Sleep Dysfunction in Parkinson’s Disease

INTRODUCTION: Sleep is defined as a periodic reversible physiological state of loss of consciousness from which a person can be aroused by adequate sensory stimuli and it is necessary for the recoupment and well being of the individual. We spend around 8 hours per day for sleep which means 56 hours per week, 224 hours per month and 2688 hours per year (ie) almost nearly 1/3 of our lives we spent for sleep. Sleep helps in energy conservation, physical restoration, memory reinforcement and consolidation, thermoregulation, preserving synaptic efficiency and brain plasticity, immune function, brain growth and development. Parkinson’s disease (PD) is a progressive neurodegenerative disorder associated with a loss of dopaminergic nigrostriatal neurons. It is named after James Parkinson, the English physician who in an “Essay on the Shaking Palsy” in 1817 described Parkinson’s disease as “involuntary tremulous motion, with lessened muscular power, in parts not in action and even when supported, with a propensity to bend the trunk forward, and to pass from a walking to a running pace, the sense and intellect being uninjured.” Sleep disorders have been mentioned since the first description of the extra-pyramidal diseases in James Parkinson’s Essay on the Shaking Palsy, but only recently they have become the subject of attention, thanks to new acquisitions in clinical knowledge and polysomnography technology. AIMS & OBJECTIVES: 1. To evaluate the frequency and the nature of the sleep abnormalities in Idiopathic parkinson’s disease. 2. To analyse the sleep architecture in Parkinson’s disease using polysomnography and to correlate the results with the disease parameters. MATERIALS AND METHODS: STUDY DESIGN: Cross sectional study. STUDY SITE: This study was carried out in the Department of Neurology, Madras Institute of Neurology, Chennai. STUDY PERIOD: December 2011 to December 2012. INCLUSION CRITERIA: Patients who fulfill the “UK Parkinson’s Disease Society- Brain Bank Clinical Diagnostic Criteria” admitted in Neurology ward/consulting in Neurology outpatient clinic in Rajiv Gandhi Government General Hospital. EXCLUSION CRITERIA: Patients who are bedridden associated with co-morbidities which affects the sleep like uncontrolled diabetes, LV dysfunction, Bronchial Asthma, Chronic obstructive Pulmonary disease, vascular Parkinsonism, head injury, dementia, Parkinson plus syndromes. METHODS AND ANALYSIS: 1) Detailed history and neurological examination. 2) Assessment of severity of Parkinsons disease using Unified Parkinsons Disease Rating Scale(UPDRS). 3) Sleep assessment using Parkinsons disease sleepiness scale (PDSS) and Epworth Sleepiness Scale(ESS). 4) Polysomnography. SAMPLE SIZE: 50 patients suffering from Idiopathic Parkinsons Disease STASTITICAL DATA ANALYSIS: Pearson’s Correlation Analysis and logistic regression, SPSS16. RESULTS: Fifty patients of Idiopathic Parkinson’s disease were recruited based on United Kingdom Parkinson’s Disease Society brain bank Criteria for the sleep study. All of them underwent clinical assessment. Their staging and severity was scored using Hoehn and Yahr staging system and Unified Parkinsons Disease Rating Scale part III respectively. Subjective sleep disturbance was assessed using standard sleep related questionnaire (Parkinsons Disease sleepiness scale). They were asked about their nature of sleep disturbance. Disturbed sleep was reported by 35 patients. Of them 30 have difficulty in falling sleep and 24 have difficulty in maintaining the sleep due to frequent awakenings. Most of the patients told that they woke up in the night mainly for passing urine. Objective sleep analysis was done using overnight polysomnography. The day time disturbance was assessed using Epworth sleepiness scale. ESS Score more than ten was considered significant. Day time somnolence was reported by 15 patients. CONCLUSION: 1. Sleep disturbance occurred in 80% of the patients with Idiopathic Parkinson’s disease. 2. Total sleep time is significantly decreased in patients with increased severity, staging and duration of the disease. 3. There is a significant prolongation in the sleep latency and the sleep efficiency is also markedly diminished. 4. Patients spent less time in slow wave sleep (N3) and there is significant prolongation of N1/N2 stages of sleep. 5. The mean REM sleep duration is also reduced. 6. REM sleep behaviour disorder is seen in 20% of the patients which did not correlate with the disease parameters. 7. Periodic limb movements in sleep is noted in 36% of patients and Restless leg syndrome is noted in 20% of our patients. They showed a significant positive correlation with the progression of the disease and higher staging and severity. 8. Sleep disordered breathing is noted in 42% of the patients which did not correlate with the disease parameters and sleep scores. 9. Snoring is noted in 28% of patients and it correlated well with the Epworth sleepiness score. Sleep architecture is markedly affected in patients with Parkinson’s disease. The latency of sleep is prolonged causing difficulty in falling asleep. The sleep efficiency is grossly diminished as there is defect in the maintenance of sleep due to frequent awakenings. Periodic limb movements in sleep, restless leg syndrome, and obstructive sleep apnoea also contribute to the sleep fragmentation resulting in defective day time functioning. It is essential that all the patients with Parkinson’s disease should be evaluated for sleep disorders so that appropriate intervention can be taken to improve their quality of life

