Association of sleep disturbance with diabetic retinopathy.

PURPOSE: Diabetes mellitus (DM) patients are more likely to experience sleep disturbances than normal. Sleep disturbances may contribute to the development of diabetic retinopathy (DR) by higher inflammatory markers in circulation. We investigated the association between sleep quality and DR. METHODS: Institutional case control study with type 2 DM patients of <10 years duration and HbA1c ⩽8%; 70 cases with DR and 70 controls without DR (NODR) (power 0.8). Sleep quality was assessed by Pittsburg sleep quality index (PSQI) questionnaire and compared. RESULTS: Cronbach's alpha was 0.777 with high internal homogeneity. Global PSQI score in DR (7.44 ± 3.99; 95%CI 6.88, 9.42) was more than in NODR (4.30 ± 3.26; 95%CI 3.87, 6.45) (p < 0.001). All sleep disturbance scores were more in DR except sleep duration. Poor sleep (PSQI score>5) was more prevalent in DR (p = 0.000) and associated with increasing DR severity (p = 0.026). Normal sleep latency was recorded in 78.57% and 42.85% patients in NODR and DR respectively (p < 0.001). Severe difficulty in subjective sleep quality (p = 0.024), sleep latency (p = 0.002) and daytime dysfunction (p < 0.001) was seen more in DR. Elevated daytime dysfunction was observed with increasing DR severity (p = 0.008). The optimal cut-off for global PSQI score and sleep latency for DR was 5.5 (OR: 5.97; 95%CI 2.86, 12.47) and 25 min(OR: 4.89; 95%CI 2.32, 10.26) respectively. CONCLUSION: Sleep disturbance is positively associated with DR. Our study identifies cut off value for DR of a modifiable parameter like sleep latency. It emphasizes the need of sleep quality assessment for risk assessment of DR.

Association of the Val66Met polymorphism of the BDNF gene and the deletional mutation of CYP2D6 gene with the prevalence and severity of depressive disorder in an Eastern Indian population.

Background: The Val66Met single nucleotide polymorphism (SNP) of the brain-derived growth factor (BDNF) and deletional mutation of the cytochrome P4502D6 (CYP2D6) have been reported to be linked to the etiology and severity of depressive disorders (DD) in a variable manner among different ethnicities and populations. Aims: The present study was aimed to find the relationship of mutational variations of these two neurotrophins with the severity of DD and their serum cortisol levels as a marker of the stress factor. Methods: In 104 drug-naïve newly diagnosed cases of DD and 106 control subjects, the severity of depression was assessed using the HAM-D score. Val66Met SNP of the BDNF was analyzed in them using restriction digestion of its polymerase chain reaction (PCR) product. CYP2D6 deletional variants were detected by the absence of their PCR products. Serum cortisol levels were measured by the enzyme-linked immunosorbent assay (ELISA) technique. Results: The Chi-square test (Χ2 = 1.42, P = 0.49) did not show any higher prevalence of Val66Met SNP of the BDNF gene in the case group. A correlation coefficient (R) of -0.14 for HAM-D score with a P value of 0.29 signified no direct link of the severity of DD with this SNP. However, a Χ2 of 12.68 with P < 0.001 indicated a significantly higher prevalence of the CYP2D6 deletional mutants in DD cases, whereas an R-value of 0.39 for HAM-D score with P < 0.001 suggested a significantly higher severity of DD having with them. Serum cortisol level showed a significant positive correlation with the deletional variants of CYP2D6 (R = 0.198, P = 0.04) and the HAM-D score (R = 0.22, P = 0.025). Conclusion: We conclude that CYP2D6 deletion significantly contributes to the severity and stress factor in the DD patients in our study population. Early identification of these mutations may provide important molecular and cellular predisposition for the disease and may lay the ground for possible more effective measures of intervention.

Immunomodulatory potential of apolipoproteins and their mimetic peptides in asthma: Current perspective.

