Tumor microenvironment induced switch to mitochondrial metabolism promotes suppressive functions in immune cells.

Understanding the intricacies of the metabolic phenotype in immune cells and its plasticity within the tumor microenvironment is pivotal in understanding the pathology and prognosis of cancer. Unfavorable conditions and cellular stress in the tumor microenvironment (TME) exert a profound impact on cellular functions in immune cells, thereby influencing both tumor progression and immune responses. Elevated AMP:ATP ratio, a consequence of limited glucose levels, activate AMP-activated protein kinase (AMPK) while concurrently repressing the activity of mechanistic target of rapamycin (mTOR) and hypoxia-inducible factor 1-alpha (HIF-1α). The intricate balance between AMPK, mTOR, and HIF-1α activities defines the metabolic phenotype of immune cells in the TME. These Changes in metabolic phenotype are strongly associated with immune cell functions and play a crucial role in creating a milieu conducive to tumor progression. Insufficiency of nutrient and oxygen supply leads to a metabolic shift in immune cells characterized by a decrease in glycolysis and an increase in oxidative phosphorylation (OXPHOS) and fatty acid oxidation (FAO) rates. In most cases, this shift in metabolism is accompanied by a compromise in the effector functions of these immune cells. This metabolic adaptation prompts immune cells to turn down their effector functions, entering a quiescent or immunosuppressive state that may support tumor growth. This article discusses how tumor microenvironment alters the metabolism in immune cells leading to their tolerance and tumor progression, with emphasis on mitochondrial metabolism (OXPHOS and FAO).

Knowledge and Attitudes Toward Organ Donation Among Students and Professionals in Medical Colleges in the Eastern Part of India.

BACKGROUND:  Organ transplantation is a critical, life-saving procedure revolutionizing healthcare. Despite medical advancements, there remains a global shortage of organs available for transplantation. This is more pronounced in India where the organ donation rate is significantly low. OBJECTIVE:  To assess the knowledge and attitude toward organ donation among students and professionals in medical colleges of Patna, Bihar. METHODS:  A cross-sectional study was conducted in three government medical colleges located in Patna that included 666 participants comprising faculty, resident doctors, nursing staff, medical and nursing students, and interns. Data were collected using a pre-designed structured questionnaire comprising a socio-demographic profile and knowledge and attitude of participants toward organ donation. The data were analyzed using descriptive statistics and multivariate analysis. RESULTS: The mean age of study participants was 23±4.24 (SD). The majority (504, 75.7%) of participants were aged between 21 and 30 years and the majority (372, 55.9%) were females. There were significant differences in knowledge about organ donation across groups. Faculty and resident doctors demonstrated higher awareness (113, 73.9%) compared to others. Attitude toward organ donation was positive overall, with the majority (614, 92.2%) supporting organ donation campaigns. However, misconceptions about organ donation and its legal aspects persisted among participants. CONCLUSION:  There is a need for targeted educational intervention to improve knowledge and dispel myths about organ donation among medical students and professionals.

Prevalence of diabetes distress and its correlates among adults with type 2 diabetes mellitus in a primary health center of Bihar - A cross-sectional study.

Context: Diabetes is a chronic disease associated with many complications. Approximately 20% of people living with diabetes suffer from some form of depression. "Diabetes distress" (DD) is used to describe the significant negative psychological reactions related to emotional burdens and worries specific to an individual's experience to manage severe, complicated chronic disease such as diabetes. Aim: To determine the proportion having DD and to identify the sociodemographic and morbidity related factors associated with the presence of DD among adults with Type2DM who are being treated at PHC Naubatpur, Bihar. Material and Methods: This facility based cross-sectional analytical study was done over 3 months among 260 Type2DM patients attending PHC Naubatpur. Sociodemographic details and morbidity related details were collected followed by PAID questionnaire to assess DD. Results: Around 60% of the participants were of age ≤60 years. Majority (63.8%) of the participants were having diabetes from past 1-10years. One-fourth (24.6%) of them were having score of ≥40, therefore having DD. Alcohol consumption and presence of diabetes complications in the participants were found to be independent predictors of DD. Conclusion: This study showed a high (24.6%) prevalence of DD. It is essential to identify high-risk patients with different mental health needs. Healthcare providers should focus on reducing DD and devise ways to increase self-care practices and coping skills.

