The effect of a single dose of multivitamin and mineral combinations with and without guaraná on functional brain activity during a continuous performance task

Objectives: Relatively few studies have explored the possibility of acute cognitive effects of multivitamin ingestion. This report explores the acute brain electrophysiological changes associated with multivitamin and mineral supplementation, with and without guaraná, using the steady-state visually evoked potential (SSVEP).

Methods: Based on the known SSVEP correlates of A-X continuous performance task (CPT) performance, and sensitivity to acute psychopharmacological manipulations, the A-X CPT was adopted as a task paradigm to explore treatment-related neurophysiological changes in attentional processing. Twenty healthy non-smoking adults aged 21–39 years (mean age = 28.35 years, SD = 5.52) took part in this double-blind, placebo-controlled, randomized, balanced crossover design study.

Results: The study demonstrated both transient and tonic changes in the SSVEP response during completion of the A-X CPT following multivitamin and mineral treatment both with and without guaraná. Transient changes in SSVEP response in prefrontal regions were observed after a single dose of a multivitamin and mineral preparation indicative of enhanced activity within brain regions engaged by the attentional demands of the task. This pattern of change in frontal regions was correlated with improved behavioural performance after treatment with the multivitamin and mineral combination. Where tonic shifts in SSVEP response were investigated, multivitamin and mineral treatment was associated with a pattern of increased inhibition across posterior regions, with enhanced excitatory processing in prefrontal regions. In contrast, multivitamin and mineral treatment with additional guaraná showed a tonic shift towards greater excitatory processes after a single treatment, consistent with the caffeine content of this treatment.

Discussion: While preliminary in nature, these findings suggest a single multivitamin/mineral dose is sufficient to impact on functional brain activity in task-related brain regions.     

Metachronous bilateral primary low-grade mucosa-associated lymphoid tissue non-Hodgkins lymphoma of the breast

We report the rare occurrence of bilateral low-grade MALT lymphoma of the breast in a 73 year old female. The clinical, pathological and treatment details are discussed, with a review of the literature.     

Multifocal Visual Evoked Potential (mfVEP) and Pattern-Reversal Visual Evoked Potential Changes in Patients with Visual Pathway Disorders: A Case Series

The purpose of this study was to evaluate multifocal visual evoked potential (mfVEP) and pattern-reversal visual evoked potential (PVEP) changes in patients with pathology at various levels of the visual pathway determined by other methods. Six patients with different visual pathway disorders, including vascular ischaemic events and compressive optic neuropathy, were reviewed. All patients were tested with both mfVEP and full-field and half-field PVEPs. Results were assessed in relation to other diagnostic tests such as magnetic resonance imaging, Humphrey visual field test, and optical coherence topography. The cases in this study demonstrate a potential higher sensitivity of mfVEP compared with conventional PVEPs in detecting lesions affecting the peripheral field, horizontal hemifields, and lesions of the post-chiasmal pathway. The limitation of the PVEP in this setting is probably due to phase cancellation and overrepresentation of the macular region. mfVEP provides a more accurate assessment of visual defects when compared with conventional PVEP. The independent assessment of different areas of the visual field improves the detection and localization of lesions and provides an objective topographical map that can be used in clinical practice as an adjunct to other diagnostic tests and to assess disease progression.     

New Agents for Treating Dry Eye Syndrome

Dry eye syndrome (DES) is characterized by an inadequate volume and/or quality of tears resulting in chronic ocular surface irritation and inflammation. Affecting up to 30 % of adults, DES has a considerable impact on visual function and quality of life. DES may complicate allergic ocular disease and allergy medication may exacerbate DES. The pathophysiology of DES involves osmotic, mechanical and inflammatory insults to the tear film, epithelium and subepithelial nerve plexus. Various immune-related molecular targets have been the focus of research aimed at developing new therapeutic agents for treating DES. This article provides an overview of established, new and future agents for treating DES.     

Impact of fesoterodine on quality of life: pooled data from two randomized trials

OBJECTIVE

To evaluate the effect of fesoterodine on health‐related quality of life (HRQoL) in patients with overactive bladder (OAB) syndrome.

PATIENTS AND METHODS

Pooled data from two randomized placebo‐controlled phase III studies were analysed. Eligible patients with frequency and urgency or urgency urinary incontinence were randomized to placebo or fesoterodine 4 or 8 mg for 12 weeks; one trial also included tolterodine extended release (tolterodine‐ER) 4 mg. HRQoL was assessed using the King’s Health Questionnaire (KHQ), International Consultation on Incontinence Questionnaire–Short Form (ICIQ‐SF), a six‐point Likert scale measuring the severity of bladder‐related problems, and treatment response.

RESULTS

By the end of treatment, all active‐treatment groups had significantly improved HRQoL compared with those on placebo, as shown by an improvement in the KHQ and ICIQ‐SF scores, treatment response rate, and a major improvement in self‐reported bladder‐related problems. The fesoterodine 8‐mg group had statistically significant improvements over placebo in eight of nine KHQ domains. Fesoterodine 4 mg and tolterodine‐ER produced statistically significant improvements in seven of nine KHQ domains. Fesoterodine 8 mg gave better results than 4 mg in two domains; Emotions and Symptom Severity (P < 0.05). A major improvement (≥2 points) in bladder‐related problems was reported by 33% of patients on fesoterodine 4 mg, 38% on fesoterodine 8 mg, and 34% on tolterodine‐ER, vs 21% on placebo (P < 0.001).

CONCLUSIONS

Fesoterodine significantly improved HRQoL in patients with OAB. Both fesoterodine 4 and 8 mg produced significant improvements on most KHQ domains, the ICIQ‐SF, treatment response rate, and a Likert scale measuring bladder‐related problems.