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Surani SR, Surani SS, Sadasiva S, Surani Z, Khimani A, Surani SS. Effect of animated movie in combating child sleep health problems. Springerplus 2015; 4:343. [PMID: 26191471 PMCID: PMC4501343 DOI: 10.1186/s40064-015-1130-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 07/01/2015] [Indexed: 02/08/2023]
Abstract
Objective Sleep deprivation among teens is a major health issue. Only 15% of teens get 8.5 h of sleep on school nights. Sleep deprivation can lead to poor grades, sleepiness and moodiness. We undertook a study
to assess the prevalence of sleep habit disturbance among elementary school students in South Texas with Hispanic ethnicity predominance. We also found how much a video based on sleep education had an impact on these children. Method Once the Corpus Christi Independent School District (CCISD) approved the collection of baseline sleep data, questionnaires were administered using the Children’s Sleep Habit Questionnaire (CSHQ.) These questionnaires were distributed prior to the viewing of the educational and animated movie KNIGHTS (Keep Nurturing and Inspiring Good Habits in Teen Sleep). Four months later, a random follow-up was performed and the children were requested to respond to the same CSHQ. Results 264 children from two elementary schools participated in this educational program. At baseline, 55.56% of the children had trouble sleeping. When the questionnaire was administered four months later, only 23.26% (p < 0.05) had trouble sleeping. Additionally, at baseline, approximately 60–70% children had some baseline bedtime resistance, anxiety dealing with sleep, issues with sleep duration and/or awakenings in the middle of the night. In the follow up questionnaire, results showed significant improvements in overall sleep habits, bedtime resistance, sleep anxiety and night awakenings amongst students (p < 0.05). However, no significant differences were seen in sleep duration and daytime sleepiness. Conclusion Sleep deprivation and good sleep habits remain as a pervasive challenge among elementary school students. Administering an animated video about sleep education along with a provider-based education may be an effective tool for educating elementary school students and decreasing the prevalence of these sleep-related issues. Future prospective randomized studies are suggested.
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Affiliation(s)
- Salim R Surani
- Texas A&M University, 1177 West Wheeler Ave, Suite 1, Aransas Pass, TX 78336 USA
| | | | | | - Zoya Surani
- Pulmonary Associates, Corpus Christi, TX USA
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Surani S, Varon J. Editorial from Editor-in-Chief: Lung Dialysis: Are We There Yet? CRMR 2015. [DOI: 10.2174/1573398x1004150520143612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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103
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Johnson S, Surani S. Emerging Approved Treatments for Idiopathic Pulmonary Fibrosis: Some Hope for Patients? CRMR 2015. [DOI: 10.2174/1573398x11666141208233106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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104
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Sudhakaran S, Surani SR. Guidelines for perioperative management of the diabetic patient. Surg Res Pract. 2015;2015:284063. [PMID: 26078998 PMCID: PMC4452499 DOI: 10.1155/2015/284063] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 05/05/2015] [Accepted: 05/06/2015] [Indexed: 02/06/2023] Open
Abstract
Management of glycemic levels in the perioperative setting is critical, especially in diabetic patients. The effects of surgical stress and anesthesia have unique effects on blood glucose levels, which should be taken into consideration to maintain optimum glycemic control. Each stage of surgery presents unique challenges in keeping glucose levels within target range. Additionally, there are special operative conditions that require distinctive glucose management protocols. Interestingly, the literature still does not report a consensus perioperative glucose management strategy for diabetic patients. We hope to outline the most important factors required in formulating a perioperative diabetic regimen, while still allowing for specific adjustments using prudent clinical judgment. Overall, through careful glycemic management in perioperative patients, we may reduce morbidity and mortality and improve surgical outcomes.
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Nannapaneni S, Lee SJ, Kashiouris M, Elmer JL, Thakur LK, Nelson SB, Bowron CT, Danielson RD, Surani S, Ramar K. Preliminary noise reduction efforts in a medical intensive care unit. Hosp Pract (1995) 2015; 43:94-100. [PMID: 25687293 DOI: 10.1080/21548331.2015.1015389] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Abstract
Obstructive sleep apnea (OSA) is a chronic disease with increasing prevalence. Underdiagnosed in the surgical population, OSA can reach a prevalence of up to 70% in bariatric surgery, and be associated with difficult airways and postoperative cardiopulmonary adverse events. Despite its association with escalation of care, increased health care resource utilization, and length of hospital stay, < 25% of health care institutions in the United States have OSA perioperative protocols to improve patient safety. This is explained in part by a lack of studies that support a widely accepted systematic approach to preoperative screening and risk stratification. This review evaluates the role of preoperative screening tools for adult patients with suspected OSA.
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Affiliation(s)
- Bernardo J Selim
- Assistant Professor in Medicine, Mayo Clinic Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, MN
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107
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Mahmood K, Farhan R, Surani A, Surani AA, Surani S. Restless Legs Syndrome among Pakistani Population: A Cross-Sectional Study. Int Sch Res Notices 2015; 2015:762045. [PMID: 27347546 DOI: 10.1155/2015/762045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 01/02/2015] [Accepted: 01/08/2015] [Indexed: 02/05/2023]
Abstract
Objective. Restless leg syndrome (RLS) is a chronic distressing disease characterized by an urge to move the legs with an unpleasantsensation during periods of rest. The global prevalence estimates of RLS range from 2.5% to 15%. Method. This cross-sectional study was conducted at various hospitals in Karachi during August 13 to March 14. The visitors who had accompanied patients to Outpatient Department or had come to visit admitted patients were approached conveniently. Subjects were interviewed regarding the essential criteria of RLS and its attributes. Results. The sample size was 390 with 56% being females. The point prevalence of RLS was estimated to be 23.6%. The prevalence in females was twice as high as compared to males. Smoking and low level of education were associated with RLS (P < 0.001). Among RLS positive individuals, 50.1% reported frequency of their symptoms to be greater than 16 days per month and 64.1% graded their symptom severity as mild to moderate. About 37% of RLS positive individuals consulted a general physician for their symptoms. Conclusion. RLS is highly prevalent and underdiagnosed condition among Pakistani population. Efforts must be directed to raise the awareness of this condition among physicians and general population.
