EXAMINATION OF THE INCIDENCE OF POOR SLEEP QUALITY AND FACTORS ASSOCIATED FOR POOR SLEEP DURING THE VARIOUS PHASES OF PREGNANCIES

Objective - to measure poor sleep quality, its components, and the variables that contribute to it in a cohort of pregnant women across time. Four hundred and eighty-six strong singleton pregnancies were collected ahead of the fourteenth gestational week. Data on poor sleep quality were gathered before pregnancy and analyzed five distinct times in each trimester and six months after delivery. "Poor sleep quality (PSQ) was defined as a score of fewer than eight on the Athens Insomnia Scale (AIS), and for each trimester, adjusted odds ratios (aOR) with 95% confidence intervals (CI)"were acquired by use of multivariate logistic regression analysis. Pregnancy prevalence of poor SQ was 6.1 percent, followed by 44.2 percent in the first trimester (TR1), 46.3 percent in the second trimester (TR2), and 63.7 percent in the third trimester (TR3). Poor sleep quality after pregnancy was reported by 33.2 percent of women "(28.2-37.9) (p<0.001 for pre-gestational versus TR1, TR2 vs. TR3, and TR3 vs. post-pregnancy)."Due to a decrease in the quality of their nocturnal sleep, TR3's mean AIS score went from 2.34 before pregnant to 9.87; in contrast, TR1's detrimental impact on daytime functioning was larger. Poor sleep during the previous trimester was linked to poor sleep in TR2 and TR3. Poor SQ during pregnancy was a factor in TR1's poor SQ, and obesity was linked to bad sleep in TR3. The risks of having poor sleep quality in TR3 were instead decreased by moderate physical activity. Poor sleep throughout pregnancy was shown to be much more common than good sleep at any point in the pregnancy. In the latter stages of pregnancy, two out of every three expecting moms suffer poor SQ. Particular attention should be paid to pre-gestational poor SQ prevention and high body mass index.

Mitochondrial dysfunction in neurodegenerative disorders

Recent advances in understanding the role of mitochondrial dysfunction in neurodegenerative diseases have expanded the opportunities for neurotherapeutics targeting mitochondria to alleviate symptoms and slow disease progression. In this review, we offer a historical account of advances in mitochondrial biology and neurodegenerative disease. Additionally, we summarize current knowledge of the normal physiology of mitochondria and the pathogenesis of mitochondrial dysfunction, the role of mitochondrial dysfunction in neurodegenerative disease, current therapeutics and recent therapeutic advances, as well as future directions for neurotherapeutics targeting mitochondrial function. A focus is placed on reactive oxygen species and their role in the disruption of telomeres and their effects on the epigenome. The effects of mitochondrial dysfunction in the etiology and progression of Alzheimer's disease, amyotrophic lateral sclerosis, Parkinson's disease, and Huntington's disease are discussed in depth. Current clinical trials for mitochondria-targeting neurotherapeutics are discussed.

Expanding the genetic causes of small-fiber neuropathy: SCN genes and beyond

Small-fiber neuropathy (SFN) is a disorder that exclusively affects the small nerve fibers, sparing the large nerve fibers. Thinly myelinated Aδ-fibers and unmyelinated C-fibers are damaged, leading to development of neuropathic pain, thermal dysfunction, sensory symptoms, and autonomic disturbances. Although many SFNs are secondary and due to immunological causes or metabolic disturbances, the etiology is unknown in up to half of the patients. Over the years, this proportion of "idiopathic SFN" has decreased, as familial and genetic causes have been discovered, thus shifting a proportion of once "idiopathic" cases to the genetic category. After the discovery of SCN9A-gene variants in 2012, SCN10A and SCN11A variants have been found to be pathogenic in SFN. With improved accessibility of SFN diagnostic tools and genetic tests, many non-SCN variants and genetically inherited systemic diseases involving the small nerve fibers have also been described, but only scattered throughout the literature. There are 80 SCN variants described as causing SFN, 8 genes causing hereditary sensory autonomic neuropathies (HSAN) described with pure SFN, and at least 7 genes involved in genetically inherited systemic diseases associated with SFN. This systematic review aims to consolidate and provide an updated overview on the genetic variants of SFN to date---SCN genes and beyond. Awareness of these genetic causes of SFN is imperative for providing treatment directions, prognostication, and management of expectations for patients and their health-care providers.

