A. Abyad, MD, MPH, MBA, AGSF, AFCHSE (Editor) A. Abyad, MD, MPH, MBA, AGSF, AFCHSE (Editor) Abyad Medical Center & Middle East Longevity Institute Azmi Street, Abdo Center, 2nd Floor PO BOX 618, Tripoli LEBANON Tel & Fax: 961 6 443684/5/6 Email: aabyad@cyberia.net.lb Web: www.amc-lb.com

This is the second issue this year that is rich with papers from the region,. A paper from Jordan provides a position statement by the current author about using ECT treatment modalities among major depressive patients, especially who are irresponsible to psychotropic drugs and psychotherapies. The author did search strategies database of Pub Med, Google Scholar, and American Psychiatric Association was used; they provided many studies about the current topic with using some words as Depression, Electroconvulsive Therapy, Irresponsible, Benefits and Risks. The current (as position statement) author supports to use Electroconvulsive Therapy among major depressive patients especially who are treatment resistant to other treatment modalities to enhance psychiatric symptoms and illness relief. The author concluded that Electroconvulsive therapy is considered effective treatment modality over patients with major depression especially with severe cases and irresponsible to other treatments modalities. Although it has side effect as life threatening for very strict cases, that can be prevented by holistic medical assessment and care.

A second paper looked at the Impact of Prolonged Bed Rest After Percutaneous Coronary Intervention in Term of Vascular Complications and other Patients' Outcomes. The aim of this paper was to highlight the effect of prolonged bed rest after the PCI procedure in term of vascular complications and other patients' outcomes, and to emphasize the importance of early ambulation post-PCI. The methodology was descriptive design has been used with multiple times measurement. to assess the impact of prolonging bed rest after percutaneous coronary intervention . 30 patients were selected to describe selected patients' outcomes including low back pain, puncture site pain, fatigue, comfort, satisfaction, urinary discomfort, hematoma, and bleeding. Using visual analogue scale ( VAS) . This paper recommends that early ambulation after percutaneous coronary intervention is safe and practical, consequently leading to higher levels of satisfaction and comfort and lower level of fatigue, low back pain and urinary discomfort without jeopardizing patient safety.

The third paper looked at the effect of 4- Methylnaltrexone or laxatives for the Management of Opioid-induced Constipation among Palliative Patients on Opioid Therapy. Constipation is a common symptom in advanced cancer patients. Studies have demonstrated that 40 to 80% of patients on a palliative care service have constipation, this proportion increases to ? 90% when patients are treated with opioids. The aim of this article is to determine the effectiveness of methylnaltrexone and laxatives in the management of opioid-induced constipation among cancer patients in palliative care setting, with focus on randomized clinical trials. A comprehensive and extensive online database search of Science Direct Database, PubMed, Springer Online Database, and HINARI/WHO Database was conducted; also reference lists of related studies were searched, six studies fulfilling the inclusion criteria from 1991 to 2009 were selected and formed the basis for this paper. In three studies the laxatives lactulose, senna, co danthramer, misrakasneham, and magnesium hydroxide with liquid paraffin were evaluated, in three methylnaltrexone. In studies comparing the different laxatives evidence was inconclusive. Evidence on subcutaneous methylnaltrexone was clearer; evidence on laxatives for management of constipation remains limited due to insufficient RCTs. Ultimately it can be suggested from the data presented here that subcutaneous methylnaltrexone is effective in inducing laxation in palliative care patients with opioid-induced constipation and where conventional laxatives have failed.

The fourth paper looked at the Association between Vitamin D and Depression Symptoms. Vitamin D (calciferol) comprises a group of seco-sterols, they are considered hormones because of their endocrine, paracrine, and autocrine. Vitamin D reduces the frequency of fractures and falls, reduces symptoms of influenza or colds, and helps to prevent of cardiovascular disease. There are Benefits are seen in depression, Crohn disease, diabetes mellitus, pain, multiple sclerosis, and possibly autism. There are many receptors for vitamin D in the brain, for this reason vitamin D has been linked with mental health problems and depression, as well Vitamin D plays important role in brain development. For patients who show the effectiveness of vitamin D as antidepressant, Vitamin D is one of the most cost-saving therapies and less side effects treatments in psychiatry. There are many number of researches supported the hypothesis of an association between vitamin D and depression symptoms. In addition, to a number of other researches has rejected this association.