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Background and purpose: The prevalence of cerebral small vessel disease (CSVD) is increasing due to the accelerating global aging process, resulting in a substantial burden on all countries, as cognitive dysfunction associated with CSVD is also on the rise. Clock genes have a significant impact on cognitive decline and dementia. Furthermore, the pattern of DNA methylation in clock genes is strongly associated with cognitive impairment. Thus, the aim of this study was to explore the connection between DNA promoter methylation of PER1 and CRY1 and cognitive dysfunction in patients with CSVD. Methods: We recruited patients with CSVD admitted to the Geriatrics Department of the Lianyungang Second People's Hospital between March 2021 and June 2022. Based on their Mini-Mental State Examination score, patients were categorized into two groups: 65 cases with cognitive dysfunction and 36 cases with normal cognitive function. Clinical data, 24-h ambulatory blood pressure monitoring parameters, and CSVD total load scores were collected. Moreover, we employed methylation-specific PCR to analyze the peripheral blood promoter methylation levels of clock genes PER1 and CRY1 in all CSVD patients who were enrolled. Finally, we used binary logistic regression models to assess the association between the promoter methylation of clock genes (PER1 and CRY1) and cognitive dysfunction in patients with CSVD. Results: (1) A total of 101 individuals with CSVD were included in this study. There were no statistical differences between the two groups in baseline clinical data except MMSE and AD8 scores. (2) After B/H correction, the promoter methylation rate of PER1 was higher in the cognitive dysfunction group than that in the normal group, and the difference was statistically significant (adjusted p < 0.001). (3) There was no significant correlation between the promoter methylation rates of PER1 and CRY1 in peripheral blood and circadian rhythm of blood pressure (p > 0.05). (4) Binary logistic regression models showed that the influence of promoter methylation of PER1 and CRY1 on cognitive dysfunction were statistically significant in Model 1 (p < 0.001; p = 0.025), and it still existed after adjusting for confounding factors in Model 2. Patients with the promoter methylation of PER1 gene (OR = 16.565, 95%CI, 4.057-67.628; p < 0.001) and the promoter methylation of CRY1 gene (OR = 6.017, 95%CI, 1.290-28.069; p = 0.022) were at greater risk of cognitive dysfunction compared with those with unmethylated promoters of corresponding genes in Model 2. Conclusion: The promoter methylation rate of PER1 gene was higher in the cognitive dysfunction group among CSVD patients. And the hypermethylation of the promoters of clock genes PER1 and CRY1 may be involved in affecting cognitive dysfunction in patients with CSVD.
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During the COVID19 pandemic, there were changes in the organization of healthcare together with immunoglobulins shortage, which had influence on cybetween clic treatment regimens in some patients. In Poland, intravenous immunoglobulin (IVIg) treatment is used only as inpatient treatment, which was challenging during the COVID19 pandemic. The aim of the study was to assess how the COVID19 pandemic influenced the therapy regimen and the course of the disease in patients with chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy (MMN) treated with cyclic IVIg. Materials and methods: 15 patients were cyclically treated with IVIg our center: 8 with MMN (5F and 3M) mean age 54.6 years and 7 with CIDP (3F and 4M) mean age 51 years. Three periods were compared: Before the pandemic (Jan.2019-Feb.2020) and two periods during the pandemic: I (Mar- Dec.2020), II (Jan-Dec.2021). The following parameters were assessed: Mean doses (g / kg bw / week), mean intervals between drug administrations (weeks) and treatment efficacy assessed using functional scales: For MMN-INCAT, MMN-RODS, for CIDP-INCAT. Results: During the pandemic, lengthening of the intervals between administrations or reduction of the doses per treatment were observed in the majority of patients. A reduction in mean doses was demonstrated in 4/8 patients with MMN and CIDP in 1/7 compared to period I pandemic and in 3/7 compared to period II pandemic. Due to disease progression, the mean dose was increased in 3/8 patients with MMN. Prolongation of intervals was observed in 3/8 patients with MMN and 3/7 with CIDP. Most patients had a point in time when symptoms worsened (worsening of INCAT by at least 1) due to lack of treatment in MMN in 6/8 and in CIDP in 5/7, reversible with increased dose. The extension of the intervals resulted not only from the pandemic restrictions, but from the limited availability of IVIg as well. No statistically significant differences were found between the mean periods, between consecutive IVIg administrations and the mean IVIg doses in the periods before the pandemic and during the pandemic (I, II) and functional assessments at the end of analyzed period. Conclusion: The limited availability of IVIg and epidemiological restrictions during the COVID19 pandemic required modification of treatment regimens. Drug dose reduction and prolongation of the intervals between drug administrations, lead in the majority of CIDP patients to temporary deterioration in functional status, reversible by increased dosage of IVIg.
