Blood-borne Research Articles

Pathogenic bacteria exploit transferrin receptor transcytosis to penetrate the blood–brain barrier

The human blood-brain barrier (BBB) comprises a single layer of brain microvascular endothelial cells (HBMECs) protecting the brain from bloodborne pathogens. Meningitis is among the most serious diseases, but the mechanisms by which major meningitis-causing bacterial pathogens cross the BBB to reach the brain remain poorly understood. We found that Streptococcus pneumoniae, group B Streptococcus, and neonatal meningitis Escherichia coli commonly exploit a unique vesicle fusion mechanism to hitchhike on transferrin receptor (TfR) transcytosis to cross the BBB and illustrated the details of this process in human BBB model in vitro and mouse model. Toll-like receptor signals emanating from bacteria-containing vesicles (BCVs) trigger K33-linked polyubiquitination at Lys168 and Lys181 of the innate immune regulator TRAF3 and then activate the formation of a protein complex containing the guanine nucleotide exchange factor RCC2, the small GTPase RalA and exocyst subcomplex I (SC I) on BCVs. The distinct function of SEC6 in SC I, interacting directly with RalA on BCVs and the SNARE protein SNAP23 on TfR vesicles, tethers these two vesicles and initiates the fusion. Our results reveal that innate immunity triggers a unique modification of TRAF3 and the formation of the HBMEC-specific protein complex on BCVs to authenticate the precise recognition and selection of TfR vesicles to fuse with and facilitate bacterial penetration of the BBB.

Under the sea: How can we use heart rate and accelerometers to remotely assess fish welfare in salmon aquaculture?

Recent advances in bio-sensing technologies open for new possibilities to monitor and safeguard the welfare of fishes in aquaculture. Yet before taken into practice, the applicability of all novel biosensors must be validated, and the breadth of their potential uses must be investigated. Here, we investigated how ECG and accelerometry-derived parameters measured using bio-loggers, such as heart rate, acceleration and variance of acceleration, relate to O2 consumption rate (MO2) and blood borne indicators of stress and tissue damage to determine how biologgers may be used to estimate stress and welfare. To do this, we instrumented 13 fish with a biologger and an intravascular catheter and subjected them to a swimming protocol followed by a stress protocol throughout which the physiological parameters were measured and analyzed a posteriori. Additionally, based on the empirical data obtained, we calculated the mathematical relationships between the bio-logger data and the other parameters and tested the relationship between the calculated parameters using the linear regression algorithms and the measured parameters. Our results show that acceleration is a good proxy for swimming activity as it is closely related to tail beat frequency. In addition, we show that heart rate, acceleration and variance of acceleration all can be used as predictors for metabolic rate. Accelerometry based data, especially variance of acceleration, significantly explain some of the variation in venous partial pressure of O2, blood lactate and plasma cortisol concentration. Variance of acceleration also significantly explains some of the variation in pH and mean corpuscular hemoglobin concentration. These relationships are explained by variance of acceleration being a good indicator of the onset of burst-swimming activity, which is often followed by acid-base imbalances and release of catecholamines. The results herein indicate that bio-logger data can be used to extrapolate a range of stress-related physiological events when these are accompanied by increases in activity and highlight the great potential of biosensors for monitoring fish welfare.

International harm reduction indicators are still not reached: results from a repeated cross-sectional study on drug paraphernalia distribution in Germany, 2021

BackgroundTo prevent the transmission of blood-borne infections and reach the elimination of viral hepatitis by 2030, the World Health Organization (WHO) has set the goal to distribute 300 sterile needles and syringes each year per person who injects drugs (PWID). We aimed to assess drug paraphernalia distribution in Germany in 2021, including the WHO indicator, and to analyse changes to the distribution measured in 2018.MethodsWe conducted a repeated cross-sectional study of low-threshold drug services in Germany. We assessed type and quantity of distributed drug paraphernalia and the number of supplied PWID in 2021 using an online and paper-based questionnaire. We conducted a descriptive statistical analysis of data from 2021, assessed fulfillment of the WHO indicator and changes in services that participated 2021 and in the previous study 2018.ResultsFive hundred and eighty-nine of 1760 distributed questionnaires were returned in 2021. 204 drug services from 15 out of 16 federal states confirmed drug paraphernalia distribution, covering 20% of Germany’s rural and 51% of urban counties. 108 services had also participated in 2018. The most frequently distributed paraphernalia for injecting drug use in 2021 were syringes (97% of services), needles (96%) and vitamin C (90%). Pre-cut aluminium foil (79% of services) and pipes (28%) for inhaling, and sniff tubes (43%) for nasal use were distributed less frequently. We found a median reduction in distributed syringes by 18% and by 12% for needles compared to 2018. Of 15 states, two reached the 2030 WHO-target for needles and one for syringes.ConclusionsThe current national estimates and changes from 2018 to 2021 for drug paraphernalia distribution seem far from meeting the WHO target. Reasons could include a change in drug consumption behaviour towards less injecting use and more inhaling, and effects of the COVID-19 pandemic (supply difficulties, social distancing, lockdown, reduced opening hours of services). We observed pronounced regional differences in drug paraphernalia distribution. To close existing gaps, Germany should expand its drug paraphernalia distribution programmes and other harm reduction services, such as drug consumption rooms. Further investigation of determinants for adequate distribution is essential to reduce blood-borne infections in this key population.

