Hyperleukocytosis is defined as WBC >100,000/mL and seen in up to 20% of acute myelogenous leukemia (AML).1 However, clinical signs of leukostasis and/or leukemic infiltration develop in 30-40% patients even at lower WBC counts with acute respiratory failure being a major cause for early mortality.3,5 CASE PRESENTATION: An 86-year-old woman, recently diagnosed with AML three-weeks ago not yet started on chemotherapy, and deep venous thrombosis (DVT) on anticoagulation, was admitted with dyspnea. On exam, she had diminished breath sounds, crackles in the right base, and right lower extremity edema. Initial leukocyte count was 25,000/mL with monocytic predominance. She was tachycardic and tachypneic but breathing comfortably on room air. A venous blood gas (VBG) showed pH 7.41, pCO2 38 mmHg and lactate 2.5 mmol/L. Chest radiograph showed bilateral patchy opacities. CT Angiogram was unremarkable for pulmonary embolism (PE). Duplex US was unrevealing for DVT. At 20-hours after admission, she had progressively altered mentation, increased work of breathing at 30-40 breaths/minute and hypoxia requiring supplemental oxygen. VBG showed pH 7.36, pCO2 37 mmHg and lactate 6.1 mmol/L. Leukocyte count increased to 55,000/mL. At 28-hours, respiratory support was escalated to BiPAP and VBG showed pH 7.10, pCO2 47 mmHg, and lactate of 9.7 mmol/L. Leukocyte count increased to 72,000/mL. While planning for emergent leukapheresis, the patient suffered a respiratory arrest and died despite full resuscitative efforts. Autopsy examination showed extensive infiltration by leukemic monocytic cells in the lungs, heart and brain. Notably, the lungs had a pale white-pink pallor and intraluminal material showed congestion in larger pulmonary vessels and infiltration within the alveolar by atypical hematolymphoid cells.

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Background: Live lectures are commonly used in medical education, yet many students prefer video lectures instead. As different learning modalities may affect knowledge, it was necessary to explore medical students' perspectives about the two learning modalities in Pakistan. Objectives: This study aimed to explore and compare the medical students' perspectives regarding live lectures and video lectures. Methods: This cross-sectional study used an online questionnaire. This was distributed to medical students via internet platforms after institutional approval. Data were analyzed with SPSS version 23 using descriptive statistics. Results: 585 students, from 11 medical colleges across six cities of Pakistan, were enrolled. 64.4% (n=377) of the students were females, while 34.0% (n=199) were males. The first years comprised 32.7% (n=191), second years, 29.2% (n=171), and third years, 38.1% (n=223) of the total. The commonest reason for attending live lectures was 'they are compulsory'. The commonest reason for not attending was 'poor teaching quality'. 5.0% (n=29) of 585 students reported live lectures and 51.8% (n=290 of 560) found video lectures to be 'very helpful' in concept clarification. 85.1% (n=258) of 303 students found video lectures more effective for learning. For 45.4% (n=254) of students, video lectures improved their grades a lot; more students used video lectures for exam preparation over the years. 50.6% (n=296) of students wanted video lectures to be compulsory, compared with 28.5% (n=167) for live lectures. The main improvement in live lectures was not using slides. Conclusion: Medical students in Pakistan prefer video lectures over live lectures for learning and exam preparation. More students wanted video lectures to be compulsory in medical education. Several improvements have been suggested for live lectures.

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