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108
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Sudhakaran S, Surani SR. Comorbidity of diabetes and obstructive sleep apnea in hospitalized patients. Hosp Pract (1995) 2015; 43:79-84. [PMID: 25599880 DOI: 10.1080/21548331.2015.1004295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Obstructive sleep apnea (OSA) and type 2 diabetes are two morbidities commonly encountered in the hospitalized setting. Both diseases will present with an array of complications if not managed in a timely, competent manner. However, a growing body of evidence suggests a link between these two pathologies. It is our hope that through careful review of the literature, we may generate heightened awareness of the OSA/diabetes comorbidity. Through better understanding of these conditions and their interactions, we may insure efficient management in the clinical setting and prevent exacerbation of common complications.
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Abstract
Obstructive sleep apnea (OSA) is frequently encountered in an undiagnosed, untreated state in perioperative patients. It increases the risk of respiratory, cardiac, and infectious complications following surgical procedures. Patients with OSA may require additional monitoring, unplanned escalations in care, and prolonged hospitalization. It is important to identify patients at risk for OSA during the preoperative assessment so that appropriate anesthesia, postsurgical monitoring, and pain control can be planned. Herein, we discuss data regarding perioperative outcomes in patients with OSA, methods to quickly identify patients at high risk for OSA, and implementation of clinical safeguards to minimize OSA-associated complications. An algorithm is provided to guide the perioperative management of patients with OSA.
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Affiliation(s)
- Melissa C Lipford
- Center for Sleep Medicine and Department of Neurology, Mayo Clinic , Rochester, MN
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Mack R, Slicker K, Ghamande S, Surani SR. Actinomyces odontolyticus: Rare Etiology for Purulent Pericarditis. Case Rep Med 2014; 2014:734925. [PMID: 25580131 DOI: 10.1155/2014/734925] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 12/01/2014] [Indexed: 02/05/2023] Open
Abstract
Purulent pericarditis is one of the most common causes of cardiac tamponade and if left untreated has a mortality of 100%. Staphylococcus aureus and Streptococcus pneumonia have been implicated as the main etiology of purulent pericardial effusion followed by fungi and anaerobic sources. Actinomyces odontolyticus pericardial involvement has been reported in the literature only once. To our knowledge, this is the first fatal case of A. odontolyticus purulent pericarditis in the absence of periodontal disease.
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111
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Surani S, Tan J, Ahumada A, Surani SS, Sudhakaran S, Varon J. Delayed recurrence of atypical pulmonary carcinoid cluster: a rare occurrence. Case Rep Pulmonol 2014; 2014:620814. [PMID: 25506019 DOI: 10.1155/2014/620814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 10/28/2014] [Accepted: 10/30/2014] [Indexed: 02/05/2023] Open
Abstract
Carcinoid is one of the most common tumors of the gastrointestinal tract followed by the tracheobronchial tree. Bronchial carcinoid compromises 20% of total carcinoid and accounts for 1–5% of pulmonary malignancies. Carcinoid can be typical or atypical, with atypical carcinoid compromises 10% of the carcinoid tumors. Carcinoid usually presents as peripheral lung lesion or solitary endobronchial abnormality. Rarely it can present as multiple endobronchial lesion. We hereby present a rare case of an elderly gentleman who had undergone resection of right middle and lower lobe of lung for atypical carcinoid. Seven years later he presented with cough. CT scan of chest revealed right hilar mass. Flexible bronchoscopy revealed numerous endobronchial polypoid lesions in the tracheobronchial tree. Recurrent atypical carcinoid was then confirmed on biopsy.
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112
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Sesteaga G, Surani S, Varon J. Editorial from Editor-in-Chief: Are Implanted Upper Airway Stimulation Devices for the Treatment of Obstructive Sleep Apnea Ready for Primetime? CRMR 2014. [DOI: 10.2174/1573398x1002141114102339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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113
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Hesselbacher S, Subramanian S, Rao S, Casturi L, Surani S. Self-reported sleep bruxism and nocturnal gastroesophageal reflux disease in patients with obstructive sleep apnea: relationship to gender and ethnicity. Open Respir Med J 2014; 8:34-40. [PMID: 25352924 PMCID: PMC4209499 DOI: 10.2174/1874306401408010034] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 08/05/2014] [Accepted: 08/05/2014] [Indexed: 02/08/2023] Open
Abstract
Study Objectives : Nocturnal bruxism is associated with gastroesophageal reflux disease (GERD), and GERD is strongly associated with obstructive sleep apnea (OSA). Gender and ethnic differences in the prevalence and clinical presentation of these often overlapping sleep disorders have not been well documented. Our aim was to examine the associations between, and the symptoms associated with, nocturnal GERD and sleep bruxism in patients with OSA, and to examine the influence of gender and ethnicity. Methods : A retrospective chart review was performed of patients diagnosed with OSA at an academic sleep center. The patients completed a sleep questionnaire prior to undergoing polysomnography. Patients with confirmed OSA were evaluated based on gender and ethnicity. Associations were determined between sleep bruxism and nocturnal GERD, and daytime sleepiness, insomnia, restless legs symptoms, and markers of OSA severity in each group. Results : In these patients with OSA, the prevalence of nocturnal GERD (35%) and sleep bruxism (26%) were higher than the general population. Sleep bruxism was more common in Caucasians than in African Americans or Hispanics; there was no gender difference. Nocturnal GERD was similar among all gender and ethnic groups. Bruxism was associated with nocturnal GERD in females, restless legs symptoms in all subjects and in males, sleepiness in African Americans, and insomnia in Hispanics. Nocturnal GERD was associated with sleepiness in males and African Americans, insomnia in females, and restless legs symptoms in females and in Caucasians. Conclusion : Patients with OSA commonly have comorbid sleep bruxism and nocturnal GERD, which may require separate treatment. Providers should be aware of differences in clinical presentation among different ethnic and gender groups.