Compliance with good practice guidelines for the prevention of vascular access infections: the multi-centre PHYDEL survey in French haemodialysis units

French guidelines for the prevention of vascular access infections in a haemodialysis setting were released in 2005. Compliance with these guidelines is currently unknown. The aim of this study was to assess compliance with the guidelines for vascular access infection prevention in French haemodialysis units, and to describe the difficulties reported. A cross-sectional survey was conducted between March and December 2019 in 200 haemodialysis units in France, selected at random. Data were collected via questionnaire, completed by telephone interview with an infection control practitioner. A practice was deemed compliant when >85% of units declared that they always complied with the guidelines. In total, 103 units (51.5%) agreed to participate. Most practices complied with the guidelines; however, some practices did not reach the 85% compliance threshold for working in pairs when connecting central venous catheter (CVC) lines, performing hand hygiene before disconnecting lines, rinsing antiseptic soap before painting CVC exit site or arteriovenous fistula (AVF) puncture site, allowing antiseptic paint to dry, handling CVC branches with antiseptic impregnated gauze, performing hand hygiene after AVF compression with gloves, wearing protective eyewear when connecting/disconnecting CVC or when puncturing AVF, and wearing a gown when puncturing AVF. The most frequently reported difficulties were understaffing, difficulties with skin preparation because of exit site skin damage, and lack of buttonhole technical expertise. Despite good overall compliance, this survey highlights some shortcomings in compliance with infection prevention guidelines, which could be associated with either higher risk of vascular access infection or increased blood-borne virus transmission.

Retrospective review of rates of sexually transmitted and blood-borne infection (STBBI) testing in provincial corrections facilities in Newfoundland and Labrador.

Sexually transmitted and blood borne infection (STBBI) testing is recommended for people who are incarcerated (PWAI). We sought to determine the rate of STBBI testing during admissions to provincial correctional institutions in Newfoundland and Labrador (NL). This retrospective cohort study collected the identification of all admissions records in provincial correctional facilities in NL between July 1, 2020 and June 31, 2021 using the Provincial Corrections Offender Maintenance System database. Admissions to provincial detention centers were excluded. Records were linked with STBBI results, when available, within the electronic medical record (Meditech) using demographics. Testing rates, STBBI positivity rates, and univariate analysis of predictors for STBBI testing were completed. Of the 1,824 admissions identified, 1,716 were available for linkage to laboratory results. Admissions to detention centers (n = 105) were excluded. Any STBBI test result was available for 72 (4.5%) of admissions. No admission had complete testing for all STBBI. Facility testing rates ranged from 1.9 to 11.2% and 37.5% of STBBI tests had any positive results. Sixteen out of the 21 (76.2%) hepatitis C virus (HCV) antibody positives received HCV RNA testing, and 11/16 (88.8%) were HCV RNA positive. Institution (p = 0.001) and sex (p = 0.004) were found to be significant predictors of STBBI testing, while age was not significant (p = 0.496). STBBI testing rates were low in provincial correctional facilities in NL, and STBBI prevalence, especially for HCV, was high among those tested. Strategies to increase the rate of testing could contribute to STBBI control in corrections facilities.