Whole Abdominal Pencil Beam Scanned Proton FLASH Increases Acute Lethality.

PURPOSE: Ultrahigh dose-rate FLASH radiation therapy has emerged as a modality that promises to reduce normal tissue toxicity while maintaining tumor control. Previous studies of gastrointestinal toxicity using passively scattered FLASH proton therapy (PRT) have, however, yielded mixed results, suggesting that the requirements for gastrointestinal sparing by FLASH are an open question. Furthermore, the more clinically relevant pencil beam scanned (PBS) FLASH PRT has not yet been assessed in this context, despite differences in the spatiotemporal dose-rate distributions compared with passively scattered PRT. Here, to our knowledge, we provide the first report on the effects of PBS FLASH PRT on acute gastrointestinal injury in mice after whole abdominal irradiation. METHODS AND MATERIALS: Whole abdominal irradiation was performed on C57BL/6J mice using the entrance channel of the Bragg curve of a 250 MeV PBS proton beam at field-averaged dose rates of 0.6 Gy/s for conventional (CONV) and 80 to 100 Gy/s for FLASH PRT. A 2D strip ionization chamber array was used to measure the dose and dose rate for each mouse. Survival was assessed at 14 Gy. Intestines were harvested and processed as Swiss rolls for analysis using a novel artificial intelligence-based crypt assay to quantify crypt regeneration 4 days after irradiation. RESULTS: Survival was significantly reduced after 14 Gy FLASH PRT compared with CONV (P < .001). Our artificial intelligence-based crypt assays demonstrated no significant difference in intestinal crypts/cm or crypt depth between groups 4 days after irradiation. Furthermore, we found no significant difference in 5-ethynyl-2'-deoxyuridine+ cells/crypt or Olfactomedin4+ intestinal stem cells with FLASH relative to CONV PRT. CONCLUSIONS: Overall, our data demonstrate significantly impaired survival after abdominal PBS FLASH PRT without apparent differences in intestinal histology 4 days after irradiation.

Awareness and Attitude Towards Tobacco Products and Tobacco Industry and Perception about Government's Role in Tobacco Control among the Adult Rural Population: A Cross-sectional Study in the Indian State of Bihar.

Background: Attitudes and impressions toward the tobacco industry and tobacco products among the general public are important determinants for curbing the menace of the tobacco epidemic. Accordingly, this study aimed to assess the knowledge and perceptions about the tobacco industry and tobacco products and analyze attitudes towards social denormalization (SD) of tobacco use and tobacco industry denormalization (TID) among the rural population of Bihar, India. Methods: This community-based cross-sectional survey was conducted on 421 adults aged 18 to 65 years who were selected using multistage systematic random sampling in a rural area of Bihar State in India from January to March 2022. Results were presented as proportions and the factors associated with support for TID and SD were identified using the chi-square test and binary logistic regression. Findings: Out of 421 participants, 342 (81.2%) did not consider smokeless tobacco to be very dangerous. Nearly half (192, 45.6%) of the individuals believed that tobacco companies never tell the truth about the ill effects of tobacco use on health. Maximum, 345 (89.5%) also believed that the tobacco industry is responsible for adverse health effects of tobacco use and that the government should sue them. The prevalence of favorable attitudes toward TID and SD was found to be 55.1% [95% CI: 50.3% - 59.8%] and 38.2% [95% CI: 33.7% - 42.9%], respectively. Conclusion: One out of every two and one out of every three individuals showed favorable attitudes toward TID and SD, respectively. There is a need to inform and educate the public on the ill effects of tobacco and the deceptive strategies used by the tobacco industry to help them choose health over tobacco.

Validation of the Indian (Hindi) version of the life-space assessment scale among community-dwelling older adults: a multicentric cross-sectional study.

