Chronobiology of Parkinson's disease: Past, present and future

Parkinson’s disease is a neurodegenerative disorder predominately affecting midbrain dopaminergic neurons that results in a broad range of motor and non-motor symptoms. Sleep complaints are among the most common non- motor symptoms, even in the prodromal period. Sleep alterations in Parkin- son’s disease patients may be associated with dysregulation of circadian rhythms, intrinsic 24-h cycles that control essential physiological functions, or with side effects from levodopa medication and physical and mental health challenges. The impact of circadian dysregulation on sleep disturbances in Parkinson’s disease is not fully understood; as such, we review the systems, cellular and molecular mechanisms that may underlie circadian perturbations in Parkinson’s disease. We also discuss the potential benefits of chronobiology- based personalized medicine in the management of Parkinson’s disease both in terms of behavioural and pharmacological interventions. We propose that a fuller understanding of circadian clock function may shed important new light on the aetiology and symptomatology of the disease and may allow for improvements in the quality of life for the millions of people with Parkinson’s disease

COVID-19 related hospitalization costs; assessment of influencing factors

Objective: Our aim is to assess the effective factors on hospitalization costs of COVID-19 patients. Methods: Data related to clinical characteristics and cost of hospitalized COVID-19 patients from February 2020 until July 2020, in a public teaching hospital in Tehran, Iran was gathered in a retrospective cohort study. The corresponding factors influencing the diagnostic and therapeutic costs were evaluated, using a generalized linear model. Results: The median COVID-19 related diagnostic and therapeutic costs in a public teaching hospital in Iran, for one hospitalized COVID-19 patient was equal to 271.1 US dollars (USD). In patients who were discharged alive from the hospital, the costs increased with patients’ pregnancy (P<0.001), loss of consciousness during hospitalization (P<0.001), a history of drug abuse (P=0.006), history of chronic renal disease (P<0.001), end stage renal disease (P=0.002), history of brain surgery (P=0.001), history of migraine (P=0.001), cardiomegaly (P=0.033) and occurrence of myocardial infarction during hospitalization (P<0.001). In deceased patients, low age P<0.001), history of congenital disease (P=0.024) and development of cardiac dysrhythmias during hospitalization (P=0.044) were related to increase in therapeutic costs. Conclusion: Median diagnostic and therapeutic costs in COVID-19 patients, hospitalized in a public teaching hospital in Iran were 271.1 USD. Hoteling and medications made upmost of the costs. History of cardiovascular disease and new onset episodes of such complications during hospitalization were the most important factors contributing to the increase of therapeutic costs. Moreover, pregnancy, loss of consciousness, and renal diseases are of other independent factors affecting hospitalization costs in COVID-19 patients

Electrocardiographic Findings and In-Hospital Mortality of COVID-19 Patients; a Retrospective Cohort Study

Background: Although current evidence points to the possible prognostic value of electrocardiographic (ECG) findings for in-hospital mortality of COVID-19 patients, most of these studies have been performed on a small sample size. In this study, our aim was to investigate the ECG changes as prognostic indicators of in-hospital mortality. Methods: In a retrospective cohort study, the findings of the first and the second ECGs of COVID-19 patients were extracted and changes in the ECGs were examined. Any abnormal finding in the second ECG that wasn’t present in the initial ECG at the time of admission was defined as an ECG change. ECGs were interpreted by a cardiologist and the prognostic value of abnormal ECG findings for in-hospital mortality of COVID-19 patients was evaluated using multivariate analysis and the report of the relative risk (RR). Results: Data of the ECGs recorded at the time of admission were extracted from the files of 893 patients; likewise, the second ECGs could be extracted from the records of 328 patients who had an initial ECG. The presence of sinus tachycardia (RR = 2.342; p <0.001), supraventricular arrhythmia (RR = 1.688; p = 0.001), ventricular arrhythmia (RR = 1.854; p = 0.011), interventricular conduction delays (RR = 1.608; p = 0.009), and abnormal R wave progression (RR = 1.766; p = 0.001) at the time of admission were independent prognostic factors for in-hospital mortality. In the second ECG, sinus tachycardia (RR = 2.222; p <0.001), supraventricular arrhythmia (RR = 1.632; p <0.001), abnormal R wave progression (RR = 2.151; p = 0.009), and abnormal T wave (RR = 1.590; p = 0.001) were also independent prognostic factors of in-hospital mortality. Moreover, by comparing the first and the second ECGs, it was found that the incidence of supraventricular arrhythmia (RR = 1.973; p = 0.005) and ST segment elevation/depression (RR = 2.296; p <0.001) during hospitalization (ECG novel changes) are two independent prognostic factors of in-hospital mortality in COVID-19 patients. Conclusion: Due to the fact that using electrocardiographic data is easy and accessible and it is easy to continuously monitor patients with this tool, ECGs can be useful in identifying high-risk COVID-19 patients for mortality