Physical Abuse in the Absence of Ubuntu

Students in Africa and worldwide should learn about Ubuntu at the school, secondary school, college, and university levels. It should be incorporated into the educational process. Tobacco-free days, alcohol-free (dry days), and drug-free days could all be ways to commemorate Ubuntu. Female smokers are at a higher risk than male smokers. Following such measures may aid in raising awareness. Legislators in Africa need to employ incentives to amend legislation to fully integrate Ubuntu into society. It is possible to prevent violence against women and children by instilling Ubuntu principles in the community and society. It is sufficient to refer to the existing Ubuntu documentation to design and validate the necessary training programme. Still, in the case of Ubuntu, more experimental research should be encouraged. Such research must be funded by both the government and the private sector. Even though Ubuntu started in Africa, it can be globalized. Nevertheless, Ubuntu has not been adopted to its full potential in the current situation. The Zulu people of South Africa is well-known for its kindness and hospitality, and it is to them that we owe the concept of Ubuntu. According to Ubuntu, we are people not because of who we are but because of how we connect with other people. This implies that relationships are essential. With over three thousand diverse African tribes, diversity management is critical, and Ubuntu can be a driving force in bringing all the diversity under one umbrella. There are cultural mechanisms in all African traditions and events that exist “to unite”, but this aspect of unity is within the community, and Ubuntu can be implemented to lead the same element of harmony with various communities. There are ways to integrate Ubuntu as a cultural event into the calendar, bringing together diverse African communities as one force, culture, nation, and identity. Regardless of the level of diversity, the most important thing is to include everyone and give them the recognition they deserve

Women\u27s Empowerment, Mindfulness, and Role of Women in Eradicating Alcohol and Drug Addiction from Indian Society

Women’s empowerment and self-help groups are functional and successful in India in most instances; it is possible to improve them further by incorporating quality parameters in the various training programs. Most of the locally organized skill-training by different empowerment cells operates effectively. Training and operating procedures must be devised to ensure that self-help groups meet international standards for their products. The training is often held in remote locations, making it difficult for the facilitator to visit and provide instruction. There must be established criteria for selecting trainers and a planned curriculum for training. There is a social impediment in the overall empowerment process; one of the social evils is drug and alcohol addiction and specific cultural and societal norms. Women can help to curtail such societal problems, and the Naga Mothers’ Association has made an impact in reducing addiction in Indian society. The Naga Mother’s Association is doing an excellent job of reducing addiction; however, their work needs to be supported by legislative provisions. Similar to the Naga Mothers’ Association, the women’s wing of the Koch Rajbongshi student union has been able to mobilize and disseminate information about the ill effects of addiction among its community members. This paper argues that mindfulness, a concept of Buddhist origin, is necessary to effect revolutionary change. Mindfulness and compassion are the keys to resolving the issue, but reflection is also an essential component of the practice of mindfulness and compassion. The leaders of these women’s associations are playing a pivotal role in helping to eradicate social evils and addiction from Indian society. One of the most critical components is mindfulness of the current situation and circumstances and making decisions accordingly