Co-occurrence of VHL and SDHA Pathogenic Variants: A Case Report

Von Hippel Lindau(VHL)syndrome presents with cerebellar and spinal hemangioblastomas, renal cell cancer, neuroendocrine pancreatic tumor, and pheochromocytoma and it is caused by germline mutations in the VHL gene. Pathogenic germline variants in the succinate dehydrogenase A (SDHA) gene are associated with paraganglioma and pheochromocytoma. Here we report co-occurrence of germline pathogenic variants in both VHL and SDHA genes in a patient who presented with pancreatic neuroendocrine tumor. As these genes converge on the pseudo-hypoxia signaling pathway, further studies are warranted to determine the significance of co-occurrence of these variants in relation to tumor penetrance, disease severity, treatment response and clinical outcomes in this selected group of patients.

Retinal ciliopathies through the lens of Bardet-Biedl Syndrome: Past, present and future

The primary cilium is a highly specialized and evolutionary conserved organelle in eukaryotes that plays a significant role in cell signaling and trafficking. Over the past few decades tremendous progress has been made in understanding the physiology of cilia and the underlying pathomechanisms of various ciliopathies. Syndromic ciliopathies consist of a group of disorders caused by ciliary dysfunction or abnormal ciliogenesis. These disorders have multiorgan involvement in addition to retinal degeneration underscoring the ubiquitous distribution of primary cilia in different cell types. Genotype-phenotype correlation is often challenging due to the allelic heterogeneity and pleiotropy of these disorders. In this review, we discuss the clinical and genetic features of syndromic ciliopathies with a focus on Bardet-Biedl syndrome (BBS) as a representative disorder. We discuss the structure and function of primary cilia and their role in retinal photoreceptors. We describe the progress made thus far in understanding the functional and genetic characterization including expression quantitative trait locus (eQTL) analysis of BBS genes. In the future directions section, we discuss the emerging technologies, such as gene therapy, as well as anticipated challenges and their implications in therapeutic development for ciliopathies.

Novel Autoantibodies in Idiopathic Small Fiber Neuropathy

Objective

Small fiber neuropathy (SFN) is clinically and etiologically heterogeneous. Although autoimmunity has been postulated to be pathophysiologically important in SFN, few autoantibodies have been described. We aimed to identify autoantibodies associated with idiopathic SFN (iSFN) by a novel high‐throughput protein microarray platform that captures autoantibodies expressed in the native conformational state.

Methods

Sera from 58 SFN patients and 20 age‐ and gender‐matched healthy controls (HCs) were screened against >1,600 immune‐related antigens. Fluorescent unit readout and postassay imaging were performed, followed by composite data normalization and protein fold change (pFC) analysis. Analysis of an independent validation cohort of 33 SFN patients against the same 20 HCs was conducted to identify reproducible proteins in both cohorts.

Results

Nine autoantibodies were screened with statistical significance and pFC criteria in both cohorts, with at least 50% change in serum levels. Three proteins showed consistently high fold changes in main and validation cohorts: MX1 (FC = 2.99 and 3.07, respectively, p = 0.003, q = 0.076), DBNL (FC = 2.11 and 2.16, respectively, p = 0.009, q < 0.003), and KRT8 (FC = 1.65 and 1.70, respectively, p = 0.043, q < 0.003). Further subgroup analysis into iSFN and SFN by secondary causes (secondary SFN) in the main cohort showed that MX1 is higher in iSFN compared to secondary SFN (FC = 1.61 vs 0.106, p = 0.009).

