BACKGROUND Research has shown that more than 50% of patients have insufficient postoperative pain relief despite the use of multiple pain management modalities. Insufficient pain relief leads to several pathophysiological effects. One of the barriers to optimal pain relief is patient's lack of knowledge regarding the options available for pain management and their potential side effects. In this survey, we evaluated surgical patients' knowledge about postoperative pain and its management in patients undergoing major upper abdominal surgeries at a tertiary care hospital. METHODS AND MATERIAL This was a cross-sectional survey. A total of 155 patients (18-60 years of age) scheduled to undergo elective major upper abdominal surgery were included after ethical approval and informed consent. Preoperatively, patients were interviewed through a questionnaire regarding knowledge about postoperative pain and its management. RESULTS The average age of the patients was 42.97 ± 13.05 years. Excellent and good knowledge were observed in 11.61% and 21.94% patients, respectively, whereas fair and poor knowledge were seen in 42.58% and 23.87%, respectively. Inadequate knowledge was more marked regarding analgesic side effects and addiction risk. Education level, history of surgery, and adequate information provision about pain management plan by surgeons preoperatively were significantly associated with a higher level of knowledge about pain and its management (p-value 0.0005, 0.002, and 0.0005, respectively). CONCLUSION A considerable proportion of patients have inadequate knowledge about their postoperative pain and its management, particularly in areas of side effects and addiction risk. Copyright © 2020, Nasir et al.Perforation of a gastrointestinal tract as a complication of intubation is unusual, and only few cases have been reported. Prompt recognition and management of gastrointestinal tract perforation are needed to limit the morbidity and mortality of this condition. We presented a case of an acutely ill patient who developed gastric perforation following difficult intubation to remind clinicians of a life-threatening complication that can develop following a life-saving procedure. Copyright © 2020, Suwanwongse et al.Diaphragmatic hernias (DH) may be congenital or acquired in origin. Those causing obstructive jaundice in the elderly are extremely rare but can occur. These patients may present with painless jaundice, early satiety, and weight loss due to biliary tract obstruction and stomach compression by the hernia. Therefore, clinicians should consider an anatomic anomaly when evaluating patients with jaundice.  https://www.selleckchem.com/products/vvd-214.html  Here, we report the case of a 71-year-old female, with a medical history of hypertension and chronic obstructive pulmonary disease, who presented with jaundice. The patient was found to have dilation of the common bile duct due to external mechanical compression of abdominal organs from a DH. Because the patient had poor functional status and multiple comorbidities, the risks of surgically correcting the hernia outweighed the benefits. The patient instead received a biliary decompression and stent, and her jaundice significantly improved. Copyright © 2020, Hoang et al.Introduction Due to conflicting data in the literature, there is a continuing debate on whether advanced hypopharyngeal carcinoma patients should be treated with definitive surgery or chemoradiotherapy. The purpose of this study is to evaluate the management and outcomes of advanced hypopharyngeal carcinoma in a tertiary care institution over the last 25 years. Methods An Institutional Review Board (IRB)-approved and HIPPA-compliant retrospective analysis was performed of patients with advanced-stage squamous cell carcinoma of the hypopharynx treated at our institution between January 1994 and December 2018. Data regarding demographics, stage, treatment, and follow-up were collected. Outcomes including median survival and overall survival were calculated using the Kaplan Meier method. All analyses were performed using SPSS v. 24.  Results This study included a total of 103 advanced stage hypopharyngeal cancer patients. The median age for this cohort is 61 years (range 41-88, SD 9.3). Of the total 103 eligible 41.5% vs 18.5%, p = 0.049) and disease-free survival (DFS; 75.3% vs 56%; p = 0.029) were significantly better for patients in the surgery group compared to the chemoradiotherapy group. On multivariate Cox-regression analysis, lymph nodal status (HR = 1.27, CI 1.00-1.62, p = 0.047) and chemoradiation treatment (HR = 1.82, CI 1.00-3.29, p = 0.048) were associated with higher risk of mortality.  Conclusion In our single institutional experience of advanced hypopharyngeal carcinoma management, the five-year overall survival rate was found to be 25.5 % and was the poorest among head and neck cancers. The patients with advanced hypopharyngeal cancer treated with surgery followed by adjuvant radiation or chemoradiation have significantly improved overall survival compared to those treated with definitive chemoradiotherapy. Further research warranted for early detection and better treatment to improve the cure rate in hypopharyngeal carcinoma patients. Copyright © 2020, Vengaloor Thomas et al.Hyperammonemia is a common cause of encephalopathy encountered in an intensive care unit (ICU). Absence of pre-existing liver disease may misguide a clinician and cases of non-cirrhotic hyperammonemia may be missed in ICU leading to life-threatening outcomes such as cerebral edema and herniation. A critical care physician must look beyond liver cirrhosis as a cause of hyperammonemia so that infrequent but potentially reversible causes of encephalopathy are not missed, and patient treatment is not jeopardized. Copyright © 2020, Sharma et al.Pericardiocentesis is a procedure performed to aspirate fluid from the pericardial space. It is most often performed as an acute therapeutic procedure in cases of massive pericardial effusion or pericardial tamponade. Our case describes an unusual complication of pericardiocentesis leading to hemorrhagic pericardial effusion and hemodynamic compromise. Copyright © 2020, Nair et al.