A scoping review of the evidence on pharmacological and non-pharmacological interventions for idiopathic hypersomnia.

STUDY OBJECTIVES: Idiopathic hypersomnia (IH) is characterized by excessive sleepiness during the day, prolonged sleep at night, and difficulty waking up. The true prevalence of IH is uncertain. ICSD provides criteria for diagnosing IH; however, the definition has evolved. Managing IH involves using pharmacologic and non-pharmacologic approaches, although the most effective strategies are still unclear. The objective of this scoping review was to identify the extent, range, and nature of the available evidence, identify research gaps, and discuss the implications for clinical practice and policy. METHODS: To conduct this review, a comprehensive search was conducted across scientific databases, without any restrictions on the date or study type. Eligible studies examined the effectiveness of pharmacologic and non-pharmacologic treatments for IH and reported the outcomes of these interventions. Data from the studies were screened, analyzed, and synthesized to provide an overview of the available literature landscape. RESULTS: 51 studies were included in this review, which used various methods and interventions. Pharmacological treatments, particularly modafinil, have been frequently studied and have yielded positive results. There is also emerging evidence for alternative medications such as low-sodium oxybate and pitolisant. Non-pharmacological approaches, such as CBT-H and tDCS have also shown promise in managing IH. CONCLUSIONS: This review highlights the complexity of managing IH management and emphasizes the need for personalized multidisciplinary approaches. Pharmacological interventions are important in managing IH and can be complemented by non-medication strategies. Larger-scale studies are necessary to advance our understanding of IH and to improve treatment outcomes.

Physiological and molecular insight of microbial biostimulants for sustainable agriculture.

Increased food production to cater the need of growing population is one of the major global challenges. Currently, agro-productivity is under threat due to shrinking arable land, increased anthropogenic activities and changes in the climate leading to frequent flash floods, prolonged droughts and sudden fluctuation of temperature. Further, warm climatic conditions increase disease and pest incidences, ultimately reducing crop yield. Hence, collaborated global efforts are required to adopt environmentally safe and sustainable agro practices to boost crop growth and productivity. Biostimulants appear as a promising means to improve growth of plants even under stressful conditions. Among various categories of biostimulants, microbial biostimulants are composed of microorganisms such as plant growth-promoting rhizobacteria (PGPR) and/or microbes which stimulate nutrient uptake, produce secondary metabolites, siderophores, hormones and organic acids, participate in nitrogen fixation, imparts stress tolerance, enhance crop quality and yield when applied to the plants. Though numerous studies convincingly elucidate the positive effects of PGPR-based biostimulants on plants, yet information is meagre regarding the mechanism of action and the key signaling pathways (plant hormone modulations, expression of pathogenesis-related proteins, antioxidants, osmolytes etc.) triggered by these biostimulants in plants. Hence, the present review focuses on the molecular pathways activated by PGPR based biostimulants in plants facing abiotic and biotic challenges. The review also analyses the common mechanisms modulated by these biostimulants in plants to combat abiotic and biotic stresses. Further, the review highlights the traits that have been modified through transgenic approach leading to physiological responses akin to the application of PGPR in the target plants.

A Comparative Study between Autologous Noncultured Trypsinized Melanocytes-Keratinocytes Cell Suspension and Autologous Noncultured Nontrypsinized Epidermal Cells Grafting (Jodhpur Technique) in Stable Vitiligo.

