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Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with increased morbidity and mortality. We retrospectively analysed the perioperative anesthetic management in patients undergoing HIPEC surgery.

Acetaminophen toxicity is one of the major causes of acute liver failure worldwide. Due to wide availability and perception regarding safety, it also remains the most common drug used in cancer pain settings. Incidental detection of acute liver failure during the hospital course may be observed in cachexia cancer patients. N-acetyl cysteine (NAC) can be used as a rescue drug in case of liver injury as manifested clinically or from altered lab values. There are only a few cases reported of acetaminophen toxicity in malnourished subjects. This case report can provide insight into the importance of reducing of dosage of acetaminophen in cachectic patients. A 47-year-old female patient with no known comorbidities was diagnosed with locally advanced squamous cell carcinoma mid-oesophagus. She was advised best supportive care and was referred to the palliative medicine department where she presented with complaints of central chest pain and absolute dysphagia. General examination revealed a body weight of around 30 kg, Body Mass Index (BMI) of 14.5, and performance status of 4. Her analgesics included an injection of tramadol 50 mg twice daily and an injection of paracetamol 1 g thrice daily. During her stay in the hospital routine examinations revealed an acute rise in the liver enzymes, aspartate transaminase (AST) was 1526 U/L, and alanine transaminase (ALT) was 1880 U/L, compared to the previous day’s values (on admission to the department the AST and ALT values were 38 and 40 U/L, respectively). Acute liver injury due to paracetamol overdose was suspected. N-acetyl cysteine was initiated according to the 21-hour protocol. Later liver enzymes declined and the patient improved clinically and was discharged home in a stable condition. This case report underlines the importance of cautious dose reduction of acetaminophen in chronic pain patients with less than 50 kg to not more than 2 g per day for the prevention of acute liver failure. [ABSTRACT FROM AUTHOR]

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In this article, Gallagher and Mishra state that "innovation" is in vogue in the increasingly competitive and globalized higher education landscape, particularly in the world of serving working professionals in continuing higher education. Too often, however, colleges and universities do not consider the voice of the consuming public--in particular, that of prospective students--in creating a roadmap for innovation and growth. Listening to customers' voices can help sort through the noise of interesting and nascent ideas in order to prioritize and focus on initiatives that will meet the needs of students and the public. In the spirit of continuous innovation and maintaining alignment with evolving market needs, Northeastern University places considerable emphasis on regularly surveying prospective professional students and other parties. Gallagher and Mishra use this article to build on the results of a number of Northeastern's marketplace surveys and opinion polls over the last year and make a case for fundamental innovations that professional students and others are demanding. The authors' conclude that, in order to keep pace with market trends, and indeed, to stay ahead of them, higher education institutions and their professional and continuing education units must continually evaluate the needs and interests of their customers. In addition, innovation and new investments should be grounded in evidence and reflect customer demands rather than reacting to the direction of peer institutions.

Byline: Nitish. Thakur, Mahima. Gupta, Raghav. Gupta, Seema. Mishra Major head and neck surgery is a known factor for postoperative delirium; however, Cotard's syndrome (CS) has been rarely reported following [...]

Byline: Shilpi. Agarwal, Vikram. Singh, Akansha. Sangwan, Seema. Mishra Pain is a common and highly distressing symptom in children with advanced malignancies and it is often multifactorial at the end-of-life. [...]