Safe and effective use of a passive safety needle by healthcare professionals in a simulated environment, including perceptions and preferences

ABSTRACT Background Needlestick injuries (NSIs) may potentially expose healthcare professionals (HCPs) to bloodborne pathogens. Safety needles are designed to protect against NSIs. We evaluated whether a new fully passive safety needle could be used safely by HCPs. Research design and methods The passive safety needle was tested by physicians, nurses, and pharmacists in subcutaneous or intramuscular injection scenarios in simulation studies (1–3). Data collected included successes, close calls, difficulties, use errors, and failures. In study 4, HCPs rated the device safety (21-item questionnaire). Results Overall, 104 participants completed 4772 simulated tasks, including 932 injections. 915 injections (98.18%) were performed successfully and no NSIs (0%) were observed in any of the studies. Studies 1 & 2: 84.15% tasks and 96.06% injections were completed successfully, but use errors occurred, mostly arising from the participants’ mental model. There were no failures in Study 3. In Study 4, >98% of participants responded positively to every question, while all felt that the passive safety feature could eliminate NSIs and would better protect against bloodborne pathogens than other existing devices with active or semi-passive safety mechanisms. Conclusions The passive safety needle was used successfully by HCPs, did not lead to any NSIs, and was rated as the safest compared to similar devices.

On assessing the viral safety of individual units of the substance "Human plasma for fractionation" by nucleic acid amplification

Scientific relevance. The absence of blood-borne viruses in human plasma-derived medicinal products must be ensured by the control of raw materials and the manufacturing process.Aim. This study aimed to analyse system suitability criteria for analytical procedures to assess the viral safety of individual units of the substance "Human plasma for fractionation" in terms of the content of nucleic acids of blood-borne viruses, considering the requirements of the European Pharmacopoeia.Materials and methods. The authors analysed individual units of the substance "Human plasma for fractionation" (hereinafter, plasma). The study used the International Standards (ISs) for human immunodeficiency virus RNA, hepatitis A virus (HAV) RNA, hepatitis C virus (HCV) RNA, hepatitis B virus (HBV) DNA, and parvovirus B19 DNA, as well as nucleic acid detection kits for these viruses based on polymerase chain reaction (PCR).Results. HCV RNA was not detected in any of the eight plasma samples studied, and parvovirus B19 DNA was detected in one of the samples at a concentration not exceeding 104 IU/mL. Three tests with the corresponding ISs showed that the studied reagent kits detected HCV RNA at a concentration of 102 IU/mL and parvovirus B19 DNA (M1 genotype) at a concentration of 104 IU/mL. In additional tests that were conducted in two samples considering the requirements of the European Pharmacopoeia for the detection of HCV RNA and parvovirus B19 DNA, a new batch of reagent kit I detected the HCV RNA IS at a concentration of 102 IU/mL only in one of three replicates, which did not correspond to the claimed sensitivity of the reagent kit. HCV RNA was not detected in either replicate in one of two plasma samples spiked with the HCV RNA IS at concentrations of 102 and 103 IU/mL, possibly because of plasma inhibitory properties. The sensitivity of the reagent kits to parvovirus B19 DNA corresponded to the label claims; the study did not show any inhibitory properties of the plasma samples.Conclusions. Polymerase chain reaction testing of the viral safety of plasma intended for manufacturing medicinal products should include control samples calibrated in IU/mL. Further research and appropriate pharmacopoeial reference materials are needed to set system suitability criteria for analytical procedures using such control samples.

Therapeutic Management of Babesiosis in a Cow: A Case Report

Babesiosis is a haemoprotozoan disease intraerythrocytic protozoan parasites of the genus Babesia that infect a wide range of domestic and wild animals. It is one of the common tick borne haemoprotozoan diseases affecting the bovines in tropical and subtropical parts of Africa, Australia, America, and Asia including India (Kumar and Kala, 2018). In India, annual economic losses to livestock due to babesiosis are estimated to be about 57.2 million US dollars which is mainly caused by two most important species, i.e., Babesia bovis and Babesia bigemina (Bock et al., 2004). The cattle tick Rhipicephalus microplus is the main vector involved with the transmission and is the only known vector for bovine babesiosis (Souza et al., 2018). Due to universal distribution of the ixodid tick, babesiosis is considered as the second most widespread blood-borne disease of animals (Homer et al., 2000) and is prominently gaining increasing interest as an emerging zoonosis of humans also (Homer et al., 2000; Zintl et al., 2003). Clinical symptoms of Babesiosis are classical haemoglobinuria which is often present, with anaemia and jaundice that develops especially in more protracted cases (Bock et al., 2004). The disease has been recorded in all the cattle breeds but more commonly in exotic and crossbred cattle than in indigenous ones (Chakrabarti, 2003). The present communication describes the haemato-biochemical profile and therapeutic management of a non-descript native cow with babesiosis infection.

