Improved sleep, cognitive processing and enhanced learning and memory task accuracy with Yoga nidra practice in novices.

Complementary and Alternative medicine is known to have health benefits. Yoga nidra practice is an easy-to-do practice and has shown beneficial effects on stress reduction and is found to improve sleep in insomnia patients. Effect of yoga nidra practice on subjective sleep is known but its effect on sleep and cognition objectively is not documented. The aim of the study was to study the effect of yoga nidra practice on cognition and sleep using objective parameters. 41 participants were enrolled, and baseline sleep diary (SD) collected. Participants volunteered for overnight polysomnography (PSG) and cognition testing battery (CTB) comprising of Motor praxis test, emotion recognition task (ERT), digital symbol substitution task, visual object learning task (VOLT), abstract matching (AIM), line orientation task, matrix reasoning task, fractal-2-back test (NBACK), psychomotor vigilance task and balloon analog risk task. Baseline CTB and after one and two weeks of practice was compared. Power spectra density for EEG at central, frontal, and occipital locations during CTB was compared. Repeat SD and PSG after four weeks of practice were done. After yoga nidra practice, improved reaction times for all cognition tasks were seen. Post intervention compared to baseline (95%CI; p-value, effect size) showed a significant improvement in sleep efficiency of +3.62% (0.3, 5.15; p = 0.03, r = 0.42), -20min (-35.78, -5.02; p = 0.003, d = 0.84) for wake after sleep onset and +4.19 µV2 (0.5, 9.5; p = 0.04, r = 0.43) in delta during deep sleep. Accuracy increased in VOLT (95% CI: 0.08, 0.17; p = 0.002, d = 0.79), AIM (95% CI: 0.03, 0.12; p = 0.02, d = 0.61) and NBACK (95% CI: 0.02, 0.13; p = 0.04, d = 0.56); ERT accuracy increased for happy, fear and anger (95% CI: 0.07, 0.24; p = 0.004, d = 0.75) but reduced for neutral stimuli (95% CI: -0.31, -0.12; p = 0.04, r = 0.33) after yoga nidra practice. Yoga Nidra practice improved cognitive processing and night-time sleep.

Assessment of Six-Minute Walk Test Among Discharge-Ready Severe COVID-19 Patients: A Cross-Sectional Study.

Background Among patients hospitalized for severe pneumonia due to coronavirus disease (COVID-19), clinical stability and normal resting peripheral oxygen saturation (SpO2) levels are widely used as a discharge criterion after recovery. It is unknown whether a test to assess the functional exercise capacity, like a six-minute walk test (6MWT), can add to the appropriateness of discharge criteria. Methods A cross-sectional study was conducted at a tertiary care COVID-19 hospital in India from 01st to 31st May 2021. All patients considered fit for discharge after recovery from "severe" COVID-19 pneumonia were subjected to 6MWT. Fitness for discharge was assessed by clinical stability and resting SpO2 above 93% for three consecutive days. Patients were considered to have failed the 6MWT if there was ≥4% fall in SpO2 or if they could not complete the test. Serum samples were analyzed for levels of C-reactive protein (CRP), interleukin-6 (IL-6), and lactate dehydrogenase (LDH) at the time of discharge. Results Fifty-three discharge-ready patients with a mean age of 54.54 ± 14.35 years with a male preponderance (60.38%) were analyzed. Thirty-three (62.26%) patients failed the 6MWT with a median six-minute walk distance (6MWD) of 270 m (60-360). A total of 45 (84.91%) patients had a fall in SpO2 during the test. The median change in SpO2 (∆SpO2) was 5% ranging from -6% to 8%. Serum LDH was significantly higher among patients who failed the 6MWT with a median LDH of 334 IU/L (38.96-2339) versus 261 IU/L (49.2-494) (p = 0.02). The difference was not significant for CRP or IL-6. There was no statistically significant correlation between the inflammatory markers with either 6MWD or (∆SpO2). Conclusion Two-thirds of the patients considered fit for discharge after recovery from severe COVID-19 pneumonia failed 6MWT, implying reduced functional exercise capacity and exertional hypoxia. Serum LDH levels were higher in these patients but not in other inflammatory markers. None of the inflammatory markers at discharge correlated with 6MWD or ∆SpO2 of 6MWT.

Relationship of Computed Tomography Severity Score With Patient Characteristics and Survival in Hypoxemic COVID-19 Patients.

Background Computed tomography (CT) scans and CT severity scores (CTSS) are widely used to assess the severity and prognosis in coronavirus disease 2019 (COVID-19). CTSS has performed well as a predictor in differentiating severe from non-severe cases. However, it is not known if CTSS performs similarly in hospitalized severe cases with hypoxia at admission. Methods We conducted a retrospective comparative study at a COVID-care center from Western India between 25th April and 31st May 2021, enrolling all consecutive severe COVID-19 patients with hypoxemia (peripheral oxygen saturation < 94%). Neutrophil-lymphocyte ratio (NLR), C-reactive protein (CRP), interleukin-6 (IL-6), lactate dehydrogenase (LDH), D-dimer, ferritin, and CT thorax were done within 24h of admission before being initiated on any anti-COVID-19 therapy. CTSS was calculated by visual assessment and categorized into three severity categories and was correlated with laboratory markers and overall survival (OS). Statistical analysis was done using John's Macintosh Project (JMP) 15.0.0 ver. 3.0.0 (Cary, North Carolina). Results The median age of the study population (n-298) was 59 years (24-95) with a male preponderance (61.41%, n=183). The 15 and 30-day survivals were 67.64% and 59.90%, respectively. CTSS did not correlate with age, gender, time from vaccination, symptoms, or comorbidities but had a significant though weak correlation with LDH (p=0.009), D-dimer (p=0.006), and NLR (p=0.019). Comparing demographic and laboratory aspects using CT severity categories, only NLR (p=0.0146) and D-dimer (p=0.0006) had significant differences. The 15d-OS of mild, moderate, and severe CT categories were 88.62%, 70.39%, and 52.62%, respectively, while 30d-OS of three categories were 59.08%, 63.96%, and 49.12%, respectively. Conclusion Among hospitalized severe COVID-19 patients with hypoxemia at admission, CT severity categories correlate well with outcomes but not inflammatory markers at admission.