Interpretation

Novel autoantibodies MX1, DBNL, and KRT8 are found in iSFN. MX1 may allow diagnostic subtyping of iSFN patients. ANN NEUROL 2022;91:66–77

Anti-phospholipid syndrome and COVID-19 thrombosis: connecting the dots

As the coronavirus disease 2019 (COVID-19) pandemic, which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is spreading rapidly worldwide, it has emerged as a leading cause of mortality, resulting in >1 million deaths over the past 10 months. The pathophysiology of COVID-19 remains unclear, posing a great challenge to the medical management of patients. Recent studies have reported an unusually high prevalence of thromboembolic events in COVID-19 patients, although the mechanism remains elusive. Several studies have reported the presence of aPLs in COVID-19 patients. We have noticed similarities between COVID-19 and APS, which is an autoimmune prothrombotic disease that is often associated with an infective aetiology. Molecular mimicry and endothelial dysfunction could plausibly explain the mechanism of thrombogenesis in acquired APS. In this review, we discuss the clinicopathological similarities between COVID-19 and APS, and the potential role of therapeutic targets based on the anti-phospholipid model for COVID-19 disease.

A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak

OBJECTIVE

Since the declaration of the coronavirus 2019 (COVID-19) outbreak as pandemic, there are reports on the increased prevalence of physical symptoms observed in the general population. We investigated the association between psychological outcomes and physical symptoms among healthcare workers.

METHODS

Healthcare workers from 5 major hospitals, involved in the care for COVID-19 patients, in Singapore and India were invited to participate in a study by performing a self-administered questionnaire within the period of February 19 to April 17, 2020. Healthcare workers included doctors, nurses, allied healthcare workers, administrators, clerical staff and maintenance workers. This questionnaire collected information on demographics, medical history, symptom prevalence in the past month, Depression Anxiety Stress Scales (DASS-21) and the Impact of Events Scale-Revised (IES-R) instrument. The prevalence of physical symptoms displayed by healthcare workers and the associations between physical symptoms and psychological outcomes of depression, anxiety, stress, and post-traumatic stress disorder (PTSD) were evaluated.

RESULTS

Out of the 906 healthcare workers who participated in the survey, 48 (5.3%) screened positive for moderate to very-severe depression, 79 (8.7%) for moderate to extremely-severe anxiety, 20 (2.2%) for moderate to extremely-severe stress, and 34 (3.8%) for moderate to severe levels of psychological distress. The commonest reported symptom was headache (32.3%), with a large number of participants (33.4%) reporting more than four symptoms. Participants who had experienced symptoms in the preceding month were more likely to be older, have pre-existing comorbidities and a positive screen for depression, anxiety, stress, and PTSD. After adjusting for age, gender and comorbidities, it was found that depression (OR 2.79, 95% CI 1.54-5.07, p = 0.001), anxiety (OR 2.18, 95% CI 1.36-3.48, p = 0.001), stress (OR 3.06, 95% CI 1.27-7.41, p = 0.13), and PTSD (OR 2.20, 95% CI 1.12-4.35, p = 0.023) remained significantly associated with the presence of physical symptoms experienced in the preceding month. Linear regression revealed that the presence of physical symptoms was associated with higher mean scores in the IES-R, DASS Anxiety, Stress and Depression subscales.

CONCLUSIONS

Our study demonstrates a significant association between the prevalence of physical symptoms and psychological outcomes among healthcare workers during the COVID-19 outbreak. We postulate that this association may be bi-directional, and that timely psychological interventions for healthcare workers with physical symptoms should be considered once an infection has been excluded.

Understanding the underlying motives and intention among Indian blood donors towards voluntary blood donation: A cross-sectional study

OBJECTIVES

The present study aims to fill the gap in the literature by conducting a comprehensive research on Indian donor's intention towards voluntary blood donation in India. The study attempts to conceptualize and validate an integrative framework incorporating voluntary function inventory (VFI) in the theory of planned behaviour (TPB) model with the purpose tomeasure the voluntary blood donation intention.

