Leveraging social media for resident training in developing countries: A case study of Libya.

Social media platforms have emerged as invaluable tools for remote training in resource-constrained countries. This study presents the development, implementation, and preliminary assessment of a remote intensive care unit (ICU) training program conducted in Libya utilizing social media platforms. This educational initiative was based on the Checklist for Early Recognition and Treatment of Acute Illness and iNjury (CERTAIN) program, targeting Libyan resident physicians. The initiative comprised a series of live-streamed pulmonary/critical care lectures and asynchronous discussion of clinical cases via a private messaging chat. Participant engagement, satisfaction, and learning outcomes were evaluated using social media analytics and surveys. A total of 323 learners joined the Libyan ICU training program chat group, and two tele-education sessions were broadcast, accumulating a total of 749 views. The majority (72.6%) of learners had graduated from medical school within the past five years and were in residency training. Clinical cases and learning materials were shared through 2,991 messages in the chat group. Learners' objective and subjective clinical knowledge improved after each tele-education session, and 88% of survey respondents rated the remote ICU training program as excellent. This study highlights the potential of using widely available social media platforms for remote ICU education in resource-limited settings.

Where Are We Heading With Fluid Responsiveness and Septic Shock?

When hypovolemia is left uncorrected, it can lead to poor tissue oxygenation and organ dysfunction. On the other hand, excessive fluid administration can increase the risk of complications. Assessing volume responsiveness in critically ill patients is therefore crucial. In this article we summarized the literature addressing the most sensitive and specific dynamic predictors for fluid responsiveness, to help clarify the best way to guide clinicians in managing patients with shock. Data were collected from PubMed and EMBASE of high-quality articles, randomized controlled trials (RCTs), retrospective research, and metanalyses; articles were identified from January 2000 to February 2021. We identified and critically reviewed the published peer-reviewed literature investigating the dynamic predictors to assess fluid responsiveness. Evidence suggests that the traditional use of static predictors for fluid responsiveness should be abandoned. Over the last 20 years, a number of dynamic tests have been developed. These tests are based on the principle of inducing short-term changes in cardiac preload using heart-lung interactions. However, in routine practice the conditions to meet the requirements of these dynamic parameters are frequently not met. Therefore, more dynamic predictors that do not depend on heart-lung interaction have developed such as the mini fluid challenge test and passive leg raising test These tests have fewer limitations and higher sensitivity and specificity compared to the other tests.

Arterial embolism in a patient with pulmonary embolism and patent foramen ovale.

Paradoxical embolization is an uncommon but devastating complication of pulmonary embolism and continues to be frequently missed. Although the prevalence of patent foramen ovale is 25% to 30%, the risk of paradoxical embolism is <2% of all arterial ischemia. Paradoxical embolism is infrequent but can involve almost any artery of the body. Here, we present a case of a 65-year-old woman with paradoxical systemic arterial embolism secondary to deep venous thrombosis and pulmonary embolism in the presence of patent foramen ovale. High suspicion for paradoxical embolism is needed in the event of unexplained arterial occlusion. Awareness of this complication with prompt recognition and treatment could serve to preclude significant disability and death.

Small Cell Carcinoma of Prostate: A Case Report of a Patient With Concomitant Transitional Cell Cancer of the Bladder.

Small cell carcinomas (SCCs) are aggressive neoplasms commonly associated with a pulmonary origin. However, albeit rare, extrapulmonary SCC can occur in a variety of sites with an incidence in North America approximated to be 0.1% to 0.4%. Among these sites, approximately 10% of extrapulmonary SCC cases occur in the prostate and are associated with a poor mortality with a median survival of 10 months. Because of the rarity of the prostatic SCC, there is no formal treatment protocol. In this case report, we present a patient who was diagnosed with SCC in the prostate as primary origin. Adjuvant concurrent chemoradiotherapy was started, which he is tolerating so far. While the management of metastatic disease is well documented with the use of chemotherapy, specific data on nonmetastatic disease is lacking. As some studies suggest, a combined surgical and chemotherapeutic approach is helpful in localized disease. In our case, this approach has led to a good clinical outcome in a disease that does not usually allow such results.

Pembrolizumab reactivates pulmonary granulomatosis.

Sarcoid like reaction is a well-known entity that occurs as a consequence to several malignancies or their therapies. Immunotherapy has gained a lot of interest in the past few years and has recently gained approval as first line therapy in multiple advanced stage malignancies. Pneumonitis has been described as complication of such therapy. Granulomatous inflammation has been only rarely reported subsequent to immunotherapy. We describe a case of granulomatous inflammation reactivation affecting the lungs in a patient previously exposed to Pembrolizumab and have evidence of a distant granulomatous infection. We discuss potential mechanisms of the inflammation and assert the importance of immunosuppression in controlling the dis-inhibited immune system.