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Affiliation(s)
- Sean Hesselbacher
- Sentara Healthcare, Virginia Beach, VA, USA ; Eastern Virginia Medical School, Norfolk, VA, USA
| | | | - Shweta Rao
- Baylor College of Medicine, Houston, Texas, USA
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Abstract
Patient: Female, 56 Final Diagnosis: Ventricular asystole Symptoms: Dizziness, headache, near-syncope, weakness Medication: — Clinical Procedure: — Specialty: Cardiology
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Affiliation(s)
- Sivakumar Sudhakaran
- Department of Medicine, Texas A&M University Health Science Center, College Station, USA
| | - Saherish S Surani
- Research Assistant, Pulmonary Associates of Corpus Christi, Aransas Pass, USA
| | - Salim R Surani
- Department of Medicine, Texas A&M University Health Science Center, College Station, USA
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115
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Najmuddin A, Surani S. Percutaneous Dilatational Tracheostomy - An Update. CRMR 2014. [DOI: 10.2174/1573398x10666140328223356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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116
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117
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Surani S. Preface (Thematic Issue: Update on Interventional Pulmonology). CRMR 2014. [DOI: 10.2174/1573398x1001140811145838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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118
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119
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Surani S, Allen K, Surani S, Varon J. Endobronchial lipomatous polyp: a rare benign tumor of the lung. Case Rep Pulmonol 2014; 2014:240834. [PMID: 24971188 DOI: 10.1155/2014/240834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 04/26/2014] [Indexed: 02/05/2023] Open
Abstract
Endobronchial lipomatous polyp is a rare nonmalignant tumor of the lung. It comprises 5% of the benign lung tumor, with the majority of benign tumors being hamartoma. Lipomatous polyp often leads to endobronchial lesion, associated with postobstructive pneumonia, hemoptysis, and atelectasis. We hereby present a case and discussion of an elderly man with endobronchial lipomatous polyp, presenting as recurrent pneumonia.
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120
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Surani S, Allen K, Ocegueda-Pacheco C, Varon J. Atrioventricular Dissociation following Blunt Chest Trauma. Case Rep Med 2014; 2014:349652. [PMID: 24799910 DOI: 10.1155/2014/349652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 03/06/2014] [Indexed: 02/05/2023] Open
Abstract
Blunt chest trauma (BCT) is a common clinical presentation seen in emergency departments. Few cases of cardiac conduction abnormalities due to BCT have been reported in the medical literature. This dysrhythmias may present as permanent conduction defects requiring permanent pacemaker or may have temporary conduction abnormalities requiring temporary pacemaker or supportive care. We present the case of a young woman who suffered from BCT after being kicked by a horse with the development of a significant substernal hematoma. She developed temporary atrioventricular block, which was completely resolved with the decrease in the size of the substernal hematoma suffered.
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Abstract
BACKGROUND Professional burnout has been widely explored in health care. We conducted this study in our hospital intensive care unit (ICU) in United States to explore the burnout among nurses and respiratory therapists (RT). MATERIALS AND METHODS A survey consisting of two parts was used to assess burnout. Part 1 addressed the demographic information and work hours. Part 2 addressed the Maslach Burnout Inventory-Human Service Survey. RESULTS The analysis included 213 total subjects; Nurses 151 (71%) and RT 62 (29%). On the emotional exhaustion (EE) scale, 54% scored "Moderate" to "High" and 40% scored "Moderate" to "High" on the depersonalization (DP) scale. Notably 40.6% scored "Low" on personal accomplishment (PA) scale. CONCLUSION High level of EE, DP and lower PAs were seen among two groups of health care providers in the ICUs.
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Affiliation(s)
- Kalpalatha K Guntupalli
- Departments of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, USA
| | - Sherry Wachtel
- Department of Innovation and Research, Christus Spohn Health System, Corpus Christi, USA
| | - Antara Mallampalli
- Department of Pulmonary and Critical Care Medicine, Baylor College of medicine, Houston, USA
| | - Salim Surani
- Department of Medicine, section of Pulmonary, Critical Care and Sleep Medicine, Texas A and M University, Texas USA
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122
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Surani S, Rao S, Surani S, Varon J. Role of the IBV Valve in Persistent Air Leak. CRMR 2014. [DOI: 10.2174/1573398x10666140115232721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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124
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Dam T, Mahmood A, Linville K, Bailey M, Surani S. Meningeal carcinomatosis: a metastasis from gastroesophageal junction adenocarcinoma. Case Rep Med 2013; 2013:245654. [PMID: 24454393 DOI: 10.1155/2013/245654] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 11/22/2013] [Accepted: 12/09/2013] [Indexed: 02/05/2023] Open
Abstract
Gastroesophageal adenocarcinoma is a malignant type of cancer, which can metastasize to multiple organs. However, there have not been many case reports in the literature pertaining the relationship of gastroesophageal adenocarcinoma and carcinomatous meningitis. In this case, a 65-year-old African American male with a history of dysphagia was initially diagnosed with adenocarcinoma at gastroesophageal junction. The patient was treated with both chemotherapy and radiation, but chemotherapy was interrupted due to significant weight loss, anemia, and sudden onset of change in mental status. Patient was admitted to our facility for further evaluation of his neurological symptoms. The patient became more confused and delirious during hospital stay, and symptoms could not be explained by radiological studies and laboratory values. Therefore, a lumbar puncture was done to search for infectious and neoplastic causes that were not shown up on Computed Tomography scan (CT) and Magnetic Resonance Imaging scan (MRI) of the brain. The cerebrospinal fluid (CSF) cytology showed metastatic poorly differentiated adenocarcinoma. The patient's prognosis was poor because there is no specific treatment recommendation for primary gastroesophageal cancer at this stage. The patient passed away 4 weeks later under hospice care. The goal of our case report is to raise awareness of the rare metastatic possibility in advanced stage of gastroesophageal adenocarcinoma. In doing so, physicians can help educate and prepare family for unfavorable outcomes.
