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Bell’s palsy is a rapid unilateral peripheral paralysis of cranial nerve VII whose etiology is varied, most commonly associated with an acute infectious or inflammatory demyelinating process. Nerve injury can result in edema because of increased permeability of vascular structures, which can sometimes be seen as a locus of enhancement of magnetic resonance imaging (MRI). Bell’s palsy is typically considered a clinical diagnosis and the specificity and sensitivity of imaging have been poorly studied. Herein is describe a case of a 73-year-old male who presented to the emergency department with left-sided facial droop and no other focal neurological abnormalities. With a history of a Janus kinase 2 (JAK2) mutation and the new initial facial drooping, acute cerebrovascular insult was high on the differential. Initial labs and computerized tomography (CT) head were inconclusive, but MRI showed pronounced enhancement of the left distal internal carotid artery (ICA) with contiguous enhancement of the labyrinthine, geniculate, and tympanic segments of the left facial nerve. Diagnosing Bell’s palsy can be a challenge as there are numerous postulated etiologies stemming from trauma, infection, and neoplasm; with infection (particularly viral) postulated to be the most likely source. Though MRI is currently not validated as a tool in expediting Bell’s palsy diagnosis, findings such as the enhancement seen here provide some insight into the benefit of MRI as a diagnostic modality in some cases. This case is unique both for the diagnostic dilemma between stroke and Bell’s palsy and the potential for MRI imaging to help guide clinical decision-making into treatment.

Purpose – The purpose of this paper is to create a “go-to-guide” of best practices in the creation of asynchronous courses. Due to the global pandemic, millions of students around the world transitioned from in-class instruction to online programs, which ranged from completely synchronous classrooms to completely asynchronous classrooms. Students were forced to learn how to engage within an online classroom environment with minimal notice and instructors were abruptly thrusted into a different operational environment, with many required to construct educational ecosystems in an unfamiliar and digitized interface. This led to several actions and the utilization of a multitude of different teaching techniques, many of which were poorly implemented. Design/methodology/approach – Key words, “Asynchronous learning”, “Learning”, “Feedback”, “Online Instruction”, and “Classroom Design” were searched in online data bases (Google Scholar, PubMed, EBSCO and Data Base of Open Access Journals). These then were read by the authorial team and authoritative papers were selected by the team based on the frequency of utilization by other papers in the field and the utility of these papers for the design of asynchronous courses. Findings – This paper explores asynchronous learning from the perspective of how instructional science and learning science can be applied to create the best classroom for both pupil and instructor. Originality/value – It looks to provide a go-to-guide for best practices in asynchronous learning and the development of K-12 classrooms, graduate and medical school classrooms and finally continuous medical education classrooms. Finally, this guide looks to facilitate the development of master instructors through statements on how to properly provide feedback to students.

Purpose: The purpose of this paper is to create a "go-to-guide" of best practices in the creation of asynchronous courses. Due to the global pandemic, millions of students around the world transitioned from in-class instruction to online programs, which ranged from completely synchronous classrooms to completely asynchronous classrooms. Students were forced to learn how to engage within an online classroom environment with minimal notice and instructors were abruptly thrusted into a different operational environment, with many required to construct educational ecosystems in an unfamiliar and digitized interface. This led to several actions and the utilization of a multitude of different teaching techniques, many of which were poorly implemented. Design/methodology/approach: Key words, "Asynchronous learning", "Learning", "Feedback", "Online Instruction", and "Classroom Design" were searched in online data bases (Google Scholar, PubMed, EBSCO and Data Base of Open Access Journals). These then were read by the authorial team and authoritative papers were selected by the team based on the frequency of utilization by other papers in the field and the utility of these papers for the design of asynchronous courses. Findings: This paper explores asynchronous learning from the perspective of how instructional science and learning science can be applied to create the best classroom for both pupil and instructor. Originality/value: It looks to provide a go-to-guide for best practices in asynchronous learning and the development of K-12 classrooms, graduate and medical school classrooms and finally continuous medical education classrooms. Finally, this guide looks to facilitate the development of master instructors through statements on how to properly provide feedback to students.

Objective: To study the outcomes of noninvasive ventilation (NIV) administered through a tabletop device for coronavirus disease 2019 acute respiratory distress syndrome in the respiratory intermediate care unit (RIMCU) at a tertiary care hospital in India. Patients and Methods: We retrospectively studied a cohort of hospitalized patients deteriorating despite low-flow oxygen support who received protocolized management with positive airway pressure using a tabletop NIV device in the RIMCU as a step-up rescue therapy from July 30, 2020 to November 14, 2020. Treatment was commenced on the continuous positive airway pressure mode up to a pressure of 10 cm of H2O, and if required, inspiratory pressures were added using the bilevel positive air pressure mode. Success was defined as weaning from NIV and stepping down to the ward, and failure was defined as escalation to the intensive care unit, the need for intubation, or death. Results: In total, 246 patients were treated in the RIMCU during the study period. Of these, 168 received respiratory support via a tabletop NIV device as a step-up rescue therapy. Their mean age was 54 years, and 83% were men. Diabetes mellitus (78%) and hypertension (44%) were the commonest comorbidities. Treatment was successful with tabletop NIV in 77% (129/168) of the patients; of them, 41% (69/168) received treatment with continuous positive airway pressure alone and 36% (60/168) received additional increased inspiratory pressure via the bilevel positive air pressure mode. Conclusion: Respiratory support using the tabletop NIV device was an effective and economical treatment for coronavirus disease 2019 acute respiratory distress syndrome. Further studies are required to assess the appropriate time of initiation for maximal benefits and judicious utilization of resources.

Cystic fibrosis (CF) is a life-limiting genetic condition with multisystemic manifestations. However, there are vast phenotypic as well as genotypic variations. This contributes to delay in diagnosis, especially in pancreatic-sufficient patients who may not manifest typical symptomatology. The last decade has witnessed significant breakthroughs in CF therapeutics. This in combination with early diagnosis through newborn screening, and aggressive supportive care can offer near-normal life expectancy for a majority of patients with CF (pwCF) worldwide. Even while addressing disparities in CF care around the world, it is crucial to train medical professionals to suspect and diagnose CF in children as well as in adults. Here, we share our experience of pwCF diagnosed beyond 16 years of age with an aim to highlight the clinical presentations in young adults, the need for screening family members of a newly diagnosed pwCF, and the negative effects of late diagnosis of CF.