Nonalcoholic Fatty Liver Disease in Shift Workers and Its Effect on Peripheral Nerve Conduction: A Cross-Sectional Study.

Introduction Nonalcoholic fatty liver disease (NAFLD) presents as a multisystem disorder, heightening the risk of developing type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVDs). Occupation emerges as a significant factor influencing the occurrence of NAFLD. Research indicates that individuals engaged in shift work face an elevated risk of NAFLD, alongside obesity and T2DM, attributed to disruptions in their circadian rhythm, which precipitate hepatic steatosis and inflammation. Remarkably, peripheral neuropathy has been observed in conjunction with advanced liver disorders and NAFLD in the general population. However, the correlation between NAFLD and peripheral neuropathy remains unestablished in shift workers. Objective To identify NAFLD in seemingly healthy rotating shift workers and assess any potential impact of NAFLD on nerve function in this demographic. Methods This cross-sectional study involved 73 apparently healthy nonalcoholic security guards (aged 35 to 60 years) working in rotating shifts. The study included a comprehensive assessment, beginning with a medical history, an evaluation of physical activity, and anthropometric measurements. Confirmation of NAFLD was achieved through abdominal ultrasonography (USG), followed by the analysis of biochemical parameters. Motor and sensory nerve conduction studies (NCS) were conducted on participants with normal vitamin B12 levels using the Aleron electromyograph (EMG) machine (Recorders and Medicare Systems Private Ltd, Budanpur, India). The evaluation encompassed the Median and Common Peroneal motor nerves, as well as Median and Sural sensory nerves. Recorded parameters for motor nerves included distal motor latency (DML), compound muscle action potential (CMAP) amplitude, conduction velocity (CV), and F-wave minimum latency (F-wave), while sensory nerve parameters comprised sensory onset latency (SOL), sensory nerve action potential (SNAP) amplitude, and CV. Results Among 73 healthy security guards working in rotating shifts, 76.1% were diagnosed with NAFLD through abdominal ultrasound. Following participant withdrawals and exclusions due to vitamin B12 deficiency, a comparison of NCS parameters between NAFLD (n=24) and Non-NAFLD (n=12) groups revealed no significant disparities in motor or sensory parameters, except for a slightly diminished CMAP amplitude in the peroneal nerve of NAFLD subjects (8.21±2.83mV vs ±10.22±2.30 mV, p< 0.040). However, these differences fell within normal ranges, indicating no notable impact on peripheral nerve conduction in the presence of NAFLD. Conclusion The results indicate a high prevalence of NAFLD among individuals working rotating shifts. Moreover, the investigation suggests that despite the presence of NAFLD, there is no discernible influence on motor and sensory peripheral nerve conduction, particularly in common peroneal, median, and sural nerves.

Assessment of visual and auditory evoked potentials in young obese males.

Background: Obesity is a chronic condition, affecting central and peripheral nervous system. Studies on cranial nerve conduction in obesity are scarce and unclear; therefore, we planned this study. The aim of this study was to evaluate optic and auditory nerve conductions in obesity. Methods: It was a case-control study, with inclusion of 40 young males (20 obese and 20 controls) in age group of 18-30 years. We recorded pattern reversal visual evoked potential (PRVEP) and brainstem auditory evoked potential (BAEP). The PRVEP P100 latency and BAEP absolute and interpeak latencies were analyzed. Results: In obese individuals, BAEP absolute latencies of wave V were significantly prolonged in both the ears and wave I in left ear. In addition, significant prolongation of interpeak latency III-V was observed in both the ears and I-V latency, in right ear among obese cases. A positive correlation was seen between body mass index and interpeak latency I-V. In PRVEP recordings, P100 latency did not show any significant difference in both the groups. Conclusion: Therefore, we can conclude that obesity does not affect optic nerve conduction, but auditory nerve conduction is affected. BAEP I-V interpeak latency may be an indicator of subclinical auditory conduction defects in young obese males.

EEG-ERP Correlates of Cognitive Dysfunction in Polycystic Ovarian Syndrome.

