous tubules and spermatogenic epithelium. Methodology: Male Wistar albino rats of 12 weeks of age were considered. The restraint stress group was given stress for 6 h daily for 21 days. The treatment groups were administered with 10 and 20 mg/kg doses of RES orally were continued till the 28 th day by using an oropharyngeal tube. The control group received 0.5% sodium carboxymethyl cellulose only. Results: This study observed that the rats which underwent restraint stress have demonstrated decreased diameter of the seminiferous tubules and standard epithelial height ( P < 0.001). However, these dimensions were significantly improved ( P < 0.001) after the administration of both doses of RES. The thinned-out basement membrane was reversed along with the organization of germinal epithelium, and there was no cell clumping. The qualitative analysis also showed that RES decreased the coagulation of testicular tissue, when compared to rats which received restraint stress only. Conclusion: This study reports that the administration of RES reversed the distorted histomorphology of the seminiferous tubules and spermatogenic epithelium, which occurred due to the toxic effects of restraint stress.

Abstract Background & Aims: Small intestinal bacterial overgrowth (SIBO) and intestinal methanogen overgrowth (IMO) are increasingly recognised in functional and structural gastrointestinal disorders, yet uncertainty persists regarding the accuracy of breath tests, the true effect of antibiotic and non-antibiotic therapies, and the risk of recurrence after apparent eradication. We conducted a comprehensive systematic review and meta-analysis to evaluate diagnostic performance, treatment efficacy and recurrence patterns, and to grade the certainty of evidence across these domains. Methods: We searched MEDLINE, Embase, Web of Science, CENTRAL and Scopus from inception to 30 November 2025, supplemented by trial registries and reference lists. Prospective diagnostic accuracy studies comparing glucose breath test (GBT) and/or lactulose breath test (LBT) with small-bowel aspirate culture, interventional studies of antibiotics, herbal antimicrobials or elemental diet, and cohorts reporting SIBO/IMO recurrence after eradication were included. Two reviewers independently performed screening, data extraction and risk-of-bias assessment (QUADAS-2, RoB 2, ROBINS-I, AMSTAR 2). Random-effects bivariate models were used for diagnostic accuracy and random-effects meta-analyses for treatment outcomes. Certainty of evidence was rated using GRADE. Results: Eighty-nine studies met inclusion criteria: 14 diagnostic accuracy studies (n = 757), 32 treatment studies, 18 systematic reviews/meta-analyses and 25 additional observational cohorts. GBT showed pooled sensitivity 54.5% and specificity 83.2% versus culture (diagnostic odds ratio [DOR] 5.17; area under the curve [AUC] 0.74), whereas LBT had sensitivity 42.0%, specificity 70.6% and AUC 0.56, indicating clearly inferior performance. Lower hydrogen cut-offs (10–15 ppm) and post–gastrointestinal surgery cohorts improved GBT accuracy (AUC up to 0.86). Rifaximin achieved pooled intention-to-treat eradication of 70.8% and per-protocol eradication of 72.9%, with adverse events in 4–5%. Across six randomized trials (n = 196), antibiotics increased global symptom response versus placebo (risk ratio 2.46; 95% CI 1.33–4.55). In methane-positive IMO, combination rifaximin–neomycin therapy yielded methane eradication rates of 87% and higher clinical response than either agent alone. Observational cohorts reported recurrence rates of approximately 40–45% within 9–12 months after successful eradication, with lower relapse when prokinetic maintenance was used. GRADE ratings were moderate for GBT accuracy and low for rifaximin eradication, symptom benefit, combination therapy in IMO and recurrence outcomes. Conclusions: GBT, interpreted with contemporary cut-offs, offers moderate, clinically useful accuracy and outperforms LBT as a non-invasive diagnostic test for SIBO. Rifaximin provides substantial but not definitive microbiological eradication and symptom relief, while combination therapy appears necessary for optimal management of methane-dominant IMO. High recurrence rates and low-certainty treatment evidence support viewing SIBO/IMO as chronic relapsing conditions that require integrated strategies targeting motility, structural risk factors and diet, alongside judicious antimicrobial use. Large, well-designed randomized trials with standardized diagnostic and outcome criteria are urgently needed to refine these estimates and guide precision management.

