Should testing for obstructive sleep apnea be offered routinely to older family medicine patients? A prospective cohort study

In our previous studies, we offered older family medicine patients testing for obstructive sleep apnea (OSA) and discovered that 80% of patients who accepted, were later diagnosed with unsuspected OSA. In the present study, we followed such patients for 3 years of usual treatment. The goals were to (1) observe whether wider testing for OSA would increase case recognition and treatment uptake; (2) identify symptom and health characteristics associated with diagnosis and treatment efficacy. 101 women and 75 men (>45 years) recruited from family medicine clinics completed questionnaires, polysomnography and consented to chart review (Time 1). Participants with OSA were offered treatment and follow-up with a sleep medicine specialist. All were re-evaluated after 3 years (Time 2). At Time 1, 93% of participants received a diagnosis of OSA. Of these, 53 initiated treatment (46 PAP therapy); at Time 2, 24 PAP users met criteria for adherence. PAP-adherent participants had worse OSA and worse reported symptoms at Time 1 than non-adherent participants. At Time 2, PAP-adherent participants improved on insomnia and daytime symptoms compared to non-adherent participants who showed no change. Adherent and non-adherent participants showed no difference in health indices at Time 1 and no change at three-year follow-up. Benefits of treatment included improvements in co-morbid insomnia and daytime functioning; however, offering wider testing for OSA to older, family medicine patients yielded a high rate of diagnosis but low treatment adoption and adherence. Therefore, a cost-effective strategy would identify and support those likely to adopt and adhere to treatment.

An evaluation of the accuracy and safety of prescribing antidepressants and anxiolytics in a paediatric population

Introduction

An NHS Digital survey found that 1 in 8 children aged between 5-19 had at least one mental health disorder in England in 2017.1 Since this survey the prescribing of antidepressants and anxiolytics has increased every year for the past five years in England.2 A GP surgery within East Sussex requested an evaluation of whether prescribing of mental health disorder medication in paediatrics was following legal and clinical guidance. This evaluation reviewed whether the GP practice had followed Summary of Product Characteristics (SPC) prescribing requirements and the East Sussex Healthcare NHS Trust (ESHT) formulary requirements in the use of antidepressants and anxiolytics in the paediatric population.

Aim

To evaluate whether medicines were prescribed in accordance with their SPC, the ESHT Formulary requirements and monitoring requirements. The evaluation also assessed whether patients’ GP records were up to date as per clinic letters and whether patients were receiving cognitive behavioural therapy (CBT) and/or were under the care of appropriate mental health specialists.

Methods

A search was conducted via the EMIS system. Inclusion criteria were that the patient was under the age of eighteen, had an anxiolytic and/or antidepressant prescribed and were registered with the practice between the beginning of March 2022 to the end of April 2022. Data was analysed via excel spreadsheet with patients allocated a random number. Ethics approval was not required as this was a service evaluation.

Results

Eleven patients met the above criteria. Out of these patients 46% were on sertraline, 46% on fluoxetine, 18% on mirtazapine and 9% on citalopram. Audit results demonstrated that 90% of patients were under the supervision of a mental health specialist and/or receiving CBT, 66% of medications were prescribed as per their SPC with 69% prescribed in accordance with the ESHT formulary. Monitoring requirements conducted within the last 12 months was completed for 64% of patients. In addition, 45% of patients had an incorrect medication list when compared to neurology clinic letter with errors ranging from missing medication to incorrect dosing. It was also found that 82% of patients had incorrect coding on their problem lists with errors ranging from missed diagnoses to medication being incorrectly linked to problems.

Discussion/Conclusion

The results show that most prescribing followed formulary and SPC requirements, and that patients had CBT either in place or in the process of being organised. However, more care is needed with monitoring, coding and processing clinic letters within this practice. Clinic letters with new diagnoses and medication changes were not seen by a clinical professional, potentially leading to errors. A small cohort of patients and COVID restrictions with staff and patients were the primary limitations of this study. More research is needed to determine whether other GP surgeries have the same strengths and challenges found within this surgery, and whether lessons can be learnt to standardise practice.

