Altered Sleep Microarchitecture and Cognitive Impairment in Patients With Temporal Lobe Epilepsy

BACKGROUND AND OBJECTIVES

To investigate the spatiotemporal characteristics of sleep waveforms in temporal lobe epilepsy (TLE) and examine their association with cognition.

METHODS

In this retrospective, cross-sectional study, we examined overnight EEG data from adult patients with TLE and nonepilepsy comparisons (NECs) admitted to the epilepsy monitoring unit at Mass General Brigham hospitals. Automated algorithms were used to characterize sleep macroarchitecture (sleep stages) and microarchitecture (spindles, slow oscillations [SOs]) on scalp EEG and to detect hippocampal interictal epileptiform discharges (hIEDs) from foramen ovale electrodes simultaneously recorded in a subset of patients with TLE. We examined the association of sleep features and hIEDs with memory and executive function from clinical neuropsychological evaluations.

RESULTS

A total of 81 adult patients with TLE and 28 NEC adult patients were included with similar mean ages. There were no significant differences in sleep macroarchitecture between groups, including relative time spent in each sleep stage, sleep efficiency, and sleep fragmentation. By contrast, the spatiotemporal characteristics of sleep microarchitecture were altered in TLE compared with NEC and were associated with cognitive impairments. Specifically, we observed a ∼30% reduction in spindle density in patients with TLE compared with NEC, which was significantly associated with worse memory performance. Spindle-SO coupling strength was also reduced in TLE and, in contrast to spindles, was associated with diminished executive function. We found no significant association between sleep macroarchitectural and microarchitectural parameters and hIEDs.

DISCUSSION

There is a fundamental alteration of sleep microarchitecture in TLE, characterized by a reduction in spindle density and spindle-SO coupling, and these changes may contribute to neurocognitive comorbidity in this disorder.

COVID-19 vaccine delay: An examination of United States residents' intention to delay vaccine uptake

The current study examines differences between COVID-19 vaccine intention and delay. A survey was administered to 585 US respondents in late November 2020 as part of an online longitudinal study. Respondents provided information on whether they would obtain a COVID-19 vaccine, once available, and how long they intended to wait before obtaining it. In the negative intention group, 3.4% reported waiting a few weeks, 34.0% waiting a few months, and 62.6% never getting vaccinated. In multivariable models, social norms were a significant and independent predictor of all vaccine delay and intention models. Vaccine delay was associated with low levels of worry about becoming infected with COVID-19, political conservatism, concerns about vaccine side effects, and low levels of believing a vaccine would be effective. Negative vaccine intentions were associated with worries about becoming infected with COVID-19, concerns about vaccine side effects, beliefs that the vaccines were developed too quickly, and low endorsement of the altruistic belief that older people should have vaccination priority. The study results highlight the importance of a multifactorial approach to assessing vaccine attitudes. The findings suggest that uptake programs should focus on enhancing pro-vaccine norms.

Behavioral and Attitudinal Correlates of Trusted Sources of COVID-19 Vaccine Information in the US

There is a critical need for the public to have trusted sources of vaccine information. A longitudinal online study assessed trust in COVID-19 vaccine information from 10 sources. A factor analysis for data reduction revealed two factors. The first factor contained politically conservative sources (PCS) of information. The second factor included eight news sources representing mainstream sources (MS). Multivariable logistic regression models were used. Trust in Dr. Fauci was also examined. High trust in MS was associated with intention to encourage family members to get COVID-19 vaccines, altruistic beliefs that more vulnerable people should have vaccine priority, and belief that racial minorities with higher rates of COVID-19 deaths should have priority. High trust in PCS was associated with intention to discourage friends from getting vaccinated. Higher trust in PCS was also associated with participants more likely to disagree that minorities with higher rates of COVID-19 deaths should have priority for a vaccine. High trust in Dr. Fauci as a source of COVID-19 vaccine information was associated with factors similar to high trust in MS. Fair, equitable, and transparent access and distribution are essential to ensure trust in public health systems' abilities to serve the population.

