Multisystem Inflammatory Syndrome in Adult Following COVID-19 Vaccination (MIS-AV).

The last 2 years have been dominated by coronavirus disease-2019 (COVID-19), its various presentations, complications, and their management. The first COVID-19 vaccine, produced by Pfizer-BioNTech, was granted regulatory approval on December 2, 2020, by the UK medicines regulator medicines and healthcare products regulatory agency (MHRA). It was evaluated for emergency use authorization (EUA) status by the US Food and Drug Administration (FDA) and in several other countries. Following millions of doses, during the early months of 2021, reports of side effects of the vaccines began to emerge. In this case report, we discuss the case of a 22-year-old female patient who presented with fever and confusion, with later progression to multiple organ failure, following administration of Pfizer-BioNTech vaccine. She was successfully treated with intravenous (IV) immunoglobulin (Ig) and high-dose IV corticosteroids. This case report is unique as lymph node biopsy was carried out-this showed marked suppurative inflammation with vasculitic changes, thus supporting the diagnosis. How to cite this article: Ganapathiram RN, Hudson S. Multisystem Inflammatory Syndrome in Adult Following COVID-19 Vaccination (MIS-AV). Indian J Crit Care Med 2022;26(5):649-650.

Reinventing Undergraduate Clinical Placements with a Switch to Delivery by Clinical Teaching Fellows.

PURPOSE: Undergraduate clinical placements have the potential for significant improvement. Previous research has shown the growing value of clinical teaching fellows (CTFs) within medical education. Changing traditional placements to a model whereby CTFs have defined roles and lead the majority of teaching can positively reinvent undergraduate clinical teaching. We wanted to see how a structured teaching programme delivered by CTFs could affect student experience and personal development within a large associate teaching hospital. We consider how such a model could be implemented and explore the opportunities for CTFs to develop in personal and professional capacities. METHODS: A mixed methods study was organised to assess student experience of a CTF-led placement. A novel structured teaching programme was delivered by 14 CTFs, who provided or were involved with the majority of teaching for all medical students. Thematic analysis was conducted on focus groups with 48 final year medical students from Queen Mary University of London following completion of their clinical placements. The same students were asked to complete an anonymous survey from which results were analysed using modified 5-point Likert scales. RESULTS: Eight themes were identified from the focus groups. Students appreciated the increased individualisation, relevance and variety of teaching and the ability to record progress. Other perceived effects were higher teacher to student ratios, more learning opportunities and increased familiarity and reliability with CTFs. Of the students surveyed, 96% felt their overall placement experience was very good in comparison to previous placements elsewhere. Survey results supported focus group themes and demonstrated perceived growth in students' personal development. CONCLUSION: Placement models where CTFs lead most teaching can improve medical undergraduate experience and training. A move towards CTF-delivered teaching can be of financial benefit to hospital trusts whilst allowing time for junior doctors to explore different clinical specialities and hone their teaching skills.

Flavor Alterations Associated with Miracle Fruit and Gymnema sylvestre.

Taste and flavor (retronasal olfaction) interact in the brain. The rules of that interaction are not well understood. This study uses 2 taste modifiers that alter sweet to examine the effects on flavors. Subjects used the Global Sensory Intensity Scale to assess the aroma, sweetness, sourness, and flavor of 10 foods. As previous work had shown, miracle fruit added sweetness to acids, which secondarily reduced sourness (mixture suppression) and Gymnema sylvestre reduced sweetness in sweet foods as well as the sweetness induced by miracle fruit. In this study, multiple regression showed that both sweet and sour contribute to flavor. Gymnema sylvestre reduced the perceived sweet of predominantly sweet foods (chocolate and maple syrup) as expected; reducing the sweet, reduced the flavor. The effects of miracle fruit were complicated by its dual action: intensification of sweet and reduction of sour. Predominantly sour foods (vinegar, lemon, mustard, pickle) were sweetened by miracle fruit but any flavor enhancement associated with the added sweet appears to have been countered by the flavor reduction associated with reduced sourness. Moderately sour foods that are also sweet (tomatoes, strawberries) were sweetened by miracle fruit and thus flavor was enhanced; flavor loss through sour reduction was apparently not sufficient to counter the flavor enhancement due to increased sweet so the net result was that tomato and strawberry flavors were enhanced. The flavors of control foods (not predominantly sweet or sour [sausage, peanuts]) showed only small changes.

Heterotopic ossification--a long-term consequence of prolonged immobility.

Heterotopic ossification is a condition affecting an appreciable minority of critical care patients; it can have long-lasting effects on recovery and return to functional status. Ectopic bone forms in soft tissues near the large joints, causing pain, swelling, limitation of movement and ultimate disability. X-ray changes may be delayed for several weeks after the diagnosis is clinically suspected. Magnetic resonance imaging may be more sensitive for detecting early changes, yielding positive results several weeks before X-rays. However it is not clear that diagnosing the process early will influence long-term patient outcome, because no effective treatments are available.