Incidence of and Factors Associated with New-Onset Insomnia Among Lebanese Hospitalised Patients

Objectives: This study aimed to determine the incidence and post-discharge resolution of new-onset insomnia in hospitalised patients with no previous history of insomnia, as well as to define major correlates of in-hospital insomnia. Methods: This prospective observational study was conducted between November 2019 and January 2020 at a tertiary care centre in Lebanon. All hospitalised patients >18 years of age with no history of insomnia were screened for new-onset insomnia using the Insomnia Severity Index (ISI) scale. Subsequently, patients were re-assessed two weeks after discharge to determine insomnia resolution. Results: A total of 75 patients were included in the study. Of these, nine (12%) had no insomnia, 34 (45.3%) had subthreshold insomnia, 22 (29.3%) had moderate insomnia and 10 (13.3%) had severe insomnia. The mean ISI score was 14.95 ± 6.05, with 88% of patients having ISI scores of >7 (95% confidence interval: 0.822–0.965). The frequency of new-onset insomnia was significantly higher among patients who shared a room compared to those in single-bed rooms (95.7% versus 75%; P = 0.011). Other factors were not found to be associated with new-onset insomnia, including the administration of medications known to cause insomnia, in-hospital sedative use, overnight oxygen, cardiac monitoring and self-reported nocturnal toilet use. Overall, insomnia resolution occurred in 78.7% of patients two weeks after discharge. Conclusion: There was a high incidence of acute new-onset insomnia among hospitalised patients at a tertiary centre in Lebanon. Additional research is recommended to further examine inhospital sleep disturbance factors and to seek convenient solutions to limit insomnia. Keywords: Sleep Wake Disorders; Insomnia; Hospitalization; Incidence; Risk Factors; Lebanon.

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Revaccination following suspected vaccine triggered hypersensitivity reactions: experience of a tertiary care centre

Allergologia et Immunopathologia ◽

10.15586/aei.v49i1.32 ◽

2021 ◽

Vol 49 (1) ◽

pp. 128-134

Author(s):

Aysegul Ertugrul ◽

Ozlem Cavkaytar ◽

Ilknur Bostanci ◽

Serap Ozmen

Keyword(s):

Tertiary Care ◽

Previous History ◽

Atopic Disease ◽

Hypersensitivity Reactions ◽

Tertiary Care Centre ◽

Provocation Tests ◽

History Of ◽

Study Participants ◽

Actual Vaccine ◽

Paediatric Allergy

Introduction and objectives: Suspected hypersensitivity reactions (HRs) associated with vaccines are frequently reported, but confirmed cases of vaccine-triggered HRs are rare. Suspected HRs should be distinguished from actual HRs. The aims of this study are to identify the rate of actual vaccine-triggered hypersensitivity in patients who were referred to the paediatric allergy clinic due to a suspected HR and to explore the rate of revaccination in a real clinical setting. Materials and methods: A retrospective study was performed with a group of preschool children who were evaluated by skin and/or provocation tests (PTs) for the suspected HRs following vaccination. Results: A total of 26 paediatric patients (61.5% male; median age 9 months) with a previous history of suspected vaccine-triggered HR were included. In this group, 69.2% and 38.5% of the patients had a pre-existing atopic disease and an immediate reaction (emerging <1 hour after vaccine administration), respectively. Skin rash was the most frequent clinical presentation (96.1%). Vaccine-triggered anaphylaxis was reported in six patients (23.1%). Measles-mumps-rubella was the most frequently suspected vaccine causing HRs. The skin test positivity with the suspected vaccine was 4%, whereas PTs revealed no reaction after reimmunisation in 76.9% (20/26) of the study participants tested. Conclusions: Most incidents of skin rashes after immunisation are not suggestive of actual HRs. The results in the current study showed that the majority of the patients presenting with suspected HRs tolerated revaccination, including those with a previous history of suspected anaphylaxis. Revaccination of these patients is safe with adequate precautions. It is absolutely essential to be equipped for the management of anaphylaxis.

