Sex-specific differences in presenting symptoms of obstructive sleep apnea.

OBJECTIVES: Scant data from India are available on the gender differences in presenting features of Obstructive Sleep Apnea (OSA) in India. This study aims to compare male and female patients with OSA for general characteristics and presenting symptoms. METHODOLOGY: Retrospective study was done in OSA patients diagnosed in our sleep lab. History, biochemical reports, and polysomnography variables were retrieved from the sleep registry and were compared between males and females. RESULTS: Out of 514 patients of OSA (367 males; 147 females). Females were older (55.97 ± 9.73 v/s 50.2 + 12.70 years, P<0.001) and more obese (BMI 35.26 ± 7.17 v/s 29.58 ± 5.49 Kg/m2; P<0.001). Waist and hip circumference were significantly higher in the female patients (P = 0.009 and <0.001 respectively). Morning headache, nocturia, fatigability (P < 0.001), and depression (P = 0.005) was more common in females (P = 0.036). Hypersomnia was more commonly seen in males (P < 0.001). Mean diastolic blood pressure was significantly higher in males, although no difference was seen in Systolic BP. Females had higher mean Fasting Blood glucose (FBS) (P = 0.02). Apnea hypopnea index was significantly higher in females {P = 0.01}. CONCLUSION: Women with OSA are more obese, elderly, and with higher fasting blood glucose than males at the time of diagnosis. Females have a higher prevalence of symptoms like fatigability, depression, nocturia and early morning headache and had more severe AHI than males.

First report of tomato chlorosis virus (ToCV) and detection of other viruses in field-grown tomatoes in North-Western region of India.

Tomato crop is known to be infected by large number of viruses across the globe causing severe losses in its yield. Accurate information on the distribution and incidence of different viruses is essential to implement virus control strategies. This study provides information on prevalence and distribution of different viruses infecting tomato crop in North-western region of India. Leaf samples of 76 symptomatic tomato and 30 symptomatic and asymptomatic plants of Chenopodium sp. (weed) were collected from eight villages. DAS-ELISA and/or RT-PCR/PCR were used to detect occurrence of nineteen viruses and one viroid in tomatoes. Nine viruses viz. cucumber mosaic virus, groundnut bud necrosis virus, potato virus M, potato virus S, potato virus X, potato virus Y, tomato chlorosis virus, tomato leaf curl New Delhi virus and tomato mosaic virus were detected in 58 of 76 tomato samples. Detection of viruses was confirmed by cloning of specific amplicons followed by sequencing and submission of sequences to the GenBank database. None of the targeted pathogens were found in collected weed samples. Tomato leaf curl New Delhi virus (ToLCNDV) was the most prevalent virus (64.47%) followed by potato virus Y (PVY) (23.68%). Double, triple, quadruple and quintuple infections were also noticed. Phylogenetic analysis of nucleotide sequences was also carried out. Nine viruses infecting tomato crop from North-western region of India were detected. ToLCNDV was most prevalent with highest incidence. To the best of our knowledge, this is the first report of ToCV on tomato from India. Supplementary Information: The online version contains supplementary material available at 10.1007/s13337-022-00801-y.

Efficacy and Safety of Thrombolysis in COVID-19 Related ARDS.

