Fat Embolization Syndrome Secondary to Steroid Treatment in a Case of Sickle Cell Vaso-Occlusive Crisis.

Fat embolization syndrome (FES) is often seen as a complication of fractures and has been known to cause respiratory failure, rashes of the skin, thrombocytopenia, and neurological damage. Nontraumatic FES is uncommon and occurs due to bone marrow necrosis. Vaso-occlusive crisis in sickle cell patients secondary to steroid therapy is a rare entity and not widely acknowledged. We report a case of FES secondary to steroid therapy administered for a patient with intractable migraine. FES is an uncommon yet serious complication that occurs due to bone marrow necrosis and is usually associated with increased mortality or damaging neurologic sequelae for the surviving patient. Our patient was initially admitted for intractable migraine and worked up to rule out any acute emergency conditions. She was then given steroids for her migraine which did not subside with the initial treatment. Her condition worsened, and she developed respiratory failure along with altered mental status requiring care in the intensive care unit (ICU). Imaging studies showed microhemorrhages throughout the cerebral hemispheres, brainstem, and cerebellum. The imaging of her lungs confirmed severe acute chest syndrome. The patient also had hepatocellular and renal injuries indicative of multiorgan failure. The patient was treated with a red cell exchange transfusion (RBCx) leading to an almost complete recovery in a few days. The patient, however, had residual neurological sequelae with the presence of numb chin syndrome (NCS). This report thus highlights the need to recognize potential multiorgan failure secondary to steroid treatment and the importance of initiating treatment with red cell exchange transfusions to decrease the risk of such complications secondary to steroids.

Virtual Interviews: A Cross-Sectional Quality Improvement Project Aimed to Improve the Interview Process in an Internal Medicine Residency Program.

BACKGROUND: The residency interview is a crucial step that helps the program identify potential new trainees while the trainees find out more about the program. With the onset of the COVID-19 pandemic, it became essential to hold interviews virtually. OBJECTIVE: Here, we conducted a questionnaire-based study to identify areas of improvement in the virtual interview process in our program. METHODS: The study was conducted among the residency interview applicants of the 2022 match cycle. A questionnaire was sent via email to all applicants who were invited to our residency program for an interview. Out of the 600 applicants who were interviewed in our program, 230 applicants answered the survey, an 11-point questionnaire pertaining to the various aspects of the interview process. RESULTS:  A virtual interview with an option of in-person is the most favored answer among the different groups, i.e., American Medical Graduates (AMGs), International Medical Graduates (IMGs) without need for a visa, and IMGs with a need for a visa, respectively, were, 37.5%, 42.8%, and 38.65%, respectively. An updated website with all required information was a top resource used by 95%, 84.5%, and 89.6% of the different groups of candidates. American medical graduates (32.50%) place high importance on resident interaction, while international medical graduates want the programs to focus on their website and provide more information about all aspects of the program during the virtual interview. CONCLUSIONS: In the post-COVID-19 era, Internal Medicine programs will need to improve several aspects of virtual interviews while assessing what is important to candidates.

Cystic Glioblastoma: A Mimicker of Infection? A Case Report and Literature Review.

Glioblastoma multiforme (GBM) is the most frequent malignant and aggressive type of glioma. Most cases of GBM present as a single solitary solid tumor; however, there are rare instances in which it may present as a cystic lesion. Here, we report an even rarer case of GBM presenting as bilateral multicystic lesions, mimicking infectious etiology. Our case highlights the importance of identifying clinical features of cystic GBM to ensure early diagnosis and treatment. A literature review was conducted in PubMed, looking at the common characteristics and treatment options for cystic GBM.

Back pain: An unusual manifestation of acute lymphoblastic leukemia - A case report and review of literature.

Acute lymphoblastic leukemia (ALL) presented with bone pain and leukopenia is a well-recognized complex. Bone and joint pain are seen as presenting symptoms in 25% of patients with acute leukemia, but generalized osteopenia and vertebral complications are less common. Back pain due to vertebral changes as an early feature has been infrequently reported. We report a case of a 9-year-old female child who presented with back pain for 3 weeks. Blood counts and peripheral smear were normal. X-ray of the spine showed wedge-shaped deformity in L3-L5 vertebrae. Magnetic resonance imaging of the spine confirmed the lytic lesions of L3-L5 vertebrae. Infective etiological evaluation was normal. Bone marrow aspiration revealed pre-B-cell lymphoblastic leukemia. She was started on ALL protocol and pain subsided within a week, and remodeling of the bony lesions could be seen 2 months later. This case highlights that spinal involvement may be a presenting feature despite normal peripheral blood counts.

A prospective study on the attitude of post graduates in general pediatrics toward pediatric oncology subspeciality as a career.

OBJECTIVES: The health care scenario in India is experiencing an increase in the number of children affected with cancer and the number of pediatric oncologists available to treat these children are few and the awareness of childhood cancer is decimally low. Hence, the purpose of this study was to determine the attitude of post-graduate students of general pediatrics towards childhood cancer and to assess their interest in pursuing pediatric oncology as a specialty in their carrier. MATERIALS AND METHODS: The study was conducted among 188 post-graduates hailing from various Medical colleges all over South India who were attending a 2 day workshop at Chennai. The survey was a 10 point questionnaire pertaining to their previous training, competence, interest toward the field of hematooncology. The data were analyzed by SPSS 18.V software. RESULTS: Among the post-graduates, 74.7% of them reported that they did not have a pediatric oncology unit in their institution. 63.3% reported that they never been posted in pediatric oncology clinical postings before. 62% were not interested in pursuing pediatric oncology as a sub-specialty at all. 45.3% felt that pediatric oncology was too depressing to take as a specialty. 46.7% felt that late diagnosis and referral was the main factor which contributed to the failure of effective treatment of childhood cancers. 52.7% had never attended a class on pediatric oncology. 61.3% felt that they did not have sufficient knowledge to suspect and refer a child with cancer. 92% felt that there was a need to improve pediatric oncology teaching in their curriculum. 56.7% felt that the best way to imprint awareness on childhood malignancies was to improve pediatric oncology teaching in their medical curriculum. CONCLUSION: The results show that majority of post-graduates in pediatrics were not interested in pursuing pediatric oncology as a sub-specialty. The main reasons may be lack of specialized Pediatric oncology units in the majority of the medical institutions, lack of opportunity of these post-graduates to attend clinical postings and theory classes. They thus lack sufficient information in this field and hence do not want to take up a career in pediatric oncology.

The need of pediatric palliative care education among pediatric postgraduates in South India.

OBJECTIVES: To assess the status of Pediatric Palliative care education among the pediatric postgraduates in South India and reinforce the need to introduce a targeted curriculum to improve their skills and confidence levels in handling terminally ill children. METHODS: The study was conducted in a 2 d workshop attended by 180 pediatric postgraduates from South India. An 18 point questionnaire was given to the participants and the questions were to test their clinical knowledge and confidence levels in treating terminally ill children. SPSS 18.V software was used for statistical analysis. RESULTS: Eighty eight percent of the postgraduates had never received any training in any aspect of palliative care. 77.3 % felt uncomfortable in initiating a discussion about palliative care with the family members. 60.7 % were not comfortable with the care of the dying patient. 87.3 % strongly supported that a formal training in palliative care would improve their competence in this field. CONCLUSIONS: There is a huge lacunae in the delivery of palliative care services and hence an urgent need to inculcate targeted curriculum to provide focused skills and training for the pediatric postgraduates.