Saccade vigor and the subjective economic value of visual stimuli

Decisions are made based on the subjective value that the brain assigns to options. However, subjective value is a mathematical construct that cannot be measured directly, but rather is inferred from choices. Recent results have demonstrated that reaction time, amplitude, and velocity of movements are modulated by reward, raising the possibility that there is a link between how the brain evaluates an option and how it controls movements toward that option. Here, we asked people to choose among risky options represented by abstract stimuli, some associated with gain (points in a game), and others with loss. From their choices we estimated the subjective value that they assigned to each stimulus. In probe trials, a single stimulus appeared at center, instructing subjects to make a saccade to a peripheral target. We found that the reaction time, peak velocity, and amplitude of the peripherally directed saccade varied roughly linearly with the subjective value that the participant had assigned to the central stimulus: reaction time was shorter, velocity was higher, and amplitude was larger for stimuli that the participant valued more. Naturally, participants differed in how much they valued a given stimulus. Remarkably, those who valued a stimulus more, as evidenced by their choices in decision trials, tended to move with shorter reaction time and greater velocity in response to that stimulus in probe trials. Overall, the reaction time of the saccade in response to a stimulus partly predicted the subjective value that the brain assigned to that stimulus.NEW & NOTEWORTHY Behavioral economics relies on subjective evaluation, an abstract quantity that cannot be measured directly but must be inferred by fitting decision models to the choice patterns. Here, we present a new approach to estimate subjective value: with nothing to fit, we show that it is possible to estimate subjective value based on movement kinematics, providing a modest ability to predict a participant's preferences without prior measurement of their choice patterns.

Amalaki rasayana, a traditional Indian drug enhances cardiac mitochondrial and contractile functions and improves cardiac function in rats with hypertrophy

We evaluated the cardioprotective effect of Amalaki Rasayana (AR), a rejuvenating Ayurvedic drug prepared from Phyllanthusemblica fruits in the reversal of remodeling changes in pressure overload left ventricular cardiac hypertrophy (LVH) and age-associated cardiac dysfunction in male Wistar rats. Six groups (aging groups) of 3 months old animals were given either AR or ghee and honey (GH) orally; seventh group was untreated. Ascending aorta was constricted using titanium clips in 3 months old rats (N = 24; AC groups) and after 6 months, AR or GH was given for further 12 months to two groups; one group was untreated. Histology, gene and protein expression analysis were done in heart tissues. Chemical composition of AR was analyzed by HPLC, HPTLC and LC-MS. AR intake improved (P < 0.05) cardiac function in aging rats and decreased LVH (P < 0.05) in AC rats as well as increased (P < 0.05) fatigue time in treadmill exercise in both groups. In heart tissues of AR administered rats of both the groups, SERCA2, CaM, Myh11, antioxidant, autophagy, oxidative phosphorylation and TCA cycle proteins were up regulated. ADRB1/2 and pCREB expression were increased; pAMPK, NF-kB were decreased. AR has thus a beneficial effect on myocardial energetics, muscle contractile function and exercise tolerance capacity.

Absorption of non heme iron in typical and standard meals using extrinsically labeled iron 59Fe

OBJECTIVE

To study the bioavailibility of nonheme iron from standard and test meals in Pakistani adults and to determine iron absorption using extrinsically tagged iron 59Fe.

SUBJECTS AND METHODS

Nonheme iron absorption was measured from standard and test meals in ten healthy individuals. Total calories, carbohydrates, proteins, fats, ascorbic acid, total iron, phytate and ascorbic acid content were determined in both meals. Retention of iron was detected by whole body counting using gamma counter before and after administration of standard, test meals and reference dose.

RESULTS

Iron absorption with test meal was 13% and after adjustment with serum ferritin and reference dose was 16.5 % and 14% respectively. The absorption of standard meal was 6.7% which after adjustment with serum ferritin and reference dose was 8.8% and 6.9% respectively. The iron and ascorbic acid content of test meal was 6.5 mg and 5.7 mg respectively while phytate phosphorus content was 114 mg. The iron and ascorbic acid content of standard meal was 1.3 mg and 2.4 mg respectively while phytate phosphorus content was 137 mg.

CONCLUSION

This evaluated absorption from one of the typical Pakistani diet compared to the standard meal was better. This shows that there are some other physiological factors that lead to iron deficiency anemia in Pakistan.

Preventive strategy to control iron deficiency anemia in children and adults

OBJECTIVE

To compare improvement in hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin and ferritin levels in children aged 5-10 years and women of reproductive age (15-45) supplemented with daily oral and once weekly with single and double dose of ferrous sulphate.

METHOD

Twenty children received 200 mg ferrous sulfate daily and 20 received the same dose once weekly for two months. Ten women received 300 mg ferrous sulfate daily, 10 received the same dose once weekly while 10 received 600 mg of ferrous sulfate once weekly for one month.

RESULTS

All parameters improved significantly in children who received 200 mg ferrous sulfate daily and weekly. Similarly, the parameters improved significantly in women who received 300 mg of ferrous sulfate daily and 600 mg of ferrous sulfate weekly.

