Delivering surgical education: a specialist surgical society and undergraduate student collaboration.

Currently, the delivery of the undergraduate medical curriculum includes various teaching, learning and assessment strategies. Self-directed learning is an important aspect of this mix and includes the use of resources, sometimes not provided by the parent University, in the student's own time to enhance the student's knowledge, skills and professional practice. Societies aimed at a particular specialty contain a pool of professionals that can provide undergraduate students with opportunities for further self-directed learning, development of specialty-specific core skills and exploration of research interests. This may then enhance and enlighten the students' approach to a particular orthopaedic problem and reinforce the curriculum they are studying while providing an understanding of current areas of debate that are not part of the curriculum at present. The collaboration of postgraduate societies with undergraduate students in developing and implementing undergraduate engagement strategies is of benefit to undergraduate education, the specialty society and the collaborating students. We explore the planning and implementation of an interactive webinar series run by the British Indian Orthopaedic Society in collaboration with undergraduate students. We provide a case study of a surgical specialty society engaging with undergraduate students with synergistic effect. We pay particular attention to the benefits accrued by the specialty society and the student collaborators by this joint effort.

Patients' Family Satisfaction in Intensive Care Unit: A Leap Forward.

Garg SK. Patients' Family Satisfaction in Intensive Care Unit: A Leap Forward. Indian J Crit Care Med 2022;26(2):161-163.

Anti-cytokine Therapy in Hospitalized Patients with COVID-19: The Jury is Out.

How to cite this article: Garg SK. Anti-cytokine Therapy in Hospitalized Patients with COVID-19: The Jury is Out. Indian J Crit Care Med 2022;26(10):1069-1071.

Antibiotic misuse during COVID-19 Pandemic: A Recipe for Disaster.

How to cite this article: Garg SK. Antibiotic misuse during COVID-19 Pandemic: A Recipe for Disaster. Indian J Crit Care Med 2021;25(6):617-619.

Differing Sensitivity of COVID-19 PCR Tests and Consequences of the False-negative Report: A Small Observation.

The world at large cannot afford to miss even a single case of COVID-19 because of its far-reaching consequences; therefore, the diagnostic development to achieve test with much higher sensitivity should be made available at a mass level as early as possible. HOW TO CITE THIS ARTICLE: Garg SK. Differing Sensitivity of COVID-19 PCR Tests and Consequences of the False-negative Report: A Small Observation. Indian J Crit Care Med 2021;25(9):1077-1078.

Autoimmune Hemolytic Anemia in Intensive Care Unit and Blood Transfusion: Lesson Learnt-A Case Report.

Clinicians are often in a difficult situation while managing severe anemia due to autoimmune hemolysis in intensive care unit (ICU). It is hard to get properly cross-matched blood due to the presence of autoantibody in the patient's serum. Still, such patients should not be devoid of transfusion. How to cite this article: Garg SK, Garg P. Autoimmune Hemolytic Anemia in Intensive Care Unit and Blood Transfusion: Lesson Learnt-A Case Report. Indian J Crit Care Med 2021;25(10):1201-1202.

Differential Diagnosis of Ketoacidosis in Hyperglycemic Alcoholic Diabetic Patient: Role of Insulin.

It is important to differentiate between diabetic ketoacidosis (DKA) and alcoholic ketoacidosis (AKA) in an alcoholic diabetic patient since it has significant management implications. Ketoacidosis in an alcoholic diabetic patient is a diagnostic challenge as both these clinical entities have metabolic acidosis with high anion gap. Most patients with DKA have hyperglycemia. The majority of AKA patients present with normal or low glucose levels; however, AKA may also present with high glucose levels, more so in diabetics. The situation becomes quite perplexing when an alcoholic diabetic patient presents with hyperglycemia since it can be attributed to DKA or AKA. How to cite this article: Garg SK, Garg P. Differential Diagnosis of Ketoacidosis in Hyperglycemic Alcoholic Diabetic Patient: Role of Insulin. Indian J Crit Care Med 2021; 25(10):1203-1204.

Pain Control and Opioid Use in ICU should be a Quality Parameter.

How to cite this article: Garg SK, Garg P. Pain Control and Opioid Use in ICU should be a Quality Parameter. Indian J Crit Care Med 2021; 25(10):1205-1206.

Is There Any Lower Limit of Serum Bicarbonate in Diabetic Ketoacidosis?