Assessment of occupational risks of bloodborne infectious diseases for dental personnel

BACKGROUND: Awareness of dental workers about the epidemiology of blood-borne infections (HIV, hepatitis B virus [HBV], and hepatitis C virus infections) and knowledge about actions to take if accidents occur in the workplace such as contact with blood and other biological fluids are a key link in the prevention of these infections.
 AIMS: To assess awareness and adherence of dental personnel to the algorithm of postexposure prophylaxis of occupational infections with blood-borne pathogens.
 MATERIALS AND METHODS: This descriptive crosssectional study enrolled the dental staff of public and private dental clinics in Kazan, Russia. A survey of 173 dental staff was conducted in FebruaryMarch 2023. The rates of incidents caused by contact with blood and their nature among dental staff were determined, and the frequency of correctly performed algorithm of actions during an incident was calculated. The frequency of the implementation of measures for the prevention of occupational infections with blood-borne pathogens was estimated. Categorical data were described as absolute values and proportions (%).
 RESULTS: In total, 65 specialists (37.6%) had encountered incidents such as contact with blood at the workplace. These incidents were significantly more common among women than among men: 44.7% (55/123) vs. 20.0% (10/50), respectively (p=0.002). The last incident in 50 respondents was associated with skin damage (needlestick injury or cut exposure); in 17 participants, their mucous membranes were exposed to blood (including two people with a mixed characteristic of incident: skin damage + exposure of their mucous membranes to blood). After contact with blood, local treatment was carried out correctly (according to Russian recommendations) in 18.0% of the participants with skin damage and 70.5% with blood exposure to mucous membranes. After the incident, 58.5% of the participants (38/65) reported to the head of the department or clinic, and a third of the respondents (23/65, 35.4%) recorded a case of contact with blood in the incident log. Nearly all respondents always use gloves (172/173, 99.4%) when they work in the dental office. Moreover, 64.2% of the respondents (111/173) always use safety glasses or screens. Nine respondents (9/173, 5.2%) do not use personal eye protection. Others (53/173, 30.6%) wear safety glasses/screens only when performing certain procedures. In addition, 85.0% (147/173) of the respondents have been vaccinated against HBV, 18 have not been vaccinated (10.4%), and 8 (4.6%) do not know their vaccination status.
 CONCLUSIONS: The results of this study present the necessity of raising awareness among dental staff regarding the epidemiology and prevention of blood-borne infections to reduce the risk of occupational infections.

Annual incidence and fatality rates of notifiable infectious diseases in southeast China from 1950 to 2022 and relationship to socioeconomic development.

Over the past 70 years, China has advanced significantly in the prevention and treatment of infectious diseases while simultaneously undergoing a socioeconomic transformation, making it a useful source of data for analysing relationships between public health policy and the control of infectious diseases. We collected data on the incidence of notifiable infectious diseases and associated fatalities in Jiangsu province in southeast China from the Provincial Center for Disease Control and Prevention, Provincial Institute of Parasitic Diseases, and the Nationwide Notifiable Infectious Diseases Reporting Information System. We compared data from different historical periods using descriptive statistical methods, joinpoint regression, and correlation analysis. During 1950-2022, 75 754 008 cases of 46 notifiable infectious diseases were reported in Jiangsu, with an average annual incidence was 1679.49 per 100 000 population and a fatality rate of 1.82 per 1000 persons. The incidence of classes A-B decreased (average annual percent change (AAPC) = -2.1) during the entire study period, while the incidence of class C increased (AAPC = 10.8) after 2004. The incidence of intestinal diseases (AAPC = -4.4) and vector-borne and zoonotic diseases (AAPC = -8.1) decreased rapidly, while the incidence of sexually transmitted and blood-borne diseases (AAPC = 1.8) increased. The number of medical and health institutions and the per capita gross domestic product correlated negatively with the annual incidence of diseases in classes A-B, but not with fatality rates. Although the annual incidence of many severe infectious diseases has decreased in Jiangsu since 1950, the incidence of sexually transmitted and blood-borne diseases increased. Socioeconomic growth and sustainable investment in health systems are associated with better control of infectious diseases.

Macrophage superclusters to the rescue.

Macrophage aggregates step in to capture blood-borne pathogens in the injured liver.

