Insomnia is a pervasive and often debilitating sleep disorder that profoundly affects health and overall wellbeing. This comprehensive review focuses on the historical context, clinical significance, diagnostic criteria, investigative methods, and global treatment guidelines for insomnia. Historically, references to insomnia have appeared in ancient Egyptian and Greek texts, but it was not until the 19th century that they were rigorously studied and classified. Notable individuals, including Vincent van Gogh, Franz Kafka, and Marilyn Monroe, have struggled publicly with insomnia, underscoring its widespread nature. The pathophysiology of insomnia is multifactorial, involving physiological, psychological, and environmental factors. Hyperarousal, dysregulation of the sleep-wake cycle, and neurotransmitter imbalances are central to its development. Insomnia can be categorized into acute, chronic, comorbid, idiopathic, and behavioral types. Epidemiological studies have revealed that up to 30% of adults experience insomnia, with a higher prevalence among women, older adults, and those with a lower socioeconomic status. Insomnia is associated with adverse health outcomes, including cardiovascular diseases, metabolic disorders, cognitive impairment, and increased mortality risk. The COVID-19 pandemic has exacerbated insomnia owing to stress and lifestyle changes. Diagnosis involves a comprehensive assessment, including sleep history, physical examination, and objective evaluations, such as polysomnography. Treatment combines pharmacological and non-pharmacological interventions with cognitive behavioral therapy for insomnia as the first-line approach. Pharmacotherapy includes benzodiazepines, non-benzodiazepine hypnotics, antidepressants, melatonin, and orexin receptor antagonists. Guidelines from the American Academy of Sleep Medicine and the European Sleep Research Society emphasize individualized, evidence-based treatment plans to improve sleep quality and overall health.

Insomnia is a pervasive and often debilitating sleep disorder that profoundly affects health and overall wellbeing. This comprehensive review focuses on the historical context, clinical significance, diagnostic criteria, investigative methods, and global treatment guidelines for insomnia. Historically, references to insomnia have appeared in ancient Egyptian and Greek texts, but it was not until the 19th century that they were rigorously studied and classified. Notable individuals, including Vincent van Gogh, Franz Kafka, and Marilyn Monroe, have struggled publicly with insomnia, underscoring its widespread nature. The pathophysiology of insomnia is multifactorial, involving physiological, psychological, and environmental factors. Hyperarousal, dysregulation of the sleep-wake cycle, and neurotransmitter imbalances are central to its development. Insomnia can be categorized into acute, chronic, comorbid, idiopathic, and behavioral types. Epidemiological studies have revealed that up to 30% of adults experience insomnia, with a higher prevalence among women, older adults, and those with a lower socioeconomic status. Insomnia is associated with adverse health outcomes, including cardiovascular diseases, metabolic disorders, cognitive impairment, and increased mortality risk. The COVID-19 pandemic has exacerbated insomnia owing to stress and lifestyle changes. Diagnosis involves a comprehensive assessment, including sleep history, physical examination, and objective evaluations, such as polysomnography. Treatment combines pharmacological and non-pharmacological interventions with cognitive behavioral therapy for insomnia as the first-line approach. Pharmacotherapy includes benzodiazepines, non-benzodiazepine hypnotics, antidepressants, melatonin, and orexin receptor antagonists. Guidelines from the American Academy of Sleep Medicine and the European Sleep Research Society emphasize individualized, evidence-based treatment plans to improve sleep quality and overall health.

Insomnia is a pervasive and often debilitating sleep disorder that profoundly affects health and overall wellbeing. This comprehensive review focuses on the historical context, clinical significance, diagnostic criteria, investigative methods, and global treatment guidelines for insomnia. Historically, references to insomnia have appeared in ancient Egyptian and Greek texts, but it was not until the 19th century that they were rigorously studied and classified. Notable individuals, including Vincent van Gogh, Franz Kafka, and Marilyn Monroe, have struggled publicly with insomnia, underscoring its widespread nature. The pathophysiology of insomnia is multifactorial, involving physiological, psychological, and environmental factors. Hyperarousal, dysregulation of the sleep-wake cycle, and neurotransmitter imbalances are central to its development. Insomnia can be categorized into acute, chronic, comorbid, idiopathic, and behavioral types. Epidemiological studies have revealed that up to 30% of adults experience insomnia, with a higher prevalence among women, older adults, and those with a lower socioeconomic status. Insomnia is associated with adverse health outcomes, including cardiovascular diseases, metabolic disorders, cognitive impairment, and increased mortality risk. The COVID-19 pandemic has exacerbated insomnia owing to stress and lifestyle changes. Diagnosis involves a comprehensive assessment, including sleep history, physical examination, and objective evaluations, such as polysomnography. Treatment combines pharmacological and non-pharmacological interventions with cognitive behavioral therapy for insomnia as the first-line approach. Pharmacotherapy includes benzodiazepines, non-benzodiazepine hypnotics, antidepressants, melatonin, and orexin receptor antagonists. Guidelines from the American Academy of Sleep Medicine and the European Sleep Research Society emphasize individualized, evidence-based treatment plans to improve sleep quality and overall health.