MATERIAL AND METHODS

Structural equation modeling (SEM) has been used to rigorously test the hypothesized interrelationships among the underlying motives influencing voluntary blood donation intention. A self-administered questionnaire was used to collect data from a sample of respondents selected conveniently from selct locations in India. Total 450 completed questionnaires were received out of 1000 distributed.

RESULTS

The study develops a final conceptual framework that determines the drivers of blood donor's intention towards voluntary donation. The components of theory of planned behavior (TPB) model which include 'attitude', 'subjective norms' (SN), and 'perceived behavioral control' (PBC) along with modified volunteer functions namely 'value', 'social', 'career' and 'enhancement' were found significantly explaining the donation intention in the model.

CONCLUSION

The model achieves robustness with respect to predicting Indian donor's intention towards the voluntary donation of blood. The proposed model in this study advances the theory and research on thevolunteering motives towards blood donation. The study would provide a comprehensiveunderstanding of donors' intention to the practitioners, policy makers and Non-Government Organization (NGO), helping them to frame a calibrated strategydirected towards facilitating healthy blood donation practices.

A framework of intelligent decision support system for Indian police

Purpose

– The purpose of this paper is to introduce architecture of an Intelligent Decision Support System to fulfill the emerging responsibilities of law enforcement agencies.

Design/methodology/approach

– The proposed Intelligent Police System (IPS) is designed to meet the emerging requirements and provide information at all levels of decision making by introducing a multi-level structure of user interface and crime analysis model. The proposed framework of IPS is based on data mining and performance measurement techniques to extract useful information like crime hot spots, predict crime trends and rank police administration units on the basis of crime prevention measures.

Findings

– IPS has been implemented on actual Indian crime data provided by National Crime Records Bureau (NCRB), which illustrates effectiveness and usefulness of the proposed system. IPS can play a vital role in improving outcome in the crime investigation, criminal detection and other major areas of functioning of police organization by analyzing the crime data and sharing of the information.

Research limitations/implications

– The research in intelligent police information system can be enhanced with some important additional features which include web-base management system, geographical information system, mobile adhoc network technology, etc.

Practical implications

– IPS can easily be applied to any police system in the world and can equally be useful for any law enforcement agencies for carrying out homeland security effectively.

Originality/value

– The research reported in this manuscript is outcome of the research project funded by NCRB. This paper is the first attempt to build framework of IPS for Indian police who deal with large volume and high rate of crimes that are unmatched to any police force of the world.

An efficient statistical feature selection approach for classification of gene expression data

Classification of gene expression data plays a significant role in prediction and diagnosis of diseases. Gene expression data has a special characteristic that there is a mismatch in gene dimension as opposed to sample dimension. All genes do not contribute for efficient classification of samples. A robust feature selection algorithm is required to identify the important genes which help in classifying the samples efficiently. In order to select informative genes (features) based on relevance and redundancy characteristics, many feature selection algorithms have been introduced in the past. Most of the earlier algorithms require computationally expensive search strategy to find an optimal feature subset. Existing feature selection methods are also sensitive to the evaluation measures. The paper introduces a novel and efficient feature selection approach based on statistically defined effective range of features for every class termed as ERGS (Effective Range based Gene Selection). The basic principle behind ERGS is that higher weight is given to the feature that discriminates the classes clearly. Experimental results on well-known gene expression datasets illustrate the effectiveness of the proposed approach. Two popular classifiers viz. Nave Bayes Classifier (NBC) and Support Vector Machine (SVM) have been used for classification. The proposed feature selection algorithm can be helpful in ranking the genes and also is capable of identifying the most relevant genes responsible for diseases like leukemia, colon tumor, lung cancer, diffuse large B-cell lymphoma (DLBCL), prostate cancer.

