Positive reinforcement targeting abstinence in substance misuse (PRAISe): Study protocol for a Cluster RCT & process evaluation of contingency management.

There are approximately 256,000 heroin and other opiate users in England of whom 155,000 are in treatment for heroin (or opiate) addiction. The majority of people in treatment receive opiate substitution treatment (OST) (methadone and buprenorphine). However, OST suffers from high attrition and persistent heroin use even whilst in treatment. Contingency management (CM) is a psychological intervention based on the principles of operant conditioning. It is delivered as an adjunct to existing evidence based treatments to amplify patient benefit and involves the systematic application of positive reinforcement (financial or material incentives) to promote behaviours consistent with treatment goals. With an international evidence base for CM, NICE recommended that CM be implemented in UK drug treatment settings alongside OST to target attendance and the reduction of illicit drug use. While there was a growing evidence base for CM, there had been no examination of its delivery in UK NHS addiction services. The PRAISe trial evaluates the feasibility, acceptability, clinical and cost effectiveness of CM in UK addiction services. It is a cluster randomised controlled effectiveness trial of CM (praise and financial incentives) targeted at either abstinence from opiates or attendance at treatment sessions versus no CM among individuals receiving OST. The trial includes an economic evaluation which explores the relative costs and cost effectiveness of the two CM intervention strategies compared to TAU and an embedded process evaluation to identify contextual factors and causal mechanisms associated with variations in outcome. This study will inform UK drug treatment policy and practice. Trial registration ISRCTN 01591254.

Efficacy of 0.5% Hyperbaric Bupivacaine with Dexamethasone versus 0.5% Hyperbaric Bupivacaine alone in Spinal Anaesthesia for Patient Undergoing Lower Abdominal Urological and Lower Limb Orthopedic Surgeries.

Spinal anaesthesia with local anaesthetics has limited duration. Different additives have been used to prolong spinal anaesthesia. The aim of this study was to determine the efficacy of adding dexamethasone to bupivacaine in spinal anaesthesia specially whether it would prolong the duration of sensory block/ surgical analgesia and post-operative analgesia/pain free period or not. This randomized, prospective, double-blind, clinical study was conducted in the Department of Anaesthesia, Analgesia and Critical Care of Combined Military Hospital, Chittagong from October 2016 to August 2017. Seventy two (72) adult patients scheduled for lower abdominal urological and lower limb orthopedic surgery under spinal anaesthesia were included. They were divided in two groups; each group comprised 36 patients to receive 20mg 0.5% hyperbaric bupivacaine (Bupivacaine group) or 15mg 0.5% hyperbaric bupivacaine plus 5mg dexamethasone (Bupivacaine-Dexamethasone/case group) intrathecally. The patients were evaluated for quality, quantity and duration of sensory block/surgical analgesia, post-operative analgesia/pain free period, blood pressure, heart rate, nausea, and vomiting or other complications. There were no significant differences in demographic data, sensory level and onset time of the sensory block between two groups. Duration of sensory block/Surgical analgesia in the bupivacaine group was 92.32±8.34 minutes and in the bupivacaine- dexamethasone/case group was 122.11±10.59 minutes which was statistically highly significant (p<0.001). The duration of post-operative analgesia/pain free period was 208.78±41.57 minutes in the bupivacaine group; whereas it was 412.82±71.51 minutes in the bupivacaine-dexamethasone/case group which was also statistically highly significant (p<0.001). The frequency of complications was not different between two groups. This study has shown that the addition of dexamethasone to bupivacaine in spinal anaesthesia significantly improved the duration of sensory block/surgical analgesia as well as post-operative analgesia/pain free period without any complications.

Case report: anxiety and fear in a patient with meningioma compressing the left amygdala.

The amygdalae are an important part of fear and anxiety circuits in the mammalian brain, involved in the encoding and storage of fear memories. In this case report we discuss a 26-year-old male patient with a temporal lobe meningioma that presented with unilateral abducens palsy, deep-seated headaches, and persistent psychiatric symptoms including depression and anticipatory anxiety. The patient's psychiatric symptoms and clinical diagnosis provided the impetus for the eventual diagnostic imaging and discovery of the intracranial lesion.

Synthesis and characterization of iron(II) complexes with tetradentate diiminodiphosphine or diaminodiphosphine ligands as precatalysts for the hydrogenation of acetophenone.

