ObjectiveAlcohol is a hypnotic that modifies immune function, specifically the cytokines interferon gamma (IFN-γ) and interleukin 2 (IL-2). We evaluated the association between unscheduled napping and acute alcohol-induced augmentation of IFN-γ and IL-2 expression.MethodsIn this prospective, observational pilot study, volunteers completed questionnaires on sleep quality, alcohol use, and hangover characteristics. Actigraph recordings began three nights before and continued for four nights after study initiation. Napping was recorded by actigraphy and self-reporting. A weight-based dose of 100-proof vodka was consumed, and the blood alcohol content (BAC) and phytohemagglutinin-M stimulated cytokine level were measured before and 20 minutes, 2 hours, and 5 hours after binge consumption.ResultsTen healthy volunteers participated (mean age, 34.4 ± 2.3 years; mean body mass index, 23.9 ± 4.6 kg/m2; 60% female). The mean 20-minute BAC was 137.7 ± 40.7 mg/dL. Seven participants took an unscheduled nap. The ex vivo IFN-γ and IL-2 levels significantly increased at all time points after binge consumption in the nappers, but not in the non-nappers.ConclusionAugmented IFN-γ and IL-2 levels are associated with unscheduled napping after binge alcohol consumption. Further studies are needed to clarify the associations among alcohol consumption, sleep disruption, and inflammatory mediators.

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Conducting clinical research on subjects admitted to intensive care units is challenging as they frequently lack the capacity to provide informed consent due to multiple factors including ICU acquired delirium, coma, the need for sedation, or underlying critical illness. However, the presence of one or more of these characteristics does not automatically designate a potential subject as lacking capacity to provide their own informed consent. We review the ethical issues involved in obtaining informed consent for medical research from mechanically ventilated, critically ill patients, in addition to the concerns that may arise when a legally authorized representative is asked to provide informed consent on behalf of these patients.

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Sarcoidosis is a multisystem disorder that takes a variable clinical course. Cardiac involvement is noteworthy as it markedly affects patient's morbidity and mortality. Cardiac manifestations include atrioventricular block, arrhythmia's, heart failure and, and sudden cardiac death (SCD). We highlight a new diagnosis of cardiac sarcoidosis initially presenting with syncope.CASE PRESENTATION: A 63-year-old African American female presented after a syncopal episode. She had been cooking in her kitchen felt dizzy and lightheaded while standing. Physical examination revealed no jugular venous distention, no murmurs or gallops on cardiac auscultation, clear lung auscultation, and no lower extremity edema.Vital signs were as follows: HR 93 BPM, BP 120/76mmhg, and saturating 100% breathing ambient air. Orthostatic vital signs were negative. Laboratory work up revealed serum creatinine 1.4 mg/dL (ref. range 0.5-1.10) and troponin I 0.29 ng/mL (ref. range 0.00-0.04). Twelve lead electrocardiogram demonstrated sinus tachycardia, first degree AV block and complete left bundle branch block. She was admitted for syncope evaluation and non-ST elevation MI.