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Adult croup is a distinct disease entity that probably represents a heterogeneous clinical syndrome. Three cases of adult laryngotracheitis characterized by upper airway infection and progression to airway obstruction are illustrated. Close observation and prompt decisions regarding airway intervention are critical in effective management, and complete resolution is expected.

Research suggests that an 8-week Mindfulness-Based Stress Reduction (MBSR) program (a structured form of meditation) might be effective in the treatment of various health problems including chronic pain. Our objective was to compare the clinical effectiveness of the MBSR program with a multidisciplinary pain intervention (MPI) program in terms of pain intensity, pain-related distress, quality of life, and mood in patients with chronic pain.A randomized, comparative clinical trial was conducted, including 6-month posttreatment follow-up. Ninety-nine participants, aged 24 to 64 years, with pain for a minimum of 3 months, were recruited from community-based clinics, hospitals, and community service centers. Participants were randomly allocated to either the MBSR program (51 participants) or a MPI program (48 participants). The study used validated Chinese versions of self-reported questionnaires measuring pain, mood symptoms, and health-related quality of life.Thirty-nine participants (77%) completed the MBSR program and 44 (90%) completed the MPI program. Patients in both the groups were comparable with regard to demographical characteristics, pain intensity, mood symptoms, and health-related quality-of-life measures before intervention. In both the groups, patients who completed the trial demonstrated statistically significant improvements in pain intensity and pain-related distress. However, no statistically significant differences were observed in overall results between the MBSR and MPI groups.This randomized, clinical trial showed that both MBSR and MPI programs reduced pain intensity and pain-related distress although no statistically significant differences were observed between the 2 groups and the improvements were small.

Pulmonary arteriovenous malformation (PAVM) during pregnancy is a rare condition. There were 34 cases reported in the literature of which three were fatal. The major cause of death was pulmonary hemorrhage. Physiological changes during pregnancy can worsen PAVM and can increase its risk of hemorrhage. The mechanism can be twofold. High estrogen and progesterone levels during pregnancy lead to venous distensibility and hence trigger the growth of PAVM whereas the increase in blood volume and cardiac output could raise the pulmonary blood flow and could cause dilatation and rupture of the thin-walled vessels. This explains that the majority of the hemorrhage occurs during the second and third trimesters when blood volume and cardiac output increased to their maximum. We describe a case of hemothorax as a result of ruptured PAVM and discuss its management during pregnancy. (excerpt)

Summary Aim To describe a course designed to help medical undergraduates develop the necessary competencies to recognise and manage acutely ill patients. Materials and methods Primary description by the authors of the content, development and implementation of a course designed to teach competencies recommended by the Acute Care Undergraduate Teaching (ACUTE) project of the Resuscitation Council (UK) and Intercollegiate Board of Training in Intensive Care Medicine. The course format was designed to balance best teaching methods within the context of limited available teaching time and resources. Various components of the course were rated by 155 final year medical students who attended the course. Results A one and a half day integrated acute care course based on self-learning (course manual, CD-ROM, web material), lectures, interactive tutorials, skill stations and formative and summative assessment is described. The course addresses 55/71 (77%) of competencies considered important by the ACUTE project. It was well accepted by medical students and on a scale of 1 (poor) to 5 (excellent) median student ratings of various components of the course ranged from 4–5. Conclusion The course offers a method of teaching acute care for medical undergraduates in an educationally sound, resource-efficient manner.