Six complexes of the type trans-[Fe(NCMe)2(P-N-N-P)]X2 (X = BF4(-), B{Ar(f)}4(-)) (Ar(f) = 3,5-(CF3)2C6H3) containing diiminodiphosphine ligands and the complexes trans-[Fe(NCMe)2(P-NH-NH-P)][BF4]2 with a diaminodiphosphine ligand were obtained by the reaction of Fe(II) salts with achiral and chiral P-N-N-P or P-NH-NH-P ligands, respectively, in acetonitrile at ambient temperature. The P-N-N-P ligands are derived from reaction of ortho-diphenylphosphinobenzaldehyde with the diamines 1,2-ethylenediamine, 1,3-propylenediamine, (S,S)-1,2-disopropyl-1,2-diaminoethane, and (R,R)-1,2-diphenyl-1,2-diaminoethane. Some complexes could also be obtained for the first time in a one-pot template synthesis under mild reaction conditions. Single crystal X-ray diffraction studies of the complexes revealed a trans distorted octahedral structure around the iron. The iPr or Ph substituents on the diamine were found to be axial in the five-membered Fe-N-CHR-CHR-N- ring of the chiral P-N-N-P ligands. A steric clash between the imine hydrogen and the substituent probably determines this stereochemistry. The diaminodiphosphine complex has longer Fe-N and Fe-P bonds than the analogous diiminodiphosphine complex. The new iron compounds were used as precatalysts for the hydrogenation of acetophenone. The complexes without axial substituents on the diamine had moderate catalytic activity while that with axial Ph substituents had low activity but fair (61%) enantioselectivity for the asymmetric hydrogenation of acetophenone. The fact that the diaminodiphosphine complex has a slightly higher activity than the corresponding diiminodiphosphine complex suggests that hydrogenation of the imine groups in the P-N-N-P ligand may be important for catalyst activation. Evidence is provided, including the first density-functional theory calculations on iron-catalyzed outer-sphere ketone hydrogenation, that the mechanism is similar to that of ruthenium analogues.

Primary hydatidosis of gluteus maximus.

Hydatid disease is a parasitic infestation of humans and herbivorous animals, caused by echinococcus granulosus. Dogs and some wild carnivores, like foxes, are definitive hosts, harboring worms in their intestines. Eggs are passed in feces and eaten by intermediate hosts and larvae encyst in the liver, lungs and other organs. Primary muscular hydatidosis without involving the thoracic or abdominal organs is extremely rare. A case of intramuscular gluteal hydatid cyst is being reported with the intent of highlighting this atypical localization of the disease. Since the soft tissue tumors may be confused with hydatid cysts, preoperative evaluation of these patients is critical for proper handling during surgery to avoid life-threatening complications. We report a case of a 24-year-old male patient with a cystic gluteal swelling turning out to be hydatid cyst on sonography and computerized scanning. Surgical excision with postoperative antihelmenthics formed the main modality of treatment.

Primary osteosarcoma of the skull.

Primary osteogenic sarcoma of the skull is an exceedingly rare condition. An adult male patient is described, who had a painless swelling in the right forehead that had rapidly enlarged in the previous 6 months. Radiological investigations showed a large destructive mass lesion involving the right side of the frontal bone with extension into the frontal sinus, causing marked extradural compression of brain parenchyma. Histopathological examination confirmed the lesion to be primary osteogenic sarcoma.

PGE2 suppresses intestinal T cell function in thermal injury: a cause of enhanced bacterial translocation.

Increased gut bacterial translocation in burn and trauma patients has been demonstrated in a number of previous studies, however, the mechanism for such an increased gut bacterial translocation in injured patients remains poorly understood. Utilizing a rat model of burn injury, in the present study we examined the role of intestinal immune defense by analyzing the T cell functions. We investigated if intestinal T cells dysfunction contributes to bacterial translocation after burn injury. Also our study determined if burn-mediated alterations in intestinal T cell functions are related to enhanced release of PGE2. Finally, we examined whether or not burn-related alterations in intestinal T cell function are due to inappropriate activation of signaling molecule P59fyn, which is required for T cell activation and proliferation. The results presented here showed an increase in gut bacterial accumulation in mesenteric lymph nodes after thermal injury. This was accompanied by a decrease in the intestinal T cell proliferative responses. Furthermore, the treatments of burn-injured animals with PGE2 synthesis blocker (indomethacin or NS398) prevented both the decrease in intestinal T cell proliferation and enhanced bacterial translocation. Finally, our data suggested that the inhibition of intestinal T cell proliferation could result via PGE2-mediated down-regulation of the T cell activation-signaling molecule P59fyn. These findings support a role of T cell-mediated immune defense against bacterial translocation in burn injury.