References

1. NHS Digital. Mental health of children and young people in England, 2017. Available from: https://dera.ioe.ac.uk/32622/1/MHCYP%202017%20Summary.pdf

2. NHS Business Services Authority. Medicines Used in Mental Health – England – 2015/16 to 2020/21. Available from: https://www.nhsbsa.nhs.uk/statistical-collections/medicines-used-mental-health-england/medicines-used-mental-health-england-201516-202021

P229 IMPROVED CLINICAL–INSTRUMENTAL OUTCOMES IN PATIENTS WITH CHRONIC DILATED HYPERTENSIVE / ISCHEMIC HEART DISEASE, UNDERGOING CCM, CARRIER OF CRTD WITH PERSISTENT SEVERE LEFT VENTRICULAR DYSFUNCTION

A 62–year–old man repeatedly subjected to PTCA + stent with severe left ventricular dysfunction and estimated FE 15%. After some hospitalizations for heart failure in 2015 he underwent an AICD implant Biventricular. Followed up in our clinics dedicated to heart failure, the patient did not present the characters of the CRT responder presenting a constant high end–systolic volume (224 ml) and none FE improvement of 15%. There was also an asthenia and tendency to inactivity and elevated NT Pro BNP levels despite optimal medical therapy even with entresto 24/26 mg x 2 / day. It has been decided to submit the patient enrolled in the cardiac transplant and / or VAD implantation lists to an implantation procedure of CCM system (cardiac contractility modulation). After two active fixation placement leads on the interventricular septum and connection to the CCM system housed in the subcutaneous pocket right contralateral to the biventricular AICD, the patient was monitored. We have noticed since the first days conditions of hemodynamic stability. Scheduled CCM therapy delivery for 10 hours a day. Following subsequently in the follow up at 3 – 6 – 12 – 18 months the patient showed an improvement of minneshota quality of life questionnaire in heart failure: MLWHFQ (44 at baseline, 17 at two months, 15 to six months, 10 to 12 months and 3 to 18 months), an increase in FE from 15 to 23 up to 26%, a reduction of the NTPROBNP from 13444 to 1178 then climbed back to 5549 and 3712 at 18 months for atrial fibrillation, without any requires re–hospitalization, an increased physical activity of the patient detected by the sensors of the two devices

P29 AICD IMPLANTATION IN A PATIENT RESURRECTED FROM CARDIAC ARREST, WITH THE R / T PHENOMENON AT THE HOLTER

A 72–year–old woman with hypertension for thirty years, resuscitated from cardiac arrest during prosthetic surgery of the right knee in January 2020, with external heart massage and orotracheal intubation. On examination Holter performed in February 2021, presence of couples and R / T phenomenon with Lown 1B–3–4A–5 class. The patient is subjected to coronary angiography which showed only mild atheroma without stenosis hemodynamically significant of the arterial districts explored. On the Echocardiogram, FE estimated at 60%. Based on the anamnestic data and the feedback from the fifth class of Lown at the Holter, it was decided to implant a dual chamber defibrillator for secondary prevention. The vulnerable point of refractory ventricular notoriously falls below 300 msec and in the clinical case in question there is a comparison to the holter of fifth class of lown with phenomenon R on T and coupling interval of 276 msec. The precocity of the ventricular ectopias is already in itself a risk factor for MI, reinforced in the case of clincio in question from a history of resuscitated cardiac arrest in a hospital setting. Not indicated to ours opinion of the electrophysiological inducibility study, given the positive clinical history and dynamic ECG according to Holter who examines the arrhythmic phenomenon in its spontaneous and natural way of presenting itself in circadian rhythm. The reproducibility in the laboratory with the SEI, of the electrical vulnerability was in fact in the recent years downsized, due to high specificity but low sensitivity, as there is in the clinical reality of patient neurovegetative and biohumoral fluxuonary factors, which favor the induction of malignant arrhythmias and that escape the predictive laboratory analysis. Making the patient safe with the implant of the bicameral AICD resulted from a clinical – diagnostic – instrumental analysis and after extensive discussion by the heart team in our Operating Unit.