INTRODUCTION: COVID-19 causes significant pulmonary microthrombi in some individuals, leading to ARDS and death. Thrombolysis could be an effective approach in some patients with severe ARDS. We describe our experience with the usage of thrombolytic agents in critically ill COVID-19 patients who were in worsening respiratory failure. METHODS: Retrospective chart analysis was done in patients who were thrombolysed between May 2020-Sept 2020. Analysis was done to find out factors associated with improvement in oxygenation and survival. RESULTS: Twenty-seven patients with severe ARDS [all had respiratory rate >30, FiO2 >0.6 (on NIV/HFNC) and PiO2/FiO2 ratio <120] were thrombolysed in our ICU for COVID19 causes. C.T. Pulmonary Angiography could not be done in any of the 27 patients due to poor general condition, but 2D echo was normal in most (5 had dilated RA, RV), and none of the patients was in shock. So, there was no conventional indication of thrombolysis in these patients, yet after thrombolysis, we observed dramatic changes in oxygenation (defined by a decrease in FiO2 by ≥0.2) in twenty patients. Five patients had a major bleed. Eleven patients survived (survival rate of 40.7%) and the survival rate was high {66% (8/12)} in patients who were thrombolysed within 2 days of oxygen requirement. CONCLUSION: In this unprecedented pandemic with high mortality rates, efficacy of early thrombolysis needs to be further explored in randomised controlled trials.

Enhanced skin burn assessment through transfer learning: a novel framework for human tissue analysis.

Visual inspection is the typical way for evaluating burns, due to the rising occurrence of burns globally, visual inspection may not be sufficient to detect skin burns because the severity of burns can vary and some burns may not be immediately apparent to the naked eye. Burns can have catastrophic and incapacitating effects and if they are not treated on time can cause scarring, organ failure, and even death. Burns are a prominent cause of considerable morbidity, but for a variety of reasons, traditional clinical approaches may struggle to effectively predict the severity of burn wounds at an early stage. Since computer-aided diagnosis is growing in popularity, our proposed study tackles the gap in artificial intelligence research, where machine learning has received a lot of attention but transfer learning has received less attention. In this paper, we describe a method that makes use of transfer learning to improve the performance of ML models, showcasing its usefulness in diverse applications. The transfer learning approach estimates the severity of skin burn damage using the image data of skin burns and uses the results to improve future methods. The DL technique consists of a basic CNN and seven distinct transfer learning model types. The photos are separated into those displaying first, second, and third-degree burns as well as those showing healthy skin using a fully connected feed-forward neural network. The results demonstrate that the accuracy of 93.87% for the basic CNN model which is significantly lower, with the VGG-16 model achieving the greatest accuracy at 97.43% and being followed by the DenseNet121 model at 96.66%. The proposed approach based on CNN and transfer learning techniques are tested on datasets from Kaggle 2022 and Maharashtra Institute of Technology open-school medical repository datasets that are clubbed together. The suggested CNN-based approach can assist healthcare professionals in promptly and precisely assessing burn damage, resulting in appropriate therapies and greatly minimising the detrimental effects of burn injuries.

Metabolic syndrome in non-obese patients with OSA: learning points of a cross-sectional study from a tertiary care hospital in Central India.

STUDY OBJECTIVES: Obesity is often considered mandatory for the diagnosis of Metabolic Syndrome (MS). Data on the prevalence of MS in non-obese patients with Obstructive Sleep Apnea (OSA) is scarce. This study was aimed to determine the prevalence of MS in non-obese patients with OSA. METHODOLOGY: All consecutively diagnosed patients with OSA between October 2018 and November 2019 were screened for metabolic syndrome. Patients with OSA and BMI < 25 kg/m2 (NOOSA) vs BMI > 25 kg/m2 (obese OSA) were compared. Lean waist NOOSA was defined as BMI < 25 kg/m2 and WC < 80 cm (32 in.) for women or < 90 cm (36 in.) for men. RESULTS: During the study period, 502 patients were diagnosed with OSA. MS was observed in 35% of patients with NOOSA compared to obese patients with OSA (79%). In the NOOSA group, hypertension, impaired fasting glucose, diabetes mellitus and dyslipidemia were observed in 65, 48, 14 and 61% respectively and all of these parameters were significantly more common in the obese group (p < 0.001). Parameters of OSA severity (apnea-hypopnea index or AHI, time spent below 90% saturated or T90, and nadir oxygen) were significantly more severe in the obese group with OSA. Approximately 83% of patients in the NOOSA group had at least two metabolic risk factors, compared to the obese OSA group, in which 95% had two or more metabolic risk factors. Sixty-four percent of patients with NOOSA with lean waist had at least two metabolic risk factors. At BMI cut-offs of < 25, < 27 and < 30 kg/m2; 35, 46 and 57% of patients with OSA respectively had metabolic syndrome. CONCLUSION: Metabolic syndrome was observed in approximately one in three patients with OSA and BMI < 25 kg/m2. Approximately two of every three lean waist non-obese patients with OSA had at least two markers of metabolic syndrome. The role of OSA in the development of metabolic syndrome in non-obese individuals needs further exploration.

