Effectiveness of the T-Control catheter: A study protocol

Background

Foley catheters have been subject to limited development in the last few decades. They fulfil their basic function of draining urine from the bladder but cause other associated problems. T-Control is a new silicone Foley catheter with an integrated fluid control valve whose design aims to reduce the risks associated with bladder catheterisation by a multifactorial approach. The general purpose of this study is to evaluate the effectiveness and cost-effectiveness of the T-Control catheter versus the Foley-type catheter in patients with Acute Urine Retention (AUR).

Study design

This is a pragmatic, open, multicentre, controlled clinical trial with random allocation to the T-Control catheter or a conventional Foley-type catheter in patients with AUR.

Endpoints

The magnitude of infections will be analysed as a primary endpoint. While as secondary endpoint, the following will be analysed: rate of symptomatic and asymptomatic infections; days free of infection; quality of life-related to self-perceived health; indication of associated antibiotic treatments; determination of biofilm; number of catheter-related adverse events; use of each type of catheterisation's healthcare resources; level of satisfaction and workload of health professionals and acceptability of the T-Control device as well as the patient experience.

Patients and methods

Eligible patients are male adults aged ≥50 years, with AUR and with an indication of bladder catheterisation for at least 2 weeks. The estimated sample size is 50 patients. Patient follow-up includes both the time of catheter insertion and its removal or change 2 weeks later, plus 2 weeks after this time when the patient will be called for an in-depth interview.

Photodegradation of the fungicide thiram in aqueous solutions. Kinetic studies and identification of the photodegradation products by HPLC-MS/MS

In this study, the relevance of photodegradation processes on the persistence of the fungicide thiram in waters was investigated. The photodegradation of thiram in Milli-Q water and in aqueous solutions of humic and fulvic acids, as well as the photodegradation in spiked river water were studied. Both pure thiram and one of its commercial formulations were used to prepare the solutions which were irradiated in a solar light simulator. In general, thiram photodegradation follows pseudo-first order kinetics. The half-life time of thiram 2mgL(-1) in Milli-Q water was 28min. However, the degradation rate of thiram was significantly increased (p=0.02) by the inert components of the thiram commercial formulation as well as by commercial humic acids and by fulvic acids isolated from river water (p<0.004). Thus, the half-life time of thiram decreased to 24min in the presence of the inert formulation components, while, in the presence of both humic and fulvic acids (10mgL(-1)) it decreased to 22min. Furthermore, thiram photodegradation in natural river water showed that there is a significant enhancement of the degradation rate constant of thiram relatively to Milli-Q water, corresponding to a decrease of about 38% in its half-life time. This increase of the degradation rate in river water seems to be higher than that observed in the presence of FA, suggesting that beyond organic matter, other natural river components can increase the thiram photodegradation rate. These results allow us to conclude that photodegradation by solar radiation can be an important degradation pathway of thiram in natural waters. HPLC-MS/MS allowed to identify, for the first time, three products of the photodegradation of thiram in aqueous solution. Three compounds were identified and their structure was corroborated by the MS(n) spectra fragmentation profile. Pathways for the formation of the products from thiram photodegradation are proposed and discussed.

Effect of long term organic amendments on adsorption-desorption of thiram onto a luvisol soil derived from loess