Anatomical and biochemical studies of Spartium junceum infected by Xylella fastidiosa subsp. multiplex ST 87

Spartium junceum L. is a typical species of Mediterranean shrubland areas, also grown in gardens and parks as an ornamental. In recent years in Europe, S. junceum has been recurrently found to be infected by different subspecies and genotypes of the quarantine regulated bacterium Xylella fastidiosa (Xf). This work presents for the first time the anatomy of S. junceum plants that we found, by means of genetic and immunochemistry analysis, to be naturally infected by Xf subsp. multiplex ST87 (XfmST87) in Monte Argentario (Grosseto, Tuscany, Italy), a new outbreak area within the EU. Our anatomical observations showed that bacteria colonized exclusively the xylem conductive elements and moved horizontally to adjacent vessels through pits. Interestingly, a pink/violet matrix was observed with Toluidine blue staining in infected conduits indicating a high content of acidic polysaccharides. In particular, when this pink-staining matrix was observed, bacterial cells were either absent or degenerated, suggesting that the matrix was produced by the host plant as a defense response against bacterial spread. In addition, a blue-staining phenolic material was found in the vessels and, at high concentration, in the pits and inter-vessels. SEM micrographs confirmed that polysaccharide and phenolic components showed different structures, which appear to be related to two different morphologies: fibrillary and granular, respectively. Moreover, our LM observations revealed bacterial infection in xylem conductive elements of green shoots and leaves only, and not in those of other plant organs such as roots and flowers.

Development of Three Molecular Diagnostic Tools for the Identification of the False Codling Moth (Lepidoptera: Tortricidae)

Three molecular protocols using qPCR TaqMan probe, SYBR Green, and loop-mediated isothermal amplification (LAMP) methods were set up for the identification of larvae and adults of an African invasive moth, Thaumatotibia leucotreta (Meyrick, 1913) (Lepidoptera: Tortricidae). The DNA extracts from larval and adult samples of T. leucotreta were perfectly amplified with an average Ct value of 19.47 ± 2.63. All assays were demonstrated to be inclusive for T. leucotreta and exclusive for the nontarget species tested; the absence of false positives for nontarget species showed a 100% of diagnostic specificity and diagnostic sensitivity for all assays. With the SYBR Green protocol, the Cq values were only considered for values less than 22 (cutoff value) to prevent false-positive results caused by the late amplification of nonspecific amplicons. The limit of detection (LoD) for the qPCR probe protocol was equal to 0.02 pg/µl while a value equal to 0.128 pg/µl for the qPCR SYBR Green assay and LAMP method were established, respectively. The intrarun variabilities of reproducibility and repeatability in all the assays evaluated as CV%, ranged between 0.21 and 6.14, and between 0.33 and 9.52, respectively; the LAMP values were slightly higher than other assays, indicating a very low interrun variability. In order for an operator to choose the most desirable method, several parameters were considered and discussed. For future development of these assays, it is possible to hypothesize the setup of a diagnostic kit including all the three methods combined, to empower the test reliability and robustness.

Impact of the COVID-19 pandemic on obstructive sleep apnea: recommendations for symptom management

STUDY OBJECTIVES

In the context of the current COVID-19 pandemic situation, we address the following important questions: (1) How can patients be identified for possible OSA while sleep clinic testing is temporarily unavailable or limited? and (2) What measures can be suggested to improve sleep health until proper diagnosis and treatment become safe and available again?

METHODS

As a proxy for home or in-laboratory testing, validation of a symptom-based measure of OSA risk is presented, based on an ongoing larger prospective study of 156 family medicine patients with OSA (88 women, 68 men; mean age, 57 years) and 60 control participants (36 women, 24 men; mean age, 54 years) recruited from the community. Participants completed the Sleep Symptom Checklist (SSC) and a range of other self-report measures; primary care patients also underwent a polysomnographic sleep study.