Increasing access to screening for blood-borne viruses and sexually transmissible infections for Aboriginal and Torres Strait Islander Australians: evaluation of the Deadly Liver Mob program’s ‘cascade of care’ across nine sites in New South Wales, Australia

BackgroundAboriginal and Torres Strait Islander Australians are disproportionately impacted by blood-borne viruses (BBVs) and sexually transmissible infections (STIs). Stigma remains one of the key barriers to testing and treatment for BBVs and STIs, particularly among Aboriginal and Torres Strait Islander people. The Deadly Liver Mob (DLM) is a peer-delivered incentivised health promotion program by and for Aboriginal and Torres Strait Islander Australians. The program aims to increase access to BBV and STI education, screening, treatment, and vaccination for Aboriginal and Torres Strait Islander Australians in recognition of the systemic barriers for First Nations people to primary care, including BBV- and STI-related stigma, and institutional racism. This paper presents routinely collected data across nine sites on the ‘cascade of care’ progression of Aboriginal and Torres Strait Islander clients through the DLM program: hepatitis C education, screening, returning for results, and recruitment of peers.MethodsRoutinely collected data were collated from each of the DLM sites, including date of attendance, basic demographic characteristics, eligibility for the program, recruitment of others, and engagement in the cascade of care.ResultsBetween 2013 and 2020, a total of 1787 Aboriginal and Torres Strait Islander clients were educated as part of DLM, of which 74% went on to be screened and 42% (or 57% of those screened) returned to receive their results. The total monetary investment of the cascade of care progression was approximately $56,220. Data highlight the positive impacts of the DLM program for engagement in screening, highlighting the need for culturally sensitive, and safe programs led by and for Aboriginal and Torres Strait Islander people. However, the data also indicate the points at which clients ‘fall off’ the cascade, underscoring the need to address any remaining barriers to care.ConclusionsThe DLM program shows promise in acting as a ‘one stop shop’ in addressing the needs of Aboriginal and Torres Strait Islander people in relation to BBVs and STIs. Future implementation could focus on addressing any potential barriers to participation in the program, such as co-location of services and transportation.

Drugs for opioid use disorder.

Opioid use disorder is a chronic, relapsing disease with physical and psychiatric components. It is associated with economic hardship, social isolation, incarceration, increased rates of blood-borne infections such as HIV and viral hepatitis, adverse pregnancy outcomes, and increased mortality. According to the NIH, there were 80,411 deaths involving an opioid in the US in 2021, more than in any previous year. Several guidelines on the management of opioid use disorder are available; all recommend maintenance pharmacotherapy as the standard of care.

A Retrospective Study to Determine the Genotypic Distribution of Hepatitis-C from a Tertiary Care Hospital in South India

Hepatitis C virus (HCV) is a blood-borne pathogen that transmits infection via transfusion. Hepatocellular carcinoma is the fifth most common cancer and a major cause of death in patients with chronic HCV infection. Response to treatment is mainly based on the genotypic characterization of HCV. The gold standard for genotyping HCV is by sequencing highly conserved regions such as NS5, core, E1, and 5’UTR. Serum samples of patients who visited the tertiary care hospital with clinical features suggestive of HCV infection formed the study group. HCV genotyping was performed using multiplex Polymerase Chain Reaction in the samples tested positive by Chemiluminescence Immunoassay (CLIA). The viral loads were also performed on selected patient samples. In the present study, Genotype 4 (35.71%), followed by Genotype 3 (17.53%) and 1 & 1b (12.34%) were the common genotypes observed. Genotype 1,1b & 4 mixed type and genotype 4 and 5 mixed type was detected in one sample each (0.65%). The mean measured value of HCV antibody was 11.51 ± 4.57. The viral load was detected in 61 out of 81 samples tested. The mean viral load ranged from 550 to 552769250IU/ml (log 2.74-log 8.74). Genotype 4 was the most common genotype demonstrated in our study as opposed to the other studies were genotype 3 was the dominant one in south India.

A Cross-Sectional Analysis of Sharps Injuries Among Dermatologic Surgeons: A Survey of American College of Mohs Surgery Members.

