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Jet lag can impair a variety of physical and mental functions. The impact of jet lag on athletic performance has been assumed but difficult to prove methodologically. The challenges have involved eliminating the impact of the quality of the opponent and the difficulties determining when an athlete actually traveled across time zones. Analyzing free throw (FT) shooting in the National Basketball Association allowed these challenges to be overcome. 48,309 games across 19 consecutive seasons were examined of which 675 games involved a team that met our definition of jet lag. In these games, players on the jet lagged teams made 12,154 of 16,286 (74.6%) FTs that were attempted while in the remaining games of that season, the same players on these teams made 993,962 of 1,318,188 (75.4%) FTs attempted, X2 (1, N = 1,334,474) = 5.21, p =.02. There was no significant impact of jet lag on the players who took the most number of FTs in these jet lagged games. However, the remaining players on the team made 7,394 of 10,016 (73.8%) FTs attempted in jet lagged games while the same players made 794,009 of 1,056,587 (75.1%) FTs in other games that season, X2 (1, N = 1,066,603) = 9.35, p =.002. When subcategorized further, the impact on the players on jet lagged teams was only seen when they traveled from east to west but not when travel was from west to east. Our analysis reveals that jet lag does negatively influence athletic performance, primarily through circadian rhythm disruption. However, elite athletes appear to be able to overcome this impact if they are given enough opportunities to do so. [ABSTRACT FROM AUTHOR]

Objectives: We administered aerosolized histamine to 32 subjects with tetraplegia to determine whether there were differences in spirometric and/or lung volume parameters between responders and nonresponders. Results: Baseline pulmonary function parameters revealed mild to moderate restrictive dysfunction. We found that 25 subjects (78%) were hyperreactive to histamine (mean provocative concentration of a substance causing a 20% fall in FEV[sub 1] [PC[sub 20]], 1.77 mg/mL). Responders (PC[sub 20], <8 mg/mL) had significantly lower values for forced expiratory flow between 25% and 75% of the outflow curve (FEF[sub 25-75]), FEF[sub 25-75] percent predicted, and FEF[sub 25-75]/FVC ratio. Among all 32 subjects, the natural logarithmic transformation performed on PC[sub 20] values (lnPC[sub 20]) correlated with FEF[sub 25-75] percent predicted, FEV[sub 1] percent predicted, and FEF[sub 25-75]/FVC ratio but not with FVC percent predicted. Responders with PC[sub 20] values <2 mg/mL (n = 13) had significantly reduced values for FVC, FVC percent predicted, FEV[sub 1], and FEV[sub 1] percent predicted compared to those with PC[sub 20] values between 2 mg/mL and 8 mg/mL. In addition, among responders, there was a significant correlation between lnPC[sub 20] and FVC percent predicted. A significant relationship was found between maximal inspiratory pressure (PImax) and both FEV[sub 1] percent predicted and FEF[sub 25-75] percent predicted, but not between lnPC[sub 20] and either PImax or maximal expiratory pressure (PEmax). Conclusions: These findings demonstrate that subjects with tetraplegia who exhibit airway hyperreactivity (AHR) have reduced baseline airway caliber and that lower values for lnPC[sub 20] are associated with parallel reductions in surrogate spirometric indexes of airway size (FEV[sub 1] percent predicted and FEF[sub 25-75] percent predicted) and airway size relative to lung size (FEF[sub 25-75]/FVC ratio). The absence of an association between lnPC[sub 20] and FVC percent predicted for the entire group or between lnPC[sub 20] and either PImax or PEmax indicates that reduced lung volumes secondary to respiratory muscle weakness cannot explain the mechanism(s) underlying AHR. Among responders, however, a possible role for reduction in lung volume, as it pertains to increasing AHR, cannot be excluded. Proposed mechanisms for reduced baseline airway caliber relative to lung size in subjects with tetraplegia include unopposed parasympathetic activity secondary to the loss of sympathetic innervation to the lungs and/or the inability to stretch airway smooth muscle with deep inhalation. [ABSTRACT FROM AUTHOR]

Background: Hyponatremia develops in approximately a third of patients with aneurysmal subarachnoid hemorrhage (SAH). Studies have been conflicting about the association between hyponatremia and cerebrovascular spasm (CVS).Aims: To investigate whether hyponatremia can signal the onset of CVS.Settings and Design: Retrospective chart review of all patients with SAH treated at a tertiary-care university hospital from January to May 2002.Materials and Methods: 106 patients were included in the study. Serum sodium levels were recorded from days 1 to 14 of hospitalization. Hyponatremia was defined as serum sodium level<135 meq/l and a fall in sodium level of >4 meq/l from the admission sodium level. The presence of CVS was determined by transcranial doppler sonography. Patients were assigned to one of four groups based on the presence or absence of CVS and hyponatremia.Statistical Analysis: Student's t-test was used for comparison of means. A logistical regression model was constructed and odds ratios (OR) were calculated.Results: 41 patients developed hyponatremia and 44 developed CVS. Among the 41 with hyponatremia, 22 (54%) had evidence of CVS, whereas among the 65 patients without hyponatremia, 22 (34%) had evidence of CVS (P=0.023). Among those with hyponatremia, the mean sodium drop was 7.9 meq/L in those with CVS compared to 7.0 meq/L in those without CVS (P=0.068). More than half of those with hyponatremia and CVS (13/22) developed hyponatremia at least a day before CVS was diagnosed.Conclusion: In patients with SAH, hyponatremia is associated with a significantly greater risk of developing CVS and may precede CVS by at least one day. [ABSTRACT FROM AUTHOR]

