Fear of Coronavirus Disease 2019 among People with Epilepsy.

BACKGROUND: Epileptic patients are worried about getting coronavirus disease 2019 (COVID-19) infection and have recurrent thoughts of becoming infected with this virus. MATERIALS AND METHODS: This study involved 205 patients diagnosed with epilepsy. The questionnaire included questions about sociodemographic information to analyze the demographic composition. The evaluation of the fear of COVID-19 infection was conducted utilizing the Fear of COVID-19 Scale (FCV-19S). RESULTS: The study enrolled 113 participants (55.10% male and 44.90% female) with an average age of 27.34 years. The mean fear score (FCV-19S) was 14.25, and fear of COVID-19 infection was present in 41 (20%) participants with a mean [standard deviation (SD)] FCV-19S score of 23.19 (3.33). Participants who were >45 years of age, married, graduated, and had low family income were significantly more likely to be fearful of COVID-19. Using logistic regression, education, marital status, and family income were identified as risk factors for having significant fear of coronavirus infection. CONCLUSION: Given the notable prevalence of COVID-19-related fear within the epilepsy community, it is advisable to develop a well-thought-out strategy for promptly identifying vulnerable patients who may be at an increased risk of experiencing fear and anxiety.

The efficacy of oral ketamine in severely depressed patients at high risk of suicide.

BACKGROUND: Ketamine is most easily and inexpensively administered by the oral route and in racemic form. Oral racemic ketamine may be an important approach to the emergency management of suicide risk in clinical settings, especially in third world countries, that have a limited range of available healthcare resources. METHODS: In a prospective, uncontrolled, open-label investigation, we studied 30 severely depressed inpatients who consented to participate in a pilot hospital service offering ketamine for management of high suicide risk. Patients sipped a solution of racemic ketamine (150 mg) across 10-15 min in 3 alternate day sessions. Patients were assessed using the Modified Scale for Suicidal Ideation (MSSI), Montgomery-Asberg Depression Rating Scale (MADRS), and Clinical Global Improvement-Severity (CGI-S) scale at baseline and 1 day after the last ketamine session. RESULTS: There was statistically and clinically significant improvement on all outcomes. Mean (standard deviation) MSSI scores dropped from 25.1(1.8) to 17.3(5.6), MADRS scores from 28.8(3.4) to 21.9(3.6), and CGI-S scores from 6.0(0.2) to 3.6(0.9). At endpoint, MSSI scores had dropped from severe to low or mild-to-moderate in 67% of patients. The 90 ketamine sessions were uneventful; the treatment was well tolerated and no patient dropped out. CONCLUSION: Oral racemic ketamine may be a useful and potentially life-saving approach to the emergency management of severely depressed patients at high risk of suicide.

MicroRNA-3692-3p is overexpressed in lung tumors but may not serve as a prognostic biomarker in lung cancer patients.

BACKGROUND: We previously reported overexpression of miR-3692-3p in the serum of non-small cell lung cancer patients. However, the expression profile and clinical utility of miR-3692-3p in the tumor tissues of lung cancer patients are not yet reported. METHODS AND RESULTS: We quantified the expression levels of miR-3692-3p in the tumors and adjacent normal lung tissues of early-stage (n = 29) and tissue biopsies of locally advanced and metastatic (n = 85) lung cancer patients using TaqMan advanced miRNA assay. We correlated miR-3692-3p expression with survival outcomes, therapeutic response, and other clinicopathological variables. We also predicted the target genes of miR-3692-3p, constructed a protein-protein interaction network, and performed functional enrichment analysis using various in silico tools. We found significant overexpression of miR-3692-3p in the tumors (Log2 fold change = 3.672; p < 0.0001) and tissue biopsies (Log2 fold change = 2.08; p = 0.0001) compared to normal lung tissues of lung cancer patients. The expression of miR-3692-3p did not correlate with overall survival (OS), progression-free survival (PFS), and response to therapy. In multivariate analysis, therapeutic response emerged as an independent prognostic biomarker of OS (HR = 3.47; p = 0.022) and PFS (HR = 19.86; p < 0.001). Our in silico analysis predicted 238 target genes of miR-3692-3p. CONCLUSIONS: Overexpression of miR-3692-3p could contribute to the development of lung cancer. However, mechanistic studies are warranted to shed further light on its role in lung carcinogenesis.