RESULTS

Results showed that (1) individuals with OSA reported more symptoms on the SSC related to insomnia, daytime symptoms, sleep disorders, and psychological maladjustment than did the control group (all P < .001), and (2) their sleep-related symptoms were significantly more severe than those of the control patients. In addition, several polysomnographic indices in recently diagnosed untreated individuals with OSA were significantly correlated with SSC measured sleep disorder symptoms, and SSC scores significantly distinguished participants with OSA from control participants.

CONCLUSIONS

Our findings suggest that family practitioners can effectively prescreen patients for possible OSA by inquiring about 5 items that form the SSC sleep disorders subscale. If OSA is suspected, then we can recommend a range of behavioral techniques to improve symptoms. The current pandemic causes us to reflect that the provisional targeting of symptoms and guidance regarding mitigation strategies while waiting for specialist care could serve patients well at any time.

Dream enactment behavior: review for the clinician

NONE

Dream enactment behavior commonly occurs on occasion in normal children and adults. Disruptive and frequent dream enactment behavior may come to the attention of the clinician either as the primary reason for consultation or as a prominent characteristic of a patient with other sleep disorders. Questioning patients with chronic neurologic and psychiatric disorders may also reveal previously unrecognized behavior. In the absence of sleep pathology, process of dream enactment likely begins with active, often emotionally charged dream content that may occasionally break through the normal REM sleep motor suppressive activity. Disrupted sleep resulting from many possible causes, such as circadian disruption, sleep apnea, or medications, may also disrupt at least temporarily the motor-suppressive activity in REM sleep, allowing dream enactment to occur. Finally, pathological neurological damage in the context of degenerative, autoimmune, and infectious neurological disorders may lead to chronic recurrent and severe dream enactment behavior. Evaluating the context, frequency, and severity of dream enactment behavior is guided first and foremost by a structured approach to the sleep history. Physical exam and selected testing support the clinical diagnosis. Understanding the context and the likely cause is essential to effective therapy.

An Objective Measure of Drowsy Driving: Are We There Yet?

CITATION

Rizzo D, Baltzan M. An objective measure of drowsy driving: are we there yet? J Clin Sleep Med. 2019;15(9):1191-1192.

Serum biomarkers for sepsis in children with febrile neutropenia and cancer

The National Institute for Health and Care Excellence (NICE) defines febrile neutropenia or "neutropenic sepsis" as a patient with an absolute neutrophil count (ANC) less than 0.5 x 109/L and temperature >38°C or signs and symptoms of sepsis.

Sleep, chronic pain, and opioid risk for apnea

Pain is an unwelcome sleep partner. Pain tends to erode sleep quality and alter the sleep restorative process in vulnerable patients. It can contribute to next-day sleepiness and fatigue, affecting cognitive function. Chronic pain and the use of opioid medications can also complicate the management of sleep disorders such as insomnia (difficulty falling and/or staying asleep) and sleep-disordered breathing (sleep apnea). Sleep problems can be related to various types of pain, including sleep headache (hypnic headache, cluster headache, migraine) and morning headache (transient tension type secondary to sleep apnea or to sleep bruxism or tooth grinding) as well as periodic limb movements (leg and arm dysesthesia with pain). Pain and sleep management strategies should be personalized to reflect the patient's history and ongoing complaints. Understanding the pain-sleep interaction requires assessments of: i) sleep quality, ii) potential contributions to fatigue, mood, and/or wake time functioning; iii) potential concomitant sleep-disordered breathing (SDB); and more importantly; iv) opioid use, as central apnea may occur in at-risk patients. Treatments include sleep hygiene advice, cognitive behavioral therapy, physical therapy, breathing devices (continuous positive airway pressure - CPAP, or oral appliance) and medications (sleep facilitators, e.g., zolpidem; or antidepressants, e.g., trazodone, duloxetine, or neuroleptics, e.g., pregabalin). In the presence of opioid-exacerbated SDB, if the dose cannot be reduced and normal breathing restored, servo-ventilation is a promising avenue that nevertheless requires close medical supervision.