BACKGROUND: The Life-Space Assessment (LSA) is an instrument that measures mobility in older adults as they reach different areas, defined as life-spaces extending from home to beyond towns or regions. The purpose of the study was to develop the Hindi version of the LSA (LSA- H) and to investigate the validity and reliability of the Hindi version as well as its cultural adaptation. METHODS: A cross-sectional study of two hundred forty-five older adults participated in the study from four different study practice areas. Following forward backwards translation, the LSA-H was developed, and the scores were correlated with those of the Activities-Specific Balance Confidence Scale Hindi (ABC- H), the Physical Health Subscale of the WHO-BREF Questionnaire and the Geriatric Depression Scale: Short Form Hindi (GDS-SFH) to test the criterion and concurrent validity. RESULTS: The mean score and standard deviation of the LSA-H questionnaire were 56.53 ± 35.99, those of the Physical Health Subscale of the WHO-BREF instrument were 18.54 ± 7.87, those of the GDS-SFH questionnaire were 6.95 ± 4.21 and those of the ABC- H questionnaire were 54.40 ± 28.96. The Pearson correlation coefficient (r) between the LSA-H score and ABC-H score was 0.707 (p value < 0.0001), that between the LSA-H score and the Physical Health Subscale of the WHO-BREF was 0.766 (p value < 0.0001), and that between the LSA-H score and GDS-SFG score was - 0.674 (p value < 0.0001). CONCLUSION: This study demonstrated that the Hindi version of the LSA is a valid and reliable instrument for assessing living space among older adults in the Hindi language in an Indian population. Furthermore, the LSA-H was significantly correlated with other health assessment tools in terms of functional mobility, general health status and mental well-being.

Tremor in Spinocerebellar Ataxia: A Scoping Review.

Background: Spinocerebellar ataxia (SCA) denotes an expanding list of autosomal dominant cerebellar ataxias. Although tremor is an important aspect of the clinical spectrum of the SCAs, its prevalence, phenomenology, and pathophysiology are unknown. Objectives: This review aims to describe the various types of tremors seen in the different SCAs, with a discussion on the pathophysiology of the tremors, and the possible treatment modalities. Methods: The authors conducted a literature search on PubMed using search terms including tremor and the various SCAs. Relevant articles were included in the review after excluding duplicate publications. Results: While action (postural and intention) tremors are most frequently associated with SCA, rest and other rare tremors have also been documented. The prevalence and types of tremors vary among the different SCAs. SCA12, common in certain ethnic populations, presents a unique situation, where the tremor is typically the principal manifestation. Clinical manifestations of SCAs may be confused with essential tremor or Parkinson's disease. The pathophysiology of tremors in SCAs predominantly involves the cerebellum and its networks, especially the cerebello-thalamo-cortical circuit. Additionally, connections with the basal ganglia, and striatal dopaminergic dysfunction may have a role. Medical management of tremor is usually guided by the phenomenology and associated clinical features. Deep brain stimulation surgery may be helpful in treatment-resistant tremors. Conclusions: Tremor is an elemental component of SCAs, with diverse phenomenology, and emphasizes the role of the cerebellum in tremor. Further studies will be useful to delineate the clinical, pathophysiological, and therapeutic aspects of tremor in SCAs.

Movement Disorders in Patients with Subacute Sclerosing Panencephalitis: A Systematic Review.

BACKGROUND: Subacute sclerosing panencephalitis (SSPE) is a complication of measles, occurring after a latency of 4-10 years. It continues to occur in developing countries although resurgence is being reported from developed countries. Characteristic features include progressive neuropsychiatric issues, myoclonus, seizures, movement disorders and visual impairment. Electroencephalography (EEG) typically shows periodic generalized discharges, and elevated CSF anti-measles antibodies are diagnostic. Movement disorders are being increasingly recognized as part of the clinical spectrum, and range from hyperkinetic (chorea, dystonia, tremor, tics) to hypokinetic (parkinsonism) disorders and ataxia. OBJECTIVES: This article aims to comprehensively review the spectrum of movement disorders associated with SSPE. METHODS: A literature search was conducted in PubMed and EMBASE databases in December 2023 and articles were identified for review. RESULTS: Movement disorders reported in SSPE included hyperkinetic (chorea, dystonia, tremor and tics), hypokinetic (parkinsonism), ataxia and extraocular movement disorders. Myoclonus, a core clinical feature, was the most frequent "abnormal movement." Movement disorders were observed in all clinical stages, and could also be a presenting feature, even sans myoclonus. Hyperkinetic movement disorders were more common than hypokinetic movement disorders. An evolution of movement disorders was observed, with ataxia, chorea and dystonia occurring earlier, and parkinsonism later in the disease. Neuroradiological correlates of movement disorders remained unclear. CONCLUSION: A wide spectrum of movement disorders was observed throughout the clinical stages of SSPE. Most data were derived from case reports and small case series. Multicentric longitudinal studies are required to better delineate the spectrum and evolution of movement disorders in SSPE.

