All India Institute of Medical Sciences

Night Eating Syndrome (NES) is a distinct psychopathological entity variously considered as a mental health disorder, eating disorder or circadian rhythm disorder. Medical students are faced with hectic schedules, sleep interruptions and high-stakes exams as they become healthcare providers. Such social factors coupled with poor dietary practices may impact their mental health and biological clocks, leading to NES amongst this population. However, the magnitude of its occurrence and the associated factors are still not well understood, especially in an Indian context. The present study was planned to determine the prevalence of NES and to explore the association between NES and selected psychosocial health profiles amongst undergraduates. An observational, analytical cross-sectional study was undertaken in a tertiary care hospital in Central India. The study included a total of 414 medical students representing all academic years. The data collection tool comprises a structured questionnaire comprising socio-demographic information, the Night Eating Diagnostic Questionnaire (NEDQ), Insomnia Severity Index (ISI), Simple Lifestyle Indicator Questionnaire (SLIQ) and Patient Health Questionnaire-2 (PHQ-2). The overall prevalence of Night Eating Syndrome is 13.8% and the majority are mild NES syndrome (mild: 10.1%, moderate: 1.7% and severe: 1.9%). Participants with depressive symptoms were 12.8%. In unadjusted analysis, participants having insomnia (OR = 3.16, 95% CI [1.7, 5.7]) and depression (OR = 2.05, 95% CI [1.0, 4.2]) were found to be predictors of night eating syndrome. After adjusting for age, presence of depression, personal history of chronic disease, insomnia and current year of education in medical school, insomnia (OR = 3.08, 95% CI [1.6, 5.7]) was the only predictor independently associated with NES among college-going students. BMI was not found to be a predictor of NES amongst the study participants. Night Eating Syndrome has a significant association with insomnia when adjusted for concomitant depression implying the need to tackle sleep and mental health as lifestyle factors; which play a role in the development of NES and to elucidate further on this association, emphasising its circadian impact leading onto Non-Communicable Diseases.

Levamisole is a commonly used steroid-sparing medication in pediatric nephrotic syndrome. While use of this agent is associated with development of antineutrophil cytoplasmic antibodies (ANCA), there is limited data on their prevalence and antigen specificity. This cross-sectional study, conducted from October 2020 to June 2022, included 117 patients, aged 2-18years, with steroid-sensitive nephrotic syndromeandreceiving levamisole at a dose of 2-2.5mg/kg on alternate days for ≥ 6-months. All patients were screened for ANCA by indirect immunofluorescence and conventional ELISA. Patients positive on screening underwentprofile ELISAto determine its antigen specificity. Twenty (17.1%) patients tested positive for ANCA by either screening method. On profile ELISA, antibodies showed specificity to myeloperoxidase (n = 13), human neutrophil elastase (n = 6), proteinase-3 (n = 4), and/ortheir combination (n = 3). Risk factors independently associated with presence of ANCA included female sex [adjusted odds ratio (aOR) 3.1; 95% CI 1.0-9.3; P = 0.044] and cumulative prednisolone intake in the last 6-months[aOR 0.0041; 0.0001-0.21; P = 0.006]. Following levamisole discontinuation, ANCA was negative in all 16 patients who were retested at 40.6 (3-67.2) months. Antinuclear and anticardiolipin antibodies were present in 19 and 8 patients, respectively, and leukopenia in 4 patients. A significant proportion of patients with steroid-sensitive nephrotic syndrome receiving > 6-months' therapy with levamisole show positive ANCA, with antigen specificity against myeloperoxidase, neutrophil elastase and/or proteinase-3. The risk was higher in girls and lower in those receiving concurrent therapy with prednisolone in the past 6-months.Stopping levamisole therapy was associated with resolution of ANCA.