Predictive factors for CPAP failure in obstructive sleep apnea patients.

OBJECTIVES: Some patients with obstructive sleep apnea (OSA) do not respond to Continuous Positive Airway Pressure (CPAP) and for these patients, Bi-level PAP is the next level modality. This study by a theory driven hierarchical approach, tries to identify the predictors for CPAP failure among OSA patients. METHODOLOGY: The potential predictors for the model were identified from a theoretical framework rooted in clinical examination, laboratory parameters, and polysomnographic variables pertaining to OSA patients. All patients of OSA who underwent manual titration with CPAP or Bi-level PAP (in case of CPAP Failure) between June 2015 and October 2017 were included in model building. This study compared five competitive models blocks deliberated by increasing order of diagnostic complexity and availability of resources. The fitting of the model was determined by both internal and external validation. RESULTS: Among the five competitive models, the selected model has the significant deviance reduction (-2LL = 121.99, X2 = 25.55, P < 0.0001) from the baseline model (-2LL = 217.356). This logistic regression model consists of the following binary predictors - Age >60 years (odds ratio [OR] = 3.23 [1.27-8.23]), body mass index >35 Kg/m2 (OR = 4.25 [1.78-10.13]), forced expiratory volume <60% (OR = 7.33 [2.83-18.72]), apnea-hypopnea index >75 (OR = 4.31 [1.61-11.56]) and T90 > 30% (OR = 6.67 [2.57-17.36]). CONCLUSION: These five factors (acronym as BIPAP) may aid to the clinical decision-making by predicting failure of CPAP and therefore may assist in more vigilant clinical care.

Combination of positional therapy with positive airway pressure for titration in patients with difficult to treat obstructive sleep apnea.

INTRODUCTION: Positional therapy has been described as add-on therapy to a mandibular advancement device, but the efficacy of combination of positional therapy and positive airway pressure (PPAP) has not been documented. We have found PPAP therapy as an effective method of titration in patients with difficult to treat OSA (obstructive sleep apnea). METHODOLOGY: This retrospective analysis was done in patients who had difficult to treat OSA, i.e., in whom titration in the supine position was unacceptable with any PAP device (CPAP or bilevel PAP) and could only be successfully titrated with a PAP device in the lateral position. This study describes our experience of PPAP therapy. Baseline characteristics and polysomnography data of patients who were successfully titrated in supine v/s lateral positions were compared. RESULTS: Of 272 consecutive patients with OSA selected for analysis, 218 patients (191 and 27 with CPAP and bilevel PAP, respectively) could be successfully titrated in supine position. Further 54 (20%) patients in whom titration in supine position was unacceptable were titrated in lateral position. Patients titrated with PAP in the lateral position therapy group had higher BMI, higher neck and waist circumference, and lower awake sPO2 and nadir sPO2 during sleep, and spent more time in sleep with sPO2 < 90%. CONCLUSION: Combination of positional therapy and PAP device is an effective way of titration for difficult to treat OSA patients. It can be tried in patients who fail titration in supine position.

Women with OSA have higher chances of having metabolic syndrome than men: effect of gender on syndrome Z in cross sectional study.