Mitochondria driven innate immune signaling and inflammation in cancer growth, immune evasion, and therapeutic resistance.

Mitochondria play an important and multifaceted role in cellular function, catering to the cell's energy and biosynthetic requirements. They modulate apoptosis while responding to diverse extracellular and intracellular stresses including reactive oxygen species (ROS), nutrient and oxygen scarcity, endoplasmic reticulum stress, and signaling via surface death receptors. Integral components of mitochondria, such as mitochondrial DNA (mtDNA), mitochondrial RNA (mtRNA), Adenosine triphosphate (ATP), cardiolipin, and formyl peptides serve as major damage-associated molecular patterns (DAMPs). These molecules activate multiple innate immune pathways both in the cytosol [such as Retionoic Acid-Inducible Gene-1 (RIG-1) and Cyclic GMP-AMP Synthase (cGAS)] and on the cell surface [including Toll-like receptors (TLRs)]. This activation cascade leads to the release of various cytokines, chemokines, interferons, and other inflammatory molecules and oxidative species. The innate immune pathways further induce chronic inflammation in the tumor microenvironment which either promotes survival and proliferation or promotes epithelial to mesenchymal transition (EMT), metastasis and therapeutic resistance in the cancer cell's. Chronic activation of innate inflammatory pathways in tumors also drives immunosuppressive checkpoint expression in the cancer cells and boosts the influx of immune-suppressive populations like Myeloid-Derived Suppressor Cells (MDSCs) and Regulatory T cells (Tregs) in cancer. Thus, sensing of cellular stress by the mitochondria may lead to enhanced tumor growth. In addition to that, the tumor microenvironment also becomes a source of immunosuppressive cytokines. These cytokines exert a debilitating effect on the functioning of immune effector cells, and thus foster immune tolerance and facilitate immune evasion. Here we describe how alteration of the mitochondrial homeostasis and cellular stress drives innate inflammatory pathways in the tumor microenvironment.

Similarities and Differences in Functional Movement Disorders and Functional Seizures at a Tertiary Care Center: A Prospective Study.

Background: Functional movement disorders (FMDs) and functional seizure (FS) are the two most important subcategories of functional neurologic disorders (FNDs). Objectives: This study aimed to discern similarities and differences between patients with FMD and FS. Methods: A prospective comparative study of 94 patients with FNDs (FMD = 47, FS = 47) was conducted. Results: Tremor and pauci-kinetic attack with preserved responsiveness were the most common subtypes observed in patients with FMD and FS, respectively. A significantly higher number of patients with FMD had more than one precipitating factor (P = 0.03). Headache was significantly more common in patients with FS (P = 0.03). More patients came for follow-up in the FMD group (P = 0.01). More patients in the FS group reported "very much improvement" (P = 0.04), and "no change" was more commonly reported by the FMD group patients (P = 0.009). Conclusion: Emotional stress was the most common precipitating factor in patients with FMD and FS. The prognosis was better in patients with FS.

Clinico-Etiopathogenesis of Vitamin B12, Folic Acid and Iron Deficiency in Severe Acute Malnutrition Children: A Tertiary Care Hospital Experience from Central India.

In severe acute malnutrition, micronutrient deficiency as well as protein energy malnutrition is a major obstacle to growth & development. Iron deficiency dominates the spectrum of nutritional anemia. After taking informed consent, 211 SAM children and 211 age-and sex-matched healthy children with normal nutritional status were enrolled for the study. MUAC was used to diagnose SAM. A 5-part automated hematoanalyzer was used to measure the complete blood count and red cell indices, and the peripheral smear method to determine the red cell morphology. We measured serum ferritin, Vitamin B12, and folic acid using the ELISA method. Compared to controls, children with SAM had significantly lower red cell indices, platelet counts, and white cell counts. The most common clinical symptoms seen in SAM children were diarrhea, pneumonia, acute gastroenteritis, and acute respiratory infection. Children with SAM are more likely to suffer from iron deficiency and B12 deficiency. Severe vitamin B12 deficiency was more frequently associated with severe anemia. The severe anemia in SAM children constantly changes the body's defense mechanism, affecting the haematopoiesis. In this study, haematological indices are recommended for predicting severity of anemia, and hematopoietic changes are described, in order to improve anticipatory care and outcome in children with SAM.

