Chemical, biological, radiological, and nuclear mass casualty medicine: a review of lessons from the Salisbury and Amesbury Novichok nerve agent incidents.

On March 4, 2018, two casualties collapsed on a park bench in Salisbury, Wiltshire, UK. They were later discovered to have been the victims of an attempted murder using the Soviet-era Novichok class of nerve agent. The casualties, along with three further critically ill patients, were cared for in Salisbury District Hospital's Intensive Care Unit. Before the COVID-19 pandemic, the Salisbury and Amesbury incidents were the longest-running major incidents in the history of the UK National Health Service. This narrative review seeks to reflect on the lessons learned from these chemical incidents, with a particular focus on hospital and local organisational responses.

Organophosphorus nerve agent poisoning: managing the poisoned patient.

Organophosphorus (OP) nerve agent poisoning made the headlines in 2018 with the nerve agent 'Novichok' poisonings in Salisbury, England. This event highlighted a gap in the knowledge of most clinicians in the UK. In response, this special article aims to enlighten and signpost anaesthetists and intensivists towards the general management of OP nerve agent poisoned patients. Drawing on a broad range of sources, we will discuss what OP nerve agents are, how they work, and how to recognise and treat OP nerve agent poisoning. OP nerve agents primarily act by inhibiting the enzyme acetylcholinesterase, causing an acute cholinergic crisis; death usually occurs through respiratory failure. The antimuscarinic agent atropine, oximes (to reactivate acetylcholinesterase), neuroprotective drugs, and critical care remain the mainstays of treatment. The risk to medical staff from OP poisoned patients appears low, especially if there is a thorough decontamination of the poisoned patient and staff wear appropriate personal protective equipment. The events in Salisbury in the past year were shocking, and the staff at Salisbury District General Hospital performed admirably in treating those affected by Novichok nerve agent poisoning. We eagerly anticipate their future clinical publications so that the medical community might learn from their valuable experiences.

A self-reported clinical trial investigates the efficacy of 1072 nm light as an anti-ageing agent.

BACKGROUND: Previous laboratory research has shown that human lymphocytes pre-irradiated with 1072 nm light are afforded some protection against subsequent ultraviolet light toxicity. OBJECTIVE: To investigate the possibility that 1072 nm light can prevent or reverse skin ageing which itself is known to be accelerated by ultraviolet light. METHODS: A randomized, prospective, double-blind, placebo-controlled, self-reporting study was performed to assess the effect of one daily treatment episode for a period of between 6 and 8 weeks on wrinkles and fine lines around the eyes as well as the appearance of bags under the eyes. RESULTS: Between 52% and 57% of volunteers were able to accurately identify an improvement in the fine lines and wrinkles of the treated areas of skin. Fewer volunteers, between 37% and 46%, observed an improvement in the bags under the treated eye or eyes, albeit with an emphatic statistical significance. CONCLUSION: Regular application of a non-thermal quantity of 1072nm light around the eyes demonstrated efficacy as an anti-ageing agent.