STUDY OBJECTIVES: This study was done to find out prevalence of Metabolic syndrome (MS) in patients with Obstructive Sleep Apnea (OSA) and whether there is any difference in prevalence of syndrome Z in male and female. METHODOLOGY: All consecutive diagnosed patients with OSA between June 2015 and Oct 2019 were screened for metabolic syndrome and factors associated with metabolic syndrome in OSA were analyzed. RESULTS: During study period, 502 patients (357 males; 145 females) were diagnosed with OSA. Mean age was 51.88 ± 12.18 years (females and males:55.91 ± 9.74 and 50.24 ± 12.70 years, respectively). Mean BMI was 31.60 ± 11.09 kg/m2 (female: 35.29 ± 7.19 and male: 30.1 ± 12.0 kg/m2) (p < 0.001). Mean AHI was 62.67 ± 35.22. Mild, moderate and severe category of OSA constituted 7.3%, 15.3% and 77.4% respectively. MS was found in 72.7% (365 out of 502) individuals with OSA. MS was found in 75.8%, 68.4 and 48.7% in severe, moderate and mild OSA patients respectively (p < 0.001). Females OSA patients had significantly high percentage (88.27%) of metabolic syndrome compared to males OSA patients (66.38%) {p < 0.001}. Female patients with SZ had higher metabolic score (p = 0.019) and were older (p < 0.001). CONCLUSION: Metabolic syndrome is highly prevalent in OSA population (72.7%) and is much more common in female OSA patients (88%) than males OSA (68%). All OSA patients should be screened for MS so that early intervention can be done in these patients so as to prevent cardiovascular complications.

Diagnosing obstructive sleep apnea patients with isolated nocturnal hypoventilation and defining obesity hypoventilation syndrome using new European Respiratory Society classification criteria: an Indian perspective.

BACKGROUND: Recently, new classification criteria for obesity hypoventilation syndrome (OHS) have been described. OHS prevalence according to new criteria has not been reported in obstructive sleep apnea (OSA). Prevalence of OHS has not been previously reported from India. METHODS: Retrospective study was carried out in OSA patients for whom both arterial blood gases (ABG) and end-tidal CO2 (etCO2) records were available. OHS was defined according to old and new criteria. Analysis was carried out among various groups: patients without OHS (Group A), patients with sleep hypoventilation but without daytime hypercapnia (Group B) and patients with daytime hypercapnia (Group C). RESULTS: Out of 367 patients with OSA (body mass index, BMI) 31.9 ± 12.27 kg/m2), finally 128 obese OSA patients were included for analysis. Of those, 15 (5.9%, 95% confidence interval (CI) 3.5-9.4) and 45 patients (17.8%, 95% CI 13.4-22.9) fulfilled prevalence of OHS according to old and new criteria, respectively. Continuous positive airway pressure (CPAP) titration failed in 9.6%, 53.3% and 66.7% in Groups A, B, and C, respectively. For all parameters of OSA severity (apnea-hypopnea index (AHI), Nadir O2, T90) and positive airway pressure (PAP) requirements, patients in Group B were in between those in Groups A and C. Statistically significant difference was seen between Group A and Group B, and between Groups A and C, but not between Groups B and C. CONCLUSION: One in six OSA patients and one in three obese OSA patients (BMI >30 kg/m2) have OHS according to new criteria. Since patients with isolated nocturnal hypoventilation were as sick as patients with daytime hypercapnia, screening for sleep hypoventilation should be carried out in all obese OSA patients.

Nocturic obstructive sleep apnea as a clinical phenotype of severe disease.

