Sometime I wonder how the world will change post covid- or how the board questions will change? And that is clearly seen in this article titled- Yip L et al. Serious adverse health events, including death, associated with ingesting alcohol-based hand sanitizers containing methanol — Arizona and New Mexico, May–June 2020. MMWR Morb Mortal Wkly Rep 2020 Aug 14; hand sanitizing gels and foams containing ≥60% alcohol (either ethanol or isopropyl alcohol) has been proven to be effective -- Methanol is not an acceptable substitute in this paper they looked at 15 cases of methanol poisoning due to ingestion of methanol-containing hand sanitizers From May through June 2020 All patients had a history of ingesting alcohol-based hand sanitizer presentation included visual disturbance, seizures, gastrointestinal involvement, altered mental status, and anion-gap acidosis with blood pH varying from 6.70 to 7.23. in the end Four patients died and three others were discharged with new visual impairment. I can see it now- beth comes into the office and has visual changes and slightly altered mentation – she is known to be a prepper and vary scared of covid and he husband said she recently read that if you swallow hand sanitizer it will kill covid19 just like it does when it is on your hands—what is the most likely diagnosis for this pt. and the answer will be methanol poisoning! Next artciel Are antibiotics as good as surgery for pediatric appendicitis? The answer depends on who is asking the question In this trial Association of Nonoperative Management Using Antibiotic Therapy vs Laparoscopic Appendectomy With Treatment Success and Disability Days in Children With Uncomplicated Appendicitis nonrandomized study of nonoperative treatment of 1068 pediatric patients with uncomplicated appendicitis. Roughly 65% chose to undergo urgent laparoscopic appendectomy, while 35% chose nonoperative management with IV antibiotics in the hospital followed by oral antibiotics at home The primary outcome was defined as not requiring appendectomy within 1 year of study enrollment. And in the end Two thirds of youth who received antibiotics to treat uncomplicated appendicitis avoided surgery, and Nonoperative management was associated with a 67% success rate for avoiding surgery in the subsequent year But the important thing here is how you power your study- you power it to find the minimal clinically important difference (MCID)—the MCID is a a mystery- you wont a number that is reasonable difference in practice for the reader but attainable for the study so we don’t have a million neg. trials and what this difference is completely determined by the authors. Sure they can look at other studies and see what they used but ultimately this is up to the authors—if in this trial they say I think the clinical meaningful difference is to avoid 25% of surgeries then they set that as the standard and BOOM in this trial about 65% of surgeries were avoided in those in the antibiotic arm. This trial would have been a smashing hit! But instead the authors chose a much hard outcome of 70% based on surgeons they work with! And when you asked parents they said ‘well I think 50% would have been good enough’--- HOWEVER since 70% of pts had to avoid going to surgery- this means it was a negative trial. I think this is a great article that points to the shared decision making conversation because no article or paper is 100% if you do this then this will happen, bit if you say well if you do this then about 2/3 of the time you will prevent having to go to surgery that is a much different conversation than well if you do this then you wont have to go to surgery because the truth is they still do around 33% of the time which is good enough odds for me and my child or at least any child I would be babysitting since I don’t have children. So I ask again is it ok to spare 2 out of every 3 children a surgery and invasive procedur(continued)