There is a paucity of data on sharps injuries and bloodborne pathogen exposure among Dermatologic Surgeons. Quantify occupational risks from sharps injuries among Mohs surgeons. Determine rate of injury, reporting, and confidence in staff's sharps handling. A cross-sectional analysis performed using survey responses from Mohs surgeons with membership in the American College of Mohs Surgery (ACMS). A total of 60 ACMS members completed the survey. Overall, 56.7% reported at least 1 sharps injury within the past year, of which 14.7% resulted in a bloodborne exposure (odds of exposure: 7.5% per year). The most common type of injury was self-inflicted suture needlestick (76.5%). Forty-four-point-one percent did not report their injuries. Ninety-five percent reported access to postexposure prophylaxis at their workplace. In addition, respondents in academic and single-specialty practices were more likely to report high or moderate confidence in staff sharps handling knowledge and in injury reporting compared with respondents from multispecialty and solo practices (88% vs 54% p = .02, 76%-81% vs 27% p = .0004, respectively). Sharps injuries and under-reporting of these injuries are common among Mohs surgeons. Despite reporting of higher confidence in staff knowledge and training in academic and single-specialty practices, there was no correlation with surgeon's rate of injury.

IMPACT OF NEEDLE STICK INJURIES ON STUDENT NURSES AT KTH HOSPITAL, PESHAWAR, PAKISTAN

Needle stick injury (NSI) is a significant hazard in healthcare settings that poses a potential risk of transmission of blood-borne diseases. This cross-sectional study aims to determine the prevalence of NSI among student nurses in a tertiary care hospital in Peshawar and their knowledge about NSI prevention and control. The data collected through structured questionnaires, and the sample size was 147. The results showed 37% of students had experienced NSI during the last six months, while 70% were vaccinated and 75% were screened against HBS, HCV, and HIV. The study emphasizes the need for further training, workshops, and close supervision to prevent NSI complications and enhance safe practices during healthcare services. The positive effect of free vaccination and government attention to increasing the strength of nurses to control the increasing rate of NSI is also highlighted. Due to lack of proper supervision by trained staff, student nurses often suffer from needle stick injuries during their practical work. Patients may admitted to the hospital already contaminated with communicable diseases, and their beds are not labeled to indicate this. Exposure to NSIs can cause fear, insecurity, and low self-esteem in student nurses. There are many psychological consequences associated with NSIs, such as fear, anxiety, and depression. Student nurses are at substantial risk for NSIs because they often perform invasive procedures with minimal knowledge and experience. Education and awareness-raising about NSI prevention and reporting have been shown to positively impact previous studies. Observational studies conducted in Pakistan have recommended that nurse students receive further education to reduce the incidence of NSIs, as they are often deprived of advanced knowledge and experience. A lack of staff in hospitals can contribute to NSIs as nurses may ignore their safety while performing their duties. Two-handed recapping is responsible for approximately 80% of needle stick injuries.

Health workers’ perspectives of hepatitis B-related stigma among Aboriginal and Torres Strait Islander people in New South Wales, Australia

BackgroundExperiences of stigma and discrimination can act as a significant barrier to testing, monitoring, and treatment for hepatitis B virus (HBV). Aboriginal and Torres Strait Islander Australians are a population disproportionately impacted by HBV and yet limited research has explored HBV-related stigma in these communities. To begin preliminary explorations of HBV-related stigma among Aboriginal and Torres Strait Islander people, we interviewed health workers about their perceptions regarding HBV infection and HBV-related stigma.MethodsParticipants were recruited from staff involved in the Deadly Liver Mob (DLM) program which is a health promotion program that offers incentives for Aboriginal and Torres Strait Islander clients to be educated on viral hepatitis, recruit and educate peers, and receive screening and treatment for blood-borne viruses (BBVs) and sexually transmissible infections (STIs), and vaccination. Semi-structured interviews were conducted with 11 Aboriginal and Torres Strait Islander and non-Aboriginal or Torres Strait Islander health workers who have been involved in the development, implementation, and/or management of the DLM program within participating services in New South Wales, Australia.ResultsFindings suggest that stigma is a barrier to accessing mainstream health care among Aboriginal and Torres Strait Islander clients, with stigma being complex and multi-layered. Aboriginal and Torres Strait Islander people contend with multiple and intersecting layers of stigma and discrimination in their lives, and thus HBV is just one dimension of those experiences. Health workers perceived that stigma is fuelled by multiple factors, including poor HBV health literacy within the health workforce broadly and among Aboriginal and Torres Strait Islander clients, shame about social practices associated with viral hepatitis, and fear of unknown transmission risks and health outcomes. The DLM program was viewed as helping to resist and reject stigma, improve health literacy among both health workers and clients, and build trust and confidence in mainstream health services.ConclusionsHealth promotion programs have the potential to reduce stigma by acting as a ‘one stop shop’ for BBVs and STIs through one-on-one support, yarning, and promotion of the HBV vaccine, monitoring for chronic HBV, and treatment (where required).