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125
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Abstract
Endocarditis caused by Candida dubliniensis is a rare event and limited to few case reports. In this report, the authors present a patient with a history of intravenous drug use and hepatitis C and endocarditis involving a prosthetic aortic valve. Also reviewed are the treatment guidelines for Candida sp. endocarditis.
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Abstract
Hypertonic Saline (HS) has been a proven and effective therapy and a safe alternative to mannitol in patients with increase intracranial pressure (ICP). We hereby present a case of 25-year-old women with intracranial bleed secondary to right parietal arteriovenous malformation. Patient underwent surgery for evacuation of hematoma and resection of arteriovenous malformation. Post- operative course was complicated by recurrent episodes of elevated ICP. She received total of 17 doses of 23.4% HS and 30 doses of mannitol with good outcome. Despite reluctance from some clinicians to use HS, hypertonic saline seems to be a safe and effective therapy.
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Affiliation(s)
- Salim Surani
- Division of Pulmonary and Critical Care Medicine, Texas A&M University, TX, USA
| | | | | | | | - Joseph Varon
- The University of Texas Health Science Center at Houston, TX, USA The University of Texas Medical Branch at Galveston, TX, USA University General Hospital, Houston, TX, USA
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127
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Mansukhani MP, Kolla BP, Surani S, Varon J, Ramar K. Sleep deprivation in resident physicians, work hour limitations, and related outcomes: a systematic review of the literature. Postgrad Med 2012; 124:241-9. [PMID: 22913912 DOI: 10.3810/pgm.2012.07.2583] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Extended work hours, interrupted sleep, and shift work are integral parts of medical training among all specialties. The need for 24-hour patient care coverage and economic factors have resulted in prolonged work hours for resident physicians. This has traditionally been thought to enhance medical educational experience. These long and erratic work hours lead to acute and chronic sleep deprivation and poor sleep quality, resulting in numerous adverse consequences. Impairments may occur in several domains, including attention, cognition, motor skills, and mood. Resident performance, professionalism, safety, and well-being are affected by sleep deprivation, causing potentially adverse implications for patient care. Studies have shown adverse health consequences, motor vehicle accidents, increased alcohol and medication use, and serious medical errors to occur in association with both sleep deprivation and shift work. Resident work hour limitations have been mandated by the Accreditation Council for Graduate Medical Education in response to patient safety concerns. Studies evaluating the impact of these regulations on resident physicians have generated conflicting reports on patient outcomes, demonstrating only a modest increase in sleep duration for resident physicians, along with negative perceptions regarding their education. This literature review summarizes research on the effects of sleep deprivation and shift work, and examines current literature on the impact of recent work hour limitations on resident physicians and patient-related outcomes.
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128
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Surani AA, Ramar K, Surani AA, Khaliqdina JS, Subramanian S, Surani S. Validation of the Urdu version of the Epworth Sleepiness Scale. J Pak Med Assoc 2012; 62:986-8. [PMID: 23139996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To translate and validate the Epworth Sleepiness Scale (ESS) for use in Urdu-speaking population. METHODS The original Epworth Sleepiness Scale was translated into the Urdu version (ESS-Ur) in three phases - translation and back-translation; committee-based translation; and testing in bilingual individuals. The final was subsequently tested on 89 healthy bilingual subjects between February and April, 2010, to assess the validity of the translation compared to the original version. The subjects were students and employees of Dow University of Health Sciences, Karachi. RESULTS Both English and Urdu versions of the Epworth Sleepiness Scale were administered to 59 (67%) women and 30 (33%) men. The mean composite Epworth score was 7.53 in English language and 7.7 in the Urdu version (p=0.76). The translated version was found to be highly correlated with the original scale (rho=0.938; p<.01). CONCLUSIONS The study validated the scale's Urdu version as an effective tool for measuring daytime sleepiness in Urdu-speaking population. Future studies assessing the validity of such patients with sleep disorders need to be undertaken.
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Affiliation(s)
- Asif Anwar Surani
- Medical students, Dow University of Health Sciences, Karachi, Pakistan.
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129
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Hagopian T, Zuniga F, Surani SR. Pylephlebitis: an uncommon complication of intra-abdominal infection. West J Emerg Med 2012; 12:575-6. [PMID: 22224165 PMCID: PMC3236157 DOI: 10.5811/westjem.2011.1.2197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 01/24/2011] [Indexed: 02/08/2023] Open
Abstract
We present a case of pylephlebitis, which is an infective suppurative thrombosis of the portal vein. Pylephlebitis is an uncommon complication of intra-abdominal infections and carries with it significant morbidity and mortality.
