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Background & Objective:Shift work disorder is the presence of excessive day time sleepiness and insomnia affecting people whose work hours overlap with the typical sleep period. Shift work has pronounced effect on physical and mental health of an individual. Our objective was to estimate the prevalence of symptoms of shift work disorder and the factors associated with it among hospital staff in a tertiary care hospital in Bangalore, India.Methods:This cross-sectional study was conducted at a private teaching tertiary hospital among 318 hospital workers in Bangalore during September to December 2015. Stratified random sampling method was used and the study population was divided into five strata based upon their parent department. Socioeconomic details, work profile and standard tools– Insomnia severity index, The Epworth sleepiness scale and the FACIT fatigue scale were used.Results:Of the 318 workers, 290 (91.2%) were females, between 21-25 years of age. Most had work experience of ≤4 years (77.6%). Insomnia was reported among 39.9%, and fatigue among 4.7% of hospital staff. Around 19.8% staff had excessive daytime sleepiness out of which 2.8% warranted medical attention.Conclusion:Periodic screening during annual medical check-ups and health education on practicing good sleep hygiene will help address this important issue of shift work disorders among workers.

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Objective Zolpidem is associated with sleep-related eating disorder (SRED). We compiled case reports and performed a descriptive study to identify etiology and aggravating factors. Methods A literature search on PubMed's MeSH search feature, CINAHL, and SciFinder was performed using search terms “Zolpidem,” “Feeding and Eating Disorders/chemically induced,” “Dyssomnias,” “sleep eating disorder,” and “sleep-related eating disorder.” Three reviewers examined all English and Spanish citations and extracted pertinent information. A narrative synthesis of the evidence was prepared. Results We identified 40 case reports of which 65% were female, and the mean age was 53 years. SRED onset was most commonly seen with daily zolpidem doses of 10 mg or higher (95% of patients). Prior medical history included obstructive sleep apnea (OSA) (35%), depression (32.5%), and restless leg syndrome (RLS) (25%). Even with controlled RLS and OSA, SRED developed in some patients. All patients had either partial or full amnesia with compulsive eating. Onset of SRED occurred as early as the first dose to after 9 years of use. SRED symptoms occurred nightly in 57.5% of patients. Discontinuation of zolpidem resolved SRED in all patients (n = 36). Conclusion SRED associated with zolpidem can occur with any dose, but was most common with higher doses of zolpidem. Therefore, prescribers should initiate lower doses of zolpidem. Interestingly, many patients had underlying disorders known to affect sleep (RLS, OSA, depression). Although it is recommended to control these underlying disorders prior to initiating zolpidem, SRED may still occur. Zolpidem discontinuation resolved all cases of SRED.

Traditionally, the management of patients with pulmonary embolism has been accomplished with anticoagulant treatment with parenteral heparins and oral vitamin K antagonists. Although the administration of heparins and oral vitamin K antagonists still plays a role in pulmonary embolism management, the use of these therapies are limited due to other options now available. This is due to their toxicity profile, clearance limitations, and many interactions with other medications and nutrients. The emergence of direct oral anticoagulation therapies has led to more options now being available to manage pulmonary embolism in inpatient and outpatient settings conveniently. These oral therapeutic options have opened up opportunities for safe and effective pulmonary embolism management, as more evidence and research is now available about reversal agents and monitoring parameters. The evolution of the pharmacological management of pulmonary embolism has provided us with better understanding regarding the selection of anticoagulants. There is also a better understanding and employment of anticoagulants in pulmonary embolism in special populations, such as patients with liver failure, renal failure, malignancy, and COVID-19.