STUDY OBJECTIVES: This study was done to find whether a history of nocturia is associated with severity of obstructive sleep apnea (OSA) and also whether patients with nocturia constitute a separate phenotype of OSA. MATERIALS AND METHODS: Retrospective chart review was done in consecutive OSA patients who were diagnosed in sleep laboratory of our institute. Detailed sleep history, examination, biochemical investigations, and polysomnography reports were taken for the analysis. Nocturia was defined as urine frequency ≥2/night. RESULTS: Of 172 OSA patients, 87 (50.5%) patients had nocturia. On multivariate analysis, a history of nocturia had 2.429 times (confidence interval 1.086-5.434) more chances of having very severe OSA (P = 0.031). Time between bedtime and first time for urination was significantly less in very severe OSA compared to severe OSA and mild-to-moderate OSA (2.4 ± 0.9, 3.1 ± 1.3, and 3.0 ± 1.1 h, respectively) (P = 0.021). Patients with nocturia were older (52.3 ± 11.9 vs. 47.6 ± 12.1 years; P = 0.012), had higher STOP BANG scores (P = 0.002), higher apnea-hypopnea index (AHI) (64.8 ± 35.9 vs. 43.9 ± 29.1; P < 0.001), and higher Epworth sleepiness scale (ESS) (9.2 ± 5.3 vs. 7.7 ± 4.4; P = 0.052) and were more likely to be fatigued during day (P = 0.001). Nocturics had higher body mass index (BMI) (P = 0.030), higher waist, and hip circumference (P = 0.001and 0.023, respectively). Nocturic patients had lower awake SpO2(P = 0.032) and lower nadir SpO2 during sleep (P = 0.002). CONCLUSIONS: A history of nocturia (≥2/night) predicts very severe OSA (AHI >60). Nocturic OSA is a phenotype of OSA with more severe AHI, lower oxygen levels, higher BMI, and higher ESS. We believe nocturia can be used for screening in OSA questionnaires, which needs to be validated in further community-based studies.

Bioactivities of phytochemicals present in tomato.

Tomato is a wonder fruit fortified with health-promoting phytochemicals that are beneficial in preventing important chronic degenerative disorders. Tomato is a good source of phenolic compounds (phenolic acids and flavonoids), carotenoids (lycopene, α, and ß carotene), vitamins (ascorbic acid and vitamin A) and glycoalkaloids (tomatine). Bioactive constituents present in tomato have antioxidant, anti-mutagenic, anti-proliferative, anti-inflammatory and anti-atherogenic activities. Health promoting bioactivities of tomatoes make them useful ingredient for the development of functional foods. Protective role of tomato (lycopene as a potent antioxidant) in humans against various degenerative diseases are known throughout the world. Intake of tomato is inversely related to the incidence of cancer, cardiovascular diseases, ageing and many other health problems. Bioavailability of phytoconstituents in tomato is generally not affected by routine cooking processes making it even more beneficial for human consumption. The present review provides collective information of phytochemicals in tomato along with discussing their bioactivities and possible health benefits.

Effectivity of host-Rhizobium leguminosarum symbiosis in soils receiving sewage water containing heavy metals.

Disposal of sewage water in cultivated soils often containing considerable amount of potentially toxic metals such as Cu, Zn, Ni, Cd, Pb and Cr can be beneficial or harmful to plant growth, rhizobial survival, nodulation and nitrogen fixation. Soil samples from 14 such locations were collected. Symbiotic effectivity of host-Rhizobium leguminosarum symbiosis in these soils was assessed. The total metal contents of Cd, Cu, Zn and Ni in all the 14 samples collected from farmer's fields receiving sewage water ranged between 1.3 and 6.7, 55.8-353.2, 356.0-1028.0 and 90.0-199.7 mg kg(-1) of soil, respectively. In Rohtak 1 soil, levels of Cd, Cu and Zn were highest while Ni was highest in Sonipat 2 soil. The content of available Cd, Cu, Zn and Ni in these soils ranged from 1.0-29.3; 6.2-47.0; 2.4-13.5, respectively, and was 2-9 percent of their total metal contents. All the N2 fixing parameters in pea and Egyptian clover were adversely affected by the presence of heavy metals. Available Cd and Cu contents significantly affected the N contents of pea and Egyptian clover plants, whereas Ni contents were negatively correlated with the plant biomass of pea and Egyptian clover.