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Paroxysmal sympathetic hyperactivity (PSH) is a hyperadrenergic syndrome that may follow acute brain injury. Although it is relatively a common complication following acute traumatic brain injury but not commonly seen in non-traumatic brain injury cases. It is presumed to be caused by loss of cortical inhibitory modulation of diencephalic and brain stem centres and possible additional maladaptive changes in the spinal cord that combine to produce exaggerated sympathetic responses to stimulation. Failure to timely diagnose PSH lead to worse neurologic outcomes, prolong hospital stays, more complications and delayed recovery. Here we are reporting a case of Paroxysmal sympathetic hyperactivity following non-traumatic brain injury secondary to stroke. With early recognition and prompt intervention he showed good recovery and shortened hospital stay.

Background Competency-based medical education has renewed focus on the attainment and evaluation of resident skill. Proper evaluation is crucial to inform educational interventions and identify residents in need of increased training and supervision. Currently, there is a paucity of studies rigorously evaluating resident chest tube insertion skill. Materials and methods Residents of all training levels before their intensive care unit rotation or currently rotating through the intensive care unit were invited to participate. Trainees inserted a thoracostomy tube on a high-fidelity simulator. Their performances were recorded and scored by blinded raters using the validated TUBE-iCOMPT rubric. Surgical and nonsurgical residents were compared. Results Forty-nine residents participated; 30 from nonsurgical and 19 from surgical training programs. Overall, trainees were most deficient in the “preprocedural checks” and “patient positioning and local anesthetic” domains. Surgical trainees demonstrated higher chest tube insertion skill than their nonsurgical peers (median total score 88 [interquartile range, 74-90] versus 75 [interquartile range, 66-85], respectively, P = 0.01), particularly in the “patient positioning” and “blunt dissection” domains (P = 0.01 and P = 0.03, respectively). These differences were no longer significant when controlled for experience and Advanced Trauma Life Support certification. Conclusions Overall, surgical residents were more skilled than nonsurgical residents in tube thoracostomy placement. Relative skill deficits within the domains of chest tube insertion have also been identified among residents of different specialties. These areas can be targeted with educational interventions to improve resident performance, and ultimately, patient safety.

Pulmonary hypertension (PH) is a hemodynamic state defined by a resting mean pulmonary artery pressure (PAP) at or above 25 mm Hg.[1] with normal left ventricular filling pressure (mean pulmonary wedge pressure) 15 mmHg or less. Pre-capillary PH is defined as mean PAP ≥25 mm Hg in association with PAOP ≤15 mm Hg and a pulmonary vascular resistance (PVR) >3 Wood units. This include group 1, 3, 4 and 5 (Table 1). [2] Post-capillary PH (group 2 as shown in Table 1) is characterized by a mean PAP ≥25 mm Hg in association with PAOP >15 mm Hg and PVR ≤3 Wood units.[3] This differen‐ tiation in preand post-capillary PH is important as it narrows the differential diagnosis and also has treatment implications.

BACKGROUND Percutaneous mitral valvuloplasty (PMV) is a well known non-surgical technique for treating patients with rheumatic mitral stenosis (MS). There are very few studies that have compared the 3 techniques together for their safety and efficacy.To compare the three different techniques for percutaneous mitral valvuloplasty (PMV) using Inoue balloon (IB), metallic commissurotome (PMMC), or multi-track double balloon (MTDB) in patients with MS.A total of 486 patients were subjected to PMV using any of the 3 techniques, IB, PMMC or MTDB. The overall success rate was 97.3% (n = 473); 95.7% for IB, 97.6% for PMMC, and 98.3% for MTDB. Overall, the transmitral gradient decreased from 20.7 +/- 7.2 mmHg to 6.5 +/- 3.7 mmHg (p0.001) and mitral valve area (MVA) increased from 0.87 +/- 0.2 cm(2) to 1.9 +/- 0.4 cm(2) (p0.001). Left atrial pressure decreased from 29.3 +/- 8.4 mmHg to 16.1 +/- 11.5 mmHg (p0.001) and pulmonary arterial pressure decreased from 76.9 +/- 41.8 mmHg to 45.2 +/- 17.6 mmHg (p0.001). Thirteen patients (2.7%) required mitral valve replacement (MVR) for severe mitral regurgitation (MR) while one patient (0.2%) developed cardiac tamponade requiring urgent pericardiocentesis followed by surgical repair of the tear and open mitral valvotomy. There was no statistical difference among the 3 techniques used.In conclusion, percutaneous mitral valvuloplasty is an effective procedure for MS with any of the three above techniques.