Background: Polycystic ovarian syndrome (PCOS) has been shown to affect the psychological and cognitive status of a woman. However, amidst various conflicting reports in this regard, very few studies attempted to assess these aspects objectively using electroencephalography (EEG) and event-related potential (ERP). Purpose: To assess changes in neurocognitive and psychological parameters of PCOS women without any other comorbidities. Methods: PCOS women aged 18 years to 35 years, diagnosed from obstetrics and gynecology OPD who are otherwise free of any other comorbidities, were assessed for psychological status (anxiety and depression using the State-Trait Anxiety Inventory and Beck Depression Inventory, respectively). Thereafter, a cognitive assessment was done subjectively by the Montreal Cognitive Assessment (MoCA) questionnaire and objectively by using EEG [absolute and relative power of alpha, beta, and theta waves along with theta/beta ratios (TBR) and theta/alpha ratio (TAR)] and P300 amplitude and latency of ERP during a visual oddball paradigm task in control (n = 30) and PCOS (n = 37) subjects. Results: PCOS women showed significantly higher anxiety and depression scores along with low MoCA scores. Significantly reduced absolute alpha, increased frontal beta, and markedly increased theta (relative) power with increased TAR in the PCOS group were seen. Also, a significant reduction in P300 amplitude with prolonged latency during the visual oddball paradigm task was evident in them. Conclusion: Reduced alpha and higher theta activity with increased TAR are indicative of poor neural processing ability. Reduced P300 amplitude with more latency also suggests a cognitive decline, which is corroborated by reduced MoCA scores. Our study objectively indicates the presence of subclinical cognitive impairment in PCOS patients even without any comorbidities.

Neurocognitive Changes in Sickle Cell Disease: A Comprehensive Review.

Background: Sickle cell disease (SCD) is a type of hemoglobinopathy characterized by abnormal hemoglobin molecules, which includes numerous acute and chronic complications. Ischemic stroke, silent cerebral infarction, headache, and neurocognitive impairment are the most common neurological complications associated with SCD. Summary: Acute anemia because of SCD can cause cognitive impairments because of cerebral hypoxia. Cognitive abnormalities in SCD manifest in various aspects such as working memory, verbal learning, executive functions, and attention. These neurocognitive impairments have been associated with poor functional results, such as transitioning from juvenile to adult care, adherence to medications, and unemployment. Key message: In this review, we focus on neurocognitive aspects of SCD patients based on different imaging techniques, psychological batteries, associated neuromarkers, and interventions for managing of cognitive deficiencies..

Common, But Neglected: A Comprehensive Review of Leg Ulcers in Sickle Cell Disease.

OBJECTIVE: To compile available evidence to better understand the management of leg ulcers in sickle cell disease (SCD), as well as describe potential therapeutic steps that may be required to improve the quality of life of patients with SCD leg ulcers. DATA SOURCES: MEDLINE, PubMed, EMBASE, and Web of Science databases. STUDY SELECTION: A comprehensive search was conducted to retrieve relevant studies using the keywords "sickle cell disease and leg ulcer," "ulcer treatments, diagnosis and sickle cell," and "wound sickle cell." Studies published through July 2020 were included. DATA EXTRACTION: Two independent authors selected all studies that assessed the relationship between leg ulcer and SCD identified from online databases. DATA SYNTHESIS: The authors have summarized updated information on pathophysiology (vasculopathy linked to chronic hemolysis and endothelial dysfunction), diagnosis, and available treatment options to unravel the dermohematologic connection between leg ulcers and SCD. CONCLUSIONS: It is the authors' hope that this detailed discussion of the information available on leg ulcers and SCD will lead to a better appreciation of this clinical problem by the clinicians and researchers and in turn have a long-term positive effect on the quality of life of patients with SCD. Researchers should design new trials considering these insights and potential therapeutic approaches based on current knowledge.

Circadian rhythmicity of heart rate variability and its impact on cardiac autonomic modulation in asthma.

