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Bipolar affective disorder (BAD) is one of the actual problems in modern psychiatry. The aim of the study is to investigate dyssomnia in patients with primary episode of BAD, taking into account, the sex and clinical features of the diseases debut. We have clinically examined 65 men and 88 women diagnosed with bipolar affective disorder in the period 2015–2019. It was found that dyssomnia is present in 98.3% of all patients, in 97.7% of men and in 98.7% of women with depressive variant of the primary episode of BAD, accordingly in 30.4%, 26.7% and 37.5% of patients with manic variant and at 100,0% of patients with mixed variant. The structure of sleep disorders varies significantly depending on the variant of the primary episode: with depressive, prevail night and early awakenings (100.0%), sleep disturbance (75.6%, 70.5%, and 78.7%), unstable sleep (47.9%, 59.1% and 41.3%, p

We report a patient who presented with paraplegia after ascending aorta and arch replacement using the frozen elephant trunk technique. Immediate postoperatively cerebrospinal fluid drainage allowed successful reversal of spinal chord injury. Early awakening of patients following a frozen elephant technique is mandatory because it allows recognition and treatment of this complication by prompt cerebrospinal liquor drainage.

Objectives Evaluate an enhanced recovery after surgery (ERAS)–based free flap management protocol implemented at our center. Study Design Prospective cohort study of patients after implementation of an ERAS-based perioperative care protocol for patients undergoing free flap reconstruction of the head and neck as compared with a historical control group. Setting Tertiary care academic medical center. Participants and Methods All patients undergoing free flap reconstruction were prospectively enrolled in the ERAS protocol group. A retrospective control group was identified by randomly selecting an equivalent number of patients from a records search of those undergoing free flap surgery between 2009 and 2015. Blood transfusion, complications, 30-day readmission rates, intensive care unit (ICU) and hospital length of stay, and costs of hospitalization were compared. Results Sixty-one patients were included in each group. Patients in the ERAS group underwent less frequent flap monitoring by physicians and had lower rates of intraoperative (70.5% vs 86.8%, P = .04) and postoperative (49.2% vs 27.2%, P = .026) blood transfusion, were more likely to be off vasopressors (98.3% vs 50.8%, P < .01) and ventilator support (63.9% vs 9.8%, P < .01) at the conclusion of surgery, and had shorter ICU stays (2.11 vs 3.39 days, P = .017). Length of stay, readmissions, and complication rates did not significantly differ between groups. Conclusion ERAS-based perioperative practices for head and neck free flap reconstruction can reduce time on the ventilator and in the ICU and the need for vasopressors, blood transfusions, and labor-intensive flap monitoring, without adverse effects on outcomes.

The development of Science was a part of God’s revelation which was revealed to His Prophets at the early awakening of human civilization on the earth. This Science then was spread by their followers to make people understand, apply and develop it as a means in running their duty as caliphs. However, after the death of the prophets, people tended to misuse science development. As a result, beside giving some advantages and ease for human activities, it also creates negative effects.

A vast literature review on the insomnia epidemiology, the most common sleep disorder, using MEDLINE and LILACS last 30 years of data, was performed from January 2002 to November 2003. The key-words were: sleep initiation disorders, sleep maintenance disorders, early awakening disorder, insomnia, sleep disorders, insomnia prevalence, insomnia consequences. Several insomnia definition criteria and epidemiology researches methods, with data comparison difficulties, were noticed. In the future it will be necessary similar insomnia definition and epidemiology studies criteria.

The insomnia prevalence in general population was determined by means of 408 home interviews of adults, in a representative sample of Campo Grande city, Brazil. The random sample was stratified by sex, age and economic social status. Insomnia subtypes evaluated were the disorders of sleep initiation (DSI), sleep maintenance (DSM) and early awakening (DEA). A structured questionnaire was used with the consent from the interviewed subjects. Statistics used chi-square, and Fisher tests; and inferences based on binomial distribution parameters; the significance level was 5% and confidence interval (CI) was 95%.The general prevalence of insomnia was 19.1% (sd=2.0%), mostly women (p=0.0015), and people of less years of schooling (p=0.0317), subtype DSI (14.2%, p=0.0043), and chronic (p=0.7022). Hypnotic drugs were used by 6.9%(sd=1.3%) in the last month. Use in the last 2 years, 70.3% mostly insomniacs (p