A New Selection Measure for Classification Using Decision Trees

The paper proposes a new selection measure for classification using decision trees for Data mining. Various algorithms have been proposed in the past for classification using decision trees viz. ID3, CART, SLIQ, etc. Selection measures like the Gain, Gain ratio, and Gini index have been proposed in these algorithms. However, none of the selection measures developed so far take into account the balancing of trees. This paper proposes a new selection measure which also takes into account the balancing of trees that will facilitate in improving the classification accuracy. The performance of the original SLIQ algorithm, C5 and the algorithm using the new selection measure (which takes into account the accuracy as well as the balance factor) was measured on the basis of the classification accuracy. Three real life data sets were chosen for this purpose.

Aesthetic evolution and its infusion in consumer durable

This paper explores some aspects of aesthetics, its qualities and attributes in case of a consumer durable and the association of some attributes and quality with one another. Attempt is also made to understand the extent to which these play a role in designing a consumer durable. The attribute beauty, quality, feel and experience emerged important, whereas in the case of qualities of aesthetics beauty, order and symmetry, definitions, form proportion, finishing and unity of various parts emerged important. Amongst attributes, feel and experience has the highest association with other attributes of aesthetics. The correlation between qualities of aesthetics established that there is association between all the qualities of aesthetics, which confirms interrelationship with each other.

Prognostic significance of biologic factors in squamous cell carcinoma of the esophagus

BACKGROUND

Esophageal carcinoma is one of the most lethal tumors. Therefore, it is important to identify prognostic factors for patients with this disease. The objective of this study was to clarify the relation between clinicopathologic and biologic factors in esophageal carcinoma and to determine the prognostic significance of different biologic factors.

METHODS

DNA ploidy pattern, Ki-67 labeling index (LI), and cyclin D1 and p53 protein expression were examined and detailed pathologic examinations were conducted on tumors from 53 patients (46 males and 7 females with a mean age of 66 years [range, 47-85 years]) with surgically resected esophageal squamous cell carcinoma and the prognostic value of these factors was evaluated.

RESULTS

Of the 53 esophagus carcinomas examined, 26 (49%) were classified as DNA diploid. The mean Ki-67 LI was 45 +/- 4. 9% (range, 10.5-86.1%). p53 expression was detected in 38 of the carcinomas (71.7%) and cyclin D1 expression was detected in 35 (66%). Various prognostic factors were examined using the Cox stepwise regression model, four of which were found to correlate with overall survival: tumor size (P = 0.0346), lymph node status (P = 0.0384), Ki-67 LI (P = 0.0161), and p53 expression (P = 0.001). Lower Ki-67 LI and a lower rate of p53 expression were detected in the long term survival group (> 3 years) compared with the short term survival group (P = 0.00045 and P = 0.0023, respectively).

CONCLUSIONS

The biologic factors of Ki-67 LI and p53 expression, as well as clinicopathologic factors, may be used as independent prognostic factors for patients with esophageal carcinoma. However, the results of the current study do not support cyclin D1 expression as a prognostic factor.

Prognostic significance of biologic factors in squamous cell carcinoma of the esophagus

BACKGROUND

Esophageal carcinoma is one of the most lethal tumors. Therefore, it is important to identify prognostic factors for patients with this disease. The objective of this study was to clarify the relation between clinicopathologic and biologic factors in esophageal carcinoma and to determine the prognostic significance of different biologic factors.

METHODS

DNA ploidy pattern, Ki-67 labeling index (LI), and cyclin D1 and p53 protein expression were examined and detailed pathologic examinations were conducted on tumors from 53 patients (46 males and 7 females with a mean age of 66 years [range, 47-85 years]) with surgically resected esophageal squamous cell carcinoma and the prognostic value of these factors was evaluated.