Background::Exercise and medication have similar benefits in reducing blood pressure (BP); however, hypertension management initiatives primarily focus on medicines. This is due to scarce research on the effectiveness of implementation strategies for optimal exercise adoption and adherence. Smartphones were found to be effective in delivering hypertension care and increase exercise adherence. Despite this, only a small number of research projects in India have used smartphones as a strategy for managing hypertension.Methods::We hypothesized that smartphone application-based care would lead to higher exercise adherence among adults (30-79 years) with hypertension compared to those who receive usual care. It will be a multicentric, randomized controlled, parallel-design, superiority clinical trial. The outcome assessor and data analyst will be blinded to group allocation. Participants in the intervention group will receive mobile application-based care for 6 weeks. Participants in the usual care group will receive a standard intervention. Both groups will receive the same number of follow-ups.Results::The primary outcome is the difference in the proportion of people adherent to the recommended level of physical activity evaluated using an exercise adherence rating scale in the intervention group and the control group. Exercise adoption will be measured as the percentage of eligible participants in each study setting willing to initiate the exercise program. The secondary outcome includes differences in systolic and diastolic BP and self-management (evaluated using the Hypertension Self-Care Profile). The trial outcome will be accompanied by a process evaluation.Conclusions::This research will inform about the comparative effectiveness of conventional and m-health interventions for exercise adoption and adherence in people with hypertension in resource-constrained settings.

Background::Exercise and medication have similar benefits in reducing blood pressure (BP); however, hypertension management initiatives primarily focus on medicines. This is due to scarce research on the effectiveness of implementation strategies for optimal exercise adoption and adherence. Smartphones were found to be effective in delivering hypertension care and increase exercise adherence. Despite this, only a small number of research projects in India have used smartphones as a strategy for managing hypertension.Methods::We hypothesized that smartphone application-based care would lead to higher exercise adherence among adults (30-79 years) with hypertension compared to those who receive usual care. It will be a multicentric, randomized controlled, parallel-design, superiority clinical trial. The outcome assessor and data analyst will be blinded to group allocation. Participants in the intervention group will receive mobile application-based care for 6 weeks. Participants in the usual care group will receive a standard intervention. Both groups will receive the same number of follow-ups.Results::The primary outcome is the difference in the proportion of people adherent to the recommended level of physical activity evaluated using an exercise adherence rating scale in the intervention group and the control group. Exercise adoption will be measured as the percentage of eligible participants in each study setting willing to initiate the exercise program. The secondary outcome includes differences in systolic and diastolic BP and self-management (evaluated using the Hypertension Self-Care Profile). The trial outcome will be accompanied by a process evaluation.Conclusions::This research will inform about the comparative effectiveness of conventional and m-health interventions for exercise adoption and adherence in people with hypertension in resource-constrained settings.

Bone marrow-derived cell (BMDC) therapy has numerous applications as potential biological cells for use in regenerative medicine. Here, we present an original case of endometrial atrophy associated with genital tuberculosis in a woman who achieved a live birth with BMDC. This 27-year-old woman came to our center with endometrial atrophy and primary infertility. She had a past history of genital tuberculosis and amenorrhea. Her husband’s semen quality was normal. The patient was counseled for hysteroscopy due to thin endometrium and advised in vitro fertilization (IVF) with donor eggs in lieu of poor ovarian reserve. Several attempts of IVF with hormone replacement therapy (HRT) were made, but the desired thickness of the endometrium was not achieved. Uterine artery injection of BMDC through interventional radiology was given, followed by HRT for three months, which resulted in improved endometrium. This was subsequently followed by IVF with donor egg. The treatment resulted in the conception and delivery of a 3.1-kg baby boy through lower segment caesarean section with no antenatal, intranatal or postnatal complications. Recently, there has been massive interest in stem cells as a novel treatment method for regenerative medicine, and more specifically for the regeneration of human endometrium disorders like Asherman syndrome and thin endometrium, which was the reason behind using this strategy for treatment.