New-onset seizure at high altitude among healthy males.

OBJECTIVES: The risk of developing new-onset seizure following ascent to high-altitude areas is currently unknown. We undertook a prospective study to quantify this risk. METHODS: The study was conducted at a tertiary care hospital in India between July 2015 and December 2017. It included apparently healthy males of age ≥18 years who ascended to an altitude of ≥ 2500 m and stayed there for > 30 continuous days. Individuals with a history of seizure in the past two years, those who had not undergone acclimatization protocol, and those who had a history of any chronic systemic illness were excluded. RESULTS: The 39,213 individuals included in the study together had 39,848.6 person-years of high-altitude exposure. New-onset seizure after ascent occurred in 41 of them, indicating a seizure incidence rate of 102.9 per 100,000 person-years (95% CI = 75.8-139.7). The incidence per 100,000 person-years (95% CI) at altitudes of 2,500-3,500 m, 3,500-5,800 m, and > 5,800 m was 82.3 (53.6-126.1), 134.6 (84.9-213.6), and 210.8 (52.8-841.4), respectively. Seizure was secondary to cerebral venous thrombosis in 12 (29.3%) individuals. No etiology could be determined in the remaining 29 (70.7%) individuals. CONCLUSIONS: Our findings suggest that when subjects living at sea level are exposed to high altitudes, they will be at a higher risk for new-onset seizure in the immediate few months of exposure, and that this risk increases with increasing altitude.

Headache of Wearing PPE; A Survey for Neurological Symptoms with PPE amongst Health Care Workers.

Background: The COVID-19 pandemic has put the entire medical fraternity into a very challenging and demanding situation. Along with always being at the risk of COVID infection, healthcare workers (HCWs) are also facing neurological problems due to long working hours in personal protective equipment (PPE). These symptoms and their characteristics need to be observed and studied in-depth to understand the problems experienced by HCWs and to design new solutions to overcome such problems. Objectives: This study intends to evaluate the various neurological manifestations among the HCWs wearing PPE for prolonged periods. Materials and Methods: We conducted a questionnaire-based cross-sectional study at a Covid care center from western India from April 20 to June 01, 2021 by using a self-administered web-based questionnaire. A total of 256 HCWs were surveyed. The de-identified data were analyzed using JMP 15.0.0. Results: Among a total of 256 HCWs surveyed for this study, the majority (58.6%) were aged 24-35 years, with a male preponderance (65.62%, n = 168). Participants included doctors (41%), nurses (35%), paramedical staff (22%), and housekeeping staff (1%). The symptoms encountered among the HCWs wearing the PPE were headache, classified further as donning headache in 112 (44.98%), doffing headache in 56 (26.24%), slowed mentation in 48 (21.05%), and excessive sleepiness in 86 (38.74%), which affected their work performance. The age of the HCWs had a significant correlation with all the symptoms. Conclusion: Headache, slowed mentation, and excessive sleepiness was encountered among the HCWs wearing PPE, which depended upon the duration of PPE usage. The most common symptom was headache, which was of moderate to severe intensity.

Olfactory Dysfunction Among Asymptomatic Patients with SARS CoV2 Infection: A Case-Control Study.

Olfactory dysfunction (hyposmia, anosmia) is a well-recognized symptom in patients with coronavirus disease-19 (COVID-19). Studies of olfactory dysfunction in asymptomatic patients have not been reported. We conducted a study looking for the presence of olfactory dysfunction with an objective assessment tool in asymptomatic Covid 19 and compared it with patients with mild COVID-19 and age-matched controls. We recruited 57 male patients each of Mild COVID-19, asymptomatic Covid 19, and healthy controls for the study. All participants underwent evaluation of smell threshold by Butanol Threshold test (BTT) and ability to distinguish common odors by Smell identification test. The scores of each test were recorded on a numerical scale. The participants in all three arms were matched for age, history of smoking, and pre-existing medical conditions. The mean scores of the Butanol Threshold test in Mild COVID-19, asymptomatic Covid 19 and controls were 2.95 ± 2.25 (0-7.5), 3.42 ± 2.23 (0-7.5), and 4.82 ± 1.86 (0-8), respectively. A one-way ANOVA showed a significant difference between groups (df 2, MS 53.78, F 11.94, p < 0.005). Intergroup differences using the student T-test showed significantly low BTT scores in Mild COVID-19 (p < 0.005) and asymptomatic (p < 0.005) as compared to control. BTT scores could not distinguish between asymptomatic patients and control. The smell threshold was impaired in asymptomatic Covid 19 and Mild COVID-19. Butanol Threshold Test score could not differentiate between asymptomatic Covid 19 and controls.