Obstructive sleep apnea and excessive daytime sleepiness among commercial motor vehicle drivers in Lusaka, Zambia

STUDY OBJECTIVES

Obstructive sleep apnea (OSA) is a risk factor for a major public health problem, car crashes, due to excessive daytime sleepiness (EDS). Commercial vehicle driving (CVD) is a hazardous occupation, having a high fatality rate worldwide. There have been no studies on EDS and OSA in Zambia despite the high rate of annual road traffic accidents (RTAs). We aim to determine the prevalence of EDS and OSA risk among CVDs in Lusaka, Zambia, to assess the impact of OSA on high RTA rates.

METHODS

This was a cross-sectional study. The STOP BANG questionnaire and the Epworth Sleepiness Scale were used. Consecutive sampling of drivers was done who were divided into low and high risk of OSA (HROSA). The risk factors associated with OSA in the bivariate analyses were subjected to a multivariate logistic regression model.

RESULTS

One hundred thirty-six drivers participated in the study (all male) with a mean age of 48 ± 5 years. The prevalence of HROSA was 22.8% out of whom 67.7% also had a EDS. Only 9.6% of the total cohort had EDS without HROSA. Using Fisher's exact test, HROSA was significantly associated with older age (> 50 years, P < .001), obesity (body mass index >30, P < .001), neck circumference of > 40 cm (P = .032), and hypertension (P < .001). Snoring and EDS were significantly associated with RTAs (P < .0001 and P = .007, respectively).

CONCLUSIONS

High risk of OSA and EDS are common among CMV drivers in Zambia and underdiagnosed. The risk factors for OSA are amenable to preventive interventions.

CITATION

Simpamba K, May JL, Waghat A, Attarian H, Mateyo K. Obstructive sleep apnea and excessive daytime sleepiness among commercial motor vehicle drivers in Lusaka, Zambia. J Clin Sleep Med. 2023;19(7):1191-1198.

Cancer-associated mutation and beyond: The emerging biology of isocitrate dehydrogenases in human disease

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IDH3α regulates one-carbon metabolism in glioblastoma

Mutation or transcriptional up-regulation of isocitrate dehydrogenases 1 and 2 (IDH1 and IDH2) promotes cancer progression through metabolic reprogramming and epigenetic deregulation of gene expression. Here, we demonstrate that IDH3α, a subunit of the IDH3 heterotetramer, is elevated in glioblastoma (GBM) patient samples compared to normal brain tissue and promotes GBM progression in orthotopic glioma mouse models. IDH3α loss of function reduces tricarboxylic acid (TCA) cycle turnover and inhibits oxidative phosphorylation. In addition to its impact on mitochondrial energy metabolism, IDH3α binds to cytosolic serine hydroxymethyltransferase (cSHMT). This interaction enhances nucleotide availability during DNA replication, while the absence of IDH3α promotes methionine cycle activity, S-adenosyl methionine generation, and DNA methylation. Thus, the regulation of one-carbon metabolism via an IDH3α-cSHMT signaling axis represents a novel mechanism of metabolic adaptation in GBM.

Cancer-Associated IDH1 Promotes Growth and Resistance to Targeted Therapies in the Absence of Mutation

Oncogenic mutations in two isocitrate dehydrogenase (IDH)-encoding genes (IDH1 and IDH2) have been identified in acute myelogenous leukemia, low-grade glioma, and secondary glioblastoma (GBM). Our in silico and wet-bench analyses indicate that non-mutated IDH1 mRNA and protein are commonly overexpressed in primary GBMs. We show that genetic and pharmacologic inactivation of IDH1 decreases GBM cell growth, promotes a more differentiated tumor cell state, increases apoptosis in response to targeted therapies, and prolongs the survival of animal subjects bearing patient-derived xenografts (PDXs). On a molecular level, diminished IDH1 activity results in reduced α-ketoglutarate (αKG) and NADPH production, paralleled by deficient carbon flux from glucose or acetate into lipids, exhaustion of reduced glutathione, increased levels of reactive oxygen species (ROS), and enhanced histone methylation and differentiation marker expression. These findings suggest that IDH1 upregulation represents a common metabolic adaptation by GBMs to support macromolecular synthesis, aggressive growth, and therapy resistance.