For visitor games, visitor scores increased from 95.18 (1 day rest) to 97.11 at five days rest (p<0.0001) and home team win margin decreased from 4.3 (1 day rest) to 0.471 at five days rest (p<0.0001). In multivariate regression, with visitor team westward jet-lagged & home team non-jetlagged, home wins (60% to 68%, p=0.092) & scoring (99.07 to 99.31, p<=0.0001) increased, score margin decreased (3.24 to 2.83, p=0.031), and visitor points increased (95.84 to 96.49, p=0.083). B CONCLUSIONS: b When non-jet lagged home teams played jet-lagged visitors, scoring of both teams was higher. [Extracted from the article]

An abstract of the study "Hyponatremia and Cerebrovascular Spasm in Aneurysmal Subarachnoid Hemorrhage" by Dipak Chandy and Vidya Ramachandraiah is presented.

As obesity becomes more common worldwide, the prevalence of obstructive sleep apnoea (OSA) continues to rise. Obstructive sleep apnoea is a well-known disorder that causes chronic intermittent hypoxia (CIH), which is considered a risk factor for atherosclerosis directly and indirectly. Ischaemic heart disease remains the leading cause of death. Most risk factors for atherosclerosis are well understood. However, other factors such as CIH are less well understood. Several studies have investigated the pathophysiology of CIH, attempting to uncover its link to atherosclerosis and to determine whether OSA treatment can be a therapeutic modality to modify the risk for atherosclerosis. In this article, we will review the pathophysiology of OSA as an independent risk factor for cardiovascular disease and discuss the most common markers that have been studied. We will also examine the potential impact of OSA management as a risk factor modifier on the reversibility of atherosclerosis. [ABSTRACT FROM AUTHOR]

An abstract of the article "Thrombocytosis: A Delayed Marker of Stress" by Deepthi Gandhiraj, Firas Jafri, and Dipak Chandy is presented.

Introduction: Educational milestones are now used to assess the developmental progress of all U.S. graduate medical residents during training. Twice annually, each program's Clinical Competency Committee (CCC) makes these determinations and reports its findings to the Accreditation Council for Graduate Medical Education (ACGME). The ideal way to conduct the CCC is not known. After finding that deliberations reliant upon the new milestones were time intensive, our internal medicine residency program tested an approach designed to produce rapid but accurate assessments.Material and Methods: For this study, we modified our usual CCC process to include pre-meeting faculty ratings of resident milestones progress with in-meeting reconciliation of their ratings. Data were considered largely via standard report and presented in a pre-arranged pattern. Participants were surveyed regarding their perceptions of data management strategies and use of milestones. Reliability of competence assessments was estimated by comparing pre-/post-intervention class rank lists produced by individual committee members with a master class rank list produced by the collective CCC after full deliberation.Results: Use of the study CCC approach reduced committee deliberation time from 25 min to 9 min per resident (p < 0.001). Committee members believed milestones improved their ability to identify and assess expected elements of competency development (p = 0.026). Individual committee member assessments of trainee progress agreed well with collective CCC assessments.Conclusions: Modification of the clinical competency process to include pre-meeting competence ratings with in-meeting reconciliation of these ratings led to shorter deliberation times, improved evaluator satisfaction and resulted in reliable milestone assessments. [ABSTRACT FROM AUTHOR]

The article presents a study which examined the result of the milestone- or competency-based educational innovation project implemented among internal medicine residents at New York Medical College, Westchester Medical Center.

Intrathecal (IT), intraventricular (IVt), and intracisternal administration of nicardipine deliver treatment directly into the central nervous system. This route of drug delivery is being investigated as a potential treatment of vasospasm following aneurysmal subarachnoid hemorrhage (aSAH). The authors reviewed the existing literature regarding the direct administration of nicardipine into the intracranial space for the treatment of vasospasm following aSAH. An electronic search of literature published between 1994 and 2018 was performed using PubMed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A variety of combinations of the search terms "intrathecal nicardipine," "intraventricular nicardipine," and "nicardipine prolonged-release" were used. A total of 17 studies were included in this systematic review, 3 of which were studies in animals. The studies consistently demonstrated that IT nicardipine successfully reverses vasospasm, but the effect, as shown in some studies, was limited to the immediate vicinity of drug release. The data regarding long-term clinical outcomes are variable, with some studies demonstrating marked improvement whereas others fail to demonstrate improved outcomes when compared with patients who receive standard of care. Although adverse sequalae were uncommon, IT and IVt administration and therapy were associated with adverse effects including headache, meningitis, and hydrocephalus. Given the findings presented in these studies, IT, IVt, and intracisternal (pellet) nicardipine administration can be useful treatment adjuncts for vasospasm following aSAH, especially in cases refractory to conventional forms of treatment. However, larger, controlled clinical trials are warranted. [ABSTRACT FROM AUTHOR]

An abstract of the article "Serum Creatinine May Not Be an Accurate Marker of Glomerular Filtration Rate in Rhabdomyolysis Patient" by Neeraj Sinha et al. is presented.

An abstract of the article "Outcomes of Elderly Patients in a Medical Intensive Care Unit" by Vishal Sekhri and colleagues is presented.