Objectives Insufficient sleep affects circadian hormonal profiles and inflammatory markers and may modulate attention, executive functioning and decision‐making. Medical professionals and specifically resident physicians, who are involved in long‐term nightshift schedules during their post‐graduate training, are prone to acute and chronic sleep deprivation and disruption, putting them at risk for making medical errors. The aim of the study was to evaluate the impact of chronic and acute‐on‐chronic sleep deprivation and disruption among residents on selected physiological and cognitive measures. Methods Thirty‐three medical and surgical residents were evaluated twice ‐ at baseline and after a 26‐hour shift. Eighteen young attending physicians who did not engage in nightshift schedules served as controls and were evaluated once. Measures included morning cortisol and high‐sensitivity C‐reactive protein (hs‐CRP), computerised tests of attention and behaviour, the Behaviour Rating Inventory of Executive Function, a risk‐taking questionnaire and the Pittsburgh Sleep Quality Index. Results Residents, but not attendings, reported chronic sleep disruption and deprivation. Residents at baseline exhibited reduced morning cortisol levels and elevated hs‐CRP levels, compared to attendings. Residents at baseline had impaired global executive function compared to attendings. A nightshift with acute sleep deprivation further reduced residents' executive function. Residents at baseline and after a nightshift demonstrated increased impulsivity and slower processing time than attendings. Residents and attendings did not differ in risk‐taking tendencies which were assessed in a separate cohort. Conclusions In a real‐life setting, resident physicians exhibit increased low‐grade systemic inflammation (hs‐CRP) and impaired HPA‐axis function. Their chronic sleep curtailment is associated with greater impulsivity, slower cognitive processing, and impaired executive function. Future research is warranted to understand how improving working schedule by increasing sleep duration may minimise the short‐term and potential long‐term risks to physicians in training.
OBJECTIVES: To characterize the clinical manifestations, outcomes, and complications of hijab pin ingestion in adolescents and to identify risk factors for a need for intervention.METHODS: A retrospective review of patients ,25 years of age who presented to our emergency department because of hijab pin ingestion between 2007 and 2018. Comparison was performed between impaled and nonimpaled pins. RESULTS:We reviewed 1558 foreign-body ingestion cases. Of these, 208 (13.3%) patients presented because of hijab pin ingestion, with a total of 225 ingested pins. The mean patient age was 14.7 6 4.1 years, and 88% of patients were girls. Time from ingestion to presentation was 24 6 49.5 hours. Most pins were located in the stomach (46.6%), and 18.6% of all pins were impaled. Location in the stomach (odds ratio = 4.3 [95% confidence interval: 1.9-9.2]; P , .001) and abdominal tenderness on examination (odds ratio = 2.7 [95% confidence interval: 1.3-5.6]; P = .007) were strong independent risk factors for an impaled pin. Time to intervention was 22.9 hours, and 41 endoscopies were performed. One patient required laparoscopic surgery. No complications were observed. CONCLUSIONS:The hijab pin is an increasingly encountered foreign body in pediatric practice. Its specific clinical features distinguish it from other sharp objects. A delayed interventional approach in selected patients does not carry a higher risk of complications and results in significantly fewer interventions compared to existing guidelines. These findings will help guide pediatric specialists in this prevalent clinical scenario. Management recommendations are proposed.
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