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Role of micronized progesterone in prevention of preterm labour in women with previous history of one or more preterm births: a research study at a tertiary care hospital

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20150450 ◽

2015 ◽

pp. 1176-1180

Author(s):

Rashmi Ahuja ◽

Anupa Sood ◽

Anita Pal ◽

Rita Mittal

Keyword(s):

Research Study ◽

Tertiary Care Hospital ◽

Preterm Labour ◽

Tertiary Care ◽

Previous History ◽

Preterm Births ◽

Care Hospital ◽

History Of ◽

Micronized Progesterone

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Cutting the chorda tympani: not just a matter of taste

The Journal of Laryngology & Otology ◽

10.1017/s0022215110000733 ◽

2010 ◽

Vol 124 (9) ◽

pp. 999-1002 ◽

Cited By ~ 15

Author(s):

N Guinand ◽

T Just ◽

N W Stow ◽

H Cao Van ◽

B N Landis

Keyword(s):

Middle Ear ◽

Tertiary Care ◽

Case Series ◽

Salivary Flow ◽

Middle Ear Surgery ◽

Chorda Tympani ◽

Tertiary Care Centre ◽

Ear Surgery ◽

Salivary Function ◽

History Of

AbstractIntroduction:Chorda tympani injury as a complication of middle-ear surgery has been extensively studied with regard to its effects upon taste. However, the chorda tympani also carries parasympathetic fibres to the salivary glands of the oral cavity. To date, little has been reported about the effect of chorda tympani section upon salivary function.Setting:Tertiary care centre.Material and methods:We report a case series of three patients with bilateral chorda tympani lesions. Chorda tympani function was assessed using ‘taste strips’ and unstimulated sialometry. A careful history of oral symptoms was taken.Results:All patients showed transient or permanent bilateral ageusia of the anterior two-thirds of the tongue, and a decreased resting salivary flow rate. In addition, all patients suffered from transient or persistent, distressing xerostomia.Conclusion:Taste disorders may occur after middle-ear surgery but they are mostly transient, even when the chorda tympani nerves are sectioned bilaterally. In contrast, bilateral chorda tympani lesions may lead to severe, persistent and distressing xerostomia. Based on this neglected aspect of chorda tympani function, we emphasise the importance of preserving the chorda tympani whenever possible.

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Study of incidence and prevalence of hypokalemic periodic paralysis

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20190928 ◽

2019 ◽

Vol 7 (3) ◽

pp. 810

Author(s):

Ajith Dungdung ◽

Vishwanath Malkappa Jalawadi ◽

Upendra Prasad Yadav

Keyword(s):

Tertiary Care ◽

Medical Science ◽

Periodic Paralysis ◽

High Carbohydrate Diet ◽

Strenuous Exercise ◽

Hypokalemic Periodic Paralysis ◽

Tertiary Care Centre ◽

Carbohydrate Diet ◽

High Carbohydrate ◽

History Of

Background: Hypokalemic periodic paralysis (HPP) is a rare autosomal dominant channelopathy characterised by muscle weakness or paralysis when there is a fall of potassium level in the blood. In individuals with mutation, attack begins during adolescents and most commonly occurs after sleep on awakening, rest after strenuous exercise, high carbohydrate diet and meal with high sodium content. This study was conducted to analyse the age of incidence and prevalence of HPP with various clinical presentations, diagnosis and its effective treatment.Methods: A retrospective analysis of 50 patients of Hypokalemic periodic paralysis was analysed in tertiary care centre “Rajendra institute of medical science” Ranchi, Jharkhand, India, with reference to its clinical presentation, age of incidence and prevalence with laboratory parameters and treatment outcomes.Results: Incidence of attack is more common in men between 26-35 years of age. Sudden onset of flaccid quadriparesis was the most common presentation with history of high carbohydrate diet on the background of strenuous work during summer season. Around 60% had similar history of attacks in the past and most of the patients had serum potassium levels between 2.1-3.0mEq/L. Electrocardiography (ECG) abnormalities associated with hypokalemia had been observed in 90% of patients, and also significant clinical, biochemical changes have been observed as well.Conclusions: Early diagnosis not only helps in definitive management with potassium replacement, but also prevents patient going for life threatening respiratory failure. Patients recover completely without any clinical sequelae. Therefore, it is imperative for physicians, particularly those working in acute care settings, to be aware of this condition. Further management depends on the cause, frequency of attacks, severity of symptoms and the duration of the illness.

