Pulmonary mucormycosis (PM) is a rare, life‐threatening fungal infection usually affecting immunocompromised patients. Its incidence is rising, with a recent outbreak associated with COVID‐19 co‐infection. Amphotericin B along with early surgery are considered the standard treatment. Recurrence has been reported in patients without adequate treatment and without permanent reversal of predisposing factors. We report a case of late recurrence of PM in a renal transplant recipient. In 2012, he was diagnosed with PM. Imaging at the time showed a lingular mass. He was treated with antifungal for 1 year until complete radiological resolution. Surgical intervention was considered but no further follow‐up action was taken. In 2020, he presented with fever and haemoptysis. Imaging again showed a lingular mass, which was confirmed to be PM by bronchoscopic lung biopsy. This case highlights the importance of secondary antifungal prophylaxis for PM if permanent reversal of immunosuppression is not possible.

Melioidosis is a rare but often fatal tropical infection caused by gram-negative bacteria Burkholderia pseudomallei. It most commonly manifests as pneumonia and rarely presents as pericarditis. Melioidosis can be difficult to diagnose because of its diverse clinical manifestation and close resemblance to bacteria of the genus Pseudomonas. We report a rare case of melioidosis presenting as pericarditis and pneumonia in a 61-year-old male patient with poorly controlled diabetes mellitus. He was initially misdiagnosed with Pseudomonas aeruginosa infection and later treated empirically as tuberculosis pericarditis for 2 months, before reaching the diagnosis of melioidosis.

Background In early 2022, there was a sudden surge of patients infected by the Omicron variant of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in Hong Kong (HK), resulting in 9,163 deaths as of 29 May 2022. Many of the local population had not been vaccinated before this wave. The number of patients who developed coronavirus disease 2019 (COVID-19) related respiratory failure outnumbered the capacity of intensive care unit (ICU) beds. Some of these patients had to be supported with high flow nasal cannula (HFNC) therapy outside ICU setting. HK was in crisis situation. The primary objective of this study is to assess the 28-day mortality of this group of patients. The secondary objective is to explore any predictors of non-survivors to help clinical decision-making in future crisis. Methods This is a retrospective observational study of patients suffering from COVID-19 related respiratory failure who received HFNC therapy in general medical wards of two hospitals during the period of 17 Mar to 30 Apr 2022. Survival and risk factors were reviewed. Results Forty-nine patients were recruited. Twenty-six patients (53%) survived at 28-day after initiation of HFNC support. Three clinical parameters were found to be significantly associated with mortality at 28-day: (I) SpO 2 /FiO 2 (SF) ratio <160 at 48 hours; (II) SF ratio <191 at 72 hours; (III) serial SF ratio at 48 or 72 hours showing no improvement over that at the time of initiation of HFNC therapy. Conclusions Use of HFNC outside ICU setting showed benefit to patients suffering from COVID-19 related acute hypoxemic respiratory failure (AHRF). Serial SF ratio monitoring at 48 and 72 hours after therapy initiation might serve as predictors of outcome and thus guide clinical decision-making for medical resource allocation in outbreak situation.

Background: With the advent of the COVID-19 pandemic medical residency training programs and other educational activities faced tremendous disruptions worldwide. It is important to provide continuity of teaching and learning as well as timely assessments so that certification for practice is not delayed for the benefit of the trainee. The conventional examination pattern involves clinical case presentations requiring face to face resident, assessor and patient interaction which increases the risk of transmission of infection. In addition external assessors were reluctant to travel due to the risk of exposure or due to covid induced lockdown. We were therefore forced to conduct an online examination in the virtual mode. Despite the use of this mode all around the globe, questions have been raised regarding the validity and reliability of the online mode as well as student and faculty satisfaction. Educational institutions suffered hiccups while going online. The availability of devices or lack of connectivity could put students at a disadvantage. Though online examination cannot replace the traditional assessment systems in clinical subjects many challenges can be met by careful planning and training of the faculty as well as students. Aim: In this study, we tried to evaluate the student and faculty satisfaction with the online mode through a confidential questionnaire about PG practical examination in Obstetrics and Gynecology in our institution in June 2020 during the COVID pandemic. Material and Methods: At the end of the online P.G examination, a questionnaire consisting of responses on a Likert scale and some open-ended questions were given to the students and the faculty members to assess the effectiveness, satisfaction, advantages, and challenges faced while conducting online PG practical examination.Results: Practical examination was conducted in the virtual online mode on 18 postgraduate students by 04 examiners(2 internal and 2 external). All postgraduate students and all examiners expressed satisfaction with a virtual mode of online system of examination.A few short duration of interruptions due to internet connectivity issues was challenging.Conclusions: Meticulous planning, prior student orientation and good internet connectivity for a virtual video conferencing platform appears to be an optimal alternative during the COVID pandemic for conducting online examinations.

Immune-mediated necrotising myopathy is a rare disorder characterised by muscle necrosis, fatigue, and weakness. We report one such case with symptom onset more than 3 years after regular statin use. This report serves as a diagnostic alert when a patient's statin-associated muscle symptoms fail to resolve a few weeks after statin discontinuation.