Hypnotics' association with mortality or cancer: a matched cohort study

Objectives: An estimated 6%e10 % of US adults took a hypnotic drug for poor sleep in 2010. This study extends previous reports associating hypnotics with excess mortality. Setting: A large integrated health system in the USA. Design: Longitudinal electronic medical records were extracted for a one-to-two matched cohort survival analysis. Subjects: Subjects (mean age 54 years) were 10 529 patients who received hypnotic prescriptions and 23 676 matched controls with no hypnotic prescriptions, followed for an average of 2.5 year

Inventory study of an early pandemic COVID- 19 cohort in South-Eastern Sweden, focusing on neurological manifestations

Background Neurological manifestations in patients with COVID-19 have been reported previously as outcomes of the infection. The purpose of current study was to investigate the occurrence of neurological signs and symptoms in COVID-19 patients, in the county of 6sterg\uf6tland in southeastern Sweden. Methods This is a retrospective, observational cohort study. Data were collected between March 2020 and June 2020. Information was extracted from medical records by a trained research assistant and physician and all data were validated by a senior neurologist. Results Seventy-four percent of patients developed at least one neurological symptom during the acute phase of the infection. Headache (43%) was the most common neurological symptom, followed by anosmia and/or ageusia (33%), confusion (28%), hallucinations (17%), dizziness (16%), sleep disorders in terms of insomnia and OSAS (Obstructive Sleep Apnea) (9%), myopathy and neuropathy (8%) and numbness and tingling (5%). Patients treated in the ICU had a higher male presentation (73%). Several risk factors in terms of co-morbidities, were identified. Hypertension (54.5%), depression and anxiety (51%), sleep disorders in terms of insomnia and OSAS (30%), cardiovascular morbidity (28%), autoimmune diseases (25%), chronic lung diseases (24%) and diabetes mellitus type 2 (23%) founded as possible risk factors. Conclusion Neurological symptoms were found in the vast majority (74%) of the patients. Accordingly, attention to neurological, mental and sleep disturbances is warranted with involvement of neurological expertise, in order to avoid further complications and long-term neurological effect of COVID-19. Furthermore, risk factors for more severe COVID-19, in terms of possible co-morbidities that identified in this study should get appropriate attention to optimizing treatment strategies in COVID-19 patients

Sleep Disorders and Kidney Transplant Outcomes: Findings From an 18-Year (1997-2015) Historical Cohort Study

A historic cohort study of kidney transplant recipients with a failed graft was conducted to examine the associations between sleep disorders and kidney transplant outcomes. Adult kidney transplant recipients who were transplanted and failed or died with a functioning graft during the designated study time period (January 1, 1997 to September 1, 2015, inclusive) were included (n=299). The primary independent variables, any sleep disorder and any sleep-disordered breathing disorders, were defined through a diagnosis in a subject’s medical record. Transplant outcomes included: death with a functioning graft, graft survival time, and patient survival time after graft failure. Chi-square statistics were used to compare the proportion of death with a functioning graft between subjects with versus without any sleep disorder and to help inform the censoring approach for graft survival time. Kaplan Meier survival curves were used to examine the relationship of any sleep disorder to survival time. Cox regression models, examined the adjusted relationship of any sleep disorder to the outcomes, graft survival time and patient survival time after graft failure. Sub-analyses also examined associations between sleep-disordered breathing disorders and these outcomes. The prevalence of any sleep disorder in this cohort was 20%, with the majority consisting of sleep apnea diagnoses, a sleep-disordered breathing disorder. Given a statistically significant (p≤0.01, adjusted model) sleep disorder by transplant-year heterogeneity, Cox regression models were stratified by transplant-year for the graft survival outcome. Having a sleep disorder, namely, sleep apnea, was associated with a statistically significantly increased risk of graft failure or cardiovascular related death with a functioning graft among patients transplanted in 2009-2015 (adjusted HR=2.94, p In a single-center cohort of kidney transplant recipients with a failed graft, a sleep apnea diagnosis increased the risk of graft loss nearly three-fold among patients transplanted between 2009-2015. Further research is needed to better understand this relationship and whether prevention strategies, including treating sleep apnea, might increase longevity in kidney transplant patients

Psychotropic prescribing after hospital discharge in survivors of critical illness, a retrospective cohort study (2012–2019)