Background: Noncultured epidermal cell suspension (NCES) and Jodhpur technique (JT) are two treatment options in vitiligo, in which the basic principle is the transfer of melanocytes from uninvolved skin to stable vitiligo patch in the form of either tissue graft or cellular graft. Objectives: The aim of this study was to evaluate effectiveness of two different treatment methods (NCES and JT) in stable vitiligo. Materials and Methods: This was a randomized comparative study, which included 45 patients with 153 stable vitiligo patches. Cases were randomly divided into two groups. Appropriate statistical analysis was done. A value of P < 0.05 was considered statistically significant. Results: Of 45 cases, female-to-male ratio was 1.36:1. Mean duration of disease and stability were found to be 10.44 ± 5.24 and 3.83 ± 2.31 years, respectively. Mean size of treated area for NCES and JT was 10.11 ± 10.31 and 10.13 ± 10.29 cm2, respectively. Earliest repigmentation was found at 3 weeks in NCES and 6 weeks in JT. At 6 weeks, repigmentation was better in NCES, whereas later JT showed better pigmentation. Follow-up was done at 8 days and 6, 10, 14, and 24 weeks. With respect to color match at 6 weeks, JT was found superior; however, at 24 weeks both showed similar efficacy. Mean reduction in daily life quality index was significantly decreased post-surgery. Limitations: This was a single-center, small sample size study. Conclusion: Melanocyte plus keratinocyte cell transfer is very effective in the treatment of stable vitiligo. On the basis of the results, JT may show significant contribution in vitiligo.

Multisystem Inflammatory Syndrome Associated With COVID-19 in Children (MIS-C): A Systematic Review of Studies From India.

BACKGROUND: With wide clinical spectrum, multisystem inflammatory syndrome associated with coronavirus disease 2019 (COVID-19) in children (MIS-C) is a relatively novel condition occurring weeks to months' post SARS-CoV-2 infection. The aim was to systematically review data on clinical features, laboratory parameters and therapeutics of MIS-C from India. Methods: This systematic review was done as per the PRISMA guidelines, and quality assessment was done using NIH tool for case-series. A systematic search through databases yielded studies whose data was pooled to calculate the mean frequencies with standard deviation using GraphPad software. RESULTS: Screening of 2548 articles published till December, 2021, yielded 11 case-series. World Health Organization case definition was used widely. There was a slight preponderance of males (57%), median (IQR) age was 7 (6,7) years, 63% (n=305) required intensive care unit admissions, and mortality rate was 10% (n=261). Clinical features included fever, mucocutaneous features (72%), and gastrointestinal problems (62%) in majority. Widely used treatment was corticosteroids (76%) and intravenous immunoglobulin (62%) with other options depending on patient's state. An increased level of inflammatory markers and derangement in other parameters corroborated with disease status. Kawasaki disease like features, not reported in many studies, ranged from 4-76% of patients. CONCLUSION: MIS-C presents with a wide spectrum clinical features, increased inflammatory markers and managed as per the disease course and presentation. Future studies monitoring the long-term effects of MIS-C are recommended.

Tertiary Health Care-Based Randomized Controlled Study to Compare Autologous, Non-cultured, Non-trypsinized Epidermal Cell Transplant (Jodhpur Technique) with Split-Thickness Skin Grafting (STSG) in Stable Vitiligo.

Background: Surgical treatment of vitiligo is reserved for stable recalcitrant vitiligo patches. Split-thickness skin grafting (STSG) is an important established modality for the surgical treatment of vitiligo, whereas autologous, non-cultured, non-trypsinized epidermal cell transplant, also known as Jodhpur technique (JT), is an unconventional innovative surgical modality for the treatment of stable vitiligo. Aims: To compare the two techniques, JT and STSG, with regards to the extent and pattern of repigmentation achieved, color matching of the repigmented area, patient satisfaction (Dermatology Life Quality Index [DLQI] questionnaire and patient global assessment), and adverse events (if any) in patients with stable vitiligo. Materials and Methods: It was a randomized comparative study. We randomized 32 patients with 180 stable vitiligo lesions into two groups. Patients in group 1 were treated with JT, and those in group 2 with STSG. They were subjectively evaluated 20 weeks post-surgery for the extent of repigmentation, color match, change in DLQI score, and patient satisfaction. The categorical data were presented as number (percent) and were compared among groups using Chi-square test. Mean and standard deviation were calculated for demographic data, and they were also compared by using student t-test. Probability P value < 0.001 was considered statistically significant. Results: The extent of repigmentation was excellent (90%-100% repigmentation) in 72.5% of lesions in the JT group and in 40% of lesions in the STSG group (P < 0.001). Seventy-five percent repigmentation (good repigmentation) was observed in 95% of lesions in the JT group and in 83.75% of lesions in the STSG group (P = 0.040). There was a highly significant decline in DLQI score. Post-procedure DLQI (0.79 ± 1.13) and pre-procedure DLQI (15.39 ± 4.76) in the JT group were compared with post-procedure DLQI (3.85 ± 2.89) and pre-procedure DLQI (16.19 ± 4.56) in the STSG group. The mean decline among groups differed significantly (P < 0.001). Adverse events were significantly higher in the STSG group at the recipient site. Conclusions: JT is found to be significantly better than STSG with regard to the degree of repigmentation.

