Translation of Parkinson's Disease Sleep Scale-2 (PDSS-2) in Hindi (H-PDSS-2) and its Validation for Assessment of Sleep Disturbances among Indian Parkinson's Disease Patients

Background and Objective

Parkinson's disease sleep scale-2 (PDSS-2) is a reliable sleep assessment tool which has been validated in several languages. As sleep problems have a great impact on the quality of life of Parkinson's disease patients, we aimed to translate and validate PDSS-2 in Hindi for its wider use among Hindi-speaking Indian patients. Our study objective was to translate PDSS-2 in Hindi (H-PDSS-2) and to assess the psychometric properties of H-PDSS-2 questionnaire for its use in Hindi-speaking Indian PD patients. Secondly, we aimed to compare the results with those of the other language PDSS-2 validation studies.

Material and Methods

This study was done in two phases, enrolling 16 patients and 16 controls in the first/translation phase for assessment of internal consistency and discriminative power of PDSS-2. The test-retest reliability was determined in the second phase on 35 Parkinson's disease patients who were followed-up at an interval of 7-10 days.

Results

No difficulties were faced by the patients and controls in the first phase, and internal consistency of the scale was good (Cronbach's alpha = 0.804). There was no significant difference in total H-PDSS-2 score at baseline 16.86 ± 10.59 and on retest 16.40 ± 9.54, suggesting good reliability. Intraclass correlation coefficients ranged from 0.710 to 0.901, and precision was 2.82 over the period of 7-10 days. Subdomains of H-PDSS-2 had moderate/high internal validity, and they showed significant correlation with Unified PD Rating Scale (UPDRS) and HY disease scale.

Conclusion

H-PDSS-2 is equivalent to the original PDSS-2 for tested psychometric attributes. Its use among Indian Parkinson's disease patients will help in the comprehensive assessment of sleep problems among PD patients.

Effectiveness of rehabilitation strategies in primary fibromyalgia syndrome: A systematic review and meta-analysis

Objectives

The aim of this review was to (1) summarize evidence on the effectiveness of rehabilitation strategies in fibromyalgia syndrome (FMS) and (2) determine the most effective rehabilitation strategy for reducing pain and depression in people with FMS.

Data Sources

PubMed, Ovid (Sp), and Cochrane search engines were used for identifying relevant studies done up to 1st of July 2022.

Study Selection

Randomized control trials (RCTs) that have a passive control group and an active control group were included in this review for primary and secondary aim, respectively. The primary outcome measures were pain and depression. Secondary outcome was one from the sleep or fatigue or healthy related quality of life (HRQOL).

Data Extraction

Two researchers independently selected the studies and extracted the key information.

Data Synthesis

A total of 25 RCTs were included. Studies with passive control group showed moderate to large positive effects on pain (standard mean difference -0.65, 95% confidence interval -0.93 to -0.38; I2 = 72%) and HRQOL (MD -5.40, 95% CI -10.17 to -0.62; I2 = 74%) but were not statistically significant for sleep, fatigue, and depression. Furthermore, on subgroup analysis studies with a short term protocol showed significant effects on pain only, whereas studies with long term protocols showed positive effects on pain and HRQOL only, but no statistical significance at the time of post-trial follow-up. Studies with active control groups gave non-significant results except where there was mixed exercises, which showed a positive effect (mean difference -4.78, 95% CI -7.98 to -1.57; I2 = 0%) for HRQOL.

Conclusion

All rehabilitation strategies were effective for pain and HRQOL, and had a marginal effect on depression, sleep, and fatigue but efficacy was not maintained at the time of post-trial follow-up. However, in this review, we could not differentiate any rehabilitation strategies for the best among those used in the included studies.

Effect of Early Yoga Practice on Post Stroke Cognitive Impairment

Background

Post-stroke cognitive impairment (PSCI) is a clinical entity that encompasses all types of cognitive impairment following an index stroke. Yoga has been proven to have a beneficial effect not only on cardiovascular risk factors but also on cognition. Hence, this study explored the PSCI spectrum and assessed the effect of yoga on PSCI.

Methods

Forty stroke patients were enrolled in each yoga and control arm in this study. After the baseline assessment, control arm was administered standard care (including physiotherapy) while yoga arm received additional yoga intervention. Change in MoCA scores by 2 points in either direction, or FAB scale by 2 points at 6 months was taken as primary outcome, whereas improvement in MRS, CDPSS, CBS, and P300 values were considered as secondary outcomes.