Tobacco Farming, Addiction, Promotion of Gender Equality, Well-being and Monopoly of the Indian Market

Women\u27s land rights are still suppressed in India because men hold most of the land, and men decide what crops to grow. Tobacco use and farming are both detriments to one’s health. It causes cancer, and cancer treatment is unavailable in the majority of India\u27s remote areas. On the other hand, tobacco is grown in remote regions of India, and cancer hospitals are concentrated in major cities. There are eight states in India\u27s north-eastern region, but only one cancer treatment facility in Guwahati, Assam. There is a need for new cancer hospitals in the north-eastern part of the country, where there is just one cancer hospital for eight states. Mindfulness training and tobacco harmful effects awareness education should be integrated into the educational curriculum and community centres. The school curriculum should include more mindfulness and psychoeducation about tobacco\u27s detrimental effects. The pandemic situation in India and elsewhere make any community-based response difficult right now. Some parts of India, such as A&I Island, the North-Eastern region of India, and J&K, lack high-speed internet connectivity; therefore, radio, television, audio CDs, audio files, recorded videos, reading materials, and cell phones may be the best ways to reach out. Internet-based outreach is another option. A non-governmental organisation (NGO) or other organisation would be required to create regional language reading material, audio files, and video files. Given the global pandemic crisis, such programmes must be put in place as soon as possible. A team of specialists, regional language experts, local cultural experts, and volunteers would be needed to achieve these objectives

Bounds on Energy and Laplacian Energy of Graphs

Let G be simple graph with n vertices and m edges. The energy E(G) of G, denotedby E(G), is dened to be the sum of the absolute values of the eigenvalues of G. Inthis paper, we present two new upper bounds for energy of a graph, one in terms ofm,n and another in terms of largest absolute eigenvalue and the smallest absoluteeigenvalue. The paper also contains upper bounds for Laplacian energy of graph

Bright-dark solitons and their collisions in mixed N-coupled nonlinear Schr\"odinger equations

Mixed type (bright-dark) soliton solutions of the integrable N-coupled nonlinear Schr{\"o}dinger (CNLS) equations with mixed signs of focusing and defocusing type nonlinearity coefficients are obtained by using Hirota's bilinearization method. Generally, for the mixed N-CNLS equations the bright and dark solitons can be split up in $(N-1)$ ways. By analysing the collision dynamics of these coupled bright and dark solitons systematically we point out that for $N>2$, if the bright solitons appear in at least two components, non-trivial effects like onset of intensity redistribution, amplitude dependent phase-shift and change in relative separation distance take place in the bright solitons during collision. However their counterparts, the dark solitons, undergo elastic collision but experience the same amplitude dependent phase-shift as that of bright solitons. Thus in the mixed CNLS system there co-exist shape changing collision of bright solitons and elastic collision of dark solitons with amplitude dependent phase-shift, thereby influencing each other mutually in an intricate way.Comment: Accepted for publication in Physical Review

Painlev{\'e} singularity structure analysis of three component Gross-Pitaevskii type equations

In this paper, we have studied the integrability nature of a system of three coupled Gross-Pitaevskii type nonlinear evolution equations arising in the context of spinor Bose-Einstein condensates by applying the Painlev\'e singularity structure analysis. We show that only for two sets of parametric choices, corresponding to the known integrable cases, the system passes the Painlev\'e test.Comment: 17 pages. Accepted in Journal of Mathematical Physic