Background The American Association for the Study of Liver Diseases recommends that N-acetylcysteine (NAC) may be beneficial in non-acetaminophen-related drug-induced liver injury. A subsequent review and analysis reported the current evidence to be inconclusive. Herein, we present an updated review and meta-analysis. Methods We evaluated prospective, retrospective and randomized controlled trials that compared outcomes in patients of all ages with acute liver failure (defined as abnormal liver enzymes along with elevated international normalized ratio >1.5, with or without hepatic encephalopathy) receiving NAC with the outcomes in a control group. The primary outcome was to compare the overall survival in the 2 groups. Secondary outcomes included difference in length of hospital stay, transplant-free survival, and post-transplant survival. Results Seven studies (N=883) that met the inclusion criteria were included in this analysis. The mean age of patients in the NAC group was 21.22 years compared with 23.62 years in the control group. The odds of overall survival were significantly higher in the NAC group than in controls (odds ratio [OR] 1.77, 95% confidence interval [CI] 1.3-2.41). Post-transplant survival (OR 2.44, 95%CI 1.11-5.37) and transplant-free survival were also better in the NAC group than in the control group (OR 2.85, 95%CI 2.11-3.85). Patients in the control group had statistically significant odds of a longer inpatient stay (mean difference 7.79, 95%CI 6.93-8.66). Conclusion In patients with non-acetaminophen-related acute liver failure, NAC significantly improves overall survival, post-transplant survival and transplant-free survival while decreasing the overall length of hospital stay.

Background: Hyperbaric oxygen therapy (HBOT) has been applied in the treatment of cerebral vascular diseases since the 1960s.

Background COVID-19 infection has become a pandemic and a global health issue since its origin in Wuhan, China in December 2019. The present systematic review and meta-analysis aim to assess hematological changes seen in COVID-19 infection and their association with the severity of the disease. Methods Pooled proportions were calculated using both fixed effects model and random effects model. Weighted mean difference and 95% CI were calculated and reported. Results Initial search identified 84 reference articles, 23 relevant articles were selected and reviewed. Compared to general population, the weighted mean difference of WBC count in all COVID-19 patients was lower by 0.97 × 10 9 mm 3 (95% CI = –1.29 to –0.66). In severe COVID-19 patients, the weighted mean difference of platelet count was lower by 23.85 × 10 9 /liter (95% CI = –35.18 to –9.53), as compared to general population. The weighted mean difference of prothrombin time, D-Dimer, and fibrinogen in severe COVID-19 patients was higher by 1.92 seconds (95% CI = 0.01 to 3.84), 6.23 mg/liter (95% CI = 0.11 to 12.36) and 1.88 g/liter (95% CI = 1.18 to 2.48) respectively, as compared to general population. Pooled proportion showed D-Dimer to be elevated in 80.00% (95 % CI = 50.00 to 99.00) of severe patients. Conclusions Our meta-analysis shows that patients with COVID-19 have significant thrombocytopenia, leukopenia along with elevated D-dimer, fibrinogen and prothrombin time. These laboratory findings are marked in severe COVID–19 infections and could be helpful in early recognition of severe infection.

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Objective:To compare the change in interviewers’ perception of Multiple Mini Interviews (MMI) after MMI training and after actual MMI experience.Methods:Six sessions were conducted during two weeks (October 26, 2015- to November 6, 2015) to a total of 87 faculty members. The evaluation dealt with 13 items questionnaire for representation of assessors’ perception on 5 point rating scale. Assessors rated their perceptions to complete an anonymised questionnaire about rationale behind MMI, the process of MMI, and the use of scoring criteria (rubrics). In addition, assessors were also asked to rate their level of satisfaction on MMI process after training and after interviews. Wilcoxon Signed Ranks Test (two-tailed) was used to compare participant’s pre- and post-interview ratings.Results:With 81.6% response rate, the positive views of assessors about the MMI selection process and the use of scoring criteria (Rubric) to assess the candidate are not altered after experiencing a MMI selection day (p> 0.001). Assessors (87%) would prefer to be involved in the process of MMI in future.Conclusion:The outstanding consistency of assessors’ ratings before and after interview concluded that MMI training sessions were helpful in improving knowledge and skills about MMI process and candidates’ assessment criteria (rubrics).

Surgical field fire is a very rare intraoperative complication and has potentially serious consequences. Cases of surgical field fire have been reported in literature. Usually, surgical field fire involves airway, but it can also occur in surgical field. We, hereby report a case of surgical field fire while operating on a 4-week baby for jejunal atresia. In this case report, we review causes and preventive measures for surgical field fire.

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