CLEAR - clozapine in early psychosis: study protocol for a multi-centre, randomised controlled trial of clozapine vs other antipsychotics for young people with treatment resistant schizophrenia in real world settings.

BACKGROUND: Clozapine is an antipsychotic drug with unique efficacy, and it is the only recommended treatment for treatment-resistant schizophrenia (TRS: failure to respond to at least two different antipsychotics). However, clozapine is also associated with a range of adverse effects which restrict its use, including blood dyscrasias, for which haematological monitoring is required. As treatment resistance is recognised earlier in the illness, the question of whether clozapine should be prescribed in children and young people is increasingly important. However, most research to date has been in older, chronic patients, and evidence regarding the efficacy and safety of clozapine in people under age 25 is lacking. The CLEAR (CLozapine in EARly psychosis) trial will assess whether clozapine is more effective than treatment as usual (TAU), at the level of clinical symptoms, patient rated outcomes, quality of life and cost-effectiveness in people below 25 years of age. Additionally, a nested biomarker study will investigate the mechanisms of action of clozapine compared to TAU. METHODS AND DESIGN: This is the protocol of a multi-centre, open label, blind-rated, randomised controlled effectiveness trial of clozapine vs TAU (any other oral antipsychotic monotherapy licenced in the British National Formulary) for 12 weeks in 260 children and young people with TRS (12-24 years old). AIM AND OBJECTIVES: The primary outcome is the change in blind-rated Positive and Negative Syndrome Scale scores at 12 weeks from baseline. Secondary outcomes include blind-rated Clinical Global Impression, patient-rated outcomes, quality of life, adverse effects, and treatment adherence. Patients will be followed up for 12 months and will be invited to give consent for longer term follow-up using clinical records and potential re-contact for further research. For mechanism of action, change in brain magnetic resonance imaging (MRI) biomarkers and peripheral inflammatory markers will be measured over 12 weeks. DISCUSSION: The CLEAR trial will contribute knowledge on clozapine effectiveness, safety and cost-effectiveness compared to standard antipsychotics in young people with TRS, and the results may guide future clinical treatment recommendation for early psychosis. TRIAL REGISTRATION: ISRCTN Number: 37176025, IRAS Number: 1004947. TRIAL STATUS: In set-up. Protocol version 4.0 01/08/23. Current up to date protocol available here: https://fundingawards.nihr.ac.uk/award/NIHR131175# /.

Tooth sensitivity experience among residential university students.

OBJECTIVES: The aim of this study was to assess the experience of residential University students about 'sensitive teeth'. SUBJECT AND METHODS: Self-administered questionnaires were given randomly to students in all the residential hostels located in the University campus. Data on presence of sensitive teeth, initiating stimulus and duration of each episode of discomfort were elicited. History of common aetiological factors of tooth sensitivity was also taken. RESULTS: One thousand and nineteen responses (650 males; 369 females) were analysed in this study. Approximately 697 (68.4%) volunteers claimed to have sensitive teeth. Majority described their discomfort as sharp pain, cold as the initiating stimulus and drinking was mostly interfered with. Tooth sensitivity was found to be common among hard toothbrush users. Multiple regression analysis showed that hard toothbrush had a significant association with tooth sensitivity. Other common aetiological factors, such as history of gastric acid reflux, vomiting, soft drinks and the use of vitamin C were found to have a weak association with tooth sensitivity. CONCLUSION: Prevalence of tooth sensitivity was 68.4%. Presence of tooth sensitivity among these students was associated more with history of hard toothbrush use contrary to widely held belief that erosive agents were mostly responsible. Future studies are needed to provide more epidemiological data on tooth brushing and tooth sensitivity.

The determinants and control of soft drinks-incited dental erosion / Determinantes e controle da erosão dental induzida por refrigerantes

OBJECTIVE: The aim of this paper has been to review the past and current literature on the determinants and control of soft drinks-incited dental erosion. METHODS: The authors used Medline to find relevant literature published until March 2009. Abstracts and full articles were read to identify studies and reviews describing various modifying factors and determinants of dental erosion. Additional information was obtained using manual library search. RESULTS AND CONCLUSION: Excessive exposure to various acid sources can contribute to the chemical erosion of tooth surfaces. While these acid sources have the potential to erode teeth, various chemical, biological and behavioral factors determines the erosive action of the acids they contain. Several interceptive and preventive means have been proposed to minimize damage to the dentition.

OBJETIVOS: O objetivo deste artigo foi revisar a literatura passada e atual sobre os determinantes e controle da erosão dentária induzida por refrigerantes. MÉTODO: Os autores utilizaram o MEDLINE para encontrar literatura relevante publicada até março de 2009. Resumos e artigos completos foram lidos para identificar estudos e revisões descrevendo vários fatores modificantes e determinantes da erosãodentária. Obteve-se informação adicional pela busca manual na literatura em bibliotecas. RESULTADOS E CONCLUSÕES: Exposição excessiva a várias fontes ácidas podem contribuir para a erosão química de várias superfícies dentárias. Enquanto estas fontes ácidas têm o potencial de erosionar dentes, vários fatores químicos, biológicos e comportamentais determinam a ação erosiva dos ácidos que contêm. Várias medidas preventivas e interceptivas têm sido propostas para diminuir os danos causados pela erosão.