CONCLUSION

Weekly supplementation of iron is far better in controlling iron deficiency anemia due to cost effectiveness and better compliance.

Insulin antibody response to bovine insulin therapy: functional significance among insulin requiring young diabetics in India

The majority of young diabetics in India prefer to use low-cost bovine insulin for economic reasons. Therefore, the question of insulin antibody response to bovine insulin and its functional significance is still relevant in the Indian context. We assessed insulin antibody response in 52 young diabetics (type 1, n=25, malnutrition modulated form of diabetes, n=19 and fibrocalculous pancreatopathy (FCP) n=8) on bovine insulin therapy (mean duration 3.0+/-2.1 years) using an internationally standardised in-house radioligand assay. The functional significance of insulin antibody was assessed by calculating their affinity constant, maximum binding capacity and total insulin binding power by Scatchard analysis (type 1, n=14, malnutrition modulated form of diabetes, n=11). All the patients treated with bovine insulin showed high titers of insulin antibodies with S.D. score ranging from 5.1 to 42.0. No significant difference was observed in the mean S.D. score of insulin antibodies in the three diabetic groups. The mean daily insulin dose, maximum insulin binding capacity and total insulin binding power were significantly higher in type 1 when compared to the malnutrition modulated form of diabetes (36+/-8 vs. 26+/-11 IU/day, P<0.05; 9. 7+/-7.8 vs. 4.0+/-3.9 nmol/l, P=0.03 and 59+/-29 vs. 29+/-43, P=0.01, respectively). Insulin antibodies S.D. score and its affinity did not show significant relationship with daily insulin dose and glycemic control (HbAl) at admission. Only 24+/-7% variations in daily insulin requirement were accounted for by total insulin binding power. There was a significant inverse relationship between insulin antibody S.D. score and duration of insulin therapy (r=-0. 4172, P<0.0004). To conclude, insulin antibody response following bovine insulin therapy is not different among type 1, malnutrition modulated form of diabetes and FCP diabetes. The insulin antibody response to bovine insulin therapy does not contribute significantly to increase in daily insulin requirement in bovine insulin treated insulin requiring young diabetics.

Insulin autoantibodies before and after carbimazole therapy in Asian Indian patients with Graves' disease

Carbimazole therapy can induce insulin autoantibodies (IAA) in Japanese Graves' disease patients, a phenomenon possibly linked to their immunogenetic profile. This phenomenon is not observed in Caucasians. We assessed IAA levels in 114 North Indian Graves' disease patients before and after carbimazole therapy (mean duration 6.2 +/- 3.9 months). The functional significance of IAA was assessed in 46 of them by first phase (sum of +1 and +3 min) insulin response to intravenous glucose (IVGTT) and an oral glucose tolerance test (OGTT) undertaken before commencement of the carbimazole therapy. IAA were measured using a radiobinding assay and expressed as the assay precision unit, S.D. scores (S.D.S), over healthy controls. Before treatment 22 of 114 (19.3%) patients were IAA positive (mean +/- S.D., 5.9 +/- 3.2 S.D.S). After carbimazole therapy a further 11 (9.6%) showed positive for IAA (mean +/- S.D., 3.5 +/- 1 S.D.S). Of the 22 patients who were IAA positive before treatment, 12 became negative after carbimazole therapy. The fasting insulin and first phase insulin responses were similar in IAA positive and IAA negative Graves' disease patients (mean +/- S.D., 61.7 +/- 35.9 versus 88.3 +/- 46.6 pmol/l, P = 0.123 and 1127 +/- 696 versus 1033 +/- 430 pmol/l, P = 0.716, respectively). The OGTT results were comparable in the IAA positive and the IAA negative groups. Thus, North Indian Graves' disease patients, who resemble Caucasians in their HLA haplotypes, behave like Japanese in their tendency to become IAA positive with carbimazole therapy. A subset of the patients who were IAA positive before treatment also demonstrated negative IAA (12/22) after carbimazole therapy.

Thrombocytopenia in preeclampsia: an earlier detector of HELLP syndrome

Platelet count was determined in eighty four pregnant women by direct visual method. Among them thirty normal pregnant women were taken as control. Twenty-seven were preeclamptic and twenty seven eclamptic women. There was significant (P < 0.01) reduction in platelet count of preeclamptic and highly significant (P < 0.001) in eclamptic women as compared to controls. It is concluded that there is need to do platelet count in all pregnancy induced hypertensive women, which can be an earlier detector for HELLP syndrome.