Summary The effects of age and shiftwork experience (never, past, present) on sleep were studied in a sample of 3236 wage earners and retired workers by means of a questionnaire. The sample was composed of 32-, 42-, 52-, and 62-year-old subjects, and included both sexes and various occupational statuses. Age resulted in a continuously increasing frequency of sleep disturbances and hypnotic use, except for difficulty getting back to sleep and early awakening, which peaked at 52 years and then decreased at 62 years, thus suggesting a ‘retirement effect’. Current and past shiftworkers reported more problems with falling asleep and early awakening than subjects who had never worked on shifts. This is a likely explanation of why the effect of age was massive in the latter group and much less pronounced in the former groups. There were no clear effects of the length or recency of shiftwork experience. This finding does not support the hypothesized permanent effect of shiftwork experience on subsequent sleep. Females had higher complaint rates at every age. There was little interaction between age and sex, but women were affected more by shiftwork as they got older, particularly as to hypnotic consumption. Some of the results support the hypothesis that a selection process excludes workers who are no longer able to cope with the demands of shiftwork.

Introduction – Given the high morbidity and mortality associated with intracerebral hemorrhage (ICH), family members and healthcare providers base early supportive management decisions, at least in part, on expected prognosis. In the comatose patient with ICH, this short-term prognosis is most overtly characterized by regaining of consciousness.Methods – A retrospective consecutive cohort of 51 patients admitted to a neuroICU with ICH and admission Glasgow Coma Scale score ≤ 8 was identified. Logistic regression was performed to assess the association of baseline characteristics and treatment parameters associated with awakening.Results – Awakening from coma was observed in 53% of ICH patients: 83% with an initial GCS score of 7-8, 43% with an initial score of 5-6, and 20% with an initial score of 3-4. Awakening from coma in the cohort of 27 patients who regained consciousness occurred in 59% of patients by day 2, 89% by day 7, and 96% by day 9. In multivariable analysis, only higher admission GCS score was associated with a greater likelihood of awakening from coma (OR 4.9 [95%CI 1.9–13] per 2-point category, p=0.001). DNR status during the first 24 hours was not associated with awakening but was at later time points.Conclusion – GCS score is the predominant initial predictor of early awakening in patients who present in coma after ICH. Patients who regained consciousness typically did so within the first 9 days of hospital admission.

Insomnia generally is defined as a subjective report of difficulty falling sleep, difficulty staying asleep, early awakening, or nonrestorative sleep. It is one of the most common health complaints among the general population. in this paper we try to find relationships between different insomnia cases and predisposing, precipitating, and perpetuating factors following by pharmacological treatment.

Discoveries via self-experimentation about effects of breakfast on sleep, morning faces on mood, standing on sleep, and sugar water on weight. Eating breakfast increases early awakening. Seeing faces in the morning improves mood the next day. Standing at least 8 hours per day reduces early awakening. During fructose water causes easy weight loss.

The restless and crying children in the modern post-anaesthetic recovery room have been attributed to hypoxia during the anaesthetic and to psychological causes. There is no doubt that in the great majority of cases these little patients are suffering from the pain of acute recent trauma, the hypnotic effect of barbiturates, or residual curarization. The use of meperidine intravenously, as part of the anaesthetic, reduces the incidence of these unpleasant sequelae markedly, as well as providing smooth induction and maintenance and early awakening from anaesthesia.

A difference between arterial and hepatic venous thiopental concentrations of 6.6 and 15.1 per cent was found in dogs after 3 and 5 hours, respectively, following intravenous injection of 30 mg. thiopental per pound. This and similar data in man were used to predict, in an electrical analog, the effect of liver thiopental metabolism on the rate of fall of arterial thiopental concentration. Contrary to previous belief we found that metabolism is of major importance in the early rapid reduction of arterial levels and hence plays a major role in the early awakening seen with this anesthetic. Although uptake in muscle still plays the dominant role in the early fall of the arterial concentration, this was equalled by the additive effect of metabolism and uptake in fat.