An analytical and comparative study of swallowing in a tumor-infected oesophagus: a mathematical model.

This study discusses non-steady effects encountered in peristaltic flows in oesophagus. The purpose of this communication is to evolve a mechanism to diagnose tumor in an oesophagus mathematically. The tumor is modelled by generic bump function of certain height and width. The method of solution follows long wavelength and low-Reynolds number approximations for unsteady flow, while integrations have been performed numerically in order to plot graphs, which reveal various characteristics of the flow. The goal is to assess how pressure varies across the tumor's width. The spatial, as well as temporal, dependence of pressure has been studied in the laboratory frame of reference. The pressure distribution for tumor-infected oesophagus is compared with that of normal oesophagus. An intensified pressure is obtained in the presence of tumor. The interruption while swallowing through benign oesophageal tumor is confirmed by an abrupt pressure rise across the tumor's width. Tumor position also plays a significant role whether it is at contraction or relaxation of walls. Additionally, wall-shear-stress, volumetric flow rate and streamlines have also been described and compared with that without tumor growth. The expressions corresponding to all the physical quantities are computed numerically. Further, this model may also be implemented to the two-dimensional channel flow for an industrial application.

How Mixed-Methods Research Can Improve the Policy Relevance of Impact Evaluations.

This paper describes how mixed methods can improve the value and policy relevance of impact evaluations, paying particular attention to how mixed methods can be used to address external validity and generalization issues. We briefly review the literature on the rationales for using mixed methods; provide documentation of the extent to which mixed methods have been used in impact evaluations in recent years; describe how we developed a list of recent impact evaluations using mixed methods and the process used to conduct full-text reviews of these articles; summarize the findings from our analysis of the articles; discuss three exemplars of using mixed methods in impact evaluations; and discuss how mixed methods have been used for studying and improving external validity and potential improvements that could be made in this area. We find that mixed methods are rarely used in impact evaluations, and we believe that increased use of mixed methods would be useful because they can reinforce findings from the quantitative analysis (triangulation), and they can also help us understand the mechanism by which programs have their impacts and the reasons why programs fail.

Inflammatory Myofibroblastic Tumor With Rapid Recurrence and Distant Metastasis: Report of a Rare Case.

Inflammatory myofibroblastic tumors (IMTs) are rare spindle cell tumors clinically, morphologically, and genetically heterogeneous, mimicking many other reactive and neoplastic lesions and creating great diagnostic problems. Although it is generally characterized by oncogene-derived proliferation of myofibroblasts in a background of polyclonal inflammatory cell infiltrates, morphological variations do occur requiring immunohistochemistry and molecular genetics to confirm the diagnosis. It encompasses a wide age range, and locations, mostly said to be of intermediate grade having a low risk of recurrence and metastasis. However, its biological behavior and course are variable and unpredictable. Here, we report a case of thoracic IMT in a 32-year-old adult female presenting with a history of fever, cough, and chest pain associated with neutrophilic leukocytosis. Radiological investigations revealed a large mass in the thoracic region with possibilities of hydatid cyst and neurogenic tumor. Initial core needle biopsy specimen and subsequent local resection specimen revealed the diagnosis of IMT on histopathology and immunohistochemistry, having conventional morphology with expression of Anaplastic lymphoma kinase (ALK) protein. The patient developed rapid local recurrence and was started with first-generation ALK inhibitor Crizotinib. After a brief period of response, she developed vertebral and brain metastasis within a short span of time and was switched to a third-generation ALK inhibitor, Lorlatinib. The patient is on regular follow-up, has stable disease, and maintains a good quality of life after two years of diagnosis.

Current opinions and practices in post-stroke movement disorders: Survey of movement disorders society members.