Asthma prevailed as a common inflammatory disease affecting mainly the lower respiratory tract, with notable inflammation in the upper airways leading to significant morbidity and mortality. An extensive search for a new therapeutic target is continuously being carried out. Still, the majority have failed in the trials, and eventually, the drugs, including ß2-adrenergic agonists, muscarinic antagonists, and certain corticosteroids, remain the backbone for asthma control. Numerous endogenous factors aid in maintaining the normal homeostasis of the lungs and prevents disease progression. One among them is the apolipoproteins which are different sets of lipoprotein moieties that not only aid in the transport and metabolism of lipids but also impart immunomodulatory roles in various pathologies. Modern research joins the links between the immunomodulatory nature of apolipoproteins in chronic respiratory diseases like asthma and COPD, which can assist in ameliorating the disease progression. Recent studies have elucidated the protective roles of apoA-I and apoE in asthma. This has enabled the utilization of certain apolipoprotein-mimetic peptides to treat these severe pulmonary diseases in the long run. In this review, we have described the prominent and probable mechanistic roles of apolipoproteins like apoA-I, apoB, apoE, apoJ, and apoM in the pathogenesis and treatment of asthma along with the development of apoA-I and apoE-mimetics as a cardinal treatment strategy for eosinophilic as well as corticosteroid resistant neutrophilic asthma.

A review on the effect of COVID-19 in type 2 asthma and its management.

BACKGROUND: COVID-19 is considered the most critical health pandemic of 21st century. Due to extremely high transmission rate, people are more susceptible to viral infection. COVID-19 patients having chronic type-2 asthma prevails a major risk as it may aggravate the disease and morbidities. OBJECTIVE: The present review mainly focuses on correlating the influence of COVID-19 in type-2 asthmatic patients. Besides, it delineates the treatment measures and drugs that can be used to manage mild, moderate, and severe symptoms of COVID-19 in asthmatic patients, thus preventing any exacerbation. METHODS: An in-depth research was carried out from different peer-reviewed articles till September 2020 from several renowned databases like PubMed, Frontier, MEDLINE, and related websites like WHO, CDC, MOHFW, and the information was analysed and written in a simplified manner. RESULTS: The progressive results were quite conflicting as severe cases of COVID-19 shows an increase in the level of several cytokines that can augment inflammation to the bronchial tracts, worsening the asthma attacks. Contradicting to this, certain findings reveal the decrease in the severity of COVID-19 due to the elevation of T-cells in type-2 asthmatic patients, as prominent reduction of T-cell is seen in most of the COVID-19 positive patients. This helps to counteract the balance of immune responses and hence ameliorate the disease progression. CONCLUSION: Asthmatic patients must remain cautious during the COVID-19 pandemic by maintaining all the precautions to stay safe due to limited research data. Future strategies should include a better understanding of asthmatic exacerbation and its relation to COVID-19.

Enumerating the role of properdin in the pathogenesis of IgA nephropathy and its possible therapies.

BACKGROUND: IgA nephropathy (IgAN) has become the most prevalent form of glomerulonephritis affecting almost 1.3% of the total population worldwide. It is an autoimmune disorder where the host autoantibody forms an immune complex with the defective galactose-deficient IgA1 and gets deposited at the mesangium and endocapillary region of glomeruli. IgA has the capability to activate alternative and lectin complement cascades which even aggravates the condition. Properdin is directly associated with IgAN by activating and stabilising the alternative complement pathway at the mesangium, thereby causing progressive renal damage. OBJECTIVE: The present review mainly focuses on correlating the influence of properdin in activating the complement cascade at glomeruli which is the major cause of disease exacerbation. Secondly, we have described the probable therapies and new targets that are under trials to check their efficacy in IgAN. METHODS: An in-depth research was carried out from different peer-reviewed articles till December 2020 from several renowned databases like PubMed, Frontier, and MEDLINE, and the information was analysed and written in a simplified manner. RESULTS: Co-deposition of properdin is observed along with IgA and C3 in 75%-100% of the patients. It is not yet fully understood whether properdin inhibition can attenuate IgAN, as many conflicting reports have revealed worsening of IgAN after impeding properdin. CONCLUSION: With no specific cure still available, the treatment strategies are of great concern to find a better target to restrict the disease progression. More research and clinical trials are required to find out a prominent target to combat IgAN.