The objective of this work was to assess the influence of soil organic amendments on the sorption properties of the fungicide thiram. The organic amendments studied were organic household compost (COM), sewage sludge from municipal water treatment facilities (SLU) and farmyard manure (FYM), which were compared to mineral fertilizer application (MIN). Sorption-desorption experiments were performed using the batch method and the results indicated that the adsorption isotherms were non-linear and were found to conform to the Brunauer-Emmett-Teller (BET) model, suggesting multilayer adsorption and adsorbate-adsorbate interactions after the saturation of the surface layer. In general, distribution coefficient values, K(D), are dependent on, but not proportional to, the initial concentration of thiram. For a fixed thiram initial concentration, a significant correlation (r(2)>0.851; p<0.001) between K(D) values and the soil organic carbon content (OC) was observed. The highest value of K(D) was observed for the soil amended with compost, which is the one with the highest organic carbon content. K(D) values were divided by the soil organic carbon contents in order to obtain organic carbon partition coefficients K(OC). Comparing K(OC) means from 3 (initial concentrations) x 4 (soil organic matter compositions) x 3 (replicates) factorial ANOVA allow us to conclude that there is a significant but not proportional influence of the initial concentration of thiram on those values, but changes in the soil organic matter composition, associated to different soil amendments, have no significant influence on adsorption of thiram. To evaluate the reversibility of thiram adsorption, two consecutive desorption cycles were performed with CaCl(2) 0.01 mol L(-1). The desorption K(D) values were consistently higher (approximately twice) than those for adsorption at the same equilibrium concentrations for all soil samples supporting the existence of hysteresis in the adsorption-desorption behavior of thiram. Despite the fact that the adsorption K(D) values were proportionally increased with increasing total organic carbon content, this was not the case for the desorption K(D) values.

Adsorption-desorption behavior of thiram onto humic acid

The adsorption/desorption behavior of pure thiram (Thi-P) and formulated thiram (Thi-F) onto commercial humic acids (HA) was studied using a batch equilibration procedure. Results of adsorption kinetic experiments showed that thiram adsorption is a fast process since 85% of the equilibrium concentration is reached within two hours. Experimental K(D) values between 0.110 to 0.210 L g(-1) were obtained for the adsorption of both Thi-P and Thi-F onto HA, suggesting that thiram is strongly sorbed by humic acids. In general, for both Thi-P and Thi-F, the lower the initial thiram concentration, the stronger is its adsorption (higher K(D) and percentage adsorption values). The adsorption isotherms were found to match the BET model. The results show that thiram adsorption onto condensed humic acids cannot be explained only in terms of specific interactions, such as those identified in studies of adsorption of thiram with humic acids in solution. The comparison of sorption and desorption results allowed the observation of hysteresis phenomena. Desorption K(D) values were consistently higher than those for adsorption at the same equilibrium concentration. Hysteresis was lower for the formulated thiram suggesting that adsorption is more reversible in the presence of the formulation components turning the pesticide more susceptible to be leached.

Influence of fulvic acids and copper ions on thiram determination in water

The literature concerning the application of solid-phase extraction (SPE) to the concentration of thiram (bis(dimethyldithiocarbamoyl) disulfide) from natural waters is scarce, the available results being contradictory or with no analytical significance. To clarify these contradictory results, a C18-SPE procedure combined with HPLC-UV was applied to thiram analysis in river water, and the influence of several factors on recoveries was studied. This procedure gave thiram recoveries of about 100% when applied to thiram standard solutions. However, when the same procedure was applied to river water samples spiked with thiram, the recoveries depended on the equilibration time after spiking. The influence of river fulvic acids (FAs) and Cu(II) on thiram recoveries from standard solutions was studied as a possible interference for such a result. In the presence of FA, thiram recoveries were always higher than 85%. In the presence of Cu(II), thiram recoveries decreased significantly, due to complexation, but the addition of an excess of EDTA before C18-SPE eliminated that interference, and thiram was completely recovered. However, in river water samples the addition of EDTA had to be done before thiram spiking to obtain a recovery >90%. Thiram standard solutions containing both river FA and Cu(II) showed a behavior similar to the one observed in river water samples. On the basis of these results, the catalytic effect of Cu(II) on the degradation of thiram by FA, with formation of a Cu(II)-dimethyldithiocarbamate complex, was hypothesized.

