Does REM sleep contribute to subjective wake time in primary insomnia? A comparison of polysomnographic and subjective sleep in 100 patients

Primary insomnia (PI) is characterized by low subjective sleep quality which cannot always be verified using polysomnography (PSG). To shed light on this discrepancy, subjective estimates of sleep and PSG variables were compared in patients with PI and good sleeper controls (GSC). 100 patients with PI (age: 42.57 +/- 12.50 years, medication free for at least 14 days) and 100 GSC (41.12 +/- 13.99 years) with a sex distribution of 46 men and 54 women in each group were included. Both PSG and questionnaire variables showed clear impairments of sleep quality in PI compared with GSC. The arousal index within total sleep time was increased, which was mainly because of a strong increase within rapid eye movement (REM) sleep. Subjectively, more PI than GSC subjects estimated wake times longer than obtained from PSG. Linear modeling analysis of subjective wake time in terms of PSG parameters revealed that in addition to PSG defined wake time, REM sleep time contributed significantly to subjective wake time. This REM sleep contribution was larger for PI than for GSC subjects. The findings suggest that REM sleep-related processes might contribute to subjectively disturbed sleep and the perception of waking time in patients with PI.     

Data Privacy in Cloud-assisted Healthcare Systems: State of the Art and Future Challenges

The widespread deployment and utility of Wireless Body Area Networks (WBAN’s) in healthcare systems required new technologies like Internet of Things (IoT) and cloud computing, that are able to deal with the storage and processing limitations of WBAN’s. This amalgamation of WBAN-based healthcare systems to cloud-based healthcare systems gave rise to serious privacy concerns to the sensitive healthcare data. Hence, there is a need for the proactive identification and effective mitigation mechanisms for these patient’s data privacy concerns that pose continuous threats to the integrity and stability of the healthcare environment. For this purpose, a systematic literature review has been conducted that presents a clear picture of the privacy concerns of patient’s data in cloud-assisted healthcare systems and analyzed the mechanisms that are recently proposed by the research community. The methodology used for conducting the review was based on Kitchenham guidelines. Results from the review show that most of the patient’s data privacy techniques do not fully address the privacy concerns and therefore require more efforts. The summary presented in this paper would help in setting research directions for the techniques and mechanisms that are needed to address the patient’s data privacy concerns in a balanced and light-weight manner by considering all the aspects and limitations of the cloud-assisted healthcare systems.     

Nanostructured lipid carriers of pioglitazone for transdermal application: from experimental design to bioactivity detail

Abstract

Pioglitazone (PZ) an anti-hyperglycemic agent is used in the treatment of type 2 diabetes. The aim of this study was to design PZ-loaded nanostructured lipid carriers (NLC) to investigate the bioavailability improvement by transdermal delivery. PZ NLCs were prepared using high-pressure homogenization followed by ultrasonication. The NLCs were evaluated for particle size analysis, drug loading, ex vivo skin transport studies and in vivo bioactivity study. The prepared NLCs had a mean size of 166.05?nm and drug loading of 10.41% with flux value of 47.36?µg/cm²/h. The entrapment of PZ is >70% in the NLCs with enhancement ratio of 3.2 times. The in vivo pharmacokinetic study showed 2.17 times enhancement in bioavailability study and pharmacodynamics study showed that PZ NLC-based transdermal therapeutic system (PNLG-TTS) lowers blood sugar level in a sustained pattern for a prolonged period of time as compared to Piosys tablet (marketed). The shelf life of the optimized formulation was found to be 1.83?years. These results clearly provide a lead that above NLCs-based TTS is potential controlled release formulation for PZ and could be a promising drug delivery system for the treatment of diabetes.     

Ameliorative effects of rutin against metabolic,biochemical and hormonal disturbances in polycystic ovary syndrome in rats

Background

Polycystic ovary syndrome (PCOS) is the most prevalent endocrinopathy in women of reproductive age. The study was commenced to assess the favorable effects of Rutin against metabolic, biochemical, histological, and androgenic aspects of polycystic ovary syndrome in rats.

