Scottish and Newcastle antiemetic pre-treatment for paracetamol poisoning study (SNAP)

BACKGROUND: Paracetamol (acetaminophen) poisoning remains the commonest cause of acute liver injury in Europe and North America. The intravenous (IV) N-acetylcysteine (NAC) regimen introduced in the 1970s has continued effectively unchanged. This involves 3 different infusion regimens (dose and time) lasting over 20 hours. The same weight-related dose of NAC is used irrespective of paracetamol dose. Complications include frequent nausea and vomiting, anaphylactoid reactions and dosing errors. We designed a randomised controlled study investigating the efficacy of antiemetic pre-treatment (ondansetron) using standard NAC and a modified, shorter, regimen. METHODS/DESIGN: We designed a double-blind trial using a 2 × 2 factorial design involving four parallel groups. Pre-treatment with ondansetron 4 mg IV was compared against placebo on nausea and vomiting following the standard (20.25 h) regimen, or a novel 12 h NAC regimen in paracetamol poisoning. Each delivered 300 mg/kg bodyweight NAC. Randomisation was stratified on: paracetamol dose, perceived risk factors, and time to presentation. The primary outcome was the incidence of nausea and vomiting following NAC. In addition the frequency of anaphylactoid reactions and end of treatment liver function documented. Where clinically necessary further doses of NAC were administered as per standard UK protocols at the end of the first antidote course. DISCUSSION: This study is primarily designed to test the efficacy of prophylactic anti-emetic therapy with ondansetron, but is the first attempt to formally examine new methods of administering IV NAC in paracetamol overdose. We anticipate, from volunteer studies, that nausea and vomiting will be less frequent with the new NAC regimen. In addition as anaphylactoid response appears related to plasma concentrations of both NAC and paracetamol anaphylactoid reactions should be less likely. This study is not powered to assess the relative efficacy of the two NAC regimens, however it will give useful information to power future studies. As the first formal randomised clinical trial in this patient group in over 30 years this study will also provide information to support further studies in patients in paracetamol overdose, particularly, when linked with modern novel biomarkers of liver damage, patients at different toxicity risk. TRIAL REGISTRATION: EudraCT number 2009-017800-10, ClinicalTrials.gov IdentifierNCT0105027

SaFaRI: sacral nerve stimulation versus the FENIX (TM) magnetic sphincter augmentation for adult faecal incontinence: a randomised investigation

Purpose Faecal incontinence is a physically, psychologically and socially disabling condition. NICE guidance (2007) recommends surgical intervention, including sacral nerve stimulation (SNS), after failed conservative therapies. The FENIX™ magnetic sphincter augmentation (MSA) device is a novel continence device consisting of a flexible band of interlinked titanium beads with magnetic cores that is placed around the anal canal to augment anal sphincter tone through passive attraction of the beads. Preliminary studies suggest the FENIX™ MSA is safe, but efficacy data is limited. Rigorous evaluation is required prior to widespread adoption. Method and design The SaFaRI trial is a National Institute of Health Research (NIHR) Health Technology Assessment (HTA)-funded UK multi-site, parallel group, randomised controlled, unblinded trial that will investigate the use of the FENIX™ MSA, as compared to SNS, for adult faecal incontinence resistant to conservative management. Twenty sites across the UK, experienced in the treatment of faecal incontinence, will recruit 350 patients randomised equally to receive either SNS or FENIX™ MSA. Participants will be followed-up at 2 weeks post-surgery and at 6, 12 and 18months post-randomisation. The primary endpoint is success, as defined by device in use and ≥50 % improvement in the Cleveland Clinic Incontinence Score (CCIS) at 18 months post-randomisation. Secondary endpoints include complications, quality of life and cost effectiveness. Discussion SaFaRI will rigorously evaluate a new technology for faecal incontinence, the FENIX™ MSA, allowing its safe and controlled introduction into current clinical practice. These results will inform the future surgical management of adult faecal incontinence

Continence technologies whitepaper: Informing new engineering science research

Advances in healthcare technology for continence have historically been limited compared to other areas of medicine, reflecting the complexities of the condition and social stigma which act as a barrier to participation. This whitepaper has been developed to inspire and direct the engineering science community towards research opportunities that exist for continence technologies that address unmet needs in diagnosis, treatment and long-term management. Our aim is to pinpoint key challenges and highlight related research opportunities for novel technological advances. To do so, we draw on experience and expertise from academics, clinicians, patients and patient groups linked to continence healthcare. This is presented in four areas of consideration: the clinical pathway, patient perspective, research challenges and effective innovation. In each we introduce seminal research, background information and demonstrative case-studies, before discussing their relevance to engineering science researchers who are interested in approaching this overlooked but vital area of healthcare

A Rare Case Report of Adenoid Cystic Carcinoma of the Anterior Maxilla in a Young Patient

Background and Objective: Adenoid cystic carcinoma (ACC) of the maxilla is a rare malignancy arising from minor salivary glands. The clinical and radiological appearance may be similar to any odontogenic/nonodontogenic pathology. This study aims to report a rare case of primary central ACC of the anterior maxilla. Case Report: A 31-year-old man was referred to the Department of Oral and Maxillofacial Surgery complaining of swelling and pain in the right anterior maxilla for 3 months. The patient has noticed swelling and pain in this side since about five months before and instead of diagnosing this tumoral lesion, false diagnosis and unsuccessful root canal therapy were considered. A biopsy was performed in the central region and microscopically, the lesion showed tumor cells arranged in sheets in fibrous stroma islands of epithelial cells showing a classical “Swiss cheese” pattern. Based on clinical, radiographic, and CBCT evaluation and positive immunohistochemistry of CD63, and C-Kit confirmed ACC diagnosis. After the diagnosis, the lesion was completely removed by enucleation and curettage performed by the surgeon. Postoperative radiotherapy was performed. Follow-up within 3 years since the initial diagnosis showed no sign of recurrence. Conclusion: Based on the results of this study, early diagnosis and treatment of ACC can lead to successful treatment and patient survival

Photoinduced pyrene degradation in contaminated soils by polyaniline coated photocatalysts

610-618Polyaniline (PA) coated TiO2 and ZnO nanoparticles have been used to improve the photocatalytic efficiency of pyrene degradation in soil samples. The interfacial polymerization method is used to prepare the polyaniline coated ZnO and TiO2 nanocomposites, which are characterized by scanning electron microscopy, Fourier transform infrared spectroscopy, and X-ray diffraction. The SEM images and the SPSS analysis demonstrate the particle size distribution in the range of 100–400 nm. The surface charge of the polyaniline coated TiO2 and ZnO nanocomposites are found to be 19.5 and 21.2 mV, respectively. The pyrene removal efficiency is more than 95% on the polymer coated photocatalysts surface. The high degradation efficiency of the polyaniline coated ZnO and TiO2 nanocomposites is probably due to the high capacity of polyaniline for the adsorption of pollutants from the contaminated soils; the semiconducting behavior is reflected in the chain structure of the polymer under both ultraviolet and visible irradiation. Enhanced photocatalytic activity for degradation of pyrene under UV and visible light, is possibly due to the synergistic effect of PA and NPs