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Affiliation(s)
- Tara Hagopian
- Baylor College of Medicine, Department of Radiology, Houston, Texas
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130
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Hesselbacher S, Subramanian S, Allen J, Surani S, Surani S. Body mass index, gender, and ethnic variations alter the clinical implications of the epworth sleepiness scale in patients with suspected obstructive sleep apnea. Open Respir Med J 2012; 6:20-7. [PMID: 22670164 PMCID: PMC3367266 DOI: 10.2174/1874306401206010020] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 04/12/2012] [Accepted: 04/18/2012] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION The Epworth Sleepiness Scale (ESS) is often used in the evaluation of obstructive sleep apnea (OSA), though questions remain about the influence gender, ethnicity, and body morphometry have in the responses to this questionnaire. The aim of this study was to examine differences in ESS scores between various demographic groups of patients referred for polysomnography, and the relationship of these score to sleep-disordered breathing METHODS Nineteen hundred consecutive patients referred for polysomnographic diagnosis of OSA completed questionnaires, including demographic data and ESS. OSA was determined based on a respiratory disturbance index (RDI) ≥15 by polysomnography. RESULTS In this high risk population for OSA, the ESS was 10.7 ± 5.6. The highest ESS scores were seen in obese males; non-obese females and non-obese Caucasian males scored the lowest. ESS was weakly correlated with RDI (r = 0.17, P < 0.0001). The sensitivity of ESS for the diagnosis of OSA was 54% and the specificity was 57%. The positive (PPV) and negative (NPV) predictive values were 64% and 47%, respectively. In obese subjects, the sensitivity and specificity were 55% and 53%, compared with 47% and 63% in non-obese subjects. In obese, Hispanic males, the sensitivity, specificity, and PPV were 59%, 54%, and 84%, respectively. In non-obese, Caucasian females, the sensitivity, specificity, and NPV were 43%, 59%, and 72%. CONCLUSIONS The ESS appears to be affected by many factors, including gender, ethnicity, and body morphometry. The ability of the ESS to predict OSA is modest, despite a significant correlation with the severity of OSA. The test characteristics improve significantly when applied to select populations, especially those at risk for OSA.
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Affiliation(s)
- Sean Hesselbacher
- Department of Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
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Diaz E, Fernandez IM, Jimenez L, Surani S, Rodriguez M. Is Methicillin-Resistant Staphylococcus aureus Pneumonia Epidemiology and Sensitivity Changing? Am J Med Sci 2012; 343:196-8. [PMID: 21817882 DOI: 10.1097/maj.0b013e3182284bee] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Subramanian S, Hesselbacher S, Mattewal A, Surani S. Gender and age influence the effects of slow-wave sleep on respiration in patients with obstructive sleep apnea. Sleep Breath 2012; 17:51-6. [PMID: 22252284 DOI: 10.1007/s11325-011-0644-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 11/30/2011] [Accepted: 12/30/2011] [Indexed: 02/08/2023]
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Horseman MA, Rather-Conally J, Saavedra C, Surani S. A case of severe heatstroke and review of pathophysiology, clinical presentation, and treatment. J Intensive Care Med 2012; 28:334-40. [PMID: 22232203 DOI: 10.1177/0885066611434000] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Heatstroke is life-threatening condition characterized by hyperthermia and central nervous system disturbances. It can also be classified as a form of systemic inflammatory response syndrome with multiple organ dysfunction and in many ways resembles sepsis. Like sepsis, most patients with heatstroke demonstrate a hyperdynamic hemodynamic response. In contrast to sepsis, rhabdomyolysis may complicate management and initial fluid resuscitation is not well defined. We present an illustrative case report and review of literature.
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Affiliation(s)
- Michael A Horseman
- Department of Pharmacy Practice, College of Pharmacy, Texas A & M Health Sciences Center, Kingsville, TX, USA
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Subramanian S, Jayaraman G, Majid H, Aguilar R, Surani S. Influence of gender and anthropometric measures on severity of obstructive sleep apnea. Sleep Breath 2012; 16:1091-5. [PMID: 22033627 DOI: 10.1007/s11325-011-0607-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2010] [Revised: 09/08/2011] [Accepted: 10/11/2011] [Indexed: 02/05/2023]
Abstract
PURPOSE Gender differences influence upper airway anatomy and physiology. The purpose of our study was to evaluate the influence of gender as well as anthropometric measures on severity of obstructive sleep apnea (OSA). METHODS A retrospective review of patients referred to our sleep laboratory for evaluation of OSA was done. Patients with a diagnosis of OSA (Respiratory Disturbance Index (RDI) > 5) were included in the study. Anthropometric measurements were available for all the patients included in the study. Measurements of subjects' height, weight, neck size, and waist and hip sizes were used in the study; waist-hip ratio and neck-to-height ratio were calculated. RESULTS Three hundred eighty-six females and 661 males were included. Women were older than men and had a higher body mass index (BMI) and waist-to-hip ratio; men had a thicker neck circumference and a higher neck-to-height ratio. The severity of OSA was significantly higher in males (RDI 41.2 ± 27.9 in men vs. 30.0 ± 26.7 in women, p < 0.0001) despite a lower BMI and age in the men. Severity of OSA, as measured by RDI, varied significantly with changes in anthropometric measures such as neck circumference, and waist and hip sizes in both genders. Waist-to-hip ratio was associated with severity of OSA in men but not in women (p = 0.19 and 0.0001 in women and men, respectively). However, no single anthropometric value was found to be strongly predictive of OSA severity. CONCLUSION Despite having a higher mean BMI and age, women have lower RDI compared with men. Waist-to-hip ratio is more predictive of severity of OSA in men than in women. However, the correlation of anthropometric measures with severity of OSA was weak in our subjects.
