there have been about 400 000 000 doses of the Pfizer-BioNTech COVID-19 mRNA vaccine administered worldwide.At this time, 176 cases of pancreatitis have been reported in pharmacovigilance reports submitted to the WHO. 1 No epidemiological link between the Pfizer-BioNTech COVID-19 mRNA vaccine and pancreatitis has been reported. We report a case of acute necrotising pancreatitis following the second dose of the Pfizer-BioNTech COVID-19 mRNA vaccine. This case has been reported to the New Zealand Pharmacovigilance Centre and the patient has consented to publication of the case report.A 43-year-old, NZ European male was diagnosed with acute necrotising pancreatitis 10 h following the administration of his second Pfizer-BioNTech COVID-19 mRNA vaccine. He has a background of atopy with seasonal rhinitis, eczema, and asthma, all of which are "mild." He takes no regular medications and takes as needed melatonin 2 mg nocte, cetirizine 10 mg for hay fever, and betamethasone and emollient cream for dermatitis. He has no family history of note and works in a senior professional role. He drinks six standard units of alcohol per week, has never been a tobacco smoker, and does not use recreational drugs-and his employer undertakes regular drug testing.He had a previous episode of pancreatitis in 2011, precipitated by high alcohol intake during a holiday abroad. He is otherwise previously well. There is no family history of note, his father was a smoker and died of lung cancer in his 60s, his mother is well, and he has two siblings and three children all of whom are well. He is not aware of Pfizer-BioNTech COVID-19 mRNA vaccine should be examined to see if a consistent pattern is present.

Paraquat, a common herbicide, is responsible for large numbers of deaths worldwide through both deliberate and accidental ingestion. Previous studies have eluded that the bioavailability of paraquat increases substantially with increasing dose and that these changes may in part be due to the effects that these high concentrations have on the gastrointestinal tract (GI tract). To date, the actions of acute, high concentrations (20mM for 60 min) of paraquat on the GI tract, particularly the colon which is a major site of paraquat absorption, are unknown. This study examined the effects of acute paraquat administration on colonic motility in the C57BL/6 mouse. Acute paraquat exposure decreased colonic motility and the amplitude of colonic migrating motor complexes (CMMCs), which are major motor patterns involved in faecal pellet propulsion. In isolated segments of distal colon, paraquat increased resting tension and markedly attenuated electrical field stimulation-evoked relaxations. Pharmacological dissection of paraquat's mechanism of action on both the CMMCs and field stimulated tissue using the nitric oxide synthase inhibitor NG-nitro-L-arginine and direct measurement of NO release from the myenteric plexus, demonstrated that paraquat selectively attenuates nitrergic signalling pathways. These changes did not appear to be due to alterations in colonic oxidative stress, inflammation or complex 1 activity, but were most likely caused by paraquat's ability to act as a redox couple. In summary, these data demonstrate that acute paraquat exposure attenuates colonic transit. These changes may facilitate the absorption of paraquat into the circulation and so facilitate its toxicity.

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doctors on a range of topics. Consensus amongst peers was that teaching sessions often were not particularly relevant to the needs of junior doctors.A peer-to-peer teaching scheme was launched for Foundation Year 1 (FY1) doctors in February 2018. A one-hour session dedicated to peer teaching was allocated once or twice a month within protected teaching time. Three speakers were assigned per session, each delivering a 15-20 minute presentation. Content was left to the discretion of the FY1 doctor presenting, and frequently centred around common on call scenarios.13 FY1 doctors presented topics within the peer teaching programme in the remaining 6 months of the Foundation Year 1. An end-of-year evaluation survey showed that feedback of the scheme was largely similar to regular teaching sessions, with a higher overall rating.Reflecting on our positive feedback, going forward we ensured that the programme continued to be offered to the FY1 doctors starting in August 2018, and expanded the programme to FY2 doctors.Acting upon feedback, the presentation time was lengthened to 30 minutes for the FY2 programme in order to allow the speaker to explore their chosen topic in more depth. We also developed a teaching syllabus based on the core medical/surgical curriculum to encourage teaching tailored towards membership exams.Compared to last year's FY1 programme, we have seen an increase of nearly 40% in teaching participation this year with 18/54 FY2 doctors presenting topics.We believe the positive uptake of the peer teaching programme reflects a positive engagement of junior doctors in their education, which we hope will carry through to their clinical work on the wards.