The commonly observed nocturnal attack of asthma is accompanied by circadian variations in airway inflammation and other physiological variables. It is also documented to present with a significantly higher risk of adverse cardiovascular events that are associated with lower heart rate variability (HRV) and depressed sympathetic and enhanced parasympathetic modulations. However, available literature is scarce with regard to the impact of alteration in circadian rhythmicity of long-term HRV and its day-night variation in asthmatic patients. Thus, 72-h continuous recording of RR interval and oxygen saturation was done to study the circadian variability of HRV (in terms of time and frequency domain indices) and also to assess the pattern of alterations in sympathetic and parasympathetic tones at different times of the day in asthmatic patients (n = 32) and healthy control subjects (n = 31). Repeated-measure analysis of variance and independent-samples t-test revealed significantly increased parasympathetic tone [in terms of increased square root of the mean squared differences of successive NN intervals (RMSSD), percentage of number of pairs of adjacent RR interval differing by more than 50 ms (pNN50), standard deviation of NN intervals (SDNN), and high frequency (HF)] with reduced sympathetic activity [decreased low frequency (LF) and LF/HF ratio] at early morning hours (between 04:00 and 10:00 h) in the asthma patients in contrast to the healthy subjects who had opposite response. Also, significant phase delay (p<0.05) of all the HRV indices and SpO2, was evident by cosinor analysis. Therefore, disturbed circadian rhythm of HRV indices and early morning increased parasympathetic tone points toward the possible pathophysiological basis of exacerbated asthmatic symptoms at late night/early morning hours and susceptibility of future cardiovascular pathologies. This also necessitates the assessment of HRV rhythm while dealing with the therapeutic management of asthma patients.

Impact of Altered Breathing Patterns on Interaction of EEG and Heart Rate Variability.

BACKGROUND: Altered pattern of respiration has been shown to affect both the cardiac as well as cortical activity, which is the basis of central-autonomic dual interaction concept. On the other hand, effect of this association between altered breathing with slow cortical activity, that is, electroencephalography (EEG) theta waves (associated with learning and relaxed alertness) on the cardiac autonomic balance is largely unclear. OBJECTIVE: The study aims to understand this interaction in response to altered respiratory patterns, for example, voluntary apnea, bradypnea, and tachypnea in terms of EEG and heart rate variability (HRV) correlates in normal healthy subjects. METHODS: This study was conducted on 32 adult male subjects. EEG from F3, F4, P3, P4, O1 and O2 cortical areas and Lead II electrocardiography for HRV analysis was continuously recorded during aforesaid respiratory interventions. Power spectral analysis of EEG for theta waves and HRV measures, that is, RMSSD, pNN50, HF, LF, and LF/HF was calculated as % change taking resting value as 100%. RESULTS: Apnea caused decrease in theta power, whereas an increase in LF/HF was observed in HRV. Bradypnea on the other hand, did not elicit any significant change in power of theta waves. However, decreased RMSSD and pNN50 were observed in HRV. Tachypnea led to increase in theta power with HRV depicting significantly decreased RMSSD and pNN50. Besides, significant correlation between EEG and HRV measures was found during tachypnea, which shifted toward posterior cortical sites as compared to resting condition. CONCLUSION: Various altered respiratory patterns caused either depressed parasympathetic or increased sympathetic output, whereas increased theta power along with posterior shift of correlation between theta power and HRV measures observed during post tachypnea might be due to involvement of global brain areas due to respiration-coupled neuronal activity. Thus, a definite link between cortical activity and autonomic output in relation to altered respiratory patterns may be suggested.

Association of mid sleep time and social jetlag with psychosocial behaviour of Indian population during COVID-19 lockdown.

Background: India, being the third worst affected country from COVID-19 pandemic at the time of study, faced complete lockdown to minimize community transmission that confined people to social isolation for extended durations. Design and Methods: Therefore, we conducted an online questionnaire-based survey for the Indian population after 37 days of complete lockdown to assess the integrative effects of such home restriction and social isolation on mid-sleep time, social jetlag, and their associated psychosocial behavior. From the reports of sleep onset and waking-up times before and during lockdown as obtained from a total of 1511 respondents of ≥18 years, midsleep time (MST) and social jetlag (SJL) were calculated. Participants also rated their psychosocial behavior related variables on a Likert scale. Results: Significantly delayed MST was noted during the lockdown. The majority showed reduced social jetlag; however, younger people and female subjects exhibited more SJL with delay in MST. Also, delayed MST and elevated SJL problems were more clearly demonstrated in people exhibiting more disturbances in sleep quality and daily routine, lower general mood status, irregular feeding habits (snacking frequency), worsened personal relationship, quality of life, and increased daydreaming events. Conclusion: The study emphasizes the importance of maintaining a regular daily routine with respect to sleep-wake patterns and eating habits to minimize the impact of such a crisis situation on sleep behavior, social jetlag, and associated psychosocial wellbeing.