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Abstract
Use of opioids in the treatment of both acute and chronic pain has increased significantly in the past 2 decades. Recent literature suggests that chronic opioid use is related to sleep-related breathing disorders, particularly central sleep apnea of both the periodic and nonperiodic breathing pattern. The clinical significance, pathogenesis, and treatment options of these sleep-related breathing disorders are not well understood. This article summarizes the current literature on the effects of both acute and chronic opioid use on sleep, sleep-disordered breathing, and the current evidence on various treatment options for breathing disorders related to chronic opioid use.
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Affiliation(s)
- Anil K Paturi
- Mayo Clinic, Critical Care Medicine, Rochester, MN, USA
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Surani S, Morales M, Rodriguez M, Varon J. The resilience of the human body. Am J Emerg Med 2011; 29:835-7. [PMID: 21665419 DOI: 10.1016/j.ajem.2011.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 04/19/2011] [Indexed: 02/08/2023] Open
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Abstract
Although sleep appears to be a quiescent, passive state externally, there are a multitude of physiological changes occurring during sleep that can affect cerebral homeostasis and predispose individuals to cerebrovascular disorders. Therefore, it is not surprising that sleep-disordered breathing causes significant nocturnal perturbations, such as obstructive sleep apnea (OSA), that can lead to cerebrovascular disorders. There is evidence to suggest that OSA is a risk factor for stroke, although studies have not been able to clearly discern the absence or presence of OSA before the stroke event. Sleep-disordered breathing, such as OSA and central sleep apnea, can occur as a consequence of stroke. Fortunately, treating OSA appears to decrease morbidity and possibly mortality. Unfortunately, continuous positive airway pressure compliance in this population group is low, and significant efforts and resources may be needed to improve compliance and adherence. Various other sleep disorders, such as insomnia, fatigue, hypersomnia, and parasomnia, can occur following a stroke, and physicians treating patients following a stroke need to be aware of these disorders in order to effectively treat such patients.
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Affiliation(s)
- Kannan Ramar
- Center for Sleep Medicine, Division of Pulmonary, Sleep and Critical Care Medicine, Mayo Clinic, Rochester, MN 55901, USA.
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Abstract
Mucormycosis is a rare life-threatening fungal infection occurring primarily in patients with diabetics or immunocompromised patients. The authors report a case of mucormycosis in a patient with diabetes complicated by bacterial brain abscess. The bacteria cultured from the abscess were Staphylococcus epidermidis and Enterococcus faecalis. The abscess was surgically drained and treated with antibiotics. A brief review of mucormycosis and brain abscess including treatment is provided in the discussion.
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Horseman MA, Surani S. A comprehensive review of Vibrio vulnificus: an important cause of severe sepsis and skin and soft-tissue infection. Int J Infect Dis 2010; 15:e157-66. [PMID: 21177133 DOI: 10.1016/j.ijid.2010.11.003] [Citation(s) in RCA: 193] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 10/28/2010] [Accepted: 11/09/2010] [Indexed: 02/05/2023] Open
Abstract
Vibrio vulnificus is a halophilic Gram-negative bacillus found worldwide in warm coastal waters. The pathogen has the ability to cause primary sepsis in certain high-risk populations, including patients with chronic liver disease, immunodeficiency, iron storage disorders, end-stage renal disease, and diabetes mellitus. Most reported cases of primary sepsis in the USA are associated with the ingestion of raw or undercooked oysters harvested from the Gulf Coast. The mortality rate for patients with severe sepsis is high, exceeding 50% in most reported series. Other clinical presentations include wound infection and gastroenteritis. Mild to moderate wound infection and gastroenteritis may occur in patients without obvious risk factors. Severe wound infection is often characterized by necrotizing skin and soft-tissue infection, including fasciitis and gangrene. V. vulnificus possesses several virulence factors, including the ability to evade destruction by stomach acid, capsular polysaccharide, lipopolysaccharide, cytotoxins, pili, and flagellum. The preferred antimicrobial therapy is doxycycline in combination with ceftazidime and surgery for necrotizing soft-tissue infection.
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Affiliation(s)
- Michael A Horseman
- Department of Pharmacy Practice, College of Pharmacy, Texas A&M Health Sciences Center, Kingsville, Texas, USA.
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Jayaraman G, Majid H, Surani S, Kao C, Subramanian S. Influence of gender on continuous positive airway pressure requirements in patients with obstructive sleep apnea syndrome. Sleep Breath 2010; 15:781-4. [PMID: 21076993 DOI: 10.1007/s11325-010-0436-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Revised: 09/15/2010] [Accepted: 10/27/2010] [Indexed: 02/08/2023]
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Subramanian S, Hesselbacher SE, Aguilar R, Surani SR. The NAMES assessment: a novel combined-modality screening tool for obstructive sleep apnea. Sleep Breath 2010; 15:819-26. [PMID: 21076972 DOI: 10.1007/s11325-010-0443-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 10/22/2010] [Accepted: 10/31/2010] [Indexed: 02/08/2023]
Abstract
PURPOSE Obstructive sleep apnea (OSA) remains underdiagnosed, despite our understanding of its impact on general health. Current screening methods utilize either symptoms or physical exam findings suggestive of OSA, but not both. The purpose of this study was to develop a novel screening tool for the detection of OSA, the NAMES assessment (neck circumference, airway classification, comorbidities, Epworth scale, and snoring), combining self-reported historical factors with physical exam findings. METHODS Subjects were adults without previously diagnosed OSA, referred to a community sleep center for suspicion of OSA. General health, Epworth Sleepiness Scale (ESS), and Berlin questionnaires were completed, and a physical exam focusing on modified Friedman (MF) grade, body mass index (BMI), and neck circumference (NC) was performed prior to polysomnography. OSA was defined by a respiratory disturbance index ≥15. Each variable was dichotomized, and cutoff values were determined for the NAMES tool in a pilot group of 150 subjects. The NAMES score was calculated from NC, MF, comorbidities, ESS, and loud snoring values. The performances of the NAMES, Berlin questionnaire, and ESS screening tests in predicting OSA were then compared in a validation group of 509 subjects. RESULTS In the pilot population, the cutoff value for the composite NAMES tool was calculated at ≥3 points. In the validation group, NAMES demonstrated similar test characteristics to the Berlin questionnaire, and sensitivity was better than that seen with the Epworth scale. The addition of BMI and gender to the tool improved screening characteristics. CONCLUSIONS The NAMES assessment is an effective, inexpensive screening strategy for moderate to severe OSA.