Background: Prenatal stress detrimentally impacts cognition, behavior, and psychosocial traits. Tinospora cordifolia (TC) is known for its antistress and cognitive enhancement properties. However, its effectiveness against stress induced by maternal separation and vibration is not well-documented. The purpose of the study was to assess the neuroprotective effects of TC on neonatal rats who have experienced the prenatal vibration stress and also stress caused by maternal separation. Methods: Pregnant Wistar rats in the stressed group experienced three hours of daily vibration stress from 7-16 days of gestation. The treatment group was given 6 mg/kg of TC extract before vibration stress. The neonates were separated from their mother and treated with TC postnatally. At the end treatment period, the rats were subjected to spatial learning task. Following this, animal brains were processed for Golgi cox staining to study the CA3 neuronal arborization. Results and conclusion: TC-treated mothers showed significantly better spatial learning than those subjected to vibration stress alone. Neonates exposed to prenatal stress took longer time to find the target quadrant, indicating impaired spatial memory, which improved with TC treatment. Increased dendritic branching in CA3 neurons was observed in both TC-treated mothers and neonates. TC extract improves the spatial learning in rats by attenuating the hippocampal CA3 neural damage induced by prenatal vibration stress and maternal separation.

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease that primarily affects joints and causes mobility problems. RA is associated with high mortality and morbidity as a result of the increased prevalence of cardiovascular disease (CVD) and cardiovascular (CV) risk factors, such as blood pressure (BP), in these patients. Exercise has a beneficial effect on CVD and CV risk factorsand improves the overall well-being of RA patients. This systematic review aims to investigate the effect of exercise on CVD and CV risk factors, specifically BP, in RA patients. We searched the relevant literature across databases such as PubMed, PubMed Central, Cochrane Library, ScienceDirect, and Google Scholar. In this study, we included English-language studies with full text and related information on the impact of exercise on CVD in RA patients. The study follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. We used the Joanna Briggs Institute (JBI) appraisal method for evaluating non-randomized clinical trials (RCTs), pilot studies, and observational studies, the Assessment of Multiple Systematic Reviews (AMSTAR) checklist for systematic reviews, and the Narrative Review Checklist for the narrative review studies. Eight relevant studies were included in this systematic review. The study shows that different types of exercise, from low to high intensity, have a beneficial effect on CVD and CV risk factors such as BP in RA patients. Exercise improves mortality, morbidity, and overall quality of life in this patient population. The study strongly recommends incorporating physical activity into the management of RA patients.

<title>Abstract</title> Artificial intelligence (AI) is an increasingly promising technology in psychiatry with the potential to transform mental healthcare. The number of AI applications designed for psychiatric diagnosis and treatment has grown substantially over the last few years; however, clinicians remain concerned about the real-world readiness of these applications in clinical care settings. These concerns have some validity, given recently reported cases of worsening psychosis and suicide attempts associated with AI application use. While there are a few studies that have examined the performance of AI applications on various multiple-choice question banks, the clinical usefulness and practical application of such test performance have yet to be assessed. Assessing test performance will provide an appraisal of the case complexity and appropriateness of the clinical decision-making process used by AI applications. Such an assessment offers a more definitive understanding of the real-world readiness of various AI applications in clinical scenarios, as well as their comparative performance relative to that of human physicians. We conducted a systematic review of peer-reviewed publications from April 2014 to July 2025, evaluating the real-world clinical readiness of publicly available psychiatric AI applications. Following PRISMA and MOOSE guidelines, 68 publications were identified, of which 24 met the inclusion criteria, yielding 24 unique applications. Each AI application was evaluated based on the test administered for clinical competence, with case complexity rated using the Amsterdam Clinical Challenge Scale and clinical decision-making assessed via Miller’s Pyramid of Clinical Competence. The inclusion of the various domains of psychiatric practice—evaluation, diagnosis, psychopharmacology, psychotherapy, and psychosocial intervention was also taken into consideration. Competence was determined based on the intersection of case complexity and decision-making level.Findings revealed substantial heterogeneity in performance across the various domains of psychiatry, with no AI application achieving human-level competence in all domains of psychiatric practice. Some psychotherapy-focused tools demonstrated moderate complexity and comparatively higher competence, while most applications remained limited to basic knowledge application (Miller Level 2). Core clinical domains, such as evaluation and diagnosis, were underdeveloped, with more than 70% of tools lacking defined complexity or competence ratings. Importantly, none of the applications used board certification-style testing; only 10.5% reported training on board-level material, and just 4.2% disclosed the use of training datasets.These results highlight a critical gap between the potential of psychiatric AI and its demonstrated real-world readiness. Standardized, board-style evaluation, transparency in training data, and more rigorous measures of clinical decision-making are essential to building trust and supporting safe integration into psychiatric care.