BACKGROUND: Post-stroke movement disorders (PSMD) encompass a wide array of presentations, which vary in mode of onset, phenomenology, response to treatment, and natural history. There are no evidence-based guidelines on the diagnosis and treatment of PSMD. OBJECTIVES: To survey current opinions and practices on the diagnosis and treatment of PSMD. METHODS: A survey was developed by the PSMD Study Group, commissioned by the International Parkinson's and Movement Disorders Society (MDS). The survey, distributed to all members, yielded a total of 529 responses, 395 (74.7%) of which came from clinicians with experience with PSMD. RESULTS: Parkinsonism (68%), hemiballismus/hemichorea (61%), tremor (58%), and dystonia (54%) were by far the most commonly endorsed presentation of PSMD, although this varied by region. Basal ganglia stroke (76% of responders), symptoms contralateral to stroke (75%), and a temporal relationship (59%) were considered important factors for the diagnosis of PSMD. Oral medication use depended on the phenomenology of the PSMD. Almost 50% of respondents considered deep brain stimulation and ablative surgeries as options for treatment. The lack of guidelines for the diagnosis and treatment was considered the most important gap to address. CONCLUSIONS: Regionally varying opinions and practices on PSMD highlight gaps in (and mistranslation of) epidemiologic and therapeutic knowledge. Multicenter registries and prospective community-based studies are needed for the creation of evidence-based guidelines to inform the diagnosis and treatment of patients with PSMD.

Objective response to ethanol in essential tremor: results from a standardized ethanol challenge study.

BACKGROUND AND OBJECTIVES: Ethanol has been reported to improve tremor severity in approximately two thirds of patients with essential tremor (ET), but the accuracy of that proportion is not certain and the mechanism of action is unknown. The goal of this study was to investigate alcohol response on tremor by applying an a priori objective response definition and subsequently to describe the responder rate to a standardized ethanol dose in a cohort of 85 ET patients. A secondary analysis evaluated other tremor and nontremor features, including demographics, tremor intensity, breath alcohol concentration, nontremor effects of alcohol, self-reported responder status to ethanol, and prior ethanol exposure. METHODS: This was a prospective, open-label, single-dose challenge of oral ethanol during which motor and nonmotor measurements were obtained starting immediately prior to ethanol administration and subsequently every 20 min for 120 min. We defined tremor reduction as a 35% decline in power in the patient's tremor frequency recorded during spiral drawing 60 min after ethanol administration. RESULTS: In total, 80% of patients were considered alcohol responsive using our objective definition. Responder status and change in the objective tremor metrics were significantly correlated with the change in breath alcohol concentration levels after ethanol administration, but no other relationships to nontremor metrics were found. DISCUSSION: A high percentage of patients actually respond to acute ethanol. However, their self-reported response does not correlate well with their objective response. Objective response correlates with breath alcohol level but not with sedation, indicating a specific effect of ethanol on tremor.

Association of Sleep Quality With Fatigue in Post-COVID-19 Patients in an Indian Population.

OBJECTIVE: The aims of the study are to assess the quality of sleep in recently recovered COVID-19 and long-COVID cases and to determine its associations with fatigue and pain. METHODS: Post-COVID-19 cases ( n = 201) and controls ( n = 206) were assessed using the Pittsburgh Sleep Quality Index questionnaire for sleep quality, Fatigue Severity Scale for fatigue, and Numeric Pain Rating Scale for pain in this observational study. RESULTS: Global Pittsburgh Sleep Quality Index score was higher ( P ≤ 0.001) among cases (5.7 ± 5.1; 95% confidence interval, 5.0-6.4) than controls (2.1 ± 2.0; 95% confidence interval, 1.8-2.4). Normal sleep latency was observed in 56 (27.9%) patients and 164 (79.6%) controls ( P < 0.001). Fatigue Severity Scale score was higher ( P ≤ 0.001) among cases (16.8 ± 10.2; 95% confidence interval, 15.4, 18.2) against controls (10.9 ± 4.1; 95% confidence interval, 10.3-11.4). The Fatigue Severity Scale scores in mild, moderate, and severe COVID-19 were 14.3 ± 8.1, 22.1 ± 10.8, and 22.8 ± 13, respectively ( P < 0.001) and higher in the older (20.7 ± 12.1) and middle-aged (19.6 ± 10.3) than in younger (13.9 ± 8.3) ( P ≤ 0.001) cases. The global Pittsburgh Sleep Quality Index score was positively correlated with the Fatigue Severity Scale ( r = 0.755, P < 0.001) and Numeric Pain Rating Scale scores ( r = 0.657, P < 0.001). Numeric Pain Rating Scale score correlated with Fatigue Severity Scale score ( r = 0.710, P < 0.001). Fatigue Severity Scale and global Pittsburgh Sleep Quality Index scores were higher in the long-COVID group ( P < 0.001). CONCLUSIONS: Significantly poor sleep quality was observed in post-COVID-19 individuals including long COVID being positively associated with fatigue and pain.