ABSTRACT
The outbreak of coronavirus disease (Covid-19) has impacted the health and welfare of people globally. Given the fundamental role of sleep in health and wellbeing, it is important to study the impact of Covid-19 on sleep quality, dream content and emotionality. This has not been studied among Indian population. The present study was carried out to understand the state of sleep quality, dream contents and the relation between sleep quality and emotionality in people during the Covid-19. Based on previous studies, we expected to find differences among individuals based on how much they were affected by Covid-19, which may be because of pandemic-related stressors (like altered family dynamics, economic stability, etc.). We used Mannheim Dream questionnaire (MADRE), Pittsburgh Sleep Quality Index (PSQI), Positive Affect Negative Affect Schedule (PANAS). We used robust statistics and resampling-based estimates to quantify differences and associations for hypothesis testing. The findings indicate that during pandemic, sleep quality deteriorated with increase in negative affect and improved with increase in positive affect. Sleep quality also deteriorates with an increase in the intensity of emotionally charged dreams. Furthermore, correlation analysis revealed a negative relationship between age and negative affect (NA) suggesting that the younger the age, higher the negative affective state. Subjects who reported to be Covid-19 affected had an increased frequency of nightmares and were more distressed by nightmares, compared to those reporting not affected. This supports the notion that sleep, dreams, and affective states were disrupted during the pandemic. Subjects infected with Covid-19 had dreams of relatives or friends suffering from coronavirus and this shows the strong effect of the pandemic on the dream contents. Our study highlights the impact of psychological stress on human sleep, and emotionality. According to the study findings, we suggest that monitoring sleep, dreams, and emotions may help in developing effective interventions to restore sleep quality, prevent sleep disorders, and manage affective behaviour in pandemic like situations. © 2023, International Journal of Dream Research. All Rights Reserved.
ABSTRACT
Introduction: The main clinical use of ctDNA EGFR testing has been for the detection of secondary EGFR mutations. We present our experience of upfront testing for poor performance status, nonsmoking patients. Methods: Retrospective review of four patients. Results: Patient 1: 76 year old female with left lower lobe mass with liver and bone mets. No suitable sites to biopsy. ctDNA EGFR blood test positive for exon 19 mutation. Commenced Gefitinib with good clinical and CXR response. Patient died at 2 months due to pneumonia. Patient 2: 87 year old male with previous prostate, oesophageal and colon cancers. Diagnosed with radiological diagnosis of lung cancer with liver metastasis. Deemed unfit for chemo, no biopsy performed, but ctDNA EGFR testing confirmed Exon 21 mutation and commenced Gefitinib. Disease progressed after 6 cycles. Repeat ctDNA EGFR testing confirmed T790M mutation: commenced on Osimertinib with stable disease after 3 cycles. Unfortunately, the patient then developed oesophageal squamous cell carcinoma and died 1 month later. Patient 3: 61 year old female with previous breast cancer in 2011. Left lung mass with liver and bone mets. Difficult sites to biopsy. ctDNA EGFR testing confirmed exon21 EGFR mutation. Commenced Gefinitib in between 2 prophylactic femoral IM nailing with good clinical response. Patient 4: 50 year old female with widespread disseminated in keeping with lung primary.. Unfortunate delay in obtaining biopsy. ctDNA EGFR test negative. Subsequent biopsy confirmed small cell lung cancer. Died from nosocomial COVID-19. Turnaround time for ctDNA EGFR results less than 7 days for all four cases. Conclusions: Poor performance status never smoking patients with radiological evidence of lung cancer should be considered for ctDNA EGFR testing when obtaining tissue would be challenging. In our series, 3/4 cases were promptly diagnosed with EGFR mutations, enabling commencement of TKI treatment with clinical benefit. Disclosure: No significant relationships.