Introduction: Vitamin D is a fat-soluble vitamin present in two isoforms: vitamin D3 and D2. Along with many essential functions, it also acts as a neurosteroid that plays a vital role in brain development and functioning. Vitamin D deficiency (VDD) is globally seen as associated with risk factors resulting in multiorgan dysfunctions and disorders. The need and demand for nutrition increases during pregnancy and lactation, and a lack of it hampers fetal growth. This review aims to investigate the association between maternal vitamin D levels and the neurodevelopmental health of the offspring. Materials and methods: This review utilised articles published in PubMed and Scopus from 2010 onwards, using specific keywords: maternal, vitamin D deficiency, and neurodevelopment. Systematic reviews, meta-analyses and non-English literature were excluded. A total of 98 articles were retrieved for the review. Discussion: Varying rates of vitamin D deficiency during pregnancy were noticed globally based on geography, race, income, and education. The impact of vitamin D deficiency leading to cognitive disorders such as Schizophrenia, specifically found to be associated with a decrease in GABAergic interneurons, was also reported by various authors. Cortical thickening, decreased surface area of the brain, and decreased expression of GAD proteins associated with VDD have also been reported recently. Conclusion: Vitamin D deficiency has been linked to a host of various neurodevelopmental disorders, including autism spectrum disorder, attention deficit hyperactivity disorder, and schizophrenia. This necessitates the importance of ensuring adequate maternal vitamin D levels to support offspring's cognitive and psychological well-being, thereby fostering healthier communities.

The Caribbean region suffers from a high burden of diabetes and diabetes-associated mortality. Despite the evidence for diabetes prevention programs, there have been very few such initiatives in the region. To address this gap, we describe the effectiveness and implementation of the Lifestyle Intervention and Metformin Escalation (LIME) Clinical Trial in reducing the risk of diabetes among individuals with pre-diabetes in the Caribbean. LIME is a quasi-experimental pre-post study that took place between 2018 and 2021. LIME recruited individuals with high-risk pre-diabetes (hemoglobin A1c (HbA1c) between 6.0 and 6.4%) across clinical sites in Barbados, Trinidad and Tobago, Puerto Rico, and the US Virgin Islands. Eligible participants were enrolled in a 6-week lifestyle modification workshop. Six months later, individuals who did not lose at least 5% of their bodyweight or had an HbA1c of 6% or higher were prescribed metformin medication. The primary outcome was a change in HbA1c at 6- and 12-months. Paired t-test and McNemar's test were used to examine change in primary outcome. Implementation outcomes of reach, adoption, and implementation fidelity were assessed using programmatic data. Of 914 individuals screened, 211 (23%) had high-risk pre-diabetes. Of those, 114 enrolled in the study (54% Reach). At the 6-month follow-up, there was a significant reduction in average HbA1c from 6.19% to 5.95% (p < 0.001), average weight from 86.7kg to 85kg (p < 0.001), with a reduction in added sugar intake from 7.3 tsp/day to 3.8 tsp/day (p < 0.0001) but no significant change in physical activity level or fruit and vegetable intake. Reduction in HbA1c (6.19% to 5.67%, p < 0.0001) and weight (85.1kg to 83.7kg, p = 0.0149) was maintained at 12 months. Trained facilitators variably engaged in leading workshops (adoption 25%-100%), and were 100% adherent to the protocol (fidelity). LIME is an effective diabetes prevention intervention for individuals with pre-diabetes in the Caribbean. Future work should investigate approaches to improve reach (eligible participant engagement) and adoption (participation of trained facilitators), and report on cost-effectiveness to inform scale-up of the intervention. clinicaltrials.gov NCT03258723 (23/08/2017).