Diabetic ketoacidosis (DKA) is known as one of the most serious complications of diabetes and associated with significant morbidity and mortality. It consists of a triad of uncontrolled hyperglycemia, metabolic acidosis, and increased total body ketone concentration.1 It leads to high anion gap metabolic acidosis with fall in serum bicarbonate. HOW TO CITE THIS ARTICLE: Garg SK, Garg P. Is There Any Lower Limit of Serum Bicarbonate in Diabetic Ketoacidosis? IJCCM 2019; 23(11):542.

Is Ventilator-associated Pneumonia a Misnomer? Need to Rephrase it for Better Understanding.

How to cite this article: Garg SK, Garg P. Is Ventilator-associated Pneumonia a Misnomer? Need to Rephrase it for Better Understanding. Indian J Crit Care Med 2019;23(12):593.

An Interesting Presentation of Pheochromocytoma.

Pheochromocytoma is a rare cause of hypertension, but it could have severe consequences if not recognized and treated appropriately. Pheochromocytoma classically presents with paroxysms of hypertension and adrenergic symptoms including classic triad of episodic headache, sweating, and tachycardia. The clinical presentation of pheochromocytoma can mimic a number of other medical conditions including migraine, cardiac arrhythmias, myocardial infarction, and stroke, thus making the diagnosis of pheochromocytoma difficult, and treatment is directed toward presenting issue rather than underlying problem in such patients. We present a case of a 41-year-old male patient who presented with cerebellar infarct and found to have aortic thrombi and later developed acute myocardial infaction during same hospitalization. To the best of our knowledge, this is the first reported case of this kind.

Practice Guidelines for Nutrition in Critically Ill Patients: A Relook for Indian Scenario.

BACKGROUND AND AIM: Intensive-care practices and settings may differ for India in comparison to other countries. While international guidelines are available to direct the use of enteral nutrition (EN), there are no recommendations specific to Indian settings. Advisory board meetings were arranged to develop the practice guidelines specific to Indian context, for the use of EN in critically ill patients and to overcome challenges in this field. METHODS: Various existing guidelines, meta-analyses, randomized controlled trials, controlled trials, and review articles were reviewed for their contextual relevance and strength. A systematic grading of practice guidelines by advisory board was done based on strength of the supporting evidence. Wherever Indian studies were not available, references were taken from the international guidelines. RESULTS: Based on the literature review, the recommendations for developing the practice guidelines were made as per the grading criteria agreed upon by the advisory board. The recommendations were to address challenges regarding EN versus parenteral nutrition; nutrition screening and assessment; nutrition in hemodynamically unstable; route of nutrition; tube feeding and challenges; tolerance; optimum calorie-protein requirements; selection of appropriate enteral feeding formula; micronutrients and immune-nutrients; standard nutrition in hepatic, renal, and respiratory diseases and documentation of nutrition practices. CONCLUSION: This paper summarizes the optimum nutrition practices for critically ill patients. The possible solutions to overcome the challenges in this field are presented as practice guidelines at the end of each section. These guidelines are expected to provide guidance in critical care settings regarding appropriate critical-care nutrition practices and to set up Intensive Care Unit nutrition protocols.

Iatrogenic Bilateral Simultaneous Pneumothorax: Call for Vigilance.

Iatrogenic pneumothorax refers to the pneumothorax generated after diagnostic or therapeutic procedure. We report the case of a 40-year-old male who had bilateral simultaneous iatrogenic pneumothorax with pneumomediastinum leading to cardiac arrest situation, due to wrong placement of nebulization kit in spontaneously breathing intubated patient. We report this case for its rarity, due to the critical importance of this cause as a etiology of bilateral simultaneous iatrogenic pneumothorax leading to cardiac arrest situation, and need to understand the importance of continuous training and stress of emergency environment.

Evolving paradigm of illnesses presented to medical Intensive Care Unit in body builders: Cases from tertiary care center.

Bodybuilding is the use of progressive resistance exercise to control and develop one's musculature. With the rise in number of persons adopting this activity, there is evolving paradigm of illnesses presented to intensive care in this population subset. Strict adherence to details of bodybuilding and avoidance of unsupervised medications are essential to prevent untoward effects.

How we managed a difficult to ventilate patient.

A 40-year-old female presented with respiratory difficulty, cough and sputum with blood streaking. Her right lung was destroyed, and trachea was shifted to the same side. On mechanical ventilation, she developed hypoxia and rise in blood pressure. Ventilator was not delivering set tidal volume. After looking into the cause, it was decided to reintubate the patient with new endotracheal tube after cutting bevel. Thereafter, there was successful ventilation.