Misery of Living with Parthenium Dermatitis: Correlation between Clinical Severity and Quality of Life.

BACKGROUND: Parthenium dermatitis is caused by friable plant extracts of Parthenium hysterophorus and related species. Approximately 40% of cases of plant dermatitis in India are contributed by this single species. MATERIALS AND METHODS: This was a cross-sectional, observational study conducted in the Department of Dermatology of Jhalawar Medical College. Ninety-nine consecutive patch test positive parthenium dermatitis human subjects of age more than 16 and either sex were included. The study period was 11 months between September 2019 and August 2020. Sociodemographic, clinical profile parthenium dermatitis severity score (PDSS) and Dermatology life quality index (DLQI) were obtained from each patient. Correlation between PDSS and DLQI was obtained using Pearson's two-tailed coefficients. RESULTS: Our study included 62 men and 37 women (1.67:1). The mean age was 51 ± 10.27 years. Mean duration of disease was 8.47 ± 4.45 years, and mean PDSS was 57.25 ± 17.65, mean DLQI was 17.14 ± 5.56. ABCD with CAD was the most common clinical subtype (45.45%). A significant positive correlation was observed between PDSS and DLQI. CONCLUSION: In this study, a significant impairment in quality of life (QoL) was observed in patients with higher score of PDSS and increasing duration, emphasizing that the disease needs specialized care including multiple indoor admission at the time of flare-up of disease.

Morphological Analysis, Protein Profiling and Expression Analysis of Auxin Homeostasis Genes of Roots of Two Contrasting Cultivars of Rice Provide Inputs on Mechanisms Involved in Rice Adaptation towards Salinity Stress.

Plants remodel their root architecture in response to a salinity stress stimulus. This process is regulated by an array of factors including phytohormones, particularly auxin. In the present study, in order to better understand the mechanisms involved in salinity stress adaptation in rice, we compared two contrasting rice cultivars-Luna Suvarna, a salt tolerant, and IR64, a salt sensitive cultivar. Phenotypic investigations suggested that Luna Suvarna in comparison with IR64 presented stress adaptive root traits which correlated with a higher accumulation of auxin in its roots. The expression level investigation of auxin signaling pathway genes revealed an increase in several auxin homeostasis genes transcript levels in Luna Suvarna compared with IR64 under salinity stress. Furthermore, protein profiling showed 18 proteins that were differentially regulated between the roots of two cultivars, and some of them were salinity stress responsive proteins found exclusively in the proteome of Luna Suvarna roots, revealing the critical role of these proteins in imparting salinity stress tolerance. This included proteins related to the salt overly sensitive pathway, root growth, the reactive oxygen species scavenging system, and abscisic acid activation. Taken together, our results highlight that Luna Suvarna involves a combination of morphological and molecular traits of the root system that could prime the plant to better tolerate salinity stress.

Phytohormones: Key players in the modulation of heavy metal stress tolerance in plants.