Purpose: Both primary and revisional bariatric surgery are on the rise due to global obesity pandemic. This study aimed to assess the indications for revision after one-anastomosis gastric bypass (OAGB) and the outcomes after laparoscopic conversion of OAGB to roux-en-y gastric bypass (RYGB). Materials and Methods: Retrospective review on patients that had undergone conversion of OAGB to RYGB between June 2007-June 2019 in a tertiary bariatric center, followed by literature review. Results: Out of 386 revisional bariatric surgery, a total of 14 patients underwent laparoscopic conversion of OAGB to RYGB. The mean age was 44.7 with 71% female. The mean pre-revision BMI was 29.2 kg/m2 . The primary indications for revision were bile reflux (n=7), marginal ulcer (n=3), inadequate weight loss or weight regain (IWL/WR) (n=3) and protein-calorie malnutrition (n=1). Conversion of OAGB to RYGB was completed laparoscopically in all cases.The mean length of stay was 4.1 days. There was no intraoperative or early post-operative complication. The mean total weight loss (rTWL%) after revision at year one, year three and year five post-revision were 11.5%, 18.1% and 29.1%, respectively. All patients achieved resolution of bile reflux and marginal ulcer. There was no mortality in this cohort. Conclusion Bile reflux, marginal ulcer, IWL/WR and malnutrition were the main indications for revision after OAGB in this study. In concordance with the available evidence, laparoscopic conversion of OAGB to RYGB was safe and effective in dealing with late complications of OAGB.

Bone marrow-derived cell (BMDC) therapy has numerous applications as potential biological cells for use in regenerative medicine. Here, we present an original case of endometrial atrophy associated with genital tuberculosis in a woman who achieved a live birth with BMDC. This 27-year-old woman came to our center with endometrial atrophy and primary infertility. She had a past history of genital tuberculosis and amenorrhea. Her husband’s semen quality was normal. The patient was counseled for hysteroscopy due to thin endometrium and advised in vitro fertilization (IVF) with donor eggs in lieu of poor ovarian reserve. Several attempts of IVF with hormone replacement therapy (HRT) were made, but the desired thickness of the endometrium was not achieved. Uterine artery injection of BMDC through interventional radiology was given, followed by HRT for three months, which resulted in improved endometrium. This was subsequently followed by IVF with donor egg. The treatment resulted in the conception and delivery of a 3.1-kg baby boy through lower segment caesarean section with no antenatal, intranatal or postnatal complications. Recently, there has been massive interest in stem cells as a novel treatment method for regenerative medicine, and more specifically for the regeneration of human endometrium disorders like Asherman syndrome and thin endometrium, which was the reason behind using this strategy for treatment.

Purpose: Both primary and revisional bariatric surgery are on the rise due to global obesity pandemic. This study aimed to assess the indications for revision after one-anastomosis gastric bypass (OAGB) and the outcomes after laparoscopic conversion of OAGB to roux-en-y gastric bypass (RYGB). Materials and Methods: Retrospective review on patients that had undergone conversion of OAGB to RYGB between June 2007-June 2019 in a tertiary bariatric center, followed by literature review. Results: Out of 386 revisional bariatric surgery, a total of 14 patients underwent laparoscopic conversion of OAGB to RYGB. The mean age was 44.7 with 71% female. The mean pre-revision BMI was 29.2 kg/m2 . The primary indications for revision were bile reflux (n=7), marginal ulcer (n=3), inadequate weight loss or weight regain (IWL/WR) (n=3) and protein-calorie malnutrition (n=1). Conversion of OAGB to RYGB was completed laparoscopically in all cases.The mean length of stay was 4.1 days. There was no intraoperative or early post-operative complication. The mean total weight loss (rTWL%) after revision at year one, year three and year five post-revision were 11.5%, 18.1% and 29.1%, respectively. All patients achieved resolution of bile reflux and marginal ulcer. There was no mortality in this cohort. Conclusion Bile reflux, marginal ulcer, IWL/WR and malnutrition were the main indications for revision after OAGB in this study. In concordance with the available evidence, laparoscopic conversion of OAGB to RYGB was safe and effective in dealing with late complications of OAGB.

The ongoing coronavirus threat from China has spread rapidly to other nations and has been declared a global health emergency by the World Health Organization (WHO). The pandemic has resulted in over half of the world's population living under conditions of lockdown. Several academic institutions and pharmaceutical companies that are in different stages of development have plunged into the vaccine development race against coronavirus disease 2019 (COVID-19). The demand for immediate therapy and potential prevention of COVID-19 is growing with the increase in the number of individuals affected due to the seriousness of the disease, global dissemination, lack of prophylactics, and therapeutics. The challenging part is a need for vigorous testing for immunogenicity, safety, efficacy, and level of protection conferred in the hosts for the vaccines. As the world responds to the COVID-19 pandemic, we face the challenge of an overabundance of information related to the virus. Inaccurate information and myths spread widely and at speed, making it more difficult for the public to identify verified facts and advice from trusted sources, such as their local health authority or WHO. This review focuses on types of vaccine candidates against COVID-19 in clinical as well as in the preclinical development platform.