Permissive hypercapnia: Is there any upper limit?

A 19-year-old male presented with history of massive hemoptysis. The patient was kept on mechanical ventilation because of severe hypoxia. Lung protective ventilation with low tidal volume was given in view of very poor pulmonary compliance. During the course of treatment, the patient developed a very high CO2 level of 373 mmHg. The patient was successfully weaned off on the 9(th) day without any obvious adverse consequences.

Hair dye poisoning: An unusual encounter.

A 19-year-old female patient presented with alleged history of hair dye "Super Vasmol 33" intake. She presented with cervicofacial edema with upper airway obstruction. Although patient was being managed for airway obstruction, she developed cardiac arrest. Cardiac resuscitation could not be started at that point of time because managing airway was the priority in a patient who in hypoxic cardiac arrest. As soon as the airway was secured by emergency tracheostomy, cardiac resuscitation was initiated and the patient was successfully revived.

Macroscopic Extranodal Extension In Oral Squamous Cell Carcinoma-A Subgroup With Poor Survival.

BACKGROUND: Oral cancer portends a significant cause of morbidity and mortality worldwide. Cervical lymph node metastasis with extranodal extension (ENE) is associated with a poor prognosis. There has been accumulating evidence regarding the extent of ENE to be associated with prognosis and survival. AIM: This observational study was performed to analyze the prognostic implication of macroscopic and microscopic ENE in metastatic cervical lymph nodes of oral cavity cancer patients. METHODS: A total of 92 oral cavity cancer patients with pathologically detected ENE were included in this study. Both the groups (macroscopic and microscopic ENE) were compared in terms of overall survival and disease-free survival by using Kaplan -Meier. The pattern of failure was determined by Fischer's exact test. Univariate and multivariate analyses were calculated to determine the significant risk factors of death. RESULTS: The 2 years of disease-free survival and overall survival rates for the whole cohort were 51.2% and 53.9% respectively. The 2-year survival rate for the microscopic group (≤2 mm) and macroscopic (>2 mm) was 72.6% and 0% respectively, while the distal failure rate in microscopic ENE group and macroscopic ENE group was 22.22% and 44.83% respectively (p-value = 0.026). CONCLUSIONS: Macroscopic ENE (>2 mm) in oral cavity squamous cell cancer represents an aggressive entity with early regional and distant failure as compared to microscopic ENE (≤2 mm). Thus, macroscopic ENE (>2 mm) warrants a distinct subgroup with special consideration for intensification of treatment. LEVEL OF EVIDENCE: 3 Laryngoscope, 133:588-593, 2023.

Assessment of the Global Fund-supported procurement and supply chain reforms at the Ethiopian Pharmaceuticals Supply Agency: a mixed-methods study.

OBJECTIVE: The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) partnered with the Ethiopian Pharmaceutical Supply Agency (EPSA) in 2018-2019 to reform procurement and supply chain management (PSCM) procedures within the Ethiopian healthcare system. This assessment sought to determine the impact of the reforms and document the lessons learnt. DESIGN: Mixed-methods study incorporating qualitative and quantitative analysis. Purposive and snowballing sampling techniques were applied for the qualitative methods, and the data collected was transcribed in full and subjected to thematic content analysis. Descriptive analysis was applied to quantitative data. SETTING: The study was based in Ethiopia and focused on the EPSA operations nationally between 2017 and 2021. PARTICIPANTS: Twenty-five Ethiopian healthcare decision-makers and health workers. INTERVENTION: Global Fund training programme for health workers and infrastructural improvements OUTCOMES: Operational and financial measures for healthcare PSCM. RESULTS: The availability of antiretrovirals, tuberculosis and malaria medicines, and other related commodities, remained consistently high. Line fill rate and forecast accuracy were average. Between 2018 and 2021, procurement lead times for HIV and malaria-related orders reduced by 43.0% relative to other commodities that reported an increase. Many interview respondents recognised the important role of the Global Fund support in improving the performance of EPSA and provided specific attributions to the observed successes. However, they were also clear that more needs to be done in specific critical areas such as financing, strategic reorganisation, data and information management systems. CONCLUSION: The Global Fund-supported initiatives led to improvements in the EPSA performance, despite several persistent challenges. To sustain and secure the gains achieved so far through Global Fund support and make progress, it is important that various stakeholders, including the government and the donor community, work together to support EPSA in delivering on its core mandate within the Ethiopian health system.