Internet addiction and sleep quality among medical students during the COVID-19 pandemic: A multinational cross-sectional survey.

BACKGROUND: The emergence of the COVID-19 pandemic has affected the lives of many people, including medical students. The present study explored internet addiction and changes in sleep patterns among medical students during the pandemic and assessed the relationship between them. METHODS: A cross-sectional study was carried out in seven countries, the Dominican Republic, Egypt, Guyana, India, Mexico, Pakistan, and Sudan, using a convenience sampling technique, an online survey comprising demographic details, information regarding COVID-19, the Pittsburgh Sleep Quality Index (PSQI), and the Internet Addiction Test (IAT). RESULTS: In total, 2749 participants completed the questionnaire. Of the total, 67.6% scored above 30 in the IAT, suggesting the presence of an Internet addiction, and 73.5% scored equal and above 5 in the PSQI, suggesting poor sleep quality. Internet addiction was found to be significant predictors of poor sleep quality, causing 13.2% of the variance in poor sleep quality. Participants who reported COVID-19 related symptoms had disturbed sleep and higher internet addiction levels when compared with those who did not. Participants who reported a diagnosis of COVID-19 reported poor sleep quality. Those living with a COVID-19 diagnosed patient reported higher internet addiction and worse sleep quality compared with those who did not have any COVID-19 patients in their surroundings. CONCLUSION: The results of this study suggest that internet addiction and poor sleep quality are two issues that require addressing amongst medical students. Medical training institutions should do their best to minimize their negative impact, particularly during the current COVID-19 pandemic.

Pacemaking Activity in the Peripheral Nervous System: Physiology and Roles of Hyperpolarization Activated and Cyclic Nucleotide-Gated Channels in Neuropathic Pain.

The most famous pacemaking activity found in the human body is in the cardiac system. However, pacemaking is also widely present in the nervous system. The ion channels responsible for the pacemaking activity are called hyperpolarization-activated and cyclic nucleotide-gated (HCN) channels. HCN channels are activated during hyperpolarization and create an inward current named Ih containing mixed sodium and potassium ions. The molecular mechanism of these unique features remains mysterious. In the peripheral nervous system (PNS), pacemaking is unique because it is only present in pathologic states when nerve damage occurs and leads to neuropathic pain. For this reason, pacemaking in neuropathic pain is also known as ectopic discharge. In our literature review, the HCN channel physiology is one of the research interests. We will present studies exploring the molecular mechanisms involved in HCN gating and ion permeability. The second research question is, what makes the pacemaking activity unique in the PNS? Thus, our paper will include studies that discuss the role of HCN channels in neuropathic pain. Given the fundamental role of HCN channels in regulating neuronal cells' discharge activity, the modulation of their function for therapeutic purposes could be useful in various pathological conditions. Here we review the present knowledge of the efficacy of HCN blocker treating neuropathic pain in humans.

Diabetic Ketoacidosis in an Euglycemic Patient.

Diabetes is a common disease, and the number of patients is increasing every year. We report a case of a 34-year-old man with a history of diabetes mellitus (diagnosed at eight years old) and was on treatment with tablet glimepride with poor compliance. The patient sought consultation due to vomiting and abdominal pain 12 hours after onset along with burning micturition for four days. His initial blood sugar random (BSR) level was 84 mg/dL. Further lab tests revealed pH: 7.14, bicarbonate: 6.4 mEq/dL, sodium: 141, potasium: 3.8, chloride: 107, PO2: 115, PCO2: 19.4, serum amylase: 51, base excess (BE): -21.3 mmol/L, and positive ketonemia, i.e. 1.39. He was reanimated with parenteral crystalloids and insulin infusion. Eventually with subsequent arterial blood gases (ABGs) and ketones, the patient got better and was eventually declared to be out of diabetic ketoacidosis (DKA) and later discharged. There are very less studies done on euglycemic DKA (eu-DKA); so many physicians fail to diagnose the patients properly and they fall into the invisible cases chunk.