Yin, Mingyuan

Abstract Introduction COVID-19 primarily affects the respiratory system, however, a number of clinical sequela have emerged in patients recovered from COVID-19. Besides the most commonly reported symptoms of fatigue and dyspnea, early studies have found that sleep disturbance is also a common complaint. The aim of this study is to survey for sleep disturbance, degree of fatigue and daytime sleepiness in a group of post-hospitalized COVID-19 patients. Methods Patients who were discharged from Mayo Clinic hospitals after COVID-19 hospitalization were recruited in this study. Patients who have an existing diagnosis of sleep apnea or other sleep disorders were excluded from this study. Mayo Clinic patients who never had COVID-19 infection, nor a history of sleep disorders or other sleep disorders were also recruited as controls. Patients completed Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Fatigue Severity Scale (FSS) questionnaires via REDCap. Wilcoxon rank sum test was used to evaluate the difference between cases and controls in continuous variables and Fisher’s exact test was used to compare categorical variables. Multivariable linear regression model was used to evaluate the difference in sleep and fatigue scores between cases and controls with baseline characters adjusted. All tests were two-sided with p value <0.05 considered statistically significant. Results A total of 62 patients who completed the questionnaires were included in the analysis. Among them, 33 had COVID-19. Cases were significantly older with higher BMI compared to controls. Global PSQI score (median=10 vs 6, p=0.015), ESS total score (median=8 vs 5, p=0.018) and FSS total score (median=30 vs 22, p=0.009) were all significantly higher for cases compared to control patients. After adjusting for age and BMI, the difference stayed statistically significant. The mean difference between cases vs controls was found to be 2.7 (95%CI:0.2-5.2, p=0.038), 2.93 (95% CI: 0.66-5.2, p=0.014), and 12.62 (95% CI:5.22-20.03, p=0.001) for PSQI, ESS, and FSS scores, respectively. Conclusion Preliminary results showed that sleep disturbance (PSQI) and daytime symptoms (measured by ESS and FSS) are found to be significantly higher among post COVID-19 hospitalized patients compared to controls. Support (If Any) This work is supported by the Mayo Clinic in Florida Department of Medicine Catalyst for Advancing in Academics award and the Mayo Clinic in Florida Research Accelerator for Clinicians Engaged in Research Program.

This review article examines evidence supporting the use of oral therapies in treating idiopathic, actinic, and metabolically induced skin hyperpigmentation. A thorough review of the literature regarding oral treatments for hyperpigmentation was systematically conducted through PubMed. Keywords used in the primary search include “Hyperpigmentation,” “Melanosis” or “Melasma,” “Lightening,” “Oral,” and “Therapeutics.” The search was limited to the English language, and no timeframe restrictions were implemented. Numerous orally administered therapies have been proposed for the treatment of skin hyperpigmentation. There is an abundant body of literature demonstrating the efficacy of orally administered tranexamic acid, glutathione, isotretinoin, and proanthocyanidin. It is reasonable to expect that the most effective oral therapies will address known underlying causes of hyperpigmentation such as thyroid disease, diabetes, and hormonal imbalance. Improvement due to oral therapy of otherwise unresponsive skin hyperpigmentation or hyperpigmentation of unknown cause is less predictable. This review is limited by the strength of evidence contained within the available studies. Clinical studies investigating the treatments discussed within this article are limited in number, at times lack blinding in the study design, and are based on small sample sizes. Based on existing research, the most promising oral remedies for hyperpigmentation appear to be tranexamic acid, glutathione, isotretinoin, and proanthocyanidin. Additional studies to better establish safety and efficacy are necessary.

Abstract Background Limited data are available on the development of skin cancer and the associated risk factors for non‐White liver transplant (LT) recipients. The aim of this study is to determine the incidence of newly diagnosed skin cancer postoperatively and to identify the risk factors for the development of skin cancer in non‐White LT recipients. Methods We conducted an initial retrospective chart review of non‐White LT patients who received a transplant at our center between January 1, 2011, and December 31, 2013. Results Of the 96 patients in the study cohort, 32% were Black, 17% were Asian, 15% were White Hispanic, and 10% were Black Hispanic. One patient had a history of nonmelanoma skin cancer before transplant. No skin cancers were diagnosed during follow‐up (median, 1.3 years; range, 17 days to 8.6 years). Conclusion Our center’s experience is consistent with the literature and suggests that the incidence of newly diagnosed skin cancer in non‐White liver transplant recipients is low. Longer follow‐up may provide additional insights into the specific risk factors for the posttransplant development of skin cancer.