RESULTS

Of the 53 esophagus carcinomas examined, 26 (49%) were classified as DNA diploid. The mean Ki-67 LI was 45 +/- 4. 9% (range, 10.5-86.1%). p53 expression was detected in 38 of the carcinomas (71.7%) and cyclin D1 expression was detected in 35 (66%). Various prognostic factors were examined using the Cox stepwise regression model, four of which were found to correlate with overall survival: tumor size (P = 0.0346), lymph node status (P = 0.0384), Ki-67 LI (P = 0.0161), and p53 expression (P = 0.001). Lower Ki-67 LI and a lower rate of p53 expression were detected in the long term survival group (> 3 years) compared with the short term survival group (P = 0.00045 and P = 0.0023, respectively).

CONCLUSIONS

The biologic factors of Ki-67 LI and p53 expression, as well as clinicopathologic factors, may be used as independent prognostic factors for patients with esophageal carcinoma. However, the results of the current study do not support cyclin D1 expression as a prognostic factor.

Iron overload in patients with chronic hepatitis C: a clinicopathologic study

Recent studies suggest that increased hepatic iron may impair the response to interferon therapy in patients with chronic hepatitis C. We reviewed the records and liver biopsies of 72 patients with chronic hepatitis C to determine the prevalence of iron overload and to evaluate whether there is a correlation between serum and hepatic iron concentrations and activity of liver disease. Patients with other causes of liver disease or iron overload were excluded. Necroinflammatory activity and fibrosis were evaluated using modified Knodell score. Hepatic iron was assessed using Brissot's grading system. Increased serum iron and ferritin levels were found in 29% and 43% patients, respectively. Hepatic iron grades 0, I, II, III, and IV were present in 37%, 35%, 25%, 3%, and 0% of patients, respectively. A significant correlation was found between hepatic iron grade and serum ferritin (P = .0001). There was no correlation between hepatic iron grade and histological activity index or fibrosis score. In summary, we found a high proportion of patients with chronic hepatitis C had mild to moderate increase in hepatic iron content even when patients with alcoholism and recurrent transfusions were excluded. However, very few patients had severely increased iron load.

Alkaptonuria and renal failure: a case report and review of the literature

In alkaptonuric ochronosis, the absence of homogentisic acid oxidase results in the accumulation of homogentisic acid in the body. Associated renal failure is rare and usually occurs in the later stages of the disease. We report a 19-yr-old girl who presented initially with severe renal failure, without family or past history of illness. There was no significant proteinuria or hematuria. No clinical evidence of pigmentation such as skin and subcutaneous cartilages was noted. However, pigment deposits were identified in the renal biopsy specimens obtained within a week after admission and another after a month. Two months later the peritoneal dialysis fluid and skin progressively darkened, suggesting ochronosis. This was confirmed by the detection of homogentisic acid in the serum and urine. The patient expired in renal failure. Renal biopsy tissues showed diffuse chronic tubulo-interstitial disease characterized by widespread tubular atrophy, interstitial fibrosis, and a moderate degree of inflammation. Many tubular cells contained brown, coarsely granular ochronotic pigment (OP) and a few pigment casts were in the lumina. Similar deposits were also in the interstitium and within histiocytes. Ultrastructural studies of the glomeruli revealed small sparse OP deposits in the visceral and parietal epithelial cells, mesangial cells, and rare extracellular and basement membrane deposits. The tubulointerstitial changes were varied: atrophy and dilatation of tubules, varying degrees of lysosomal OP and degeneration of tubular cells, casts containing OP with crystalline material, histiocytes distended with OP, and free interstitial pigment deposition.(ABSTRACT TRUNCATED AT 250 WORDS)

First seizure in adults: to treat or not to treat

A double-blind trial was done in 228 patients with one single seizure 2 weeks before coming to the author. One group was given sodium valproate, the other group placebo. The duration of therapy was 12 months. The results of this trial show that a person with a single seizure has epilepsy and should be treated with sodium valproate.