Molecular Typing of Bois Noir Phytoplasma Strains in the Chianti Classico Area (Tuscany, Central Italy) and Their Association with Symptom Severity in Vitis vinifera 'Sangiovese'

Bois noir (BN) is the most widespread disease of the grapevine yellows complex in the Euro-Mediterranean area. BN is caused by 'Candidatus Phytoplasma solani' (BNp), transmitted from herbaceous plants to grapevine by polyphagous insect vectors. In this study, genetic diversity among BNp strains and their prevalence and possible association with grapevine symptom severity were investigated in a Sangiovese clone organic vineyard in the Chianti Classico area (Tuscany). Field surveys over 2 years revealed a range of symptom severity on grapevine and an increase of BN incidence. A TaqMan allelic discrimination assay detected only tufB type b among BNp strains, suggesting the prevalence of the bindweed-related ecology. Nucleotide sequence analyses of vmp1 and stamp genes identified 12 vmp1 and 16 stamp sequence variants, showing an overall positive selection for such genes. The prevalent genotype was Vm43/St10, reported for the first time in this study and closely related to strains identified only in the French Eastern Pyrenees. BNp strains identified in the examined vineyard and mostly grouped in separate bindweed-related phylogenetic clusters showed statistically significant differences in their distribution in grapevines exhibiting distinct symptom severity. These results suggest the possible occurrence of a range of virulence within BNp strain populations in the Chianti Classico area.

The challenge of identifying family medicine patients with obstructive sleep apnea: addressing the question of gender inequality

PURPOSE

The purpose of this study was to examine the sleep characteristics, metabolic syndrome disease and likelihood of obstructive sleep apnea in a sample of older, family medicine patients previously unsuspected for sleep apnea.

METHODS

A total of 295 participants, minimum age 45, 58.7% women, were recruited from two family medicine clinics. None previously had been referred for sleep apnea testing. All participants completed a sleep symptom questionnaire and were offered an overnight polysomnography study, regardless of questionnaire results. 171 followed through with the sleep laboratory component of the study. Health data regarding metabolic syndrome disease (hypertension, hyperlipidemia, diabetes and obesity) were gathered by chart review.

RESULTS

Overall, more women than men enrolled in the study and pursued laboratory testing. Of those who underwent polysomnography testing, 75% of the women and 85% of the men were diagnosed with sleep apnea based on an apnea/hypopnea index of 10 or greater. Women and men had similar polysomnography indices, the majority being in the moderate to severe ranges. In those with OSA diagnosis, gender differences in sleep symptom severity were not significant.

CONCLUSIONS

We conclude that greater gender equality in sleep apnea rates can be achieved in family practice if sleep apnea assessments are widely offered to older patients.

Manifestations of Insomnia in Sleep Apnea: Implications for Screening and Treatment

The aims of this study were to examine the presence, type, and severity of insomnia complaints in obstructive sleep apnea (OSA) patients and to assess the utility of the Sleep Symptom Checklist (SSC) for case identification in primary care. Participants were 88 OSA patients, 57 cognitive-behavioral therapy for insomnia (CBT-I) patients, and 14 healthy controls (Ctrl). Each completed a sleep questionnaire as well as the SSC, which includes insomnia, daytime functioning, psychological, and sleep disorder subscales. Results showed that OSA patients could be grouped according to 3 insomnia patterns: no insomnia (OSA), n = 21; insomnia (OSA-I), n = 30, with a subjective complaint and disrupted sleep; and noncomplaining poor sleepers (OSA-I-NC), n = 37. Comparisons among the OSA, CBT-I, and Ctrl groups demonstrate distinct profiles on the SSC subscales, indicating its potential utility for both case identification and treatment planning.