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Background: The COVID-19 pandemic has contributed to lower hospital admissions and higher mortalities associated with chronic conditions such as cancer and cardiovascular diseases. The Rapid Access Lung Clinic (RALC), established in 2009 for immediate assessment of individuals at risk of lung cancer, has experienced reduced functioning particularly during the pandemic peaks in Ireland. Therefore, we undertook a retrospective chart review of the 2019-2021 referrals and attendances at the Cork University Hospital (CUH) RALC to determine the impact of COVID-19 on this pathway. Methods: The medical charts of patients referred to CUH RALC from 03/2019 to 02/2020 (period I), and from 03/ 2020 to 02/2021 (period II), were reviewed after ethical approval was obtained. Clinicodemographic characteristics including age, sex, and hometown were extracted. Average time to acquire the first CT scan, consultation at RALC, and receiving a diagnosis of cancer were calculated using the date of referral and compared between periods I and II using the t-test. Frequency and the stages of cancer diagnosis in periods I and II were compared using a Chi-squared test. Progression-free and overall survivals were measured from diagnosis date until 09/2020 for period I and 09/2021 for period II. Results: Of the 1192 medical charts reviewed;687 patients in period I and 505 patients in period II were referred to RALC;indicating a 26.5% reduction in the number of referrals during the first year of the pandemic. Average monthly referrals (p = 0.008) and reviews (p = 0.017) were significantly lower in period II compared to period I and corresponded with the COVID-19 peaks in 04/2020 and 01/2021 in Ireland. However, no significant difference was seen in the length of time from referral to review at RALC (p = 0.11). There were 33% fewer post-referral CT scans performed (p = 0.032) and shorter wait times from referral to CT scan in period II (p = 0.001). The frequency of cancers detected did not differ between periods I and II. While there was no difference in the wait times from referral to diagnosis between periods, patients ultimately diagnosed with lung cancer in period II received surgery sooner than patients in period I (p = 0.024). Progression-free and overall survivals for patients diagnosed with lung cancer were comparable between periods I and II. Conclusions: Contrary to our hypothesis, we have shown that the COVID-19 pandemic had minimal impact on the performance of RALC. Shorter wait times for CT scan and surgery during the pandemic account for fewer hospital referrals and availability of CT scanner. Fewer referrals to RALC in period II may relate to the fewer patients attending their general practitioner (GP) and/or GPs raising the thresholds for referrals to RALC during the pandemic. Ultimately, a national evaluation will be required to fully determine the impact of this pandemic on lung cancer diagnosis, management, and outcomes in Ireland.
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Introduction: COVID-19 has pushed Government of India to take various public health measures for curtailing transmission of infection. It included imposition of total lockdown on all non-essential services across the country when number of cases started increasing during the first wave. The first lockdown lasted from March 25th to may 31st 2020, following which a period of gradual unlocking began. Thereafter during the second wave of the COVID pandemic in India, lockdowns of varying intensities were imposed at different intervals by individual states. Near complete lockdown was implemented in the National Capital from April 19th 2021 to 31st May 2021, in response to a sharp rise in the number of cases. These lockdowns along with the pandemic itself has had a major impact on the healthcare system, including trauma care. There are limited number of studies specifically from India, which have examined the effect of these restrictions on trauma admissions. Objectives: Objective of this study is to assess the effect of COVID related lockdowns on trend of trauma admissions in a tertiary care facility of North India. Material and Methods: In this retrospective study, data on trauma admissions were ed from the Health Management Information system of All India Institute of Medical Sciences, Trauma Center, New Delhi corresponding to the following time periods (1) April 15, 2019, to May 31, 2019 - which corresponds with the pre-COVID phase (2) April 15, 2020, to May 31, 2020- which corresponds with first nationwide lockdown imposed in India during the first wave of the COVID outbreak and (3) April 15, 2021, to May 31, 2021- which corresponded with the near complete lockdown in state of Delhi during the second wave of COVID outbreak in India. Results: During the first-time interval (pre-COVID), a total of 8847 trauma casualty cases were reported in the Emergency Department of the level 1 Trauma Center. Due to lock down, number of patients presenting to trauma emergency had significantly reduced to 2185 during second interval. However, trauma casualty cases slightly increased during the third interval. Conclusion: This study showed that during the pandemic lockdown trauma admissions had been significantly reduced. However, the volume of trauma admissions was greater during the 2nd Peak of COVID-19, as the lockdown was partial. This study demonstrated that self-quarantines and lockdowns had led to a significant decrease in trauma footfall.
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Introduction: Student engagement in online classes is one important factor for teachers who conduct their classes online in this COVID-19 pandemic lockdown. Objectives: The present study aimed to investigate the affective and behavioural components in student engagement in online classes that was conducted in the initial period of lockdown in March 2020. Methods: This study was a descriptive study conducted among 305 under-graduate medical students through an online questionnaire. Informed consent was obtained from all participants. Data obtained is reported in frequency distribution and statistical significance was done using graph pad prism v6.0. Results: Significantly lower student engagement was seen among the medical undergraduate students attending their online classes (p<0.05). The results showed that less or no preliminary training on online classes/tools as one among the reason for poor student engagement in online classes. Conclusions: Student engagement was found to be low during this study period i.e, during the first lockdown when the whole medical education system suddenly switched into online classes due to the pandemic. However we believe that if prior training along with the suggested student engagement methods are followed, a better percentage on student engagement is possible to attain.