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Accidental tramadol ingestion in children admitted in tertiary care centre

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20195200 ◽

2019 ◽

Vol 8 (12) ◽

pp. 2661

Author(s):

Vadlakonda Sruthi ◽

Annaladasu Narendra

Keyword(s):

Pediatric Population ◽

Care Center ◽

Tertiary Care ◽

Ventilatory Support ◽

Case Series ◽

Pediatric Intensive Care ◽

Hemodynamic Instability ◽

Tertiary Care Centre ◽

Medical College ◽

History Of

Background: Tramadol use has been increasing in the adult and pediatric population. Practitioners must be alert because Tramadol misuse can lead to severe intoxication in which respiratory failure and seizures are frequent. Overdoses can lead to death. We report 47 pediatric cases with history of accidental tramadol exposure in children.Methods: An observational, retrospective, single center case -series of children with a history of accidental tramadol exposure in children admitted in pediatric intensive care unit of tertiary care center, Niloufer Hospital (Osmania Medical College) Hyderabad, Telangana India.Results: Of 47 children, 22 (47%) are male and 25 (53%) were female. At presentation 11 (23%) had loss of consciousness, 14 (29%) seizures, 17 (36%) hypotonia was noted. Pupils were miotic in 22 (47%) mydriatic in 2 (4.2%) normal in rest of children. Hemodynamic instability noted in 13 (27.6%). Serotonin syndrome (tachycardia, hyperthermia, hypertension, hyper reflex, clonus) was noted on 5 (10.6%) children. Respiratory depression was seen in 4 (8%) children who needed ventilatory support. Antidote Naloxone was given in 7 children. No adverse reaction was noted with Naloxone. All 47 children were successfully discharged.Conclusions: Overdoses can lead to death and practitioners must be alert because of the increasing use of tramadol in the adult and pediatric population. The handling of the tramadol should be explained to parents and general population and naloxone could be efficient when opioid toxicity signs are present.

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Pregnancy outcome in women with previous preeclampsia versus women normotensive in previous pregnancy

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20184964 ◽

2018 ◽

Vol 7 (12) ◽

pp. 5045

Author(s):

Jayshree Mulik ◽

Snehalata Suresh

Keyword(s):

Pregnancy Outcome ◽

Perinatal Outcome ◽

Tertiary Care ◽

Subsequent Pregnancy ◽

Care Centre ◽

Tertiary Care Centre ◽

Previous Pregnancy ◽

Index Pregnancy ◽

History Of ◽

Adverse Pregnancy

Background: Women with history of preeclampsia have reportedly higher risk of development of preeclampsia in subsequent pregnancies, along with other adverse pregnancy outcomes. Authors aimed to study the incidence of recurrent preeclampsia and compare the pregnancy outcome in women with history of preeclampsia in previous pregnancy with those who were normotensive in previous pregnancy and further compare outcomes in women with recurrent preeclampsia between their previous and index pregnancy.Methods: Pregnancy outcome was studied in women with preeclampsia in previous pregnancy (cases) and compared with women normotensive in previous pregnancy (controls). Further analysis of cases was done by dividing them into subgroups: those with recurrent preeclampsia in index pregnancy (A1) and those normotensive in index pregnancy despite being pre-eclamptic in previous pregnancy (A2). Total 100 cases and 100 controls were enrolled in the study, which was conducted at present tertiary care centre from January 2012 to June 2013.Results: Out of total 200 participants (100 cases, 100 controls) enrolled in the study; 58 out of 100 cases had recurrent preeclampsia and remaining 42 remained normo-tensive in index pregnancy. Among 100 controls, 93 were normotensive in index pregnancy.Conclusions: Women with history of preeclampsia in previous pregnancy had adverse maternal and perinatal outcome in subsequent pregnancy when compared to the women who were normotensive in the previous pregnancy. But when compared with their own previous preeclamptic pregnancy, they had better pregnancy outcome with good perinatal outcome in their index pregnancy.