Influence of TNF-α inhibition on oxidative stress of rheumatoid arthritis patients

The aim of this study was to assess circulating levels of reactive oxygen metabolites (ROMs) as a marker of oxidative stress in rheumatoid arthritis (RA) patients during an anti-tumor necrosis factor alpha (TNF-α) treatment. We enrolled 40 patients with RA (36 females; age 53 ± 13 yrs) treated with different subcutaneously administered TNF-α inhibitors. The oxidative status was determined on the basis of plasma samples taken before, at 24 and 52 weeks of the anti-TNF-α treatment. Hydroperoxide levels were measured using the d-ROMs test, a useful clinically proven oxidative stress marker. During the anti-TNF-α therapy, we observed a significant reduction in serum ROMs levels in RA patients from 33.2 ± 10 mg H2O2/L at baseline to 29.5 ± 7 and 29.3 ± 9 mg H2O2/L, at 24 and 52 weeks, respectively (p<0.05). We also identified a significant correlation between the oxidative stress status and the disease activity score on 28 joints/C-reactive protein and health assessment questionnaire disability index. The results of our study demonstrate that a good control of the disease with anti-TNF-α agents can reduce oxidative stress in RA patients. However, further studies of larger patient cohorts are needed to confirm these preliminary data.

IgM peak independently predicts treatment-free survival in chronic lymphocytic leukemia and correlates with accumulation of adverse oncogenetic events

We examined the significance of IgM peaks in chronic lymphocytic leukemia (CLL), including its association with newly reported MYD88, BIRC3, NOTCH1 and SF3B1 mutations. A total of 27, 25, 41 and 57 patients with monoclonal IgM or IgG peaks (IgM and IgG groups), hypogammaglobulinemia (Hypo-γ group) and normal immunoglobulin serum levels (normal-γ group) were, respectively, included. IgM peaks were mainly associated with Binet stage C and the del(17p). Biased usage of IGHV3-48 was shared by both IgM and IgG groups. IGHV3-74 and IGHV4-39 gene rearrangements were specific for IgM and IgG peaks, respectively. SF3B1, NOTCH1, MYD88 and BIRC3 mutation frequencies were 12%, 4%, 2% and 2%, respectively, being over-represented in IgM, IgG and Hypo-γ groups for SF3B1, and being equal between normal-γ and IgM groups for MYD88. Overall, 76%, 87%, 49% and 42% of cases from IgM, IgG, Hypo-γ and normal-γ groups had at least one intermediate or poor prognosis genetic marker, respectively. By multivariate analysis, IgM peaks were associated with shorter treatment-free survival independently from any other univariate poor prognosis biological parameters, including IgG peaks, Hypo-γ, IGHV status, SF3B1 mutations, cytogenetics and lymphocytosis. Therefore, as with IgG peaks, IgM peaks aggravated the natural course of CLL, with increased accumulation of adverse genetic events.

First Report of Knot Disease Caused by Pseudomonas savastanoi on Sweet Olive in Central Italy