Psychiatric comorbidity in clinically stable COVID-19 patients.

Aims: To identify prevalence of psychiatric comorbidity in clinically stable COVID-19 patients. Materials and Methods: A cross-sectional single point observational study was conducted among clinically stable 72 COVID-19 infected patients. Psychiatric comorbidity was assessed with the help of DSM-5 Self-Rated Level 1 CCSM-Adult scale. Results: The prevalence of psychiatric comorbidity was 76.4% (n = 55). Depression was the most common diagnosis in 44.44% (n = 32) followed by anxiety (34.72%, n = 25), somatic symptoms (26.39%, n = 19), sleep problems (23.61%, n = 17). Around 45 .83 % (n = 33) patients considered COVID-19 infection as potentially life-threatening and 23.62% (n=17) patients experienced discrimination and stigma after being diagnosed with COVID-19 infection. Using binary logistic regression, physical symptoms was identified as a risk factor for psychiatric comorbidity. Conclusion: Our study provides evidence of a significant impact of COVID-19 infection on mental health in COVID-19 patients.

SARS-CoV-2 Reinfection Rate and Estimated Effectiveness of the Inactivated Whole Virion Vaccine BBV152 Against Reinfection Among Health Care Workers in New Delhi, India.

Importance: A surge of COVID-19 occurred from March to June 2021, in New Delhi, India, linked to the B.1.617.2 (Delta) variant of SARS-CoV-2. COVID-19 vaccines were rolled out for health care workers (HCWs) starting in January 2021. Objective: To assess the incidence density of reinfection among a cohort of HCWs and estimate the effectiveness of the inactivated whole virion vaccine BBV152 against reinfection. Design, Setting, and Participants: This was a retrospective cohort study among HCWs working at a tertiary care center in New Delhi, India. Exposures: Vaccination with 0, 1, or 2 doses of BBV152. Main Outcomes and Measures: The HCWs were categorized as fully vaccinated (with 2 doses and ≥15 days after the second dose), partially vaccinated (with 1 dose or 2 doses with <15 days after the second dose), or unvaccinated. The incidence density of COVID-19 reinfection per 100 person-years was computed, and events from March 3, 2020, to June 18, 2021, were included for analysis. Unadjusted and adjusted hazard ratios (HRs) were estimated using a Cox proportional hazards model. Estimated vaccine effectiveness (1 - adjusted HR) was reported. Results: Among 15 244 HCWs who participated in the study, 4978 (32.7%) were diagnosed with COVID-19. The mean (SD) age was 36.6 (10.3) years, and 55.0% were male. The reinfection incidence density was 7.26 (95% CI: 6.09-8.66) per 100 person-years (124 HCWs [2.5%], total person follow-up period of 1696 person-years as time at risk). Fully vaccinated HCWs had lower risk of reinfection (HR, 0.14 [95% CI, 0.08-0.23]), symptomatic reinfection (HR, 0.13 [95% CI, 0.07-0.24]), and asymptomatic reinfection (HR, 0.16 [95% CI, 0.05-0.53]) compared with unvaccinated HCWs. Accordingly, among the 3 vaccine categories, reinfection was observed in 60 of 472 (12.7%) of unvaccinated (incidence density, 18.05 per 100 person-years; 95% CI, 14.02-23.25), 39 of 356 (11.0%) of partially vaccinated (incidence density 15.62 per 100 person-years; 95% CI, 11.42-21.38), and 17 of 1089 (1.6%) fully vaccinated (incidence density 2.18 per 100 person-years; 95% CI, 1.35-3.51) HCWs. The estimated effectiveness of BBV152 against reinfection was 86% (95% CI, 77%-92%); symptomatic reinfection, 87% (95% CI, 76%-93%); and asymptomatic reinfection, 84% (95% CI, 47%-95%) among fully vaccinated HCWs. Partial vaccination was not associated with reduced risk of reinfection. Conclusions and Relevance: These findings suggest that BBV152 was associated with protection against both symptomatic and asymptomatic reinfection in HCWs after a complete vaccination schedule, when the predominant circulating variant was B.1.617.2.

