Daytime eating prevents mood vulnerability in night work.

Shift workers have a 25 to 40% higher risk of depression and anxiety partly due to a misalignment between the central circadian clock and daily environmental/behavioral cycles that may negatively affect mood and emotional well-being. Hence, evidence-based circadian interventions are required to prevent mood vulnerability in shift work settings. We used a stringently controlled 14-d circadian paradigm to assess mood vulnerability during simulated night work with either daytime and nighttime or daytime-only eating as compared with simulated day work (baseline). Simulated night work with daytime and nighttime eating increased depression-like mood levels by 26.2% (p-value adjusted using False Discovery Rates, pFDR = 0.001; effect-size r = 0.78) and anxiety-like mood levels by 16.1% (pFDR = 0.001; effect-size r = 0.47) compared to baseline, whereas this did not occur with simulated night work in the daytime-only eating group. Importantly, a larger degree of internal circadian misalignment was robustly associated with more depression-like (r = 0.77; P = 0.001) and anxiety-like (r = 0.67; P = 0.002) mood levels during simulated night work. These findings offer a proof-of-concept demonstration of an evidence-based meal timing intervention that may prevent mood vulnerability in shift work settings. Future studies are required to establish if changes in meal timing can prevent mood vulnerability in night workers.

Proof-of-principle demonstration of endogenous circadian system and circadian misalignment effects on human oral microbiota.

Circadian misalignment-the misalignment between the central circadian "clock" and behavioral and environmental cycles (including sleep/wake, fasting/eating, dark/light)-results in adverse cardiovascular and metabolic effects. Potential underlying mechanisms for these adverse effects include alterations in the orogastrointestinal microbiota. However, it remains unknown whether human oral microbiota has endogenous circadian rhythms (i.e., independent of sleep/wake, fasting/eating, and dark/light cycles) and whether circadian misalignment influences oral microbiota community composition. Healthy young individuals [27.3 ± 2.3 years (18-35 years), 4 men and 2 women, body-mass index range: 18-28 kg/m2 ] were enrolled in a stringently controlled 14-day circadian laboratory protocol. This included a 32-h constant routine (CR) protocol (endogenous circadian baseline assessment), a forced desynchrony protocol with four 28-h "days" under ~3 lx to induce circadian misalignment, and a post-misalignment 40-h CR protocol. Microbiota assessments were performed on saliva samples collected every 4 h throughout both CR protocols. Total DNA was extracted and processed using high-throughput 16S ribosomal RNA gene amplicon sequencing. The relative abundance of specific oral microbiota populations, i.e., one of the five dominant phyla, and three of the fourteen dominant genera, exhibited significant endogenous circadian rhythms. Importantly, circadian misalignment dramatically altered the oral microbiota landscape, such that four of the five dominant phyla and eight of the fourteen dominant genera exhibited significant circadian misalignment effects. Moreover, circadian misalignment significantly affected the metagenome functional content of oral microbiota (inferred gene content analysis), as indicated by changes in specific functional pathways associated with metabolic control and immunity. Collectively, our proof-of-concept study provides evidence for endogenous circadian rhythms in human oral microbiota and show that even relatively short-term experimental circadian misalignment can dramatically affect microbiota community composition and functional pathways involved in metabolism and immune function. These proof-of-principle findings have translational relevance to individuals typically exposed to circadian misalignment, including night shift workers and frequent flyers.

Intradural Abscess of the Thoracic and Lumbar Spine.

Spinal abscesses are normally confined to the epidural space. Due to the anatomical seclusion of the intradural space, it is rare for the infection to spread to the area or for the cause to be idiopathic, iatrogenic in nature, or due to another phenomenon. We report a case of a 45-year-old male who was found to have a rare intradural spinal abscess two days post-laminectomy for severe central canal stenosis.

Excited Catatonia - A Delayed Neuropsychiatric Complication of COVID-19 Infection.

An increasing number of patients have been presenting with neuropsychiatric signs and symptoms associated with coronavirus disease (COVID-19). We present a case of a 69-year-old female with no prior psychiatric history who was brought to the emergency department due to bizarre behavior and paranoid thoughts for four to six weeks, worsening over the last two weeks. Psychiatric evaluation found that the patient had extreme restlessness and agitation, poor eye contact, paranoid delusions, visual hallucinations, and a flat affect with stereotypic repetition of speech and loose associations. The patient's family noted that two months prior she had symptoms of common cold associated with a severe cough and 20 pounds of weight loss. Suspicion for prior COVID-19 infection prompted an IgG antibody test, which was positive. Our patient displayed at least three of the signs needed to diagnose catatonia - agitation, rigidity, and echolalia - and had a therapeutic response to lorazepam, confirming suspicions of excited catatonia. Her seropositivity for IgG against COVID-19 suggested a COVID-induced brief psychotic disorder with catatonia, which makes this the first known case, to our knowledge, of a patient with delayed onset catatonia after COVID-19 infection. This suggests that clinicians should, after ruling out more plausible stressors, suspect possible coronavirus involvement in sudden onset psychotic disorders, especially in patients who do not fit the demographic of new-onset schizophrenia-spectrum diagnoses. Further research is needed on the pathophysiology behind COVID-19 altering neuronal function and neurotransmitter pathways.

Daytime eating prevents internal circadian misalignment and glucose intolerance in night work.

Night work increases diabetes risk. Misalignment between the central circadian "clock" and daily behaviors, typical in night workers, impairs glucose tolerance, likely due to internal misalignment between central and peripheral circadian rhythms. Whether appropriate circadian alignment of eating can prevent internal circadian misalignment and glucose intolerance is unknown. In a 14-day circadian paradigm, we assessed glycemic control during simulated night work with either nighttime or daytime eating. Assessment of central (body temperature) and peripheral (glucose and insulin) endogenous circadian rhythms happened during constant routine protocols before and after simulated night work. Nighttime eating led to misalignment between central and peripheral (glucose) endogenous circadian rhythms and impaired glucose tolerance, whereas restricting meals to daytime prevented it. These findings offer a behavioral approach to preventing glucose intolerance in shift workers.