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Background: Acute appendicitis (AA) is the most common surgical disease with a lifetime risk of 7-8%.Traditionally, appendectomy has been the treatment of choice for acute appendicitis. Mortality rate after appendectomy is very low and may range from 0.07 to 0.7% rising to 0.5 to 2.4% in patients without and with perforation. Over 250,000 appendectomies are performed each year in the USA alone.It was observed during the outbreaks of influenza and Middle East Respiratory Syndrome (MERS) in 2012 , that referrals for non-respiratory causes decreased significantly as the epidemics progressed. An outbreak of respiratory disease should not by itself affect the incidence and presentation of acute appendicitis. Nevertheless, we have noticed in our institution that as the COVID-19 pandemic spread in our community there was a significant decrease in the number of cases of acute appendicitis presenting to the ED of our institution and an increase in the number of admitted patients of AA requiring surgery. Objectives: To compare the incidence and presentation of aute appendicitis before and during the COVID-19 lockdown period.Also, to compare thepercentage of patients requiring operative management, intraoperative findings and postoperative complications before and during the COVID-19 pandemic for cases of acute appendicitis. Methodology:This prospective observational cohort study was undertaken at Government Medical College Baramulla which is a 300 bedded teaching hospital catering as a referral institute for a catchment population of roughly 1.2 million. All consecutive patients of clinically or radiologically diagnosed AA admitted between 25th March and 25th July were included in this study (corresponding to complete lockdown in our country). This was designated as group A. Data was also collected from hospital records of all acute appendicitis patients admitted in the corresponding months of 2019 i.e from 25th March 2019 to 25th July 2019 and analysed for comparison and designated as group B Results: A total of 169 Cases of Acute appendicitis were evaluated: 52from the lockdown period i.e Group A and 117 from the non-pandemic period i.e Group B. No statistical difference in the male: Female ratio and demographic pattern was observed. Duration of pain preceding admission in Group A was 57.6+_8.16 hours and 36.55+_7.81 hours in Group B and was statistically significant. It was observed that during COVID lockdown about 69.23% (36) patients had a delayed presentation compared to 20.51%(24) in group B. In Group A, 26.92% (14) patients were managed conservatively and 73.07% patients were operated. InGroupB47.86% (56) patients were managed conservatively and 52.13%(61)patients underwent operative management. Conclusion: This COVID- 19 pandemic has forced a paradigm change in all aspects of patient management worldwide and while the focus continues to remain on control of the virus, there are serious apprehensions over the effects on non- COVID patients especially surgical emergencies and malignacy patients. This message needs to reach far and wide in the community, so that the incidence of late presentation of surgical emergencies to ED's, with acute appendicitis being the commonest one is prevented.
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OBJECTIVE: To investigate the potential association of cochlear clock genes (CRY1, CRY2, PER1, and PER2), the DNF gene (brain-derived neurotrophic factor), and the NTF3 gene (neurotrophin3) with susceptivity to noise-induced hearing loss (NIHL) among Chinese noise-exposed workers. METHODS: A nested case-control study was performed with 2056 noise-exposed workers from a chemical fiber factory and an energy company who underwent occupational health examinations in 2019 as study subjects. Propensity score matching was conducted to screen cases and controls by matching sex, age, and the consumption of tobacco and alcohol. A total of 1269 participants were enrolled. Then, general information and noise exposure of the study subjects were obtained through a questionnaire survey and on-site noise detection. According to the results of audiological evaluations, the participants were divided into the case group (n = 432, high-frequency threshold shift > 25 dB) and the matched control group (n = 837, high-frequency threshold shift ≤ 25 dB) by propensity score matching. Genotyping for PER1 rs2253820 and rs2585405; PER2 rs56386336 and rs934945; CRY1 rs1056560 and rs3809236; CRY2 rs2292910 and rs6798; BDNF rs11030099, rs7124442 and rs6265; and NTF3 rs1805149 was conducted using the TaqMan-PCR technique. RESULTS: In the dominant model and the co-dominant model, the distribution of PER1 rs2585405 genotypes between the case group and the control group was significantly different (P = 0.03, P = 0.01). The NIHL risk of the subjects with the GC genotype was 1.41 times the risk of those carrying the GG genotype (95% confidence interval (CI) of odds ratio (OR): 1.01-1.96), and the NIHL risk of the subjects with the CC genotype was 0.93 times the risk of those carrying the GG genotype (95%CI of OR: 0.71-1.21). After the noise exposure period and noise exposure intensities were stratified, in the co-dominant model, the adjusted OR values for noise intensities of ≤ 85 was 1.23 (95%CI: 0.99-1.53). In the dominant model, the adjusted OR values for noise exposure periods of ≤ 16 years and noise intensities of ≤ 85 were 1.88 (95%CI: 1.03-3.42) and 1.64 (95%CI: 1.12-2.38), respectively. CONCLUSION: The CC/CG genotype of rs2585405 in the PER1 gene was identified as a potential risk factor for NIHL in Chinese noise-exposed workers, and interaction between rs2585405 and high temperature was found to be associated with NIHL risk.