Impact of COVID-19 on People Suffering with Epilepsy.

BACKGROUND: Epilepsy is one of the most common problems in neurology clinical practice and currently we are in the midst of the coronavirus outbreak. The coronavirus pandemic is an epidemiological and psychological crisis, which is likely to affect persons with epilepsy. OBJECTIVES: This study was designed to evaluate the impact of COVID-19 pandemic on patients with epilepsy and effects on their mental health. MATERIALS AND METHODS: This was a cross-sectional web-based survey carried out at the department of Neurology at a tertiary care hospital. A questionnaire was designed in the local language using Google Forms to assess basic knowledge regarding epilepsy, coronavirus, effects of COVID-19 and lockdown on epileptic patients and also effects on their mental health. The link to the online survey was distributed via WhatsApp messenger to epilepsy patients. RESULTS: One hundred fifty-six cases were enrolled with 69.1% were below 34 years of age and male: female ratio was 1.2:1. Only 34.3% of the participants were employed and 50% of patients had an income of less than Rs. 3000 per month. Of the patients enrolled, 20.5% reported the "devil" and superstitions as a cause of epilepsy and only 10% of patients thought that tantric (holy priest) could treat the disease better than doctors. 53.8% of patients worried about getting COVID-19 and could not stop thoughts about being infected by coronavirus bothering them. 30.3% patients had increased seizure frequency during COVID-19 pandemic, of which the most common reason was that they forgot to take regular antiepileptic drugs (22.7%) or they had faced difficulty in obtaining medicine due to lockdown (12.1%). During the pandemic, 17% of patients reported depression symptoms and another 21% reported anxiety symptoms. CONCLUSION: The current COVID-19 pandemic negatively affected patients with epilepsy and increased seizure frequency, depression, anxiety, unemployment, and financial difficulty in obtaining medication.

Sexual Dysfunction in Male Patients with Idiopathic Generalized Tonic Clonic Seizures.

BACKGROUND: Epilepsy is the second most common neurological disorder, and it may have a significant effect on sexual functions in epileptic patients. MATERIALS AND METHODS: Sexual dysfunctions were assessed in 146 male patients suffering from generalized tonic-clonic seizure (GTCS) with a seizure-free interval of at least 1 year. Out of 146 patients enrolled, 46 patients had a psychiatric impairment and were excluded from the study, after applying the General Health questionnaire12 (GHQ12) scale and detailed psychiatric evaluation. The remaining patients were evaluated for the presence of sexual dysfunction by applying Arizona Sexual Experience scale (ASEX). Sixty-six patients scoring more than 19 as a cutoff score on the ASEX scale were further interviewed by a psychiatrist, and a diagnosis of sexual dysfunction was made as per ICD 10 Diagnostic criteria. RESULTS: Sexual dysfunction was diagnosed in 66% (n = 66) of the patients. Erectile dysfunction was the most common sexual disorder diagnosed in 36% of the patients (n = 36) followed by premature ejaculation in 26% (n = 26) and decreased libido (hypoactive sexual desire) seen in 4% (n = 4) of the patients. In patients with sexual dysfunction, a significant association was observed with the duration of epilepsy and type of therapy (mono/polytherapy) (P value < 0.05). Erectile dysfunction and hypoactive desire were more common in patients taking polytherapy, whereas premature ejaculation was more common in patients on monotherapy. CONCLUSION: Significant impairment of sexual functions was observed in male epileptics with GTCS. A high index of suspicion should be kept in mind by the practicing clinician on diagnosing and treating sexual dysfunction in them.

