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INTRODUCTION: Sleep paralysis is a prevalent phenomenon characterized by suffocation, immobility, and hallucinations. Its causes remain unknown, although the neurotransmitter imbalance is suggested as a potential factor. This condition is closely associated with hallucinations and a sense of intrusion, often observed in patients with narcolepsy, hypertension, and seizures. METHODS: A cross-sectional study was conducted in various medical colleges in Karachi, involving 297 participants aged 18 to 30 years. The participants were divided into groups based on gender and year of study. They were surveyed about the frequency of sleep paralysis episodes, their beliefs about the phenomenon, sleep routines, and academic impacts. RESULTS: Among the respondents, a significant number of females (n=209, 70.3%) reported experiencing sleep paralysis. The overall mean age was 20±2.0 years. Correlation analysis revealed an insignificant relationship between depression and mental anxiety (p=0.147). Similarly, no significant association was found when comparing the occurrence of sleep paralysis (p=0.16). However, a notable finding was the significant link between sleep paralysis and its impact on academics (p=0.043). CONCLUSION: This study highlighted the frequency of sleep paralysis among medical students, particularly among females. Furthermore, it emphasizes the diverse beliefs held by individuals regarding these frightening episodes. To address this neglected issue, it is essential to conduct awareness sessions aimed at understanding and alleviating sleep paralysis in individuals' lives.
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Patients diagnosed with cancer often experience an abnormal occurrence of venous thromboembolism (VTE) and its related complications. In order to evaluate the safety and effectiveness of both treatment approaches, we conducted a comprehensive systematic review and meta-analysis within the realm of cancer-associated thromboembolism. A thorough search was conducted across PubMed, the Cochrane Library, and Embase databases to find studies comparing direct oral anticoagulants (DOACs) with low molecular weight heparins (LMWHs) for the treatment of VTE in patients with malignancy. The analyses utilized the random-effects model. This meta-analysis included 11 studies. The results showed that DOACs were associated with a significantly reduced risk of VTE recurrence (RR: 0.67; 95% CI: 0.55, 0.81, p<0.0001; I2: 0%) and deep vein thrombosis (DVT) (RR: 0.63; 95% CI: 0.46, 0.86, p<0.0001; I2: 0%) compared to LMWHs. However, there was no significant difference in the risk of pulmonary embolism (PE) (RR: 0.76; 95% CI: 0.54, 1.06, p=0.11; I2: 11%) between the two groups. The use of DOACs was also associated with a non-significant increase in the risk of major bleeding events (RR: 1.23; 95% CI: 0.85, 1.78, p: 0.26; I2: 49%), while clinically relevant non-major bleeding (CRNMB) was significantly higher with DOACs (RR: 1.92; 95% CI: 1.11, 3.30, p: 0.02; I2: 81%). Secondary outcomes, such as survival rates and fatal PE, did not show significant differences between the two treatment groups. Our analysis indicates that direct oral anticoagulants exhibit a substantial decrease in the occurrence of VTE recurrence, deep vein thrombosis, and pulmonary embolism when compared to low molecular weight heparin in cancer-associated thromboembolism. However, it should be noted that DOACs carry a higher risk of CRNMB. Based on these findings, DOACs are recommended as a superior therapeutic option for managing cancer-associated thromboembolism compared to LMWH.