In April 2012 the presence of hyperplastic outgrowths on trunks, branches, and twigs of sweet olive plants, Osmanthus fragrans Lour (Fam. Oleaceae), was recorded in two ornamental hedges made up of five and four plants, respectively, in the city center of Montecatini (Pistoia-Italy). All sweet olive plants were seriously affected by the disease with outgrowths appearing either singly or close together, often forming a single mass that could extend up to 20 cm along the stems, occasionally surrounding the entire circumference. The symptoms observed on O. fragrans closely resembled those induced by the bacterium Pseudomonas savastanoi on Olea europea (common olive) and other plant species. Suspecting a bacterial origin of the disorder, young knots were collected from four diseased plants and used for bacterial isolation with standard techniques on nutrient sucrose agar medium (1). After 3 days of incubation at 26°C, non-levan forming colonies about 3 mm in diameter that were circular, convex, smooth, and cream colored with entire margins appeared on the surface of the agar medium. Purified isolates were gram negative, levan negative, oxidase negative, potato rot negative, arginine dihydrolase negative, showed a tobacco hypersensitive reaction, and tested positive to PCR screening for the presence of the iaaM (tryptophan-2-monooxygenase), iaaH (indoleacetamide hydrolase), ptz (isopentenyl transferase) (1) and iaaL (IAA-lysine synthethase) (3) genes. Three isolates were selected arbitrarily and further characterized by sequencing a fragment of the housekeeping genes rpoD (sigma factor 70) and pgi (phosphoglucose isomerase) (2). All sequenced gene fragments, of 620 bp and 552 bp for the rpoD and pgi genes, respectively, were identical to those of P. savastanoi pv. savastanoi strain NCPPB3335. The pathogenicity of the three isolates was verified on three O. fragrans plants and three Olea europea (cv. Frantoio) plants. Per each isolate, three 1-cm wounds were made on the branches of each plant using a sterile scalpel dipped in a bacterial suspension (1 × 10⁸ CFU/ml). P. savastanoi pv. savastanoi PVFi-t2b isolated from olive was also inoculated as reference strain. After 30 days, all isolates including the reference strain induced typical knots on both plant species while no symptoms were observed on wounds inoculated with sterile water. Bacteria were reisolated from induced knots and Koch's postulates were confirmed. On the basis of biochemical tests, PCR screening, pathogenicity testing, and sequence analyses, the causal agent of knot disease on O. fragrans was identified as P. savastanoi. The potential susceptibility of O. aquifolium Sieb. to the causal agent of olive knot disease has been demonstrated in the past by means of artificial inoculations but interestingly, in the same trials, O. fragrans had tested negative (4). To the best of our knowledge, this is the world's first report of O. fragrans as natural host of P. savastanoi, which extends the growing list of cultivated and ornamental plant species affected by this phytopathogenic bacterium. References: (1) G. Marchi et al. Eur J. Plant Pathol. 112:101, 2005. (2) N. Parkinson et al. Plant Pathol. 60:338, 2011. (3) R. Penyalver et al. Appl. Environ. Microbiol. 66:2673, 2000. (4) C. O. Smith. Phytopathology 12:271, 1922.

Do all individuals with sleep apnea suffer from daytime sleepiness? A preliminary investigation

We derived descriptive characteristics related to habitual sleep duration and insomnia for individuals newly diagnosed with sleep apnea/hypopnea syndrome and evaluated how sleep apnea/hypopnea syndrome, insomnia, depression, and sleep duration relate to sleepiness and fatigue. In total, 100 participants were divided into three sleep groups: short (<7 hours), long (≥ 8 hours), and midrange (7-7.9 hours). Polysomnography, insomnia, sleepiness, fatigue, depression, and gender were assessed. Half of the participants were short sleepers. They were more likely to have insomnia than midrange or long sleepers and they were more likely to be sleepy than midrange or long sleepers, regardless of insomnia.