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The relationship between antihypertensive medications and mood disorders: analysis of linked healthcare data for 1.8 million patients

Psychological Medicine ◽

10.1017/s0033291719004094 ◽

2020 ◽

pp. 1-9 ◽

Cited By ~ 2

Author(s):

Richard J. Shaw ◽

Daniel Mackay ◽

Jill P. Pell ◽

Sandosh Padmanabhan ◽

David S. Bailey ◽

...

Keyword(s):

Mood Disorder ◽

Mood Disorders ◽

Cox Regression ◽

Previous History ◽

Area Deprivation ◽

Antihypertensive Medications ◽

Healthcare Data ◽

Increased Risk ◽

History Of ◽

New Onset

Abstract Background Recent work suggests that antihypertensive medications may be useful as repurposed treatments for mood disorders. Using large-scale linked healthcare data we investigated whether certain classes of antihypertensive, such as angiotensin antagonists (AAs) and calcium channel blockers, were associated with reduced risk of new-onset major depressive disorder (MDD) or bipolar disorder (BD). Method Two cohorts of patients treated with antihypertensives were identified from Scottish prescribing (2009–2016) and hospital admission (1981–2016) records. Eligibility for cohort membership was determined by a receipt of a minimum of four prescriptions for antihypertensives within a 12-month window. One treatment cohort (n = 538 730) included patients with no previous history of mood disorder, whereas the other (n = 262 278) included those who did. Both cohorts were matched by age, sex and area deprivation to untreated comparators. Associations between antihypertensive treatment and new-onset MDD or bipolar episodes were investigated using Cox regression. Results For patients without a history of mood disorder, antihypertensives were associated with increased risk of new-onset MDD. For AA monotherapy, the hazard ratio (HR) for new-onset MDD was 1.17 (95% CI 1.04–1.31). Beta blockers' association was stronger (HR 2.68; 95% CI 2.45–2.92), possibly indicating pre-existing anxiety. Some classes of antihypertensive were associated with protection against BD, particularly AAs (HR 0.46; 95% CI 0.30–0.70). For patients with a past history of mood disorders, all classes of antihypertensives were associated with increased risk of future episodes of MDD. Conclusions There was no evidence that antihypertensive medications prevented new episodes of MDD but AAs may represent a novel treatment avenue for BD.

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A study on risk factors, maternal and foetal outcome in cases of preeclampsia and eclampsia at a tertiary care hospital of South India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20175859 ◽

2017 ◽

Vol 7 (1) ◽

pp. 266

Author(s):

Bandaru Sailaja ◽

Vijayalakshmi Cooly ◽

Bhuvaneswari Sailcheemala ◽

Surayapalem Sailaja

Keyword(s):

Risk Factors ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Previous History ◽

Developed Countries ◽

Reproductive Technologies ◽

Care Hospital ◽

History Of ◽

Foetal Outcome ◽

In Pregnancy

Background: Hypertension in pregnancy remains still a major health issue for women and their descendants throughout the world but remains a major issue in developing countries rather than developed countries. Eclampsia accounts for 24% of maternal deaths during pregnancy in India according to FOGSI study in India. Changing trends in pregnancy globally with increased maternal age of conception, assisted reproductive technologies has contributed a significant impact in the risk factors for PE and eclampsia. The present study was aimed to investigate and determine the related risk factors in cases of PE and eclampsia. The maternal and foetal outcomes with major complications of the women with PE and eclampsia were also studied.Methods: A prospective cross sectional study for a period of two years was conducted at a tertiary care hospital among antenatal cases and all cases of PIH were recorded and studied. Cases were managed as per the existing obstetric protocol after clinical examination and investigations. Detailed socio demographic data and history of risk factors were collected and entered into Microsoft excel sheet and analyzed. Maternal and foetal outcome were noted in the cases of the study.Results: The incidence of PE and eclampsia in the study was 43.3% and 10.8%, 25-35 years age group being the most common. PE and eclampsia was associated with BMI>30, parous women with previous history of PE, diabetes mellitus and more in unregistered cases. PE and eclampsia were more in Illiterates and socio economic class 2 &3. The incidence of maternal complications was 32.99% with premature labour being the common and in case of foetal complications prematurity was the commonest with 16 cases. The maternal mortality was very less with only 4.64% in the study.Conclusions: Pregnancy induced hypertension with PE and eclampsia still remains a major problem in developed countries. Good antenatal care with increased awareness and increased antenatal visits may help in reducing the incidence and maternal and foetal complications. Increased incidence among illiterates and low socio economic status group provides the target group to be directed against any medical measures and national health programmes.