Coping Skills In Parents Of Children With Autism Spectrum Disorder

Raising a child with Autism Spectrum Disorder (ASD) can cause significant parental stress. This stress can cause psychological problems in them. Each parent has their own coping mechanism. In this study the psychopathology in parents of children having ASD were assessed. A total number of 50 consecutive consenting parents of children with ASD were interviewed using a semi–structured pro forma, symptom checklist 90 revised (SCL90R). Mean age for the parents was 37 (±7.40) years, and for the children, it was 8.3 (±3.42) years. There were 30 mothers. Thirty–five of parents considered their child‘s illness to be a major concern in their life. The fatalism subscale of coping was found having highest mean value followed by problem solving and expressive action

A Comparative Study Regarding The Difference In Attitude Of Interns Towards Psychiatric Illness And Chronic Medical Illness

Attitude of doctors towards a specific illness play major role in the care of patients. Internship, the final stage in MBBS training is important in developing attitudes towards different diseases. Psychiatric illnesses itself have stigma among doctors too. In our country there are little studies comparing the medical illness and psychiatric illness. In this study we tried to explore the attitude of interns towards Psychiatric illness and a chronic medical illness (Diabetes Mellitus). Total 136 interns who had completed their Psychiatric posting were included in this study. Medical Condition Regard Scale was used to assess the attitude towards the specific illness. The attitude of interns towards Psychiatric illness was comparable with the attitude towards Diabetes Mellitus.

Role of family and peers in the initiation and continuation of smoking behavior of future physicians.

BACKGROUND: Globally researchers have long back noted that the trend of substance use was on the rise particularly in the student population. OBJECTIVE: To find out the prevalence and determinants of smoking practices among undergraduate medical students. MATERIALS AND METHODS: A cross-sectional study was conducted among undergraduate medical (MBBS) students of a tertiary care medical college using a predesigned and pretested semi-structured self-administered anonymous questionnaire. RESULTS: Among 182 participants, 55 (30%) were smokers; 85.45% were regular smokers; majority in the age group 20-22 years (70%); mostly males (98%). No significant difference was observed among urban and rural students, and religion had no association. The practice of smoking for last 6 months to 1 year was in 43.6% and 40% smoked less than 6 months. Half of them (50.9%) smoked 5-9 cigarettes per day. Peer pressure was significantly high in smokers (83.6%); 42% had other addictions. The effect of parental smoking on smoking habits of the participants was quite evident among smokers (82%), which was significantly higher than nonsmokers (χ(2) = 63.49, P < 0.05). Peer pressure was the most important risk factor (57.69%) of initiation of smoking habit followed by parental influence (16.49%). Among morbidities of smokers, 60.6% were suffering from regular cough, 6% from bronchitis, and 2% had asthma. CONCLUSIONS: Our survey conducted on budding doctors surprisingly showed that undergraduate medical students smoke so much.

Comparative study of personality disorder associated with deliberate self harm in two different age groups (15-24 years and 45-74 years).

AIMS: To study the presence of personality disorder in cases of deliberate self harm (DSH) in young (15-24 years) and elderly (45-74 years) and compare. MATERIALS AND METHODS: Deliberate self harm cases admitted in Medical and surgical departments and cases attending psychiatry department of R.G. Kar Medical College, Kolkata were studied. For diagnosis of personality disorder ICD 10 International Personality Disorder Examination (IPDE) questionnaire was used. RESULTS: Percentage of elderly patients having personality disorder (64%) was higher compared to young DSH patients (58.5%). In young group, most common disorder was emotionally unstable personality disorder (28.6%) and in elderly group most common was anankastic type of personality disorder (36%). Schizoid, dissocial, histrionic, and anxious-avoidant personality disorders were found in small percentages of cases. CONCLUSION: Among DSH patients, the most common personality disorder found in young age was Emotionally unstable (Impulsive and Borderline) personality disorder, but most common personality disorder found in elderly patients was Anankastic personality disorder.