Heavy metal (HM) stress in plants has received considerable global attention as it threatens sustainable growth in agriculture worldwide. Hence, desperate efforts have been undertaken for combating the effects of this stress in plants. Interestingly, the use of phytohormones in reducing the impact of HM toxicity has gained much momentum in the recent past. Phytohormones act as chemical messengers that improve the HM stress resistance in plants, thus allowing them to retain their growth and developmental plasticity. Their exogenous application as well as manipulation of endogenous levels through precise targeting of their biosynthesis/signaling components is a promising approach for providing a protective shield against HM stress in plants. However, for the successful use of phytohormones for field plants exposed to HM toxicity, in-depth knowledge of the key pathways regulated by them is of prime importance. Hence, the present review mainly summarizes the key conceptual developments on the involvement of phytohormones in the mitigation of HM stress in plants. The role of various genes, proteins, and signaling components involved in phytohormones associated HM stress tolerance and their modulation has also been discussed. Thus, this update will pave the way for improving HM stress tolerance in plants with the advent of phytohormones for sustainable agriculture growth in the future.

Iron Deficiency and Pruritus: A Cross-Sectional Analysis to Assess Its Association and Relationship.

Background: As generalized pruritus can be a symptom of a systemic disease, iron deficiency may be the underlying internal cause of its symptoms. Because data on the relationship between iron deficiency and generalized chronic pruritus are limited, more research is needed to ensure proper diagnosis and management. Aims: To evaluate the prevalence of iron deficiency in patients with generalized chronic pruritus in the southeast region of Rajasthan and to assess the correlation of serum ferritin with iron deficiency variables. Materials and Methods: An observational, analytical study was conducted among a total of 200 patients complaining of itching all across the body without any skin lesions for more than 6 weeks and enrolled in the outdoor and indoor Dermatology, Venereology, and Leprology departments of the Government Medical College, Kota. The duration of the study experiment was 1 year from June 2018 to May 2019. Results: Females (108; 54%) were more than males (92; 46%) with a ratio of 1.17:1. The mean age of the patients was 37.35 ± 13.56. S. ferritin was found to be below 15 g/L in 58 (29%) patients. Significant correlation was found between S. ferritin and hemoglobin, MCV, MCH, and MCHC, and the P value was <0.05. Maximum number of patients (70; 35%) achieved visual analog scale (VAS) scores between 4 and 9, followed by 50 (25%) patients obtaining scores >9. Similarly, a correlation was found between the VAS score and hemoglobin, MCV, MCH, and MCHC and a statistically significant P value was obtained. Limitations: The sample size was small in the study. The overall levels of iron and serum transferrin were not checked, keeping patients' compliance in mind. Conclusion: Although statistically significant results were found, limitations were also present in our study; so, further studies for proper diagnosis and management should be conducted in greater depth.

Woolly Hair Nevus with Trichotillomania in a 9-Year-Old Boy: A Rare Case Association.

Woolly hair nevus is a rare entity characterized by structural anomaly, which presents as curly hair in a circumscribed area of scalp, in a nonNegroid individual. These are abnormal hairs which are short, thin, and sparse. The term "woolly hair" refers to tightly coiled hair covering the whole scalp or part of it and has a hereditary character. Trichotillomania is a chronic impulse control disorder, characterized by the repetitive pulling out of one's own hair, leading to noticeable hair loss. Here, we present the case of a 9-year-old male child with woolly hair nevus over the occipital area, which developed at the age of 3 years; later, he developed trichotillomania at the age of 5 years, adjacent to the nevus. According to the best of our knowledge, there is no case report of woolly hair nevus presenting with trichotillomania till date.

Reactive oxygen species dynamics in roots of salt sensitive and salt tolerant cultivars of rice.