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A study to determine the prevalence of urinary incontinence in antenatal women at a tertiary care centre in central India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20200518 ◽

2020 ◽

Vol 9 (3) ◽

pp. 956

Author(s):

Deepa Joshi ◽

Sheetal Achale ◽

Nilesh Dalal ◽

Alka Patel

Keyword(s):

Urinary Incontinence ◽

Pregnant Women ◽

Indian Subcontinent ◽

Tertiary Care ◽

Previous History ◽

Case Report Form ◽

Tertiary Care Centre ◽

Cross Sectional ◽

Pregnancy And Postpartum ◽

In Pregnancy

Background: Urinary incontinence is a common condition in pregnancy and postpartum. There are more than a thousand articles on urinary incontinence (UI) in pregnancy but very limited literature from Indian subcontinent is available. Incidence and prevalence figures of UI in association with pregnancy vary substantially. Not many reviews have focused solely on incidence and prevalence of UI in association with pregnancy. Prevalence of UI in pregnancy ranges from 32% to 64%.Methods: A cross sectional observational study was conducted in the department of obstetrics and gynecology, MGM Medical College and M.Y. Hospital, Indore over the period of 6 months on 1000 pregnant women who were following antenatal care (ANC) clinic. Pregnant women, who were severely sick, diagnosed with kidney or urinary infection and vaginal infections women were excluded from the study. The data were collected using a structured questionnaire. After the purpose of the study was explained, written consent was obtained from each voluntary participant. This study was approved by institutional ethical committee. The data was recorded in predesign coded case report form and statistical analysis was performed using the STATA 12.1.Results: In the present study the prevalence of urinary incontinence reported is 16.4% of women during pregnancy.Conclusions: In this study the prevalence of UI during current pregnancy was found to be lower compared to previous studies conducted. The previous history of surgery, constipation, obesity and respiratory problems were found to be significantly associated with UI during pregnancy.

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Aural foreign bodies and their management: our experience

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20201076 ◽

2020 ◽

Vol 6 (4) ◽

pp. 646

Author(s):

Padma Harini ◽

Suneel Kudamala

Keyword(s):

Foreign Bodies ◽

Incidental Finding ◽

Tertiary Care ◽

Age Groups ◽

Paediatric Population ◽

Outpatient Department ◽

Tertiary Care Centre ◽

Female Ratio ◽

History Of ◽

Male To Female

Background: Aural foreign bodies (FB) are a common presentation at ENT outpatient department mostly seen in paediatric population. Some are easily managed while others should be dealt with caution and extreme care. The objectives of the study were to analyze the types of aural FB, their incidence in different age groups and evaluate management methods.Methods: This is a prospective descriptive study on patients of all age groups with aural FB presenting to the ENT Outpatient Department in a tertiary care centre for a period of 1 year. The clinical presentation, type of FB, incidence in different age groups and management methods were analyzed. Results: 200 patients aged 2-78 years were evaluated. Age group of under 15 years was most affected (70%). Male to female ratio was 1:1.326. Majority (104 out of 200) presented with a history of FB insertion in the ear while others presented with aural pain and discharge. In 10 cases, ear foreign body was an incidental finding. Most common FB was seeds in children and cotton buds, bird feathers in adults. Most of the cases were managed without anaesthesia with use of headlight. Ear probes were used in 45% cases followed by forceps, suction and syringing in remainder.Conclusions: Most of the aural foreign bodies can be managed in the outpatient department itself without any anaesthesia under direct vision of headlight with the help of simple instruments without any complications.

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