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Background This study examined the effect of vitamin B12 supplementation on sleep parameters of latency, total sleep time, wake-after-sleep onset, total time in bed and sleep efficiency in healthy adults. Methods This quasi-experimental pre-test, post-test design recruited adults 25–50 years old, with normal vitamin B12 levels. Sleep parameters were assessed using Phillips Respironics Actiwatch-2® on non-dominant wrist from Monday to Thursday for four weeks. Pre-supplementation data was collected for the first two weeks; then participants started 3mg pre-packaged cyanocobalamin supplements daily for 14 days. Post-supplementation data was collected for weeks three and four. Serum was collected by venipuncture at the beginning and end of the study for vitamin B12 assay. Descriptive statistics involved median and interquartile range [IQR]. A comparison of the sleep parameters before and after cyanocobalamin supplementation was done using non-parametric inferential analysis. Results Fourteen healthy adult participants completed the study; nine females and five males with median age of 37[17] years and a normal range of serum vitamin B12 level (169–695 pmol/L). Median serum vitamin B12 level was significantly elevated following supplementation (355[217] to 961[679]) pmol/L; p = 0.020); but there was no change in any of the sleep parameters measured. Spearman's rho correlation analysis showed no correlation between serum vitamin B12 levels and the sleep parameters for pre-supplementation and post-supplementation weeks. Conclusion Two weeks of cyanocobalamin supplementation (3mg/day) resulted in the expected increase in serum vitamin B12 levels in healthy adults but did not influence their sleep wake activity.

Background: Rational use of medicines (RUM) offers a cost-saving strategy to maximize therapeutic outcomes. The aims of this study were to assess RUM for chronic non-communicable diseases (NCDs) using the World Health Organization’s (WHO) prescribing indicators in a public access facility and to evaluate the alignment of the use of drugs with therapeutic recommendations/guidelines. Design and methods: In this retrospective cross-sectional study, prescriptions of adult patients containing at least one drug for chronic NCDs, filled between January and July 2019 were reviewed using the WHO prescribing indicators for RUM. Data were analyzed and expressed as descriptive statistics. Associations were determined using chi-square tests, correlations using Pearson’s correlation and medians compared using Mann-Whitney U test. For all analyses, significance was determined at p < 0.05. Results: Of the 571 prescriptions reviewed, most were for female, elderly patients with mean age of 69 years, predominantly with hypertension and/or diabetes. Polypharmacy was noted for 53.6% of prescriptions, primarily in elderly patients ( p < 0.001), with the median number of five drugs prescribed and three dispensed. Of the drugs prescribed, 76.6% used generic prescribing, 63.3% were dispensed as written and 3.9% were antibiotics prescribed mainly for asthmatic patients (χ2 = 74.9, p < 0.001). Drugs prescribed for NCDs were aligned to therapeutic guidelines, but a significantly higher proportion of diabetes medications, (metformin and gliclazide), and cardiovascular medications (enalapril and losartan), were not dispensed as written (χ2 = 40.0, p = 0.007). Conclusion: This research indicates that there is positive alignment with recommended therapeutic guidelines, however, based on WHO prescribing factors, strategies to improve RUM in this setting are highly recommended.

ObjectivesTo assess the impact of Cannabis usage on risperidone and haloperidol therapy of schizophrenia symptoms.MethodsMale subjects, ≥18 years, admitted to the University Hospital of the West Indies psychiatric ward between February‐December 2013, and diagnosed with schizophrenia were recruited for the study. Consented subjects were prescribed either risperidone‐ or haloperidol‐monotherapy for 7‐days and oral doses converted to chlorpromazine equivalents (CPZE). Subjects were classified as Cannabis users (CU) or non‐users (non‐CU), with presence/absence of Cannabis metabolite in urine samples. Blood samples were collected on days 1&7 for assessment of cannabinoid and antipsychotic concentrations, respectively, using ultra performance liquid chromatography tandem mass spectrometry (UPLC/MS/MS). Psychotic symptoms were assessed with the Brief Psychiatric Rating Scale (BPRS) on days 1&7 and changes in the scores used as a measure of efficacy of the antipsychotic therapy. Inferential statistical analysis involved non‐parametric tests, expressed as median and IQR, with p<0.05 considered significant.ResultsForty‐Six Afro‐Caribbean males were assessed, with median (IQR) age of 25 (8) years. Majority (n=33; 72%) were CU, with Cannabis‐positive urinalysis, confirmed with the quantification of Δ9‐tetrahydrocannabinol (THC) at 3.0 (8.0) ng/mL and Carboxylated‐THC at 51.0 (53.0) ng/mL in serum samples. CU presented with more severe BPRS scores [61 (33) vs 33 (19); p<0.000] than non‐users. Additionally, more CU displayed depression (60%; r=0.403, p=0.001) and motor retardation (79%; r=0.595, p=0.002) which were positively correlated to serum THC concentration. After seven days of antipsychotic therapy, both CU and non‐CU showed significant clinical improvement of schizophrenia symptoms (≥20% reduction in BPRS scores) with risperidone or haloperidol at CPZE doses ≥300 mg/day. A significantly higher oral CPZE dose of haloperidol was prescribed to CU than non‐CU [1000 (250) vs 500 (500) mg/day; p=0.035]. However, serum concentration of haloperidol was significantly less for CU than non‐CU [3 (2) vs 8 (3) ng/mL; p=0.044]. In contrast, oral doses [300 (75) vs 300 (0); p=0.554] and serum concentration of risperidone [12 (5) vs 13 (4) ng/mL; p=0.739] were equivalent between the groups.ConclusionCannabis users display more severe BPRS‐assessed schizophrenia symptoms compared to non‐users, which can be significantly improved after 7 days of antipsychotic therapy. However, Cannabis use reduces the potency of haloperidol, thus, a significantly higher oral dose is required to adequately treat schizophrenia symptoms. Further studies are recommended.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.