Differential expression of circulating serum miR-1249-3p, miR-3195, and miR-3692-3p in non-small cell lung cancer.

Global deregulation in miRNA expression is a hallmark of cancer cell. An estimated 2300 mature miRNAs are encoded by human genome; role of many of which in carcinogenesis and as cancer biomarkers remains unexplored. In this study, we investigated the utility of miR-3692-3p, miR-3195, and miR-1249-3p as biomarkers in non-small cell lung cancer (NSCLC). For this prospective study, 115 subjects, including 75 NSCLC patients and 40 controls, were recruited. The expression of miR-3692-3p, miR-3195, and miR-1249-3p was checked using qRT-PCR. The miRNA expression was correlated with survival outcome and therapeutic response. There were no significant differences in the mean age of NSCLC patients and controls (56.2 and 55.3 years, respectively; p = 0.3242). Majority of NSCLC patients (67%) were smokers. We observed a significant upregulation of miR-3692-3p expression (p < 0.0001), while the expression of miR-3195 (p = 0.0017) and miR-1249-3p was significantly downregulated (p < 0.0001) in the serum of NSCLC patients as compared to controls. The expression of miR-1249-3p was significantly upregulated in lung adenocarcinoma versus lung squamous cell carcinoma (p = 0.0178). Interestingly, patients who responded to chemotherapy had higher expression of miR-1249-3p than non-responders (p = 0.0107). Moreover, patients with higher expression of miR-3195 had significantly longer overall survival (p = 0.0298). In multivariate analysis, miR-3195 emerged as independent prognostic factor for overall survival. We conclude that the miR-3195 may have prognostic significance, while miR-1249-3p may predict therapeutic response in NSCLC. Further studies are warranted to elucidate the role of these miRNAs in lung carcinogenesis and their utility as candidate cancer biomarkers.

Identification of differentially expressed circulating serum microRNA for the diagnosis and prognosis of Indian non-small cell lung cancer patients.

PURPOSE: Identification of noninvasive blood-based biomarkers is of utmost importance for the early diagnosis and predicting prognosis of advance stage lung cancer patients. MicroRNAs (miRNAs) has been implicated in numerous diseases, however, their role as diagnostic and prognostic biomarkers in Indian lung cancer patients has not been evaluated yet. METHODS: For the identification of differentially expressed miRNAs in the serum of non-small cell lung cancer (NSCLC) patients, we performed small RNA sequencing. We validated the expression of 10 miRNAs in 75 NSCLC patients and 40 controls using quantitative reverse transcription polymerase chain reaction (PCR). miRNA expression was correlated with survival and therapeutic response. RESULTS: We identified 16 differentially expressed miRNAs in the serum of NSCLC patients as compared to controls. We observed significant downregulation of miR-15a-5p, miR-320a, miR-25-3p, miR-192-5p, let-7d-5p, let-7e-5p, miR-148a-3p, and miR-92a-3p in the serum of NSCLC patients. The expression of miR-375 and miR-10b-5p was significantly downregulated in lung squamous cell carcinoma patients than controls. The expression of miR-320a, miR-25-3p, and miR-148a-3p significantly correlated with stage. None of the miRNAs were correlated with survival outcome and therapeutic response. CONCLUSIONS: We conclude that the relative abundance of miRNAs in serum may be explored for the development of miRNA-based assays for better diagnosis and prognosis of NSCLC. Moreover, further studies are warranted to elucidate the role of some of the less explored miRNAs, such as miR-375 and miR-320a, in the pathogenesis of NSCLC.