Twelve tips to revitalise problem-based learning.

The role of the problem-based learning (PBL) facilitator has seen different interpretations ever since PBL first gained widespread use. What has remained unchanged is the challenge for facilitators to use their knowledge and expertise sparingly and to use their interpersonal skills to improve group dynamics. Medical undergraduates attending PBL sessions have also changed in their skill sets, expectations and the use of technology. Based on the published literature and a recent faculty workshop, we provide PBL facilitators and institutions with 12 tips on how to make PBL more vibrant and interesting. We discuss our tips with reference to published literature and International Academy of Medical Education (AMEE) guidance. Our tips help students to engage with PBL, avoid monotony and make this teaching format more vibrant and fun for all involved. Introducing greater variety to the PBL process may also help with group dynamics by catering for a broader audience with different learning styles.

Negative-pressure pulmonary edema after routine septorhinoplasty: discussion of pathophysiology, treatment, and prevention.

OBJECTIVE: To provide rhinologic surgeons with an understanding of acute negative-pressure pulmonary edema (NPPE) and its treatment. DESIGN: Case report and literature review of all published adult cases of NPPE. Patient factors, anesthetic variables, and outcomes are assessed. RESULTS: A total of 146 cases in 45 case reports and series were compiled. There was approximately a 2:1 male-female patient ratio. The average age of the patients was 33 years. Fifty percent of patients had surgery on the upper aerodigestive tract, and 8% had intranasal surgery. No patients received laryngotracheal anesthesia, and 5 of the 146 received intravenous lidocaine prior to extubation. One patient had NPPE following laryngeal mask airway treatment, and 2 patients experienced this complication after conversion from monitored anesthesia care to general endotracheal anesthesia; 33.5% of patients were treated with continuous positive airway pressure alone, while 66.5% required intubation and mechanical ventilation. The average time to resolution was 11.75 hours. Three patients died. CONCLUSIONS: It is known that surgical procedures involving the upper aerodigestive tract have a higher risk of NPPE than other procedures. Rapid diagnosis and treatment is necessary to achieve early resolution and avoid significant patient morbidity. A thorough understanding is integral to the practice of nasal and paranasal sinus surgery, especially with the rising use of outpatient and office-based surgical suites. Therefore, we present a review of pathophysiologic mechanisms, possible risk factors, treatment options, and potential steps that can be taken to minimize this potentially devastating complication of general anesthesia.

Subarachnoid hemorrhage presenting as post-dural puncture headache: a case report.

A case of subarachnoid hemorrhage following spinal anesthesia for prostate radioactive seed implantation is reported. The implications of the differential diagnosis of post-dural puncture headache are discussed.

Primary acute dengue and the deletion in chemokine receptor 5 (CCR5Δ32).

Dengue virus is a significant arboviral pathogen that is continuing to spread due to human travel and invasion of the mosquito vectors into new regions. Chemokine receptor 5 (CCR5) has a truncated 32 base pair deletion form (CCR5Δ32), which has been associated with resistance to HIV but increased severity in some flaviviral diseases. If CCR5Δ32 is associated with dengue, European carriers of this mutation may be at increased risk. In a Western Australian population with the same frequency of CCR5Δ32 (0.08) as that found in southern Europe there was no significant difference in CCR5Δ32 allele frequency between returned travellers with and without dengue (p = 0.82, OR = 0.86, 95% CI = 0.35-2.1).

Melioidosis, northeastern Brazil.

Melioidosis was first recognized in northeastern Brazil in 2003. Confirmation of additional cases from the 2003 cluster in Ceará, more recent cases in other districts, environmental isolation of Burkholderia pseudomallei, molecular confirmation and typing results, and positive serosurveillance specimens indicate that melioidosis is more widespread in northeastern Brazil than previously thought.