Occurrence of Lily mottle virus on Lilium in Italy

Lily mottle virus (LMoV), a member of the genus Potyvirus, is one of the main viruses infecting lily. Symptoms on lily differ according to the susceptibility and sensitivity of different cultivars and hybrids. They range from leaf mottle or mosaic, vein clearing, chlorotic and yellow streaking, leaf curling, and necrotic spots, to milder forms of leaf symptoms. Plants may even be symptomless at some stages of growth. A varietal collection of Lilium from the early 1990s is held in Pistoia Province (Tuscany, Italy) and is composed of Asian hybrids obtained from intraspecific breeding of commercial cultivars. During a survey conducted from May to June 2010, several plants showing vein clearing, leaf mottle, leaf mosaic, and reddish brownish necrotic spots were observed. Leaf samples from 60 symptomatic or symptomless lily plants, belonging to 20 cultivars, were collected and tested for the presence of LMoV. Samples were assayed by double-antibody sandwich (DAS)-ELISA and eight of them, belonging to four different cultivars, tested positive. Total RNA was extracted from 2 g of leaf tissue of every collected sample according to the protocol described earlier (3) and cDNA synthesis was performed with an iScript cDNA Synthesis Kit (Bio-Rad, Hercules, CA). Samples were tested by reverse transcription (RT)-PCR and real-time PCR assays using primers LMoV1 (5'-GCAAATGAGACACTCAATGCTG-3') and LMoV2 (5'-CGTGCGTGAAGTAACTTCATAG-3') designed to amplify 651 bp of the coat protein (CP) gene of LMoV (1). Results obtained with RT-PCR and real-time PCR exactly matched those achieved with ELISA assay, and the eight positive samples showed amplicons of the expected size. PCR products from five infected samples were directly sequenced from both directions and submitted in GenBank (Accessions Nos. JQ655106 to JQ655110). Our isolates share more than 99% nucleotide identity among each other. Comparison with other LMoV-CP gene sequences present in GenBank showed nucleotide identities ranging from 93 to 94% with LMoV isolates from South Korea (GenBank Accession Nos. GQ150683 to GQ150686), China (GenBank Accession Nos. EU348826, AJ748256, AJ564636, and AJ564637), Australia (GenBank Accession No. JN127341), and Japan (GenBank Accession No. AB570195). To our knowledge, this is the first report of LMoV on Lilium in Italy where this virus was already reported to infect escarole (2). Considering the economic importance of Lilium production as a flowering plant in Pistoia Province, and in several other areas of Italy, the report of LMoV present on lilies suggests the use of healthy propagation material and the adoption of preventive measures to avoid its diffusion. References: (1) J.-H. Lim et al. Korean J. Microbiol. 45:251, 2009. (2) V. Lisa et al. Plant Dis. 86:329, 2002. (3) D. J. MacKenzie et al. Plant Dis. 81:222, 1997.

Predicting the human in vivo performance of different oral capsule shell types using a novel in vitro dynamic gastric model

The disintegration of a capsule shell may determine the onset of drug dissolution from capsule formulations. In this study, the release of a rapidly dissolving model drug (paracetamol), from two hydroxypropyl methylcellulose capsules containing either carageenan (HPMC-C) or gellan gum (HPMC-G) and one hard gelatin (HG) capsule, were investigated using a conventional in vitro model, the USP dissolution apparatus I, and a novel in vitro model of the human gastric compartment, the dynamic gastric model (DGM). The results obtained in vitro were compared with in vivo gamma scintigraphy human data and in vivo gastric emptying profiles available in the literature. The drug release from HPMC-G capsules, observed with the USP dissolution apparatus I, was delayed with respect to the other two capsules, while the results obtained from the DGM in the fasted state were closer together, which was in agreement with data from the in vivo studies. In the fasted state, the capsule rupture times obtained from the DGM were similar to those observed by gamma scintigraphy in vivo studies. In the fed state, the 'apparent' rupture times observed with the DGM were delayed compared to fasted, and were even longer than those observed by scintigraphy in vivo for HPMC-G and HG capsules. However, these discrepancies can reasonably be explained by considering the impact of food upon dispersion of the capsule contents and the sampling from the DGM, when compared to the human scintigraphy experiments.

Classifying Medication Use in Clinical Research

Background: Medication use data are usually collected in clinical research. Yet no standardized method for categorizing these exists, either for sample description or for the study of medication use as a variable. Objective: The present investigation was designed to develop a simple, empirically based classification scheme for medication use categorization. Method: The authors used factor analysis to reduce the number of possible medication groupings. This permitted a pattern of medication usage to emerge that appeared to characterize specific clinical constellations. To illustrate the technique’s potential, the authors applied this classification system to samples where sleep disorders are prominent: chronic fatigue syndrome and sleep apnea. Results: The authors’ classification approach resulted in 5 factors that appear to cohere in a logical fashion. These were labeled Cardiovascular or Metabolic Syndrome Medication, Symptom Relief Medication, Psychotropic Medication, Preventative Medication, and Hormonal Medication. Conclusions: The findings show that medication profile varies according to clinical sample. The medication profile for participants with sleep apnea reflects known comorbid conditions; the medication profile associated with chronic fatigue syndrome appears to reflect the common perception of this condition as a psychogenic disorder.