Chronobiology of Parkinson's disease: Past, present and future

Parkinson’s disease is a neurodegenerative disorder predominately affecting midbrain dopaminergic neurons that results in a broad range of motor and non-motor symptoms. Sleep complaints are among the most common non- motor symptoms, even in the prodromal period. Sleep alterations in Parkin- son’s disease patients may be associated with dysregulation of circadian rhythms, intrinsic 24-h cycles that control essential physiological functions, or with side effects from levodopa medication and physical and mental health challenges. The impact of circadian dysregulation on sleep disturbances in Parkinson’s disease is not fully understood; as such, we review the systems, cellular and molecular mechanisms that may underlie circadian perturbations in Parkinson’s disease. We also discuss the potential benefits of chronobiology- based personalized medicine in the management of Parkinson’s disease both in terms of behavioural and pharmacological interventions. We propose that a fuller understanding of circadian clock function may shed important new light on the aetiology and symptomatology of the disease and may allow for improvements in the quality of life for the millions of people with Parkinson’s disease

Cardiac dysrhythmia in COVID-19 patients; occurrence and risk factors

Objective: In this study, we have evaluated the occurrence and risk factors of cardiac dysrhythmia on admission and during hospitalization in COVID-19 patients.&nbsp;Methods: This study was conducted as a retrospective cohort in which 893 electrocardiograms (ECGs) taken at the time of admission and 328 ECGs taken during hospitalization were evaluated. These ECGs were assessed for cardiac dysrhythmias by a cardiologist. Finally, relationships between clinical characteristics and the occurrence of cardiac dysrhythmias in patients were assessed.&nbsp;Results: Most common cardiac dysrhythmias on admission were sinus tachycardia (64.8%), atrial fibrillation (13.5%), and sinus bradycardia (11.3%). Multivariate regression analysis showed that a history of metformin use (RR=0.83; p=0.042) was independently associated with reduced risk of cardiac dysrhythmias on admission, while male sex (RR=1.16; p=0.018), history of cardiovascular diseases (RR=1.16; p=0.017), history of cancer (RR=1.40; p=0.004) and QT prolongation on ECG (RR=1.18; p=0.017) were associated with a higher risk of cardiac dysrhythmias on admission. Also, from the 328 patients that had a second ECG, 185 (56.4%) experienced cardiac dysrhythmias during their hospitalization. Multivariate analysis showed that presence of cardiac dysrhythmias on admission (RR=1.85; 95% CI; 1.49-2.35; p&lt;0.001) was the only independent prognostic factor for the occurrence of cardiac dysrhythmias during hospitalization. no significant relationships were observed between treatment regimens and the incidence of cardiac dysrhythmias.&nbsp;Conclusion: The present study showed that more than half of COVID-19 patients have cardiac dysrhythmias on admission. Our analyses illustrated that a history of metformin use was associated with a lower risk of cardiac dysrhythmias on admission, while male sex, history of cardiovascular diseases, history of cancer, and QT prolongation were associated with a higher rate of cardiac dysrhythmias. Hydroxychloroquine use along with azithromycin and Kaletra (Lopinavir-Ritonavir) had no association with the development cardiac dysrhythmias during hospitalization