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Aim Acute pancreatitis even in its mildest form leads to dehydration that requires correction by intravenous fluid in timely fashion. The pathophysiology of fluid deficit is caused by fluid shift as a result of severe inflammation in the abdomen, lung damage and compromise to renal functions. The evidence behind choice of fluid used for resuscitation is limited, but delayed resuscitation is linked to increased mortality, however overly aggressive fluid administration could lead to lung injuries. Aggressive fluid resuscitation is defined as 15ml/kg/hour or >3.1L in the first 24 hours while conservative administration is defined as 5–10ml/kg/hour. Methods We reviewed our admissions with acute pancreatitis in August & September 2021. The age range was 24–94 years, diagnosis was confirmed by raised amylase, clinical symptoms and radiological evidence. 55.5% received Hartman's solution, 18.5% of patients received normal saline and 26% received both. The mean amount of fluids was 3Litres and the mean rate of first, second and third Litres was 4hours, 3.4 hours and 3.7 hours/Litre respectively in the first 24 hours. Results The mean LOS was 3.2 days, none of our patients were re-admitted for complications related to pancreatitis within 90 days, 1 patient had complicated necrotising pancreatitis and 1 patient deceased during their stay. Conclusion NICE guideline NG104 did not specify clear guidance on rate of fluid resuscitation, low quality evidence suggested possible benefit of aggressive therapy comparing mortality and systemic complications. We recommend individual assessment of rate of fluid administration for every patient to ensure absence of contraindications to aggressive therapy.

Introduction To gain a better understanding of the progression of coronary artery bypass grafting (CABG) and its impact on clinical practice, bibliometric citation analysis can be performed. Bibliometric citation analysis is a method of determining the most influential papers on a topic based on several citations and impact factor. Method A search of the Thomson Reuters Web of Science citation indexing database and research platform was completed using the terms "CABG," "Coronary artery bypass graft," "Coronary artery," "bypass," and/or "bypass grafting." The returned dataset was sorted by the number of citations. Results The search yielded a total of 11 560 papers which were ranked in order of citations. New England Journal of Medicine published the most papers in the top 100 and generated the most significant number of citations with 20 papers in total followed by Journal of the American College of Cardiology. It also has the highest impact factor and 5-year impact fact in 2007 of 79.26 and 67.513, respectively. Conclusion The most cited manuscripts by Serruys et al described a randomised trial comparing percutaneous coronary intervention and CABG for treating severe coronary artery disease. This work provides the most influential references related to CABG and serves as a guide as to the area of focus in CABG.

The idea that a longer duration of untreated psychosis (DUP) leads to poorer outcomes has contributed to extensive changes in mental health ser­vices worldwide and has attracted considerable research interest over the past 30 years. However, the strength of the evidence underlying this notion is unclear. To address this issue, we conducted an umbrella review of available meta‐analyses and performed a random‐effects meta‐analysis of primary studies. MEDLINE, Web of Science, PsycINFO and EMBASE were searched from inception to September 3, 2020 to identify relevant meta‐analyses of studies including patients with schizophrenia spectrum disorders, first‐episode psychosis, or affective and non‐affective psychosis. Thirteen meta‐analyses were included, corresponding to 129 individual studies with a total sample size of 25,657 patients. We detected potential violations of statistical assumptions in some of these meta‐analyses. We therefore conducted a new random‐effects meta‐analysis of primary studies. The association between DUP and each outcome was graded according to a standardized classification into convincing, highly suggestive, suggestive, weak, or non‐significant. At first presentation, there was suggestive evidence for a relationship between longer DUP and more severe negative symptoms (beta=–0.07, p=3.6×10(–5)) and higher chance of previous self‐harm (odds ratio, OR=1.89, p=1.1×10(–5)). At follow‐up, there was highly suggestive evidence for a relationship between longer DUP and more severe positive symptoms (beta=–0.16, p=4.5×10(–8)), more severe negative symptoms (beta=–0.11, p=3.5×10(–10)) and lower chance of remission (OR=2.16, p=3.0×10(–10)), and suggestive evidence for a relationship between longer DUP and poorer overall functioning (beta=–0.11, p=2.2×10(–6)) and more severe global psychopathology (beta=–0.16, p=4.7×10(–6)). Results were unchanged when analysis was restricted to prospective studies. These effect sizes are clinically meaningful, with a DUP of four weeks predicting >20% more severe symptoms at follow‐up relative to a DUP of one week. We conclude that DUP is an important prognostic factor at first presentation and predicts clinically relevant outcomes over the course of illness. We discuss conceptual issues in DUP research and methodological limitations of current evidence, and provide recommendations for future research.

Dopaminergic dysfunction is thought to be central to schizophrenia symptomatology. Previous meta-analyses of prodopaminergic drugs in schizophrenia have important limitations, and also did not include dopamine D2/D3 partial agonists. We investigated the effect of medications which increase dopamine signalling on schizophrenia symptoms by meta-analysing double-blind, placebo-controlled RCTs. 59 RCTs were included: 29 of prodopaminergic treatments, 30 of partial agonists. Partial agonists were significantly superior to placebo against positive (SMD=-0.33,p = 1.2 ×10