A solid-phase extraction procedure for the clean-up of thiram from aqueous solutions containing high concentrations of humic substances

A simple solid-phase extraction (SPE) procedure with an octadecyl bonded phase silica (C(18)) was developed for clean-up of the fungicide thiram from aqueous solutions containing high concentrations of humic substances, for future studies of thiram adsorption onto solid humic substances or soils. Suspensions of humic acids and soil, in aqueous 0.01M CaCl(2) solution, were prepared and used as samples. These extracts were spiked with thiram and immediately applied to a C(18)-SPE cartridge. Thiram was eluted with chloroform and its concentration measured by spectrophotometry at 283nm. Non-spiked aqueous extracts (blanks) and a control sample of thiram in 0.01M CaCl(2) aqueous solution were also prepared and submitted to the same SPE procedure. The results show that humic substances are extensively retained by the C(18) cartridge but are not eluted with CHCl(3). Recoveries of 100-104% were obtained for thiram in the presence of humic substances. The SPE procedure described in this work is an efficient clean-up step to remove the interference of humic substances absorbance and to be coupled to any spectrophotometric or HPLC-UV method, usually used for thiram analysis in food extracts.

Evaluation of poly(2-hydroxyethyl methacrylate) gels as drug delivery systems at different pH values

Studies of dynamic and equilibrium swelling, structural characterisation and solute transport in swollen poly(2-hydroxyethyl methacrylate) gels (pHEMA) cross-linked with tripropyleneglycol diacrylate (TPGDA) were done for a wide range of TPGDA concentrations. The influence of the pH on these pHEMA properties was evaluated. In swelling studies it was found that in changing the pH from 6.5 to 12.0, a large increase in swelling occurred, from approximately 48 to 55%, for the lowest concentration of TPGDA (1 mol%), and from 40 to 80% for the highest concentration (10 mol%). Fourier transform infrared (FTIR) and differential scanning calorimetry (DSC) measurements were made after the equilibrium swelling of the gels at different pH values, to explain these results. The advantage of using these gels as controlled drug delivery systems is illustrated using salicylic acid (SA) as a model drug. The loading and the release of the SA were made at different pH values and the results obtained showed that it is possible to modulate the hydrogel performance by controlling an external factor, the pH at which the drug loading and release were performed.

Study of the thermal stability and enzymatic activity of an immobilised enzymatic system for the bilirubin oxidation

In this work, we have studied the immobilisation of the haemoglobin/glucose oxidase coupled enzymatic system in poly(vinyl alcohol) membranes. These are to be used as a reagent phase either in the development of an optical sensor or as an efficient bilirubin (BR) removal reactor. Poly(vinyl alcohol) (PVA) was chosen as the support for this purpose, due to its good biocompatibility, hydrophilicity and non-thrombogenic effects. A hydrogel containing the enzymatic system, consisting of PVA crosslinked with glutaraldehyde, was prepared and characterised by DSC, enzyme activity measurements and release tests. Investigating protein conformational changes as a function of temperature and the enzymatic system activity we have found that, in spite of the destabilizing effect of the glutaraldehyde in the acidic medium, the PVA insolubilisation conditions seem do not perturb either the conformation of the 'native state' nor the enzymatic system activity. Moreover, it was found that PVA/glutaraldehyde membranes offer a simple way to hold enzymatic system, with the possibility of controlling the conditions to obtain either the effective prevention of leaching of the entrapped proteins or the in situ delivery of the haemoglobin.

Study of an enzyme coupled system for the development of fibre optical bilirubin sensors

We have established an analytical procedure for bilirubin (BR) determination by following the variation of its yellow absorption band in the presence of the biocatalytic system haemoglobin/glucose oxidase/glucose. The influence of the pH of the medium, the haemoglobin/hydrogen peroxide ratio, and the concentration of the various components in the mixture on the system activity was evaluated. The solubility of the unconjugated BR was analysed. An anionic detergent in Tris buffer, in which it presents a high critical micellar concentration, was selected for the BR/bovine serum albumin cleavage. The Michaelis-Menten constant of the system (after the optimisation of the various parameters) was determined and compared with Km values reported in the literature for similar catalytic systems. Preliminary results obtained with the haemoglobin and glucose oxidase immobilised either in poly(vinyl alcohol) or by crosslinking with glutaraldehyde, show that this system is promising as a future biosensor.