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Affiliation(s)
- Shyam Subramanian
- Department of Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, TX 77030, USA.
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Subramanian S, Guntupalli B, Murugan T, Bopparaju S, Chanamolu S, Casturi L, Surani S. Gender and ethnic differences in prevalence of self-reported insomnia among patients with obstructive sleep apnea. Sleep Breath 2010; 15:711-5. [PMID: 20953842 DOI: 10.1007/s11325-010-0426-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 08/31/2010] [Accepted: 09/18/2010] [Indexed: 02/05/2023]
Abstract
BACKGROUND Insomnia and obstructive sleep apnea (OSA) are the two most common sleep disorders. Studies have shown that complaints of insomnia are prevalent among sleep clinic patients evaluated for OSA. Less is known about the gender and ethnic variations in this association. OBJECTIVES This paper aims to study the influence of gender and ethnicity in the prevalence of insomnia in patients with OSA and explore the association between these two disorders with an emphasis on psychophysiologic insomnia. METHODS AND MEASUREMENTS We reviewed case files, including self-reported questionnaires and polysomnography studies of 300 OSA patients [apnea-hypopnea index (AHI) of >10] from three ethnic groups--Caucasian, Hispanic, and African American, 50 patients each, male and female, seen at a tertiary care county hospital adult sleep center. Self-reported insomnia was classified as sleep onset insomnia, sleep maintenance insomnia, or insomnia with early morning awakening. Psychophysiologic insomnia was documented if the patient reported two of the following five symptoms: racing thoughts when trying to sleep, increased muscle tension when trying to sleep, fear of being unable to sleep, fear of being unable to fall back to sleep after waking up, and lying in bed worrying. Fischer exact tests for each contingency table were run using SPSS. RESULTS Among OSA patients, women were older, had higher body mass index, and lower AHI at the time of diagnosis, compared to men. Insomnia was more prevalent among patients with OSA (84%) than the reported 30% among general adult population. Sleep onset insomnia was reported more frequently by women (62%) than men (53%) (p = 0.03). Similarly self-reported psychophysiologic insomnia also showed a female preponderance (53% vs. 45%, p = 0.03). Caucasian women had the highest rate of self-reported sleep maintenance insomnia (80%). Hispanic women are more likely to complain of symptoms suggestive of psychophysiologic insomnia (58%). CONCLUSIONS There is a higher prevalence of insomnia in OSA patients. Ethnicity and gender possibly exhibit a complex and significant influence on the reported subtype of insomnia. Further larger studies may help confirm, as well as clarify, mechanisms that underlie the ethnic and gender differences that we have noted.
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Affiliation(s)
- Shyam Subramanian
- Division of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX 77025, USA.
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Abstract
Murine typhus is widely reported in tropical and subtropical areas, especially coastal and port cities. We describe an interesting case of murine typhus in a 26-year-old woman at 26 weeks of gestation treated with ampicillin with a good response. The serology testing for murine typhus was reported after ampicillin was empirically started, and the patient's symptoms were already resolving. To the best of our knowledge, this is the first case report of murine typhus during pregnancy reported in the United States.
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Abstract
Sleep apnea is clinically recognized as a heterogeneous group of disorders characterized by recurrent apnea and/or hypopnea. Its prevalence ranges from 4% to 24%. It has been implicated as an independent risk factor for several conditions such as hypertension, stroke, arrhythmia, and myocardial infarction. Recently data has been emerging which suggests an independent association of obstructive sleep apnea with several components of the metabolic syndrome, particularly insulin resistance and abnormalities in lipid metabolism. We hereby review the salient features of the association between sleep and diabetes.
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Affiliation(s)
- Swetha Bopparaju
- Section of Pulmonary, Critical and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Corpus Christi, TX 78413, USA
| | - Salim Surani
- Section of Pulmonary, Critical and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Corpus Christi, TX 78413, USA
- Baylor College of Medicine, Texas A&M University, 613 Elizabeth Street, Suite 813, Corpus Christi, Houston, TX 78413, USA
- *Salim Surani:
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Surani S, Aguillar R, Komari V, Surani A, Subramanian S. Influence of Hispanic ethnicity in prevalence of diabetes mellitus in sleep apnea and relationship to sleep phase. Postgrad Med 2009; 121:108-12. [PMID: 19820279 DOI: 10.3810/pgm.2009.09.2057] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Recent studies have shown a strong association between insulin resistance, diabetes mellitus, and obstructive sleep apnea (OSA). This association has not been previously reported in the Hispanic population. The objective of this study was to study the prevalence of diabetes in a cohort of Hispanic patients with OSA in comparison with a white cohort. METHOD We performed a retrospective chart review of 103 Hispanic patients and 69 white patients with OSA. All patients had undergone full-night baseline polysomnography. We excluded charts of patients who underwent split-night studies and those who did not have rapid eye movement (REM) sleep. RESULTS Both groups were well matched in terms of age, gender distribution, and body mass index. The prevalence of self-reported diabetes in Hispanic patients with OSA was 42.71% compared with 24.28% of whites (P = 0.005). A REM apnea hypopnea index (AHI) of > 20 was significantly associated with an increased prevalence of diabetes in the Hispanic population; this association was not seen in the white population. CONCLUSION There was a very high prevalence of diabetes in an unselected cohort of Hispanic patients with OSA compared with white patients.