Impact of COVID-19 lockdown on sleep-wake schedule and associated lifestyle related behavior: A national survey.

Background: Lockdowns to prevent the community transmission of COVID-19 pandemic has confined the people at home and imposed social restrictions, which is expected to cause alterations in circadian driven sleep-wake schedule and its associated lifestyle behaviors. Design and Methods: An online questionnaire-based survey was conducted to assess the impact of lockdown on the sleepwake pattern, meal timings and digital media exposure time on the Indian population during lockdown. Responses of 1511 participants (age ≥18 years) were analyzed to assess the effect of gender and age on these parameters before and during lockdown. Results: The sleep onset-wakeup times and meals' time was significantly delayed during lockdown, which was more pronounced in younger subjects. However, young individuals reported increased sleep duration at this time. Increased digital media duration was evident in all age groups, mainly in males. However, females reported more delay in sleep onset-waking time and first meal timing with longer sleep duration during lockdown. Conclusions: Discord with social and natural cues due to complete lockdown during COVID-19 pandemic leads to a state of social jetlag with delayed sleep-wake, meal timings and excessive digital media exposure among Indians, which has differential impact on males and females as well as across different age groups. These findings have applied implications in sleep health and related behavior during longer social isolation conditions such as current COVID-19 or similar situations and may help to prepare better for any such future events.

Neuro-Cognitive Profile of Morning and Evening Chronotypes at Different Times of Day.

BACKGROUND: Chronotype is the circadian time preference for sleep-wake timings. However, its impact on cognitive performance is least explored. OBJECTIVE: The present study investigated the effect of chronotype (morning "M" vs. evening "E") on cognitive measures as a function of time of the day. In addition, the correlation between electroencephalogram (EEG) waves and subjective/objective cognitive measures were investigated. METHOD: Cognitive status of 28 adult male subjects (15 "M" and 13 "E") was assessed objectively through event-related potential (ERP) by administering visual odd ball paradigm test and subjectively through Montreal Cognitive Assessment questionnaire. In addition, 20 to 30 min of resting EEG was recorded. Recordings were done from 8 to 10 am and from 4 to 6 pm on a single day. Power spectral analysis of EEG for alpha and beta waves at PZ and FZ cortical sites was done after subjecting selected epochs to fast Fourier transformation. Also, latency and amplitude of P300 potential from event-related potential record were measured. Appropriate statistical tests were applied for analysis. RESULTS: Higher alpha and beta power was observed in "E" at PZ in the evening. "M" showed increased P300 latency and amplitude during evening session for frequent and rare stimuli and vice versa in "E."' Significant negative correlation was seen between latency of rare stimuli and alpha and beta power at FZ site during evening in "E" chronotype only. CONCLUSION: Result indicates better attention and alertness during evening hours in evening chronotypes and vice versa in morning chronotypes. The findings could be implemented to schedule the mental performance/cognitive load according to individual chronotype.

Assessment of pulmonary function in local healthy Nepalese men of Dharan and it's anthropometric correlation.

Healthy non smoking male subjects (n = 150) aged 18-40 years were subjected to pulmonary function testing to establish linear multiple regression model. Pulmonary parameters were considered as independent variables and physical parameters (age, height, weight, body mass index (BMI) and body surface area (BSA) and anthropometric parameters (skin fold thickness (SFT), mid arm circumference and abdominal girth) were taken as dependent variables. This study was undertaken to determine correlation coefficients between dependent variables and different pulmonary independent variables and to derive regression equations or prediction formulae in order to find out the expected normal values for the different lung function tests in a given individual. Present study revealed that the upper body fat distribution, as reflected by biceps skin fold thickness and mid arm circumference, is a significant predicator of ventilatory function.