Salinity stress is one of the major constraints for growth and survival of plants that affects rice productivity worldwide. Hence, in the present study, roots of two contrasting salinity sensitive cultivars, IR64 (IR64, salt sensitive) and Luna Suvarna (LS, salt tolerant) were compared with regard to the levels of reactive oxygen species (ROS) to derive clues for their differential salt stress adaptation mechanisms. In our investigation, the tolerant cultivar exhibited longer primary roots, more lateral roots, higher root number leading to increased root biomass, with respect to IR64. It was observed that LS roots maintained higher level of H2O2 in comparison to IR64. The activities of various enzymes involved in enzymatic antioxidant defense mechanism (SOD, CAT, GPX, DHAR and MDHAR) were found to be greater in LS roots. Further, the higher transcript level accumulation of genes encoding ROS generating (RbohA, RbohD and RbohE) and scavenging enzymes (Fe-SOD, Chloroplastic Cu/Zn-SOD, CAT and DHAR) were noticed in the roots of tolerant cultivar, LS. Moreover, the content of other stress markers such as total protein and proline were also elevated in LS roots. While, the expression of proline biosynthesis gene (P5CS) and proline catabolism gene (PDH) was observed to be lower in LS.

Reactive oxygen species generating system and brassinosteroids are linked to salt stress adaptation mechanisms in rice.

Salinity stress is one of the major environmental challenges which adversely affects plant growth and productivity. The acquisition of salinity stress tolerance has been an interesting area of investigation for plant abiotic stress management. Recently, we investigated the interdependency of reactive oxygen species (ROS) generating and scavenging system for offering salt stress adaptation in rice. In continuation to our earlier findings, in the present study we analyzed the transcript level expression of different respiratory burst oxidase homologs (Rbohs) genes in salt sensitive and salt tolerant cultivars of rice to corroborate this result with their activities. Brassinosteroid (BR) is known to confer abiotic stress tolerance by modulating ROS machinery, and hence in the present study, the expression of key genes associated in brassinosteroid biosynthesis and signaling in salt sensitive and tolerant cultivar of rice was also conducted. In the present investigation, the other stress markers involving proline catabolism and anabolism along with chlorophyllase has been analyzed to get a better insights to our understanding of salt stress adaptation mechanisms in rice.

Gastric adenocarcinoma: the role of Helicobacter pylori in pathogenesis and prevention efforts.

Gastric cancer is the third most common cause of cancer deaths in the world, prompting high-risk countries like South Korea and Japan to establish nationwide screening programmes. Helicobacter pylori is linked to the majority of gastric adenocarcinoma cases and to the vast majority of non-cardia gastric adenocarcinomas. Several studies have demonstrated the effectiveness of 'test-and-treat' programmes for H. pylori infection to prevent gastric cancer in high-risk populations. While this strategy has gained momentum, providers in low-risk developed countries may be unaware of the risk individual patients face, particularly those who have emigrated from high-risk regions and members of economically disadvantaged minority groups. Rapidly evolving science in recent years has made it difficult for clinicians to keep up with the current best practices. This article reviews the epidemiology of H. pylori and gastric cancer, screening and diagnostic tests and the current treatment regimens for clinicians.

Versatile roles of brassinosteroid in plants in the context of its homoeostasis, signaling and crosstalks.

Brassinosteroids (BRs) are a class of steroidal plant hormones that play diverse roles in plant growth and developmental processes. Recently, the easy availability of biological resources, and development of new molecular tools and approaches have provided the required impetus for deeper understanding of the processes involved in BRs biosynthesis, transport, signaling and degradation pathways. From recent studies it is also evident that BRs interact with other phytohormones such as auxin, cytokinin, ethylene, gibberellin, jasmonic acid, abscisic acid, salicylic acid and polyamine in regulating wide range of physiological and developmental processes in plants. The inputs from these studies are now being linked to the versatile roles of BRs. The present review highlights the conceptual development with regard to BR homeostasis, signaling and its crosstalk with other phytohormones. This information will assist in developing predictive models to modulate various useful traits in plants and address current challenges in agriculture.