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Subramanian S, Bopparaju S, Desai A, Wiggins T, Rambaud C, Surani S. Sexual dysfunction in women with obstructive sleep apnea. Sleep Breath 2009; 14:59-62. [PMID: 19669820 DOI: 10.1007/s11325-009-0280-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Revised: 06/22/2009] [Accepted: 06/24/2009] [Indexed: 02/05/2023]
Abstract
BACKGROUND Female sexual dysfunction is vastly under-recognized but has been previously described in chronic disease states. Sexual dysfunction in male patients with obstructive sleep apnea (OSA) is well described, but not in females. OBJECTIVE The objective of this study was to assess the prevalence of sexual dysfunction in women with OSA. METHODS We studied 21 consecutive pre-menopausal women with OSA, referred to our sleep lab, and who had a positive study for sleep apnea (respiratory disturbance index (RDI) > 5), and 11 healthy pre-menopausal women were included as the control group. Subjects were administered the Female Sexual Function Index (FSFI) questionnaire and a mood scale-Profile of Mood States. RESULTS Of the study group, 11 women (52.4%) had FSFI scores in the poor range (<23) as compared to the control group, in which none of the women (0%) had FSFI scores in the poor range (<23). Negative mood domain scores were not different in patients with poor FSFI compared to patients with normal FSFI scores. There was no correlation between obesity, severity of sleep apnea, or mood disorders on overall scores of sexual dysfunction. Among individual domains, there was a correlation between RDI and arousal scores. CONCLUSION In our study, we have found that prevalence of sexual dysfunction is high among women with OSA. Physicians should routinely screen and evaluate women with OSA for sexual dysfunction.
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Affiliation(s)
- Shyam Subramanian
- Division of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, 77025, USA.
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Surani S, Aguillar R, Aguillar R, Subramanian S. Standardization of quality assurance for sleep technologist: a model. Sleep Breath 2009; 14:3-12. [PMID: 19565291 DOI: 10.1007/s11325-009-0271-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Revised: 01/25/2009] [Accepted: 05/15/2009] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Since the last decade, there has been a tremendous growth of sleep centers in the US to meet the increasing need of diagnosing and treating sleep disorders. However, this unregulated growth has resulted in tremendous variance in the quality of sleep centers across the nation. The American Academy of Sleep Medicine, in an attempt to provide a benchmark standard, has introduced a voluntary accreditation process, part of which involves assessment of technical quality parameters. However, measuring technical quality is not easy. HYPOTHESIS We undertook a study to determine if the implementation of point system and schematic feedback on technologist performance can result in improvement and tracking of their performance. MATERIALS AND METHODS We randomly reviewed 100 charts from the preimplementation phase as control and 1,739 charts from the post implementation of the point system phase as study group. RESULTS There was a statistically significant difference in the score among technologist between the control and study groups with the average being 75 +/- 4.12 and 87.53 +/- 0.91, respectively, with a p value being 0.0001. CONCLUSION Evaluating the performance of the sleep technologist can be a way to track and monitor their performance in a standardized way and to identify weakness at an earlier stage. We present a system, which we have developed and implemented at our sleep center, as a possible model of assessing and subsequently standardizing technical quality for polysomnography.
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Surani S, Ayala E, McMillan M, Sablonte E, Acosta P. Long Term Recovery of Diaphragmatic Function in a Patient with Unilateral Diaphragmatic Pacemaker. CRMR 2009. [DOI: 10.2174/157339809787353994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Abstract
BACKGROUND AND METHODS Sleepiness in medical residents has crucial implications for the safety of both patients and residents. Measures to improve this have primarily included an Accreditation Council for Graduate Medical Education-mandated reduction in work hours in residency programs. The impact of these work-hour limitations has not been consistent. The purpose of this study was to provide an objective assessment of daytime sleepiness in medical residents working in the medical ICU. Sleep times for 2 days/nights prior to on call and on the day/night of being on call were assessed by actigraphy and sleep diaries. On-call and post-call measurements of residents' sleepiness were measured both objectively, by means of a modified multiple sleep latency test (MSLT) [two nap sessions], as well as subjectively, by the Stanford Sleepiness Scale. RESULTS Our data showed that despite an average sleep time of 7.15 h on nights leading to being on call, the mean sleep latency (MSL) on the on-call day was (+/- SD) 9 +/- 4.4 min, and 4.8 +/- 4.1 min (p < 0.001) on the post-call day. On the post-call day, 14 residents (70%) had an MSL of < 5 min, suggesting severe sleepiness, compared to 6 residents (30%) on the on-call day. CONCLUSION Our results demonstrate that residents working in the ICU despite reductions in work hours demonstrate severe degree of sleepiness post-call.
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Affiliation(s)
- Raghu Reddy
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Kalpalatha Guntupalli
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Philip Alapat
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Salim Surani
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Lata Casturi
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Shyam Subramanian
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX.
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