Methods

Female Sprague-Dawley rats were administered letrozole (1 mg/kg) per orally (p.o) for a period of 21 days for the induction of PCOS, followed by dose of rutin (100 mg/kg and 150 mg/kg, p.o) for 15 days using 0.5% w/v CMC as vehicle. Metformin was also given as a standard control to one of the rat groups.Serum estradiol, progesterone, testosterone, serum lipid parameters, CRP and glucose levels were evaluated. Furthermore, antioxidant activity was tested using superoxide dismutase, catalase, glutathione per-oxidase and reactive-oxygen species level.

Results

Rutin flavonoid had a dose-dependent effect on androgenic levels depicting more recovery in the rutin-I treated group, while rutin-II treated groups showed better antioxidant and lipid profiles as compared with PCOS groups. A decrease in the value of C reactive protein (CRP) and a restoration in the proportion of estrous phase smears were observed in the rutin treated groups. Histopathological examination of ovary revealed a significant decrease in the number of cystic follicles in post treated groups. The effects observed with rutin were moderately similar to that with standard metformin, a widely used treatment drug for PCOS.

Conclusion

The study provides evidence for the potential ameliorative effects of rutin against clinical and biochemical features of PCOS.

     

Performance of the Neonatal Tetanus Surveillance System (NTSS) in Sana'a,Yemen: Evaluation Study

BackgroundThe Neonatal Tetanus Surveillance System (NTSS) in Yemen was established in 2009 to identify high-risk areas, determine trends, and evaluate elimination activities. Since its launch, the NTSS had never been evaluated.ObjectiveThis study aimed to assess the performance of NTSS and determine its strengths and weaknesses to recommend improvements.MethodsThe US Centers for Disease Control and Prevention (CDC) guidelines were used for evaluating the NTSS. Stakeholders at the central, district, and facility levels were interviewed to rate the attributes of the NTSS. The percentage scores for attributes were ranked as poor (<60%), average (≥60% to <80%) and good (≥80%).ResultsThe overall usefulness score percentage was 38%, which indicates a poor performance. The performance of the NTSS was rated as average on flexibility (score percent: 68%) and acceptability (score percent: 64%) attributes and poor on stability (score percentage: 33%), simplicity (score percentage: 57%), and representativeness (score percentage: 39%) attributes. About 65% of investigation forms were completed within 48 hours of notification date. Data quality was poor, as 41% of the core variables were missing.ConclusionsThe overall performance of the NTSS was poor. Most of the system attributes require improvement, including stability, simplicity, quality of data, and completeness of investigation. To improve the performance of NTSS, the following are recommended: capacity building of staff (focal points), strengthening NTSS through technical support and government funding to ensure its sustainability, establishing electronic investigation forms for improving the system data quality, and expansion of NTSS coverage to include all private health care facilities.     

Electronic crime investigations in a virtualised environment: a forensic process and prototype for evidence collection and analysis

The constant evolution of virtualisation technologies and the availability of anti-forensic techniques and tools complicate efforts by forensic investigators to investigate a crime or a cyber security incident. Forensic collection can be complicated and requires significant efforts to investigate incidents involving contemporary technologies (e.g. crime launched from a virtual machine and there had been attempts to erase evidence after the incident). This paper presents a forensic process to collect and analyse traces of a virtual machine and its corresponding manager, recorded across multiple sources including the file system, Windows registry, history, and log files from a forensic viewpoint. To demonstrate utility of the forensic mechanism, the Virtual Machine Forensic Artefact Collector (VMFAC) prototype is developed and presented in this paper.     

The physician-patient relationship under the Family Health Program in three municipalities in Bahia State, Brazil

This study discusses the physician-patient relationship under the Family Health Program (FHP) in Bahia State, Brazil. Assuming that the physician-patient relationship is influenced by macro and micro-contextual factors, we linked health surveillance and the ecological model of human development, both influenced by contextualism. The methodological strategies included: a census of FHP physicians in Bahia and direct observation of consultations by 20 physicians in three municipalities (counties). There were significant differences in the implementation of the FHP in the three municipalities, with an impact on the physician-patient relationship. As for orientation of clinical practice, health surveillance has not been incorporated by the physicians observed in this study. According to the micro-contextual analysis, health problems were frequently not treated in a contextualized way. FHP guidelines, when incorporated by the municipalities, produce differences in care as observed in the physician-patient relationship. The health surveillance approach, reported as a tool for collective work, proves efficient for describing, evaluating, and improving the FHP, and this study concludes that it is a powerful conceptual tool for dealing with the physician-patient relationship.