Results

Significant improvements were observed in MoCA, FAB, MRS, CPDSS, and CBS scores in both groups after 6 months. However, intergroup comparisons revealed better MoCA (25.5, IQR 22-27) and FAB scores (15.5, IQR 14-17) in yoga group compared to controls (24, IQR20-25.75) and (14, IQR12-15.75). Equivalent improvement was observed in MRS and CBS scores in both groups at 6 months; however, CDPSS score was better in yoga group (p = 0.0008). Both P300 amplitudes and latencies improved in all patients and median P300 amplitudes were significantly better in control group; however, no difference could be appreciated in P300 latencies improvement on intergroup comparisons at follow-up.

Conclusion

Study reveals that early yoga intervention in stroke survivors leads to better improvement in cognitive abilities which would further facilitate in early reduction of caregiver burden.

Clinical Features and Outcome of Stroke with COVID-19. COVID-19 Stroke Study Group (CSSG), India

Background and Purpose:

Occurrence of stroke has been reported among patients with COVID-19. The present study compares clinical features and outcomes of stroke patients with and without COVID-19.

Methods:

The COVID-19 Stroke Study Group (CSSG) is a multicentric study in 18 sites across India to observe and compare the clinical characteristics of patients with stroke admitted during the current pandemic period and a similar epoch in 2019. The present study reports patients of stroke with and without COVID-19 (CoVS and non-CoVS, respectively) seen between February 2020 and July 2020. Demographic, clinical, treatment, and outcome details of patients were collected.

Results:

The mean age and gender were comparable between the two groups. CoVS patients had higher stroke severity and extent of cerebral involvement on imaging. In-hospital complications and death were higher among CoVS patients (53.06% vs. 17.51%; P < 0.001) and (42.31% vs. 7.6%; P < 0.001), respectively. At 3 months, higher mortality was observed among CoVS patients (67.65% vs. 13.43%; P < 0.001) and good outcome (modified Rankin score [mRS]: 0–2) was seen more often in non-CoVS patients (68.86% vs. 33.33%; P < 0.001). The presence of COVID-19 and baseline stroke severity were independent predictors of mortality.

Conclusions:

CoVS is associated with higher severity, poor outcome, and increased mortality. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and baseline stroke severity are independent predictors of mortality.

Migraine: is it related to hormonal disturbances or stress?

BACKGROUND

Common neurological syndrome (migraine without aura) is more common among women than men. Migraine is among the top 20 causes of disability. Menstruation is known to be a powerful trigger for migraine, and so is stress, but the presentation of headache is similar in both. Also, women are more vulnerable to stress as well as migraine, and this makes a complex relationship of menstruation, stress, and migraine.

OBJECTIVE

This study was done to understand the association of hormonal fluctuation in menstruation and stress with common migraine.

MATERIALS AND METHODS

A cross-sectional comparative study was conducted in 40 young adult females, of whom 20 participants were cases of migraine without aura (18-35 years old), and the remaining 20 participants were age-matched controls. The study was done in Maulana Azad Medical College, New Delhi. Study participants were selected on the basis of International Headache Society (ICHD-IIA1.1) (2004) classification. Study participants with neurological disorders, chronic diseases, and disease suggestive of any hormonal disturbances were excluded. Clinically diagnosed migraine cases were asked to maintain a headache diary and to fill in the Depression Anxiety Stress Scales questionnaire. Biochemical assessment of hormonal status for thyroid-stimulating hormone, triiodothyronine, thyroxine, estrogen, follicle-stimulating hormone, luteinizing hormone, and prolactin was also done on the second day of their menstrual cycle. We used the Mann-Whitney U test to compare hormonal levels and the χ (2) test to compare anxiety- or depression-related stress among the migraine and nonmigraine groups.

RESULTS

Significantly higher values of prolactin were observed in cases (mean ± standard deviation, 152.7 mIU/L±30.5) compared to controls (76.1 mIU/L±8.7), with a P-value <0.001. There was no statistically significant difference observed in levels of thyroid-stimulating hormone (P=0.081), estrogen (P=0.086), luteinizing hormone (P=0.091), or follicle-stimulating hormone (P=0.478). Also, anxiety with stress or depression with stress was significantly higher among the migraine group than the controls (P=0.002). Odds of any stress in migraine were higher in the migraine group than in the nonmigraine group (odds ratio 12, 95% confidence interval 2.7-53.33).

CONCLUSION

Migraine, particularly without aura, in women is mainly associated with stress-related anxiety or depression, and are more susceptible to stress in the premenstrual period.