Bioconjugation of luminescent silicon quantum dots to gadolinium ions for bioimaging applications

Luminescent imaging agents and MRI contrast agents are desirable components in the rational design of multifunctional nanoconstructs for biological imaging applications. Luminescent biocompatible silicon quantum dots (SiQDs) and gadolinium chelates can be applied for fluorescence microscopy and MRI, respectively. Here, we report the first synthesis of a nanocomplex incorporating SiQDs and gadolinium ions (Gd³⁺) for biological applications. The nanoconstruct is composed of a PEGylated micelle, with hydrophobic SiQDs in its core, covalently bound to DOTA-chelated Gd³⁺. Dynamic light scattering reveals a radius of 85 nm for these nanoconstructs, which is consistent with the electron microscopy results depicting radii ranging from 25 to 60 nm. Cellular uptake of the probes verified that they maintain their optical properties within the intracellular environment. The magnetic resonance relaxivity of the nanoconstruct was 2.4 mM⁻¹ s⁻¹ (in terms of Gd³⁺ concentration), calculated to be around 6000 mM⁻¹ s⁻¹ per nanoconstruct. These desirable optical and relaxivity properties of the newly developed probe open the door for use of SiQDs in future multimodal applications such as tumour imaging.

Crystal structure of the 30 S ribosomal subunit from Thermus thermophilus: purification, crystallization and structure determination

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Structure of a bacterial 30S ribosomal subunit at 5.5 A resolution

The 30S ribosomal subunit binds messenger RNA and the anticodon stem-loop of transfer RNA during protein synthesis. A crystallographic analysis of the structure of the subunit from the bacterium Thermus thermophilus is presented. At a resolution of 5.5 A, the phosphate backbone of the ribosomal RNA is visible, as are the alpha-helices of the ribosomal proteins, enabling double-helical regions of RNA to be identified throughout the subunit, all seven of the small-subunit proteins of known crystal structure to be positioned in the electron density map, and the fold of the entire central domain of the small-subunit ribosomal RNA to be determined.

Visual control of the arm, the wrist and the fingers: pathways through the brain

Sperry and his colleagues had shown that section of the corpus callosum blocks the normally strong interocular transfer of visual learning in chiasma sectioned monkeys. Although interhemispheric transfer of learning was blocked, monkeys could be readily trained to use any combination of eye and hand in a task that required rapid visually guided responses. Sperry suggested that there must be a subcortical pathway linking sensory to motor areas of the brain. We tested monkeys in a task which required them to orient their wrist and fingers correctly in order to remove a morsel of food from a slotted disc. Animals in which we made lesions of the dorsal extrastriate visual areas of the parietal lobe were profoundly impaired in performing this task, but showed no deficit in visual discrimination learning. A monkey with an extensive lesion of the ventral, temporal lobe extrastriate areas showed no deficit in the visuomotor task but was profoundly impaired in visual discrimination learning. Lesions of peri-arcuate cortex, a major cortical target of parietal lobe visual areas, produced only a mild deficit which was motor in character. We suggest that the visuomotor deficit caused by parietal lobe lesions is brought about by depriving the cerebellum of its cortical visual input.

Fluconazole disc diffusion testing for the routine laboratory

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Modified median episiotomy minimizes the risk of third-degree tears

The standard median episiotomy can be easily modified by adding two half-inch transverse cuts in opposite directions in the perineal fascia just above the anal sphincter. The use of this new technique, which is referred to as a modified median episiotomy, increases the diameter at the vaginal outlet 83% more than that provided by a median episiotomy alone. The increased diameter is also 10% greater than a mediolateral episiotomy alone. When an episiotomy is indicated, the exclusive use of this procedure makes the occurrence of third-degree tears extremely rare. The episiotomy is easy to repair.

Hepatic abscess due to Yersinia enterocolitica without bacteremia

A 71-yr-old diabetic patient was evaluated because of right upper quadrant pain. He was found to have a large hepatic abscess secondary to Yersinia enterocolitica infection. He lacked clinical evidence of bacteremia or gastrointestinal infection. It is postulated that Yersinia enterocolitica reached the liver through the portal system from an inapparent intestinal infection. This is the first reported case of a liver abscess secondary to Yersinia enterocolitica without evidence of systemic infection.