Direct injection analysis of oxypurinol and metformin in wastewater by hydrophilic interaction liquid chromatography coupled to tandem mass spectrometry

The increasing global prevalence of gout and diabetes has led to a rise in the use of their respective medications, allopurinol and metformin. These are excreted via urine as oxypurinol and metformin and are discharged into wastewater and the environment. Current environmental monitoring of those two polar chemicals requires labour intensive and potentially inefficient sample pre-treatments, such as using solid-phase extraction or freeze-drying. This study validated a sensitive and simple method using direct-injection LC–MS/MS for the simultaneous measurement of oxypurinol and metformin in wastewater. The final method utilised a hydrophilic interaction liquid chromatography together with simple filtration through 0.2 μm regenerated cellulose filter followed by dilution in acetonitrile with a dilution factor of 10. The developed method was validated with the limit of quantifications (LOQ) of 0.11 and 0.34 μg/L for metformin and oxypurinol, respectively. The new method was applied to 42 influent wastewater samples and 6 effluent samples collected from 6 Australian wastewater treatment plants. Both compounds were detected well above the LOQ at concentrations 29–214 μg/L in influent and 2–53 μg/L in effluent for metformin, and 24–248 μg/L in influent and 4–81 μg/L in effluent for oxypurinol, demonstrating its high applicability.     

Regional anaesthesia: risk,consent and complications

The risks of regional anaesthesia relate primarily to the technical nature of the procedure, chief among them being neurological. While rare, the direct relationship between nerve damage and the procedure itself means that patients need to be aware of this complication when consent is sought. In order to give valid consent, a patient must be informed. The extent of the information required has been defined by a 2015 legal ruling which established that the standard is the expectation of a reasonable patient, rather than the information deemed consequential by a reasonable doctor. The implications of this for clinicians are profound, and mean that the process of consent must, for example, include alternatives to the proposed treatment. Additionally, patients must have capacity and give their consent without coercion. Effective communication of risk can be challenging. As well as the barriers to comprehension that can result from language, literacy and numeracy, clinicians need to be aware of their own biases, often in favour of a regional anaesthetic approach. Patients also have biases, and doctors must be aware of these in order to best target their provision of information. Careful use of language and employing adjuncts such as information leaflets and visual aids can help to maximise the individual's autonomy. Particular care must be taken in special situations such as where patients have capacity issues or time is limited by the emergency nature of the intervention.     

Fluid Intake Monitoring Systems for the Elderly: A Review of the Literature

Fluid intake monitoring is an essential component in preventing dehydration and overhydration, especially for the senior population. Numerous critical health problems are associated with poor or excessive drinking such as swelling of the brain and heart failure. Real-time systems for monitoring fluid intake will not only measure the exact amount consumed by the users, but could also motivate people to maintain a healthy lifestyle by providing feedback to encourage them to hydrate regularly throughout the day. This paper reviews the most recent solutions to automatic fluid intake monitoring both commercially and in the literature. The available technologies are divided into four categories: wearables, surfaces with embedded sensors, vision- and environmental-based solutions, and smart containers. A detailed performance evaluation was carried out considering detection accuracy, usability and availability. It was observed that the most promising results came from studies that used data fusion from multiple technologies, compared to using an individual technology. The areas that need further research and the challenges for each category are discussed in detail.