Investigation of common Indian edible salts suitable for kidney disease by laser induced breakdown spectroscopy

Salt is an essential and important dietary mineral for maintaining life. Currently, the issue of the potential benefit or damage from salt intake in chronic kidney disease patients is controversial. The attempt of this article is to bring into focus the potential role of elements particularly sodium, Na, and potassium, K, which are the main constituents of dietary salts, in kidney patients by using laser-induced breakdown spectroscopy (LIBS). LIBS spectra of different salt samples have been recorded in the spectral region 200-500 nm with spectral resolution 0.1 nm and in the spectral region 200-900 nm with spectral resolution 0.75 nm. Quantitative elemental study was carried out to determine the constituents of different types of common Indian edible salts by using the calibration-free LIBS method. Our experimental results demonstrate that Saindha salt (commonly known as rock salt) is more beneficial than other edible salts for patients suffering from chronic kidney disease. The results of the quantitative elemental analysis of the salts obtained from LIBS measurements are also compared to atomic absorption spectroscopy (AAS).

Apoptosis: a basic physiologic process in wound healing

Apoptosis, or programmed cell death, is a complex network of biochemical pathways for controlling such events in a cell. Apoptosis is essential, as its failure can lead to disease. Because apoptosis concerns the regulation of sequential events, including the removal of inflammatory cells and the evolution of granulation tissue into scar tissue, it has an essential role in wound repair. This article examines the literature and proposes that apoptosis features in the development of diabetic foot wounds. Hyperglycemia deregulates the sequential apoptotic events by multiple mechanisms, leading to delayed wound healing. Deregulated apoptosis is emerging as a prominent cause of delayed wound healing, especially in diabetic wounds, along with the well-known triad of peripheral vascular disease, neuropathy, and infection.

Effect of glycaemic control on apoptosis in diabetic wounds

OBJECTIVE

To study the effect of glycaemic control on apoptosis in chronic ulcers in diabetic patients and the differential roles of insulin and oral hypoglycaemic agents (OHAs).

METHOD

Ten non-diabetic (group I) and 20 diabetic patients (groups II and III), with a wound of more than four weeks' duration, who were attending the wound clinic at University Hospital, Varanasi, India were recruited. The 10 patients in group 11 received insulin and the 10 in group III an oral hypoglycaemic agent; all had diabetic foot ulcers. Wound biopsy and other routine investigations were performed. Both DNA fragmentation and morphological changes under light microscopy (apoptotic index) were used as determinants of apoptosis. Different variables, including fasting and post-prandial blood sugar, serum low-density lipoprotein (LDL) and markers of microangiopathy, such as proteinuria and diabetic retinopathy, were compared with apoptosis.

RESULTS

DNA fragmentation in groups I, II and III was 40.00 +/- 2.97, 45.26 +/- 3.21 and 60.8 +/- 3.13 respectively (p < 0.01). Near linear correlation was observed with blood sugar level, particularly post-prandial blood sugar (p < 0.05) and DNA fragmentation. DNA fragmentation was significantly correlated with serum LDL and proteinuria, and it was much greater in the OHA group than in the insulin group (p < 0.05). Similarly, in the diabetic patients with background retinopathy the DNA fragmentation was 46.50 +/- 3.42 (n=3) in the insulin group and 66.70 +/- 6.48 (n=4) in the OHA group (p < 0.05).

CONCLUSION

There is a significant increase in apoptosis in diabetic wounds with poorly controlled blood sugar and microangiopathy. This increase was greater in patients on OHAs than those on insulin, and it contributes to delayed wound healing. Morphological markers do not appear to be a reliable index of apoptosis in the diabetic wound.

Prolonged incubation improves the micro-scale in-vitro test for drug sensitivity of Plasmodium falciparum

In the standard micro-scale in-vitro test for detecting resistance of Plasmodium falciparum to chloroquine, isolates are incubated for 24-28 h in medium that does not contain serum. The effect of prolonging incubation to 48 h and of adding human AB serum to the culture medium of P falciparum from Irian Jaya, Indonesia was studied. Addition of serum was not associated with any advantages or disadvantages. Production of schizonts was increased when incubation was prolonged. This facilitated reading of the malaria smears and interpretation of the results. The percentage of successful tests (greater than or equal to 20 schizonts/200 asexual parasites in control wells) increased from 31% at 28 h incubation to 94% at 48 h. Among the 7 (44%) isolates which were chloroquine-resistant in vivo, only 1 met the criteria for a positive test at 28 h incubation, but at 48 h all 7 did. To achieve optimum results from the micro-scale in-vitro test in Jayapura, Irian Jaya, isolates should be incubated for 48 h.

Large-scale use of freeze-dried smallpox vaccine prepared in primary cultures of rabbit kidney cells

A lyophilized smallpox vaccine made from infected monolayer cultures of primary rabbit kidney cells was used together with a calf lymph vaccine in a field trial in Lombok, Indonesia, in 1973. About 60 000 children below 15 years of age were vaccinated: some 50 000 with the tissue culture vaccine and about 10 000 with calf lymph vaccine. Similar results were obtained with both vaccines in primary vaccinees and in revaccinees as regards the take rate, pock reactions, and serious secondary reactions.