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Introduction: Despite the implementation of resident work hour regulations, studies have not consistently shown beneficial changes in residents’ sleep quality or duration. We hypothesized that inter-individual sleep-related differences may exist prior to training and the pre-existing sleep health and habits may impact training. Objective: To determine interns’ baseline sleep quality, sleep hygiene, chronotypes, and their correlates at the beginning of their residency training program. Methods: A cross-sectional study using an anonymous “Resident Sleep Survey” included baseline demographic information and questionnaires, including the Epworth Sleepiness Scale (ESS), the Pittsburgh’s Sleep Quality Index (PSQI), the Morningness-Eveningness Questionnaire (MEQ), and the Sleep Hygiene Index (SHI). Results: One hundred and twenty-nine subjects participated the study; 45.7 % (n=59) were male and 18.6 % (n=24) were married. Twenty percent of interns had an ESS >10. The PSQI revealed that 28% of interns had poor sleep hygiene. The mean sleep efficiency was 91.2 ±7.4% estimated from the PSQI. Non-married interns had a lower prevalence of morning chronotypes (22.3% vs. 45.8%, p=0.02). Morning chronotype interns had a lower ESS score (6.1 ±3.1 vs. 7.6 ±3.6, p=0.03) and a lower SHI (29 ±7.0 vs. 34.3 ±7.1, p=0.003). Conclusion: About a quarter of interns had poor sleep quality and excessive daytime sleepiness prior to their training. Non-morning chronotype interns appeared to have more daytime sleepiness and poorer sleep quality. Since pre-existing sleep problems may adversely affect learning, we suggest that strategies to improve sleep hygiene and quality in this specific population should be emphasized early in their training.

The aim of this study is to evaluate whether adding the item of "apple body type" to the STOP-BANG questionnaire enhances diagnostic performance of the questionnaire for detecting obstructive sleep apnea (OSA).Cross-sectional study.Sleep center setting.Two hundred and eight subjects who were referred for an evaluation of possible OSA at Tulane Comprehensive Sleep Center. The exclusion criteria were age18years old, incomplete or absent questionnaire, incomplete body type identification, polysomnography (PSG) refusal, and pregnant women.STOP-BANG items and body type data were collected on the initial clinic visit. An overnight PSG was performed on every participant.Descriptive analyses of the demographic data and PSG variables were performed. The predictive parameters of STOP and STOP-BANG without and with body type score (STOP-Apple and STOPBANG-Apple) were compared.The STOP questionnaire's sensitivity/specificity/positive likelihood ratio (+LR) (cut-off=2) was 96%/11%/1.1, respectively whereas the STOP-Apple questionnaire (cut-off=3) was 88%/39%/1.5. The STOP-BANG's sensitivity/specificity/+LR (cut-off=3) was 96%/19%/1.2, respectively whereas the STOP-BANG-Apple questionnaire (cut-off=4) was 90%/39%/1.5. The area under the Receiver Operating Characteristic (ROC) curve of STOP-Apple was comparable to the STOP-BANG (P=0.25). The addition of the apple body type item to the STOP-BANG questionnaire in participants with a score≥3 led to increased specificity (67.4%), increased the odds ratio of having OSA of 2.5 (95% CI, 1.2-5.3) and odds ratio of having moderate-severe OSA of 4.7 (95% CI, 2.5-8.7).In the sleep center setting, adding the body type item to the STOP-BANG questionnaire improves not only clinical prediction for PSG confirmed OSA but also predicts moderate to severe of OSA.

Diagnostic errors are the most common errors in primary care. Diagnostic errors have been found to be the leading cause of malpractice litigation, accounting for twice as many claims and settled cases as medication errors. Diagnostic error is common, harmful, costly, and very critical to the patient-safety issues in health care. Diagnostic errors have received relatively little attention, however. Of what is known, diagnostic errors are an important source of preventable harm. Focused research in this area is highly needed because the causes of diagnostic errors are subtle and solutions are less obvious than for other types of errors. As opposed to medication errors, where the factors predisposing to their occurrence and the resultant preventive strategies are better defined, the relationship between factors influencing the diagnostic reasoning or decision making and a diagnostic error are not as clear. This may include any failure in timely access to care; elicitation or interpretation of symptoms, signs, or laboratory results, formulation and weighing of differential diagnosis; and timely follow-up and specialty referral or evaluation. The literature reveals that diagnostic errors are often caused by the combination of cognitive errors and system failure. Increased understanding about diagnostic decision making, sources of errors, and applying some existing strategies into clinical practice would help clinicians reduce these types of errors and encourage more optimal diagnostic processes.

The aim of this study was to evaluate erectile function in monocrotaline (MCT)-treated rats with pulmonary hypertension (PH). Forty rats were divided into control (n = 20) and MCT-treated (n = 20) groups. Rats were treated with MCT (60 mg/kg subcutaneously) for 3 weeks to induce PH. Mean pulmonary arterial pressure (mPAP), medial hypertrophy index (percentage of wall thickness of pulmonary artery), and right ventricular hypertrophy (ratio of right ventricle [RV] to left ventricle + septum weight) were evaluated. In vivo erectile responses were assessed by measurement of intracavernosal pressure (ICP)/mean arterial pressure and total ICP (area under the curve). In vitro organ bath studies with corpus cavernosum smooth muscle strips were performed under both normoxic (95% O(2)/5% CO(2)) and hypoxic (by changing gas mixture to 95% N(2)/5% CO(2)) conditions. Erectile tissue was processed for immunohistochemistry. The MCT-treated group was associated with an increase in mPAP, medial hypertrophy index, and RV hypertrophy. MCT-induced PH rats had significantly reduced erectile responses compared with controls. Nitrergic, endothelium-dependent relaxations, as well as alpha-adrenergic contractile responses were significantly reduced in the corpus cavernosum of MCT rats. The functional responses during prolonged periods of hypoxia were similar to those observed in MCT-treated tissues. PH rats showed enhanced inducible nitric oxide synthase (NOS) protein localization, but endothelial NOS and neuronal NOS were unchanged. These results suggest changes in cavernosal physiology are caused by MCT acting on the penile tissues and the systemic vasculature.

Introduction Unilateral absence of the pulmonary artery (UAPA) or pulmonary artery agenesis is a rare congenital disorder presenting with a wide spectrum of symptoms. The clinical presentation is variable and many patients can be asymptomatic for many years and even throughout their lives. Case presentation We report the case of a 53-year-old African-American woman who was diagnosed with right pulmonary artery agenesis after presenting with uncontrolled asthma and recurrent bronchopulmonary infections. Conclusion In an unexplained case of recurrent respiratory infections and shortness of breath, the possibility of a rare congenital anomaly like UAPA should be considered and an appropriate evaluation should be done.