An Introduction to Harm Reduction for Medical Students: Addressing Stigma Through an Interactive Preclerkship Lecture.

Harm reduction is a non-traditional approach to addressing substance use disorders and a tool to prevent the spread of transmissible blood-borne infections. We taught an interactive lecture on harm reduction for medical students at the California University of Science and Medicine. This lecture was unique in that it is the only one that was directly developed in collaboration with a harm reduction nonprofit organization for the purpose of educating future physicians. The class was encouraged to think critically about the topic of harm reduction, their biases toward persons who use injection drugs (PWID), and the role of physicians in improving health outcomes for this population. We sent pre- and post-surveys to the students to measure changes in their attitudes toward PWID and harm reduction. Results: Overall, we successfully changed medical students' perspectives of PWID. However, their perspectives on the topic of harm reduction did not change significantly from the already positive opinions students had on the topic before the session. After the session, students were less likely to enjoy giving extra time to these patients and were more likely to find that these patients were difficult to work with. Discussion: Harm reduction interventions can potentially prevent health complications associated with drug use, such as bacterial endocarditis, abscess formation, and transmitting diseases such as hepatitis and HIV, alleviating some of the burden placed on healthcare systems by PWID. This interactive session can serve as a model for other institutions that desire to educate their medical students on the topic of harm reduction and to address the stigma that is faced by PWID.

Functional network analysis identifies multiple virulence and antibiotic resistance targets in Stenotrophomonas maltophilia

Stenotrophomonas maltophilia, an emerging multidrug-resistant opportunistic bacterium in humans is of major concern for immunocompromised individuals for causing pneumonia and bloodborne infections. This bacterial pathogen is associated with a considerable fatality/case ratio, with up to 100%, when presented as hemorrhagic fever. It is resistant to commonly used drugs as well as to antibiotic combinations. In-silico based functional network analysis is a key approach to get novel insights into virulence and resistance in pathogenic organisms. This study included the protein-protein interaction (PPI) network analysis of 150 specific genes identified for antibiotic resistance mechanism and virulence pathways. Eight proteins, namely, PilL, FliA, Smlt2260, Smlt2267, CheW, Smlt2318, CheZ, and FliM were identified as hub proteins. Further docking studies of 58 selected phytochemicals were performed against the identified hub proteins. Deoxytubulosine and corosolic acid were found to be potent inhibitors of hub proteins of pathogenic S. maltophilia based on protein-ligand interactive study. Further pharmacophore studies are warranted with these molecules to develop them as novel antibiotics against S. maltophilia.

Cost-effectiveness of Kidney Transplantation From Donors at Increased Risk of Blood-borne Virus Infection Transmission.

Demand for donor kidneys outstrips supply. Using kidneys from selected donors with an increased risk of blood-borne virus (BBV) transmission (hepatitis B virus and hepatitis C virus [HCV], human immunodeficiency virus) may expand the donor pool, but cost-effectiveness of this strategy is uncertain. A Markov model was developed using real-world evidence to compare healthcare costs and quality-adjusted life years (QALYs) of accepting kidneys from deceased donors with potential increased risk of BBV transmission, because of increased risk behaviors and/or history of HCV, versus declining these kidneys. Model simulations were run over a 20-y time horizon. Parameter uncertainty was assessed through deterministic and probabilistic sensitivity analyses. Accepting kidneys from donors at increased risk of BBVs (2% from donors with increased-risk behaviors and 5% from donors with active or past HCV infection) incurred total costs of 311 303 Australian dollars with a gain of 8.53 QALYs. Foregoing kidneys from these donors incurred total costs of $330 517 and a gain of 8.44 QALYs. A cost-saving of $19 214 and additional 0.09 QALYs (~33 d in full health) per person would be generated compared with declining these donors. Increasing the availability of kidneys with increased risk by 15% led to further cost-savings of $57 425 and additional 0.23 QALY gains (~84 d in full health). Probabilistic sensitivity analysis using 10 000 iterations showed accepting kidneys from donors at increased risk led to lower costs and higher QALY gains. Shifting clinical practice to accept increased BBV risk donors would likely produce lower costs and higher QALYs for health systems.