Background:Many people survive critical illness with the burden of new or worsened mental health issues and sleep disturbances. We examined the frequency of psychotropic prescribing after critical illness, comparing critical care to non-critical care hospitalised survivors, and whether this varied in important subgroups.Methods:This retrospective cohort study included 23,340 critical care and 367,185 non-critical care hospitalised adults from 2012 through 2019 in Lothian, Scotland, who survived to discharge.Results:One-third of critical care survivors (32 7527/23,340) received a psychotropic prescription within 90 days after hospital discharge (25 14hypnotics; 4mania medicines). In contrast, 1554,589/367,185) of non-critical care survivors received a psychotropic prescription (12 5hypnotics; 2mania medicines). Among patients without psychotropic prescriptions within 180 days prior to hospitalisation, after hospital discharge, the critical care group had a higher incidence of psychotropic prescription (10.3 1610/15,609) compared with the non-critical care group (3.2 9743/307,429); unadjusted hazard ratio (HR) 3.39, 95 3.22–3.57. After adjustment for potential confounders, the risk remained elevated (adjusted HR 2.03, 95 1.91–2.16), persisted later in follow-up (90–365 days; adjusted HR 1.38, 95 1.30–1.46), and was more pronounced in those without recorded comorbidities (adjusted HR 3.49, 95 3.22–3.78).Conclusions:Critical care survivors have a higher risk of receiving psychotropic prescriptions than hospitalised patients, with a significant proportion receiving benzodiazepines and other hypnotics. Future research should focus on the requirement for and safety of psychotropic medicines in survivors of critical illness, to help guide policy for clinical practice

Derangements of Liver Enzymes in a Study of 201 COVID‑19 Patients in Abuja, Nigeria’s Federal Capital Territory

Background: Several studies reveal abnormalities in liver function tests of COVID-19 patients. However, there are little data on African patients. Aim: This study aimed to evaluate liver function tests (LFT) in severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) infected patients admitted in Asokoro COVID‑19 Isolation and Treatment Centre in Abuja, Nigeria. Patients, Materials and Methods: This was a retrospective study of 201 laboratory‑confirmed SARS‑CoV‑2‑infected patients hospitalized in Asokoro District Hospital COVID‑19 Isolation and Treatment Centre between April 10 and July 31, 2020. Demographic, clinical, and laboratory data were obtained, and the outcome measure was LFT abnormalities at presentation. Statistical analysis was done using IBM SPSS Version 24, with P < 0.05 considered statistically significant. Results: Patient median age was 39.3 years(IQR: 26–52); 65.7% were males and 33.8% were health workers. Approximately 49.2% of patients were overweight or obese. Hypertension (22.9%) and diabetes mellitus(7.5%) were the most common comorbidities and only 1% had a known history of liver disease. Abnormal LFTs were observed in 53% of patients(n = 106), most frequently elevated direct bilirubin (78.3%) and alanine aminotransferase (38.7%). Comorbidities were not found significantly associated with LFT abnormalities. Females (odds ratio [OR] = 0.367 P = 0.004 confidence interval [CI] 0.186–0.724) and patients aged 20–29 years (OR = 0.067 P = 0.043 [CI] 0.005–0.916) were found less likely to have abnormal LFTs. Conclusion: Regardless of clinical status at presentation, about half of SARS‑CoV‑2 patients admitted at the Asokoro Isolation and Treatment Centre in Abuja had abnormal LFT results. It is therefore recommended that LFT is included as a part of baseline investigations during the management of COVID‑19 for improved outcomes

Doctor of Philosophy

dissertationThe purpose of this study was to determine the association of each of five cardiometabolic risk factors (diabetes, hypertension, elevated triglycerides, low high density lipoproteins, obesity), and MetS (three or more risk factors present) with the level of physical function 1) prior to surgery in patients with TKA/THA surgery and 2) 6 weeks postsurgery in patients with TKA/THA surgery, controlling for age, sex, physical activity, and comorbidity. Patient physical function data were retrospectively extracted from a clinical orthopedic database between September of 2008 and November of 2010. Comorbidities were obtained by chart abstraction. Patients were ≥40 years old with a primary total hip or knee arthroplasty. Relationships between MetS and its individual components, and physical function were completed using the Lower Extremity Function Scale (LEFS) and SF-36 physical component score (PCS). Covariates were age, sex, comorbidities, and physical activity. Preoperatively, a total of 174 TKA and 112 THA candidates were included. For TKA candidates, mean LEFS scores were significantly (p<0.001) lower for patients with MetS (30.0, SD 14.2) than without MetS (39.9, SD 16.0). In TKA cohort, MetS remained significantly associated with reduced lower-extremity physical function; additionally, female sex, chronic back pain and insomnia significantly reduced preoperative lower-extremity physical function, in the adjusted analysis. For THA iv candidates, adjusted analysis found MetS and being female were significantly (p<0.05) associated with worse lower-extremity physical function. Postoperatively, 170 and 111 patients with a total knee and total hip arthroplasty were included. In the adjusted analysis: Diabetes, chronic back pain and presurgical physical function remained significantly associated with reduced postoperative lowerextremity physical function. For THA, being female, chronic back pain and presurgical physical function were significantly (p<0.05) associated with worse physical health. MetS was not significantly associated with postoperative physical function (PCS or LEFS) in the THA/TKA population. This study provides evidence that MetS, back pain, and insomnia are modifiable conditions that influence preoperative physical function while back pain, diabetes and preoperative physical function are modifiable conditions that